Lung Cancer: Fellow Case Report Poster - Lung Cancer |

A Case of Proximal Tracheal Chondrosarcoma FREE TO VIEW

Christian Ghattas, MD; Augustine Andoh-Duku, MD; Michael Agustin, MD; Mandeep Hundal, MD; Samaan Rafeq, MD
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St. Elizabeth Medical Center, Boston, MA

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

Chest. 2016;150(4_S):675A. doi:10.1016/j.chest.2016.08.770
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SESSION TITLE: Fellow Case Report Poster - Lung Cancer

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary tumors of the trachea are rare, representing 0.1% of all respiratory tract tumors. Squamous cell and adenoid cystic carcinoma account for about 66% of adult primary tracheal tumors. Tracheal chondrosarcoma is rare with only 16 reported cases in the literature. We describe a unique case of an elderly man with tracheal chondrosarcoma managed endoscopically.

CASE PRESENTATION: A 91 year old male ex-smoker, with history of prostate cancer was referred for evaluation of a tracheal mass noted on chest CT. He was unable to expectorate sputum for months, associated with mild dysphonia. He denied exertional dyspnea, wheezing or stridor. He had no significant occupational or environmental exposures. His physical examination and laboratory testing were unremarkable. A CT scan of the neck showed a 15 x 11 mm mass arising from the left lateral wall of the trachea, about 3 cm below the vocal cords. Direct laryngoscopic examination was unremarkable. Chest CT did not show any evidence of tumor extension or metastasis. A rigid tracheoscopy showed a sessile tumor occluding 75% of the proximal tracheal lumen. Mechanical coring of tumor was performed. Histopathology revealed cartilaginous lesion compatible with low grade chondrosarcoma.

DISCUSSION: Cartilaginous tumors of the trachea consist mainly of chondromas and chondrosarcoma. Patients from previous cases were predominantly male with ages ranging 37 to 87. Chondrosarcomas are likely to present with extraluminal wall thickening at the mid to distal trachea. Clinical symptoms manifest when 75% of tracheal lumen is obstructed. In the largest case series, most patients had tracheal resection likely due to extratracheal extension o f the disease.

CONCLUSIONS: Cartilaginous tumor of the trachaea warrants radical removal due to its increased risk of recurrence, extra tracheal extension and malignant transformation. Endoscopic resection may be reserved for those without local extention and unable to tolerate surgical treatment. Given the advanced age, minimal symptoms, and intraluminal growth in our patient, a bronchoscopic approach was chosen with achievement of patency of the tracheal lumen.

Reference #1: Macchiarini P. Primary tracheal tumors. Lancet Oncol. 2006

Reference #2: Umezu H et al. Tracheal chondrosarcoma. Gen Thorac Cardiovasc Surg. 2008

DISCLOSURE: The following authors have nothing to disclose: Christian Ghattas, Augustine Andoh-Duku, Michael Agustin, Mandeep Hundal, Samaan Rafeq

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