Primary Malignant Tumors of the Lower Third of the Trachea: Report of a Case With Successful Treatment by Electrofulguration and Deep X-Rays

Abstract

BALTIMORE"The lower portion of the trachea is very rarely the seat of tumors," stated Ewing.1 An examination of the literature reveals that there are on record but twenty-four cases of carcinoma of the lower third of the trachea. D'Aunoy and Zoeller2 were able to collect only nineteen cases in a survey covering a period extending through 1929. Since that time there have been but five other cases reported. A perusal of the clinical records of the Johns Hopkins Hospital reveals the fact that the case that I shall present is the only one of primary carcinoma of the lower third of the trachea seen in that institution during its forty-two years of existence. Correctly enough, it could be argued that, while the previously mentioned figures would lead one to believe that tracheal tumors were rare, the actual state of affairs might be, as Chevalier Jackson declared when he saw his first case, "such are not uncommon but simply undiscovered." However, nothwithstanding the more widespread practice of endoscopy during the past few years, it cannot be denied that primary malignancy of the lower third of the trachea is certainly not frequently encountered. As to the sex and age incidence of carcinoma of the lower part of the trachea, Breslich3 found that it is almost twice as frequent in men as it is in women, and that most of the tumors occur within the age limits of 30 and 70 years.Concerning their etioliogy one can only theorize. Some maintain that they develop from cell rests, while others favor the theory of metaplasia. Simmel4 believed that the bifurcation was the most frequent From the Department of Oto-

The Use of Electrocautery as the Primary Ablation Modality for Malignant and Benign Airway Obstruction

“…The utilization of endobronchial electrocautery was first described in 1932 but was used infrequently over the next half century due to safety concerns. 21 There was initial difficulties with grounding, placing the bronchoscopist at potential risk for electric shock; however, newer systems overcame this problem by offering grounded bronchoscopes and bipolar probes that do not require grounding. 1,2,4,18 In 1985, Hooper and Jackson 16 described a series of four endobronchial electrocautery cases.…”

Use of bronchoscopic electrocautery in removing an endotracheal metastasis

“…Electrocautery is a technique of tissue destruction via an electric current, first used in the tracheobronchial tree in 1932 [5]. Electrocautery using a snare device is especially suited to the removal of pedunculated lesions.…”

Malignant central airway obstruction

“…Electrocautery has been used within the airways since the 1930s (67). Its advantages include rapid and precise tissue cutting and excellent coagulative properties which can be used both the prophylactically prevent bleeding prior to debulking and to treat active mucosal hemorrhage.…”