SESSION TITLE: Procedures: Bronchology
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM
INTRODUCTION: Primary tracheal tumours are rare and account for fewer than 0.1% of all tumours.
CASE PRESENTATION: A 57-year-old male smoker presented with worsening cough and wheeze over the past year associated with weight loss. He also reported a right parotid lump which appeared a few months ago. He had no past medical history except uneventful cholecystectomy 1 week ago. Physical examination was unremarkable except for a 1-cm right parotid mass. Chest radiograph was normal. Flow volume loop on pulmonary function testing showed fixed airway obstruction. Computed tomography (CT) scans found a left tracheal 1.3cm endoluminal soft tissue lesion, suspicious for a malignant tumour as well as a hypodense right parotid lesion. Flexible bronchoscopy revealed a pedunculated left tracheal mass, causing 80% luminal occlusion that prevented distal airway inspection. Bronchoalveolar lavage and endobronchial biopsy showed a squamous papillary lesion with no malignant cells. Fine needle aspiration (FNA) of the parotid lesion was non-diagnostic. Both tracheal tumour and parotid lesion were mildly fludeoxyglucose avid (SUV3.9, 2.5 respectively) on position emission tomography-CT. He underwent rigid bronchoscopy with nd-YAG laser photocoagulation and forceps debulking of the tumour. The base of tumour was photocoagulated after establishing full patency of the trachea to minimize recurrence. Distal airways were normal. Histology confirmed an inverted papilloma with marked resemblance to a sinonasal Schneidarian papilloma. The parotid lesion was diagnosed as a Warthin's tumour on repeat FNA. Post procedure, he had complete resolution of symptoms with no evidence of recurrence after 8 months of follow-up.