Original article
General thoracic
Uncommon Primary Tracheal Tumors

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
https://doi.org/10.1016/j.athoracsur.2006.01.065Get rights and content

Background

Primary tracheal tumors other than adenoid cystic or squamous cell carcinoma are uncommon and have a heterogeneous histologic appearance. The experience regarding their treatment and long-term outcome is limited, and alternatives to segmental tracheal resection, including endoscopic treatment or radiation, continue to be explored.

Methods

A retrospective analysis was performed of uncommon tracheal tumors among 360 primary tracheal tumors seen over 40 years, excluding adenoid cystic and squamous cell carcinoma.

Results

Of 90 patients, 34 (38%) had benign tumors and 56 malignant: 11 carcinoid tumors, 14 mucoepidermoid carcinomas, 13 sarcomas, 15 nonsquamous bronchogenic carcinomas, 2 lymphomas, and 1 melanoma. Three patients had a second tracheal malignancy. Dyspnea was the most common symptom in benign tumors and hemoptysis in malignant tumors. Twelve patients did not undergo tracheal resection (13.3%) and 1 died before resection. Surgical therapy in 77 patients (85%) consisted of laryngectomy in 3, laryngotracheal resection in 9, tracheal resection in 46, and carinal resection in 19. Hospital mortality was 2.6% (2 of 77 patients) and major complications occurred in 16% (12 of 77 patients). Mean follow-up was 9.7 years. After resection, survival at 10 years was 94% for benign and 83% for carcinoid tumors, and at 5 years survival was 60% for bronchogenic carcinoma, 100% for mucoepidermoid tumors, and 78% for sarcomas. Patients with lymphomas and melanoma are alive more than 8 years after resection. Ten patients experienced recurrence (14%).

Conclusions

Surgical resection of uncommon primary tracheal tumors alleviates airway obstruction, is curative in patients with benign or slow-growing malignant lesions, and prolongs survival in highly malignant lesions.

Section snippets

Patient Selection

A retrospective analysis was conducted at Massachusetts General Hospital of all primary tracheal tumors since 1962. Medical records and Department of Pathology databases were searched. Pathology reports, operative reports, and hospital charts were reviewed. Squamous cell and adenoid cystic carcinomas as well as tumors of adjacent anatomic regions, the glottic larynx, and those extending from mainstem bronchi or lung to the carina were excluded. Squamous papillomas and tumors of the subglottic

Results

Between 1962 and 2002, 357 patients were evaluated for primary tracheal tumors. A tracheal histologic appearance other than squamous cell or adenoid cystic carcinoma was found in 87 patients. Three additional patients had squamous cell carcinoma and a second histologic diagnosis (small cell carcinoma in 2 and mucoepidermoid carcinoma in 1); the procedures of these patients are counted, but they were excluded from survival analysis. There were 54 men and 36 women with a mean age of 43 years

Comment

Uncommon tumors of the trachea in 90 patients with 33 different histologic diagnoses were reviewed to emphasize similarities and differences in presentation and management. On the basis of our observations, these tumors may be grouped into five main types. Benign tumors display heterogeneous histologic appearance and do not recur after complete resection unless they transform into malignant tumors (1 observation). Carcinoid tumors, as elsewhere in the bronchial tree and lung, are low-grade

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