Procedures: Procedures: Bronchology |

A Rare Tracheal Tumour: Inverted Schneiderian Papilloma FREE TO VIEW

Lynette Lee, MBBS; Junyang Ken Goh, MMed; Xue Ning Choo, MMed; Devanand Anantham, MMed; Teck Boon Low, MD
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Changi General Hospital, Singapore, Singapore

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A430. doi:10.1016/j.chest.2016.02.448
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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.

DISCUSSION: We herein describe an extremely rare case of tracheal inverted Schneiderian papilloma (ISP) which is a sinonasal tumour that grows endophytically into the underlying stroma. The most characteristic attributes are its tendency to be locally aggressive with malignant potential and recurrence within the first two years after complete excision[2]. From literature search, only case reports of solitary papillomas of the tracheobronchial tree are available. In a review by Flieder et al on solitary pulmonary papillomas, only one case of 27 analysed squamous papillomas showed an inverted pattern[1]. Solitary pulmonary papillomas were predominantly found in male smokers in their sixth decade.

CONCLUSIONS: Tracheal tumours are rare and difficult to diagnose without a high index of suspicion. Laser resection and debulking via rigid bronchoscopy can produce marked symptomatic relief.

Reference #1: Flieder, Douglas B., et al. “Solitary pulmonary papillomas in adults: a clinicopathologic and in situ hybridization study of 14 cases combined with 27 cases in the literature.” The American journal of surgical pathology 22.11 (1998)

Reference #2: Margaritora, Stefano, et al. “Pulmonary inverted Schneiderian papilloma.” The Annals of thoracic surgery 77.5 (2004)

DISCLOSURE: The following authors have nothing to disclose: Lynette Lee, Junyang Ken Goh, Xue Ning Choo, Devanand Anantham, Teck Boon Low

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