Malignant pleomorphic adenoma (malignant mixed tumor) of the trachea: a case report and review of the literature

Pleomorphic adenoma of the trachea: A case report

INTRODUCTION AND IMPORTANCE

Although pleomorphic adenoma is the most common type of parotid gland tumor, its occurrence in the trachea is rare. Here, we describe a successfully resected pleomorphic adenoma of the trachea in a woman with severe respiratory failure that had been preoperatively misdiagnosed as asthma.

CASE PRESENTATION

A 69-year-old woman presented to the emergency department with symptoms of worsening dyspnea and subsequent loss of consciousness. She had a history of progressively worsening wheezing and stridor over the course of 2-years and had been diagnosed with asthma. Arterial blood gas sample analysis indicated type II respiratory failure. A chest computed tomographic scan revealed a tumor in the trachea, which was almost completely obstructing the lower tracheal lumen. The tumor was located just above the carina. To alleviate airway constriction and achieve complete resection, carinal resection with reconstruction was performed. The postoperative diagnosis was pleomorphic adenoma of the trachea.

CLINICAL DISCUSSION

Pleomorphic adenoma is a rare tracheal tumor that may present with obstructive airway symptoms that mimic asthma.

CONCLUSION

Tracheal tumors should be considered in patients with chronic respiratory symptoms that do not improve with medication.

A case report of bronchial pleomorphic adenoma in a child in China

BACKGROUND

Paediatric cases of pleomorphic adenoma of the bronchus are rare in clinical practice, despite pleomorphic adenoma being the most common histological form of salivary gland neoplasm. To date, no such cases have been reported in China.

CASE PRESENTATION

We report a case of pleomorphic adenoma of the bronchus in a 10-year-old child with no obvious positive signs on examination. Chest-enhanced computed tomography and bronchoscopy showed a large white mass in the right principal bronchus. The patient was treated by bronchial mass resection. Biopsy confirmed the diagnosis of pleomorphic adenoma.

CONCLUSIONS

We not only describe a rare benign bronchial tumour in children but also demonstrate the successful use of surgery as a radical cure for pleomorphic adenoma.

Carcinoma ex pleomorphic adenoma of the trachea: A case report

BACKGROUND

Carcinoma ex pleomorphic adenoma (CXPA) is defined as a malignant salivary gland tumor arising from a primary or recurrent pleomorphic adenoma. Only three cases of CXPA of the trachea have been reported in the literature.

CASE SUMMARY

We report a case of tracheal CXPA in a 55-year-old woman, who presented with a more than 3-mo history of progressive dyspnea. Computed tomography of the neck and thorax revealed an inhomogeneous, broad-based lesion arising from the tracheal wall on the right side. Endoscopy revealed a subglottic neoplasm causing up to 90% luminal stenosis. The tumor was resected using a high-frequency electrosurgical snare combined with argon plasma coagulation. Histopathology and immunohistochemistry revealed that the tumor was a CXPA of the trachea.

CONCLUSION

We report the fourth case of tracheal CXPA, and present the first instance of resection of CXPA using high-frequency electrosurgical snare and laser ablation. We also discuss the pathogenesis, diagnosis, histopathology, and systemic therapy of this rare disease.

Right main bronchial pleomorphic adenoma: A case report and literature review

RATIONALE

Tracheobronchial benign tumors are uncommon; particularly, bronchial pleomorphic adenoma is one of the rarest benign tumors that develop in bronchus (only 7 reported cases, among which only 4 cases of pleomorphic adenoma were seen arising from right main bronchus).

PATIENT CONCERNS

In this report, a 38-year-old woman suffered from progressive shortness of breath for 5 years due to right main bronchial pleomorphic adenoma.

DIAGNOSES

The patient was diagnosed as right main bronchial pleomorphic adenoma based on chest computed tomography enhanced scan, bronchoscopy, and histological examination.

INTERVENTIONS

An electrosurgical snare was performed to resect the neoplasm and several APC were administered at the sites of the resection to provide hemostasis and further coagulate for the residual neoplasm.

OUTCOMES

The patient was free of symptoms and the lumen of right main bronchus was clear during the follow-up period for 10 months without any procedure-related complications.

LESSONS

Bronchial pleomorphic adenoma is extremely rare, however, we should take it into consideration if a patient suffered from shortness of breath without an exact cause.

Tracheal pleomorphic adenoma with coexisting pulmonary tuberculoma

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.

Radiofrequency Ablation Is Low Invasive and Effective in Treat Pleomorphic Adenoma in Trachea Without Recurrence for At Least Five Years

The authors reported 6 patients of pleomophic adenoma in trachea in patients (57 ± 3.6 years old). Swellings in trachea (2 ± 0.85 cm) were revealed by computed tomography and bronchoscopy. All swellings were removed successfully using radiofrequency ablation through flexible bronchoscopy. Histopathological examinations of tumor specimens confirmed their diagnosis of pleomorphic adenoma. No complication nor tumor recurrences were reported throughout the 5-year postoperative follow-up period in each patient which indicate good prognosis. The authors here report an effect but mini-invasive approach to treat rare trachea tumor and demonstrate a way of successful treatment using a mini-invasive way. Compared with other treating procedures, the authors consider radiofrequency ablation is of low invasion with the consequence of cure all treated patients of pleomorphic adenoma in trachea.

Carcinoma ex pleomorphic adenoma originating from ectopic salivary gland in the neck region: case report

Carcinoma ex pleomorphic adenoma (CEPA) is the malignant salivary gland tumor originating from primary (de novo) or recurrent pleomorphic adenoma. Although parotid gland is the most common site, it can also be seen in submandibular gland or minor salivary glands. It can be seen rarely in head and neck region, such as oral cavity, trachea, nasal cavity and lacrimal gland. Although pleomorphic adenoma cases originating from ectopic salivary gland tissue in the neck region are present in the English literature, there is no published pleomorphic adenoma ex carcinoma case. In this case report we presented a CEPA as a 7.5 cm long neck mass in a 72-year-old woman originating from the submandibular region apart from submandibular gland. Difficulties in diagnosis and way to appropriate treatment are discussed with current literature.

Pleomorphic adenoma presenting with a mediastinal mass

Pleomorphic adenoma is the most common type of salivary gland tumor. Although it rarely affects the trachea and bronchus, it usually grows in the airway and presents as an endobronchial mass. We recently experienced a case of pleomorphic adenoma originating in the bronchus and growing outward into the mediastinum. We present this case with review of the computed tomography (CT) scan of the patient's chest, the endoscopic ultrasound (EUS), and the histopathology report.

Pleomorphic adenoma of the trachea

Pleomorphic adenoma in the trachea is very rare. We report the case of a 46-year-old woman who had been treated for asthma for 12 months before the diagnosis of pleomorphic adenoma of the trachea was made. The tumour was defined by fiberoptic bronchoscopy in the mid 1/3 of the trachea obstructing nearly 90 % of the lumen. Through a collar incision and partial sternotomy, 3 cm segment of the trachea was resected and end-to-end anastomosis was performed.

Pulmonary salivary gland-type tumors with features of malignant mixed tumor (carcinoma ex pleomorphic adenoma): a clinicopathologic study of five cases

We report 5 cases of pulmonary salivary gland-type tumors with features of carcinoma ex pleomorphic adenoma. Patient ages ranged from 44 to 71 years (mean, 53.8 years); 4 patients were men and 1 was a woman. In all 5 cases, the lesions were associated with the bronchial system. None of the patients had a history of a head and neck salivary gland neoplasm. Histologically, the lesions were invasive tumors containing malignant myoepithelial elements and duct-like structures embedded in a benign chondromyxoid stroma. Areas reminiscent of residual pleomorphic adenoma were noted in 2 cases. Follow-up for 3 patients revealed that 2 died 22 and 54 months after diagnosis and 1 was alive 20 months after diagnosis. The cases are characterized by unique morphologic features that, coupled with their immunoprofile, suggest the possibility that these tumors represent carcinoma ex pleomorphic adenoma, an entity that has not been well documented in the bronchopulmonary system.

Pleomorphic adenoma with an endobronchial resection

A case of bronchial pleomorphic adenoma is herein presented. The patient came to the hospital for a detailed examination of a bronchial polyp that was detected by computed tomography. Chest computed tomography revealed a bronchial tumor which was located at the distal end of the left main bronchus. The patient refused surgical resection. An electrosurgical snare was performed two times and the patient received several rounds of argon plasma coagulation with a flexible bronchoscope. The diagnosis of a pleomorphic adenoma was made following examination of the resected specimens. No recurrence has been observed by biopsy at the resected site.

Pleomorphic adenoma of the trachea mimicking bronchial asthma: report of a case

Benign tracheal tumors are rare and difficult to diagnose. A delay in diagnosis is common because the symptoms mimic those of bronchial asthma. We report the case of a 42-year-old woman who was treated for asthma for 2 years before a diagnosis of pleomorphic adenoma of the trachea was made. To our knowledge, only 33 patients with pleomorphic adenoma of the trachea have been reported. We treated our patient by performing circumferential segmental tracheal resection and end-to-end anastomosis. A dynamic Y-stent was implanted for tracheal stenosis soon after the operation and it was removed 2 years later. The patient is now asymptomatic and no recurrence has been detected in the 5 years since diagnosis.

Pleomorphic adenoma of the vulva: a review illustrated by a clinical case

The pleomorphic adenoma of the vulva is an extremely scarce diagnosis. This form of neoplasm is more frequently observed in other topographic sites of the human body. Treatment modalities largely derive from experiences with the pleomorphic adenoma located in these other sites. As a result of similarity with other tumors and scarcity of the neoplasm, the diagnosis of pleomorphic adenoma of the vulva is easily missed in daily routine practice. Recurrences of this neoplasm are frequently observed with an estimated incidence of malignant transformation of 25%. Addressing this previously mentioned issue, an extensive surgical excision and long-term follow-up is advocated. This report is illustrated by the case of a 66-year-old woman who was admitted to our hospital with a pleomorphic adenoma of the vulva, diagnosed by pathologic assessments following surgical excision. As a result of the rarity of this diagnosis, characteristics and treatment of extravulvar in addition to vulvar localizations of the pleomorphic adenoma are reviewed.

Tracheal carcinosarcoma (true malignant mixed tumour) in a Belgian Blue heifer

This report describes a case of a carcinosarcoma or true malignant mixed tumour (salivary gland type) of the trachea in a Belgian Blue heifer. At post-mortem examination a nodular, well-circumscribed, firmly attached mass was found in the tracheal wall, severely compressing the tracheal lumen. Histologically the tumour was biphasic, with varying proportions of epithelial elements dispersed throughout a matrix showing varying degrees of myxo-chondroid and cartilaginous differentiation. The histological features of the tumour were consistent with a combination of an adenoid cystic carcinoma and a chondrosarcoma. Immunolabelling demonstrated smooth muscle actin in the cytoplasm of both the epithelial and mesenchymal components, thus fulfilling the diagnostic criteria for a mixed tumour. To our knowledge this is the first report of a mixed tumour of the trachea in a domestic animal.

Carcinoma ex-pleomorphic adenoma of the breast. Report of three cases suggesting a relationship to metaplastic carcinoma of matrix-producing type

Three cases of carcinoma ex-pleomorphic adenoma of the breast are reported. Patients were 82, 60 and 56 years old and presented with a breast lump. All tumours showed areas of pleomorphic adenoma adjacent to typical areas of malignant transformation. These cases add to the spectrum of tumours shared by breast and salivary gland. The relationship between these neoplasms and metaplastic carcinoma of matrix-producing type is discussed.