Tracheal Lipoma Mimicking Asthma

Primary tracheal tumors are very rare and 10%–20% are benign tumors. Tracheal lipoma is extremely rare and only a few cases have been reported in the literature. A 69-year-old male patient presented to the emergency department with complaints of shortness of breath, respiratory distress, chest pain and cough. Chest CT scan showed a round mass in the topography of the trachea that almost caused airway obstruction. The lesion was resected endoscopically and the pedicle base was cauterized. Tracheal lipoma is a rare condition that should lie in the differential diagnosis of treatment-resistant asthma.

FEATURES OF ANESTHESIA DURING SURGERY FOR TRACHEAL CANCER

Tracheal neoplasms are rare, accounting for 0.10.2% of all malignant neoplasms [I.I. Davydovskyi, 1940]. Data from the database of the National Cancer Institute for Surveillance, Epidemiology and End Results indicate that primary tracheal carcinomas occur with an incidence of 0.7% of new cases per million people [Houston, 1963]. Patients with tracheal tumors can have severe airway obstruction. In addition to primary tracheal neoplasms, secondary tracheal affection may occur due to lesion of surrounding tissues such as thyroid, larynx, and lungs - 15.3%.

Biogeography of the Respiratory Tract Microbiome in Patients With Malignant Tracheal Tumors

BackgroundThis study aimed to characterize the bacterial microbiota in the oral cavity (OC), throat, trachea, and distal alveoli of patients with primary malignant tracheal tumors (PMTT), including squamous cell carcinoma (SCC) and salivary gland carcinoma patients (SGC), for comparison with a matched non-malignant tracheal tumor (NMTT) group.MethodsPatients with pathological diagnosis of PMTT and NMTT were included in this study. Saliva, throat swab (TS), trachea protected specimen brush (PSB), and bronchoalveolar lavage fluid (BALF) samples were collected for 16S rRNA gene sequencing. The composition, diversity, and distribution of the microbiota were compared among biogeographic sampling sites and patient groups. The relationship between the genera-level taxon abundance and tracheal tumor types was also investigated to screen for candidate biomarkers.FindingsThe most represented phyla in the four sites were Bacteroidetes, Firmicutes, Proteobacteria, and Fusobacteria. In SCC patients, the relative abundance of Bacteroidetes and Firmicutes gradually decreased with increasing depth into the respiratory tract, while the relative abundance of Proteobacteria gradually increased. Bacterial communities at the four biogeographic sites formed two distinct clusters, with OC and TS samples comprising one cluster and PSB and BALF samples comprising the other group. Principal coordinate analysis showed that trachea microbiota in SCC patients were distinct from that of SGC or NMTT patients. In the trachea, AUCs generated by Prevotella and Alloprevotella showed that the abundance of these genera could distinguish SCC patients from both NMTT and SGC patients.InterpretationThe structure of respiratory tract microbiota in PMTT patients is related to tumor type. Certain bacteria could potentially serve as markers of SCC, although verification with large-sample studies is necessary.

The first experience of tracheal recanalization by tumor resection with Nd-YAG-laser

Actuality. Tracheal cancer is a rare disease which amounts up to 0.2% of the total number of cancers. Currently, there is an increase in the number of patients with impaired tracheal patency. Endoscopic procedures are most commonly used to restore and maintain the tracheal lumen. The key treatment for primary cancer is a surgical one; however, due to late diagnostics, the tumor is often inoperable. Chemotherapy for tracheal cancer is ineffective, and practically is not used. At present, endoscopic tracheal recanalization with laser vaporization is a method of choice in patients with inoperable tracheal tumors.Objective: to improve outcomes in patients with inoperable primary tracheal cancer using Nd-YAG laser either as the fi rst component of staged treatment strategy, or as the fi nal volume treatment.Methods. Patient K., 75 years old, was admitted to the hospital with complaints of dyspnea at rest, weakness and hemoptysis. As anamnesis showed, the patient had noticed a deterioration in her breathing during the last 6 months. CT scan revealed a volumetric formation (tumor) of the cervicothoracic trachea (8.0 cm above the bifurcation) with 90% stenosing in the lumen. When performing tracheobronchoscopy in the cervicothoracic trachea, a broad-based lumpy tumor, 5 cm long, stenosing the tracheal lumen by 2/3 was found on the posterior wall. Morphological examination of biopsy material revealed adenocystic carcinoma.Results. The performed endoscopic examination with neodymium YAG laser recanalization demonstrated the advantage of this technique in patients with inoperable tracheal tumors.Conclusion. Endoscopic recanalization of the trachea with neodymium YAG laser has been proven to be effective in patients with inoperable tracheal cancer. It improves their quality of life as well.

A Novel Use of Coblation in the Treatment of Tracheal Tumors

Radiofrequency coblation is a new method of electrosurgical intervention. Most recently, its use has been reported in the treatment of laryngotracheal pathology. However, studies on coblation for tracheal tumors have not been reported. In this article, we described a novel use of coblation technology, in which a new type of airway-specific wand was used to ablate tracheal benign or malignant tumors in 3 cases. The results suggest the possibility of usage of coablation in the treatment of tracheal tumors. More studies that are larger and have longer follow-up are needed to further evaluate the use of this technique in the treatment of tracheal tumors.

Revisiting bronchoscopic intratumoral chemotherapy in malignant central airway obstruction via EUS-B approach and its review of literature

Critical central airway obstruction has always been a dreaded complication to which interventional pulmonologist commonly encounters. There have been various modalities which are used for the management and palliation, which includes mechanical coring, laser, cryoextraction, electrocautery and airway stenting. Rigid bronchoscopy with or without jet ventilation has been corner stone of therapeutics and palliation of central airway obstruction. There are only a few conditions where it is not possible to use rigid bronchoscopy. Here we report a case of metastatic tracheal tumour which presented with critical airway obstruction in a patient who had atlantoaxial instability (AAI) due to rheumatoid arthritis. Here we used endobronchial ultrasound scope (EBUS) via esophageal route, i.e. EUS-B guided approach for sampling of the tracheal tumour, and intratumoral chemotherapy was instilled in multiple sessions, which resulted in shrinking of tumour, thus relieving the critical airway obstruction. This is the first report of using EUS-B approach for intratumoral chemotherapy for tracheal tumors. Bronchoscopic intratumoral chemotherapy therapy (BITC) in tracheal tumors is also one of the options but has not been explored much and there has been a dearth of literature for it.