Yeungnam Univ J Med.  2018 Jun;35(1):114-120. 10.12701/yujm.2018.35.1.114.

Tracheal pleomorphic adenoma with coexisting pulmonary tuberculoma

• Kim J
• Oak CH
• Jang TW
• Jung MH

• KMID: 2415744
• DOI: http://doi.org/10.12701/yujm.2018.35.1.114

Abstract

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.

Keyword

Tracheal neoplasms; Pleomorphic adenoma; Pulmonary tuberculosis

MeSH Terms

Adenoma, Pleomorphic*
Asthma
Bronchi
Cough
Diagnosis
Dyspnea
Humans
Lymph Nodes
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive
Recurrence
Salivary Glands
Thorax
Trachea
Tracheal Neoplasms
Tuberculoma*
Tuberculosis, Pulmonary

Figure

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  Fig. 1. (A) Chest x-ray shows a round mass shadow in the lower tracheal level (black arrows). (B) Three-dimensional airway CT shows a round mass in lower trachea level (white arrows). (C) Lung setting of CT scan of the chest shows a 1.5×1.3 cm homogenous mass in the right lateral inner wall of the trachea (black arrows). (D) A 0.5×0.4 cm round shaped nodule in the posterior zone of right upper lobe seen on the CT (arrowhead). CT, computed tomography.

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  Fig. 2. (A) Bronchoscopic shows a polypoid and broad mass originated from right side of lower trachea have rich engorged blood vessels on the tumor surface. (B) The mass nearly occludes the orifice of right main bronchus.

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  Fig. 3. The excised tumor. (A) Macroscopic appearance of the pleomorphic adenoma; there is a well-circumscribed grey colored measuring 1.5×1.3×1.3 cm mass; cut surface shows a well-defined ovoid mass without necrosis or invasion into the paratracheal tissues. (B, C) Microscopic appearance of the pleomorphic adenoma; ductal and myxoid components in the chondromyxoid stroma consisted of eosinophilic cuboidal epithelium and myoepithelium (H&E stain, B, ×12.5; C, ×400).

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  Fig. 4. Wedge resected nodule in the right upper lobe. (A) Macroscopic appearance of the lesion; surrounded by grey capsule, 0.5×0.4× 0.4 cm ovoid nodule, the cut surface of the nodule is homogenously solid and white with yellow spot. (B) Chronic granulomatous inflammation with caseous necrosis (H&E stain, ×200). (C) Acid-fast stain-positive bacilli are identified (×1,000).

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  Fig. 5. The post-operative bronchoscopy and 3D airway CT at 2 years after operation (A, B) shows no recurrence of the tracheal lesion compared to pre-operative bronchoscopy and 3D airway CT. 3D, three-dimensional; CT, computed tomography.

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