A case of pleomorphic adenoma of trachea

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Patient female, 49. Because of repeated shortness of breath for 5 years, 2 years in September 14, 2009 to increase the hospital. Shortness o


Patient female, 49. Because of repeated shortness of breath for 5 years, 2 years in September 14, 2009 to increase the hospital. Shortness of breath in patients without apparent inducement 5 year ago, when, with breathing, outside the hospital to accept the treatment of bronchial asthma, the symptoms were not improved significantly over the past 2 years was aggravated shortness of breath. Admission examination: shortness of breath, three concave syndrome, lung auscultation can smell and inspiratory and expiratory wheezes to the sternum at the most obvious. Chest CT showed upper tracheal space occupying lesions (Figure 1). Fiberoptic bronchoscopy showed that the pressure of the left side wall of the left side of the trachea was narrow at the lower part of the glottis, and a new organism was found below the stenosis. The lumen was significantly narrowed by about 4cm, and the whole lesion was about 6cm (Figure 2) (3cm). Histopathological examination of the bronchial biopsy showed pleomorphic adenoma (Figure 3). Patients with tracheal lesions within the range, and the top of the tracheal wall cavity tumor were involved, radical surgery can not complete tracheal reconstruction after resection of the bronchus treated with argon knife and frozen, resection of tracheal tumor, several times after treatment, patients with tracheal patency, dyspnea and wheezing symptoms (Figure 4, completely eliminated figure 5), is still in close follow-up.

Tracheal pleomorphic adenoma is a rare benign tumor of the trachea. Although pleomorphic adenomas are common in the parotid gland, they are rarely seen in the trachea. Before 2007, only 34 cases of [1] were reported in the world. Ishikawa[2] and Rodriguez[3] reported a total of 1 cases in 2008 and beyond. Because of the slow growth of the pleomorphic adenoma, it is difficult to distinguish between asthma and chronic bronchitis and other non - occupying diseases. In this paper, patients with obvious symptoms of dyspnea for up to 5 years, the history of questioning, the occurrence of limited activity and other symptoms for up to ten years. 19 cases () of the patients with tracheal pleomorphic adenoma ([4]), which were summarized by Heifetz, were misdiagnosed as bronchial asthma at the beginning of the year (31.6%). The patients in this study have been misdiagnosed as bronchial asthma. Therefore, if the symptoms of persistent dyspnea, asthma and other symptoms after treatment with no significant relief, should be timely chest CT and fiberoptic bronchoscopy.

Any of various round or oval masses with a well-defined margin, with a complete or incomplete envelope. The tumor is composed of epithelial and stromal components. Epithelial components include ductal cells and non ductal cells, which can be characterized by spindle cells, squamous cells, astrocytes, class like cells, eosinophils, cuboidal cells or transparent cells. The interstitial components include varying degrees of myxoid, hyaline, cartilaginous, or osteoid differentiation. The proportion of various components varied greatly in different cases, but there was no significant correlation with the prognosis. Due to the multiple morphological features of pleomorphic adenoma and the heterogeneity of different types of tumors, it is difficult to make a diagnosis by fine-needle aspiration biopsy and biopsy of small sample [3].

Because pleomorphic adenoma of the trachea is rare, there is no formal study of its treatment and long-term follow-up. The main treatment methods include surgery, interventional therapy and radiotherapy. Pleomorphic adenoma of trachea is benign, but malignant. Therefore, complete surgical resection is the best treatment for pleomorphic adenoma of trachea. The size of the upper and lower diameters of the tracheal tumor is an important factor in the surgical resection. Because of the lack of a good artificial trachea, it is difficult to complete the reconstruction of the trachea through the end to end anastomosis after the resection of a large area of the tumor. At present, the average length of resectable tumors is less than 3cm. In this case, the patient was unable to carry out surgical resection because of the tumor size up to 6cm.

As with other primary tracheal and bronchial tumors, interventional treatment can be performed for patients who cannot undergo surgery for various reasons. Endoscopic interventional therapy can effectively remove the tumor, improve ventilation, relieve symptoms and reduce the complications. However, bronchoscopic interventional treatment can only remove the tumor mass, can not guarantee the margin of negative, will remain the tumor tissue, only for patients with inoperable patients with palliative treatment and acute airway obstruction in patients with temporary treatment. Now that the argon plasma coagulation via bronchoscopy (APC) in the treatment of airway diseases are all in the economic benefits than a supreme, is a relatively safe method, very suitable for the treatment of airway high risk. The patient received 5 APC and after cryotherapy, the airway basic mass resection, airway function recovered completely, complete remission of symptoms of shortness of breath and breathing.

There is no relevant experience of tracheal pleomorphic adenoma of chemotherapy, according to the experience in the treatment of large pleomorphic adenoma of salivary gland, for lesions or recurrence after surgery, postoperative residual not pleomorphic adenoma can accept neutron radiation therapy, the effect should be better than the conventional radiation therapy [5]. Chemotherapy has no effect on pleomorphic adenoma.


[1] Aribas OK, Kanat F, Avunduk MC. Adenoma the Mimicking Bronchial Report a Case. Surgery Today, 2007, 37: 493-495., Trachea of, Asthma: of

[2] Ishikawa S, Kimura M, Inadome Y, et al. endoluminal of pleomorphic adenoma subglottis. European of Cardio-Thoracic Surgery, 2008, 34: 1257-1259., a resection, occluding Journal

[3] Rodriguez MJ, Thomas GR, Farooq U. adenoma the Ear Nose Throat J, 2008, 87: 288-290., of Pleomorphic, trachea.

[4] Heifetz SA, Collins B, Matt BH. adenoma (benign mixed tumor) of trachea. Pediatr Pathol, 1992, 12: 563-574., Pleomorphic

[5] Douglas JG, Einck J, Austin-Seymour M, et al. radiotherapy recurrent adenomas of salivary glands. Head Neck, 2001, 23: 1037-1042., pleomorphic Neutron, major

Figure 1 tracheal mass (before treatment)

Figure 2 new living organisms (before treatment)

Figure 3 shows pleomorphic adenoma of salivary gland

Degree of gland, squamous epithelium and stroma

Figure 4 tracheal mass (after treatment)

Figure 5 new living organisms (after treatment)


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