Successful Flexible Bronchoscopic Management of Dynamic Central Airway Obstruction by a Large Tracheal Carcinoid Tumor

Abstract

Typical carcinoid of the trachea presenting as an endoluminal polypoidal mass is a rare occurrence. Herein, we report a case of a 34-year-old female patient who presented with features of central airway obstruction. Flexible bronchoscopy demonstrated a large pedunculated growth arising from the lower end of the trachea near carina which was flopping in and out of the main tracheal lumen and the proximal right bronchus leading to dynamic airway obstruction. Successful electrosurgical excision (using a snare loop) of the polypoidal growth was performed using the flexible bronchoscope itself. The patient had immediate relief of airway obstruction and histopathological examination of the polyp demonstrated features of typical carcinoid (WHO Grade I neuroendocrine tumor).

Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada

“…Si bien se trata de dos casos, hay que tener en cuenta el potencial curativo de la técnica en situaciones especiales. Existe muy poca literatura reportada a este respecto como para emitir conclusiones 12 .…”

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

“…Furthermore, there is no epidemiological data due to the lack of large prospective or retrospective clinical studies. Through individual review of most up-to-date case reports and reviews of each individual tumor, we present the prevalence of each tumor as percentage of primary pulmonary tumors (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) or as number of reported cases as well as gender predominance, age predominance and associated risk factors, Table 2 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

“…The World Health Organization (WHO) have classified neuroendocrine tumors of the lung into three main entities: carcinoid tumors (typical/atypical), large cell neuroendocrine carcinomas (LCNEC), and small cell carcinomas (SCC) (9). Classification of typical and atypical carcinoid tumors, LCNEC and SCC are based on the histologic appearance, and presence of necrosis and mitoses (9). This review focused on typical carcinoid (TC) and atypical carcinoid (AC) tumors.…”

“…Besides, the curvilinear EBUS can be used to evaluate the mediastinal lymph nodes for metastasis (57). The diagnostic approach for most the rare airway tumors discussed in this review follow the above approach (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). There are subtle differences in the diagnostic work-up for these tumors depending on the extent of the disease.…”

“…Endoscopic approach is preferred over surgical approach in patients with multiple co-morbidities and high surgical risk. Other treatment such as chemotherapy, radiotherapy and anti-inflammatory drugs may be used in conjunction with surgical or endoscopic management or as palliation for patient who have tumors that are candidates for endoscopic or surgical management (3,4,6,7,9,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). A summary of most employed treatment modalities for rare airway tumors is provided in Table 4 (26,32,36,47,49,(58)(59)(60)(62)(63)(64)(65)(66)(67).…”