Tumor of Trachea and EsophagusTumor of Trachea and Esophagus

Tracheal neoplasmTracheal neoplasm

OverviewOverview

Tracheal anatomy

Primary tracheal tumorsBenign primary tracheal tumorsMalignant primary tracheal neoplasms

Secondary tracheal tumors

Anatomy: Anatomy: TracheaTracheaAnatomy: Anatomy: TracheaTrachea

Anatomy: Anatomy: TracheaTracheaAnatomy: Anatomy: TracheaTrachea

Fibromuscular tube

Support by cartilagenous rings

Lower border of cricoid cartilage – top of the carina spur

Average length 11 cm (10-13 cm)

Adult trachea 2-2.5 cm in diameter

Extrathoracic trachea ~ 6-9 cm

C shaped with posterior membranous wall connecting the arms of the “C”Mucosa : a ciliated ciliated pseudostratified columnar pseudostratified columnar epitheliumepithelium

Anatomy: Anatomy: Blood supply to tracheaBlood supply to tracheaAnatomy: Anatomy: Blood supply to tracheaBlood supply to trachea

Branches of inferior thyroid artery supply the upper trachea

Branches of bronchial artery supply the lower trachea

Branches arrive the trachea via lateral pedicles

Tumor of trachea Tumor of trachea

Tracheal tumor 2 type

- primary tracheal tumor

- secondary tracheal tumor

Tracheal resection with end to end Tracheal resection with end to end anastomosisanastomosisTracheal resection with end to end Tracheal resection with end to end anastomosisanastomosis

Tracheal mobilization maneuversTracheal mobilization maneuversExtreme flexion of the neck (1-6 cm)Incising the annular ligament (1-2 cm)Suprahyoid or infrahyoid release of the upper laryngotracheal unit (2.5-5 cm)Blunt dissection and mobilization of the lower tracheal segment (0.5-1 cm)All combinations yields 4-6 cm (~ patient age and range of neck motion)

Primary Tracheal Tumors

Primary Tracheal TumorsPrimary Tracheal Tumors

Uncommon Incidence 2 case/million/year Men = WomenPeak age : 50- 59 yrRisk factor : SmokingIn adults : Malignant >80% In children : Benign > 90 % Most frequent : proximal and distal 1/3 of tracheaOriginate from any layer in tracheal wall Classified : - Epithelial tumors

- Mesenchymal tumorsCummings, 5 th ed.

Classification of Tracheal Tumors

Classification of Tracheal Tumors

Epithelial NeoplasmsBenignSquamous cell papilloma Papillomatosis Pleomorphic adenoma

Malignant Squamous cell carcinoma Adenoid cystic carcinoma Carcinoid Mucoepidermoid carcinoma Adenocarcinoma Small-cell undifferentiated carcinomaSecondary malignancy Invasion by adjacent malignancy Metastases Nonneoplastic tumors Tracheobronchopathia osteochondroplastica Amyloidosis Inflammatory pseudotumor

Mesenchymal NeoplasmsBenignFibroma Hemangioma Granular cell tumor Schwannoma Neurofibroma Fibrous histiocytoma PseudosarcomaHemangioendothelioma Leiomyoma Chondroma Chondroblastoma Lipoma Malignant Leiomyosarcoma Chondrosarcoma Paraganglioma Spindle-cell sarcoma Lymphoma Malignant fibrous histiocytoma Rhabdomyosarcoma

BENIGN PRIMARY BENIGN PRIMARY TRACHEAL TUMORSTRACHEAL TUMORSBENIGN PRIMARY BENIGN PRIMARY

TRACHEAL TUMORSTRACHEAL TUMORS

Benign primary tracheal tumorsBenign primary tracheal tumors

Uncommon in adult Usually smooth, well circumscribe, round, soft, and small < 2 cmChest CT

Not extend through the tracheal wallMay presence of calcium within the lesion benign histology

Cummings, 5 th ed.

Squamous papilloma

Granular cell tumor

Chondroma

Leiomyoma

Hemangioma

Benign primary tracheal tumorsBenign primary tracheal tumors

Squamous Papilloma Squamous Papilloma

Superficial, sessile or papillary masses consisting of a connective tissue core covered by squamous epithelium

Adult : rare : associate with heavy smoking

Children : most common tracheal neoplasm

Cause : HPV 6, 11Cummings, 5 th ed.

Cause : transmitted from mother to fetus during childbirth

Frequent recurs and difficult to completely eradicate

Usually regresses spontaneously after puberty

Major lesion occur isolated to the larynx (90-95%)

- 11% occur in the trachea in addition to the larynx

- 1.2 % isolated to the trachea

Squamous Papilloma Squamous Papilloma

Treatment : similar laryngeal papilloma - recent : CO2 laser : Adjuvant treatment with α-interferon

Malignant transformation to SCCA or Verrucous CA

- incidence of malignant degeneration 1.6-4.0 % - associated HPV -11

Squamous Papilloma Squamous Papilloma

Granular cell tumorGranular cell tumor

Neurogenic in origin , from schwann cell

No sex predilection Children : rare 50% of granular cell occur in the head and neck region

- 10 % in the larynx - rare : in the cervical trachea

20% Multicentric tumor, more aggressive

Finding : Non-encapsulated, : tend to invade locally

Malignant degeneration 1-2%

(never report in children)

Granular cell tumorGranular cell tumor

Management : surgery

- Tumor size < 8 mm : “ Bronchoscopic resection ”

- Tumor size > 8 mm high likelihood of full-thickness wall involvement recurrent after bronchoscopic removal

“ Segmental tracheal resection ”

Granular cell tumorGranular cell tumor

Chondroma Chondroma

Most common benign mesenchymal tracheal tumor Cartilaginous origin Most common site - internal aspect of the posterior cricoid lamina Hard , smooth , broad-based and covered by intact mucosa Radiography : 75% found calcification, not distinguish from chondrosarcoma

Management : - surgery segmental tracheal resection - endoscopic resection for palliation but leads to

recurrence

Chondroma Chondroma

Leiomyoma Leiomyoma

Origin : smooth muscle of tracheal wall , typically from the membranous portion of the lower third of the trachea

Finding : Smooth contoured , polypoid mass and usually have

a broad base

Management : surgery - segmental tracheal resection - incomplete resection local recurrence

Leiomyoma Leiomyoma

HemangiomaHemangioma

Hemangioma of the airway occur in adults and children

In adult - cavernous hemangiomas develop in the larynx

- capillary hemangioma originate in subglottic area

Tracheal Hemangioma occur more often in young children and most common obstructive subglottic mass

Asymptomatic at birth, but most will cause stridor within the first 6 months of life

Cutaneous hemangioma 50% of patient

HemangiomaHemangioma