Rare airway tumors: an update on current diagnostic and management strategies

Large airway-obstructing retropharyngeal lipoma in an asymptomatic patient: a case report

Background

Lipomas are common benign mesenchymal tumors that appear in the head and neck region in approximately 25% of cases where they are noted. Lipomas of the airway region are exceedingly rare, accounting for less than 1% of airway obstruction tumors. Correlation of radiographic findings from cone beam computed tomography (CBCT), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) of a rare retropharyngeal lipoma has not been previously reported. CBCT studies acquired for implant and/or other diagnostic purposes may be the first line of detection as an incidental finding.

Case presentation

A 66-year-old female presented for a pre-implant CBCT with no history of other complaints or signs/symptoms. CBCT imaging depicts a large, well-defined, low-attenuation/soft tissue density lesion with an undulating appearance extending from the posterior left pharyngeal wall and occluding two-thirds of the airway from C2 to C4. The lesion extends laterally into the left parapharyngeal space and inferiorly beyond the field of view of the study. Evidence of faint internal septations was noted. The patient was immediately referred for an ENT consult. Laryngoscopy, MRI, and contrast-enhanced MDCT imaging were conducted to determine the full extent and nature of the lesion, as well as to potentially plan for biopsy and/or surgical resection. Removal of the lesion was successful, and histopathologic evaluation confirmed lipoma. Periodic follow-up was recommended to monitor for possible recurrence.

Discussion

The slower growth pattern of some benign lesions may obscure any symptoms as changes the patient may normally notice take place over an extended period. Furthermore, soft tissue lesions and especially those in the posterior midline, such as in this case, may not be easily visible on routine panoramic imaging or clinical exam, allowing for substantially large growth before detection. While the soft tissue contrast of the CBCT volume is poor, enough information was present to establish an initial differential diagnosis and the need for more advanced imaging modalities. With the growing popularity and adoption of CBCT in maxillofacial imaging, a thorough understanding of the appearance of hard and soft tissue lesions, as well as a strong understanding of the baseline appearance of normal anatomy, is important to ensure no incidental pathoses go undiagnosed.

Incidental synchronous bronchial tumour: an unusual bronchoscopic finding

We describe a patient with incidental endobronchial synchronous hamartoma and typical carcinoid with different management strategy.

Granular cell tumor of the trachea as a rare cause of dyspnea in a young woman

Tracheal granular cell tumors are rare neurogenic neoplasms characterized by an indolent behavior. We report the case of a young woman affected by this tumor with non-specific clinical presentation. We performed a literature search in order to identify all the cases of tracheal granular cell tumor and to summarize the current state of knowledge about this rare disease.

Flexible bronchoscopy and cryoextraction for critical airway obstruction caused by an endobronchial angioleiomyoma

Angioleiomyomas are rare airway tumours with potential to cause central airway obstruction or haemoptysis. Methods described to manage them include surgical resection, or rigid bronchoscopy and thermal ablation techniques. We describe a case presenting with central airway obstruction, safely and effectively treated with cryoextraction of the tumour using flexible bronchoscopy.

Prognosis of patients with primary malignant main stem bronchial tumors: 7,418 cases based on the SEER database

Background

The aim of this study was to identify risk factors for patients with malignant main stem bronchial tumors (MBTs) and to develop a nomogram for predicting prognosis in those patients using data from the Surveillance, Epidemiology, and End Results (SEER) database.

Method

A process was used for case screening from the SEER database. The effect of prognostic factors on survival was evaluated using the Kaplan–Meier method and log-rank test, a competing risk model, and the Cox proportional hazards regression model. A nomogram was established for predicting 1-, 3-, and 5-year overall survival (OS) in patients with MBTs.

Results

A total of 7,418 cases were included in this study. Age, gender, pathologic grade, histologic type, tumor size, involvement of lymph nodes, tumor extension, chemotherapy, and surgery were identified as independent risk factors by univariate and multivariate analyses. A nomogram was established based on the results of the Cox model, which was validated by a C-index of 0.672 (95% CI, 0.664–0.680), and a group of calibration plots.

Conclusion

Age, gender, pathologic grade, histologic type, tumor size, involvement of lymph nodes, tumor extension, chemotherapy, and surgery were independent risk factors for OS of patients with MBTs. A nomogram was formulated to predict 1-, 3-, and 5-year OS in patients with MBTs based on individual clinical characteristics.

Tracheobronchial tumors

Tumors of trachea and bronchi are uncommon and can occur in the form of benign or low- and high-grade malignant tumors. Although tracheobronchial tumors (TBTs) represent only 0.6% of all pulmonary tumors, they are clinically significant. Delays in diagnosis of these tumors commonly occur because the signs and symptoms caused by these tumors are nonspecific and chest radiographs are often considered unremarkable. Therefore, novel radiological techniques and better access to flexible bronchoscopy enable detection of larger number of TBT. The purpose of this article is to provide a review of tracheal and bronchial tumors and discuss significant aspects of the different TBT with focus on clinical manifestations and diagnostic procedures.