Treatment of primary tracheal glomus tumors: Two case reports and a literature review

Bronchial glomus tumor with calcification: A case report

BACKGROUND

Glomus tumors (GTs), defined by modified smooth cells and normal glomus body cells, usually present with a small mass occurring in the soft tissue or dermis of an extremity, especially in the subungual region. However, other unusual sites, such as the respiratory tract, have also been reported. They are usually sporadic. Their imaging findings are usually nonspecific and likely to appear as a well-delineated round mass that usually lacks calcification. To our knowledge, we report the first case of bronchial GTs with calcification, reminding clinicians and radiologists that GT is one of the differential diagnoses when a calcified nodular mass is found.

CASE SUMMARY

We report a case of a 33-yr-old Chinese man with cough and sputum for 11 d and hemoptysis for 5 d. Chest computed tomography revealed a calcified nodular lesion on the compressed posterior wall of the lower left main bronchus and bronchiectasis in the lower lobe of the left lung. To confirm the characteristics of calcified nodules, we performed fiberoptic bronchoscopy. The tumor tissue from the biopsy of bronchial mucosal lesions established the diagnosis of GT. Because the patient had no life-threatening symptoms, he was not treated with surgery. Clinical follow-up for 25 mo showed that the patient survived well without any discomfort.

CONCLUSION

Bronchial GTs are usually not accompanied by calcification on computed tomography scans. To our knowledge, we report the first calcified bronchial GT. We recommend that clinicians consider GT as a possible differential diagnosis when a calcified mass of the bronchi is found.

18F-FDG PET/CT of Benign Tracheal Glomus Tumor

Glomus tumors are tumors that arise from the glomus bodies, which can be found in sites of arteriovenous anastomosis. Glomus tumors can occur in all parts of the body but rarely occur in the trachea. The PET/CT findings of these tumors are similar to those of malignant tracheal tumors. We reported the PET/CT findings of a pathologically proven primary glomus tumor in the trachea of a 41-year-old man.

Endoscopic submucosal dissection of tracheal deep benign fibrous histiocytoma using hybrid knife

Deep benign fibrous histiocytoma (FH) is an uncommon and poorly recognized tumor that arises in subcutaneous or deep soft tissue. Deep benign FH of the trachea is even more rare. Deep benign FH recurs in approximately 20% of cases, so surgical resection is the recommended treatment for FH. However, some patients are afraid of the trauma and potential complications from the resection of tracheal tumors, so they do not accept surgical resection. With the development of interventional pulmonology, bronchoscopic intervention plays a key role in the treatment of benign tracheal tumors. Novel tools have emerged in interventional pulmonology and optimized the traditional techniques. Here, we report a case of deep benign FH of the trachea with broad base relapse after electrocautery with snare, argon plasma coagulation (APC) and radiotherapy. It was treated successfully by endobronchial resection with a hybrid knife (HK) and APC. The HK is a hybrid device that combines an electrocautery knife with a water jet in one instrument. Submucosal injection and circumferential cutting and dissection of lesions as well as coagulation of bleeding can be performed only with the HK. During the 6 months follow-up, the deep benign FH of the trachea did not relapse. In the case reported herein, the HK enabled submucosal injection and circumferential cutting and dissection of lesions as well as access to submucosal lesions to gain further adequate APC treatment, thereby allowing a better clinical response than that achieved by traditional electrocautery with snare and APC. In conclusion, the HK with a water jet is a feasible and effective endoscopic method for management for benign or low-grade malignant neoplasms of the trachea, especially those with a wide base and submucosal involvement.