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Glomus tumor of the trachea managed by spiral tracheoplasty.

Wu HH, Jao YT, Wu MH - Am J Case Rep (2014)

Bottom Line: Postoperative course was unremarkable and she was discharged in improved condition after 9 days of hospital stay.Histopathological examination and staining are important to differentiate it from hemangiopericytoma or carcinoid tumors.Spiral tracheoplasty after tangential resection may be tried, as this preserves more tracheal tissue, decreases tension, and prevents postoperative leakage at the anastomotic site.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Tainan Municipal Hospital, Tainan, Taiwan.

ABSTRACT

Background: Glomus tumors are usually found over the dermis of the extremities, particularly over the subungual region of the fingers, and occurrence in the trachea is an extremely rare event. To date, only 29 cases of tracheal and 2 main bronchus glomus tumors have been reported in the English literature. Our patient is the first ever reported case in Taiwan that was managed by spiral tracheoplasty.

Case report: A 58-year-old woman was admitted to our hospital because of hemoptysis. Computed tomographic (CT) scan revealed a mass over the posterior wall of the trachea. Surgical resection with spiral tracheoplasty was performed due to uncontrolled bleeding and airway compromise. Histopathology and immunostaining confirmed a glomus tumor. Postoperative course was unremarkable and she was discharged in improved condition after 9 days of hospital stay.

Conclusions: Although chronic symptom presentation is the rule for tracheal glomus tumors, airway obstruction and bleeding are life-threatening presentations. Histopathological examination and staining are important to differentiate it from hemangiopericytoma or carcinoid tumors. Spiral tracheoplasty after tangential resection may be tried, as this preserves more tracheal tissue, decreases tension, and prevents postoperative leakage at the anastomotic site.

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(A) Representative low-power magnification of a cut section of the glomus tumor showing a hypervascular tumor composed of branching, dilated, thick-walled, vascular channels and thin-walled, capillary-like vascular spaces (hematoxylin and eosin, 40×). (B) High-power magnification of the tumor showing lobular arrangements of oval- to-spindle-shaped cells, with abundant eosinophilic cytoplasm and centrally-located rounded nuclei (hematoxylin and eosin, 400×). (C) Immuno-staining showing tumor cells strongly reactive to actin.
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f3-amjcaserep-15-459: (A) Representative low-power magnification of a cut section of the glomus tumor showing a hypervascular tumor composed of branching, dilated, thick-walled, vascular channels and thin-walled, capillary-like vascular spaces (hematoxylin and eosin, 40×). (B) High-power magnification of the tumor showing lobular arrangements of oval- to-spindle-shaped cells, with abundant eosinophilic cytoplasm and centrally-located rounded nuclei (hematoxylin and eosin, 400×). (C) Immuno-staining showing tumor cells strongly reactive to actin.

Mentions: On examination, the patient was afebrile and breath sounds were clear. Laboratory test results were unremarkable. A bronchoscopic examination was performed, showing a polypoid tumor over the posterior wall of the trachea (Figure 2A). During admission, the patient had another episode of massive hemoptysis, which resulted in hypotension, respiratory distress, and anemia that necessitated a blood transfusion. Our thoracic surgeon was consulted and surgery was performed. Excision of the tracheal tumor via sternotomy was performed (Figure 2B) followed by reconstruction of the trachea with spiral anastomosis. Afterwards, hemostasis was achieved, hemodynamics stabilized, and intraoperative fiberoptic bronchoscopy showed tracheal patency. Hemangiopericytoma was reported on fast-frozen section. However, histopathology showed a hypervascular tumor composed of branching, dilated, thick-walled vascular channels and thin-walled capillary-like vascular spaces, surrounded by lobular arrangements of oval-to-spindle cells, with abundant eosinophilic cytoplasm and centrally-located rounded nuclei. A focal hemangiopericytoma-like pattern interspersed with thin-to-coarse collagenous bundles was also noted (Figure 3A–3B). Immunohistochemical staining was positive for smooth muscle actin (Figure 3C), focally reactive with synaptophysin and negative for cytokeratin, chromogranin A, S-100 protein, and HMB-45. This was later diagnosed as a glomus tumor. Seven days after surgery, fiberoptic bronchoscopy was repeated, showing a patent trachea with mild granulation tissue over the oblique anastomotic line and no stenosis (Figure 2C). The patient was discharged the next day. She is currently asymptomatic and no complication or tumor recurrence has occurred in approximately 2 years of follow-up.


Glomus tumor of the trachea managed by spiral tracheoplasty.

Wu HH, Jao YT, Wu MH - Am J Case Rep (2014)

(A) Representative low-power magnification of a cut section of the glomus tumor showing a hypervascular tumor composed of branching, dilated, thick-walled, vascular channels and thin-walled, capillary-like vascular spaces (hematoxylin and eosin, 40×). (B) High-power magnification of the tumor showing lobular arrangements of oval- to-spindle-shaped cells, with abundant eosinophilic cytoplasm and centrally-located rounded nuclei (hematoxylin and eosin, 400×). (C) Immuno-staining showing tumor cells strongly reactive to actin.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4214701&req=5

f3-amjcaserep-15-459: (A) Representative low-power magnification of a cut section of the glomus tumor showing a hypervascular tumor composed of branching, dilated, thick-walled, vascular channels and thin-walled, capillary-like vascular spaces (hematoxylin and eosin, 40×). (B) High-power magnification of the tumor showing lobular arrangements of oval- to-spindle-shaped cells, with abundant eosinophilic cytoplasm and centrally-located rounded nuclei (hematoxylin and eosin, 400×). (C) Immuno-staining showing tumor cells strongly reactive to actin.
Mentions: On examination, the patient was afebrile and breath sounds were clear. Laboratory test results were unremarkable. A bronchoscopic examination was performed, showing a polypoid tumor over the posterior wall of the trachea (Figure 2A). During admission, the patient had another episode of massive hemoptysis, which resulted in hypotension, respiratory distress, and anemia that necessitated a blood transfusion. Our thoracic surgeon was consulted and surgery was performed. Excision of the tracheal tumor via sternotomy was performed (Figure 2B) followed by reconstruction of the trachea with spiral anastomosis. Afterwards, hemostasis was achieved, hemodynamics stabilized, and intraoperative fiberoptic bronchoscopy showed tracheal patency. Hemangiopericytoma was reported on fast-frozen section. However, histopathology showed a hypervascular tumor composed of branching, dilated, thick-walled vascular channels and thin-walled capillary-like vascular spaces, surrounded by lobular arrangements of oval-to-spindle cells, with abundant eosinophilic cytoplasm and centrally-located rounded nuclei. A focal hemangiopericytoma-like pattern interspersed with thin-to-coarse collagenous bundles was also noted (Figure 3A–3B). Immunohistochemical staining was positive for smooth muscle actin (Figure 3C), focally reactive with synaptophysin and negative for cytokeratin, chromogranin A, S-100 protein, and HMB-45. This was later diagnosed as a glomus tumor. Seven days after surgery, fiberoptic bronchoscopy was repeated, showing a patent trachea with mild granulation tissue over the oblique anastomotic line and no stenosis (Figure 2C). The patient was discharged the next day. She is currently asymptomatic and no complication or tumor recurrence has occurred in approximately 2 years of follow-up.

Bottom Line: Postoperative course was unremarkable and she was discharged in improved condition after 9 days of hospital stay.Histopathological examination and staining are important to differentiate it from hemangiopericytoma or carcinoid tumors.Spiral tracheoplasty after tangential resection may be tried, as this preserves more tracheal tissue, decreases tension, and prevents postoperative leakage at the anastomotic site.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Tainan Municipal Hospital, Tainan, Taiwan.

ABSTRACT

Background: Glomus tumors are usually found over the dermis of the extremities, particularly over the subungual region of the fingers, and occurrence in the trachea is an extremely rare event. To date, only 29 cases of tracheal and 2 main bronchus glomus tumors have been reported in the English literature. Our patient is the first ever reported case in Taiwan that was managed by spiral tracheoplasty.

Case report: A 58-year-old woman was admitted to our hospital because of hemoptysis. Computed tomographic (CT) scan revealed a mass over the posterior wall of the trachea. Surgical resection with spiral tracheoplasty was performed due to uncontrolled bleeding and airway compromise. Histopathology and immunostaining confirmed a glomus tumor. Postoperative course was unremarkable and she was discharged in improved condition after 9 days of hospital stay.

Conclusions: Although chronic symptom presentation is the rule for tracheal glomus tumors, airway obstruction and bleeding are life-threatening presentations. Histopathological examination and staining are important to differentiate it from hemangiopericytoma or carcinoid tumors. Spiral tracheoplasty after tangential resection may be tried, as this preserves more tracheal tissue, decreases tension, and prevents postoperative leakage at the anastomotic site.

Show MeSH
Related in: MedlinePlus