Pleomorphic Adenoma of the Trachea

Pleomorphic adenoma is a common neoplasm of salivary glands, but its occurrence in the trachea is very rare [1] . Tracheal tumors, including tracheal pleomorphic adenoma, often cause obstructive symptoms such as dyspnea and wheezing mimicking asthma, leading to delay in diagnosis [2] . Because of the rarity, consensus with regard to clinical behavior, management or prognosis is A 55-year-old man with a tracheal tumor was referred to our institution for bronchoscopic diagnosis and treatment. He had a 2-year history of dyspnea with wheezing, and was given a diagnosis of asthma by his family doctor. His symptoms were not alleviated by treatment for asthma so he was referred to another hospital for further evaluation. A chest CT revealed a polypoid tumor narrowing the distal trachea ( fig. 1 ). Positron emission tomography showed slight fluorodeoxyglucose uptake of the tumor, but no other abnormalities were found. Therapeutic bronchoscopy under general anesthesia was performed using a rigid and flexible bronchoscope, which showed a polypoid, lobulated, glossy tumor with telangiectatic surface protruding from the anterior wall of the trachea ( fig. 2 ). The tumor was resected with argon plasma coagulation, electrocautery and rigid bronchoscopic coring. A diagnosis of pleomorphic adenoma was made on the histopathology with a sheet-like structure of myoepithelial and epithelial cells embedded in a myxomatous stroma and no mitotic figures ( fig. 3 ). The patient experienced immediate relief of his respiratory symptoms with pulmonary function improvement (FEV 1 from 0.79 to 2.86 l, peak expiratory flow from 1.44 to 6.43 l/s), and was discharged 5 days after the procedure. He has since been under careful observation and there has been no evidence of recurrence in bronchoscopy and chest CT at 7 months after the procedure. Published online: April 1, 2010