Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Hsing-Hsien Wu, Yeun Tarl Fresner Ng Jao, Ming-Ho Wu
Department of Thoracic Surgery, Tainan Municipal Hospital, Tainan, Taiwan
Am J Case Rep 2014; 15:459-465
Glomus tumors are usually found over the dermis of the extremities, particularly over the subungual region of the fingers, and occurrence in the trachea is an extremely rare event. To date, only 29 cases of tracheal and 2 main bronchus glomus tumors have been reported in the English literature. Our patient is the first ever reported case in Taiwan that was managed by spiral tracheoplasty.
Case Report: A 58-year-old woman was admitted to our hospital because of hemoptysis. Computed tomographic (CT) scan revealed a mass over the posterior wall of the trachea. Surgical resection with spiral tracheoplasty was performed due to uncontrolled bleeding and airway compromise. Histopathology and immunostaining confirmed a glomus tumor. Postoperative course was unremarkable and she was discharged in improved condition after 9 days of hospital stay.
Conclusions: Although chronic symptom presentation is the rule for tracheal glomus tumors, airway obstruction and bleeding are life-threatening presentations. Histopathological examination and staining are important to differentiate it from hemangiopericytoma or carcinoid tumors. Spiral tracheoplasty after tangential resection may be tried, as this preserves more tracheal tissue, decreases tension, and prevents postoperative leakage at the anastomotic site.
Keywords: Diagnosis, Differential, Biopsy, Glomus Tumor - surgery, Reconstructive Surgical Procedures - methods, Tomography, X-Ray Computed, Trachea - surgery, Tracheal Neoplasms - surgery