[Investigation and Analysis of Primary Lung Cancer with Endotracheal and Endobronchial Metastases].

BACKGROUND: Endotracheal and endobronchial metastases (EEM) is a rare manifestation in primary lung cancer. It has not yet been reported in Chinese literatures. The aim of this study was to summarize and analyze the clinical feature of lung cancer with EEM. METHODS: We retrospectively reviewed 6 patients who presented with EEM of lung cancer from Peking University Third Hospital from January 2015 to December 2018. With "endotracheal metastases, endobronchial metastases, lung cancer" as the keywords, 13 cases were retrieved from PubMed database until February 2020. The clinical, radiologic and bronchoscopic data were collected. RESULTS: Six patients were selected from 967 patients with lung cancer, and all were diagnosed with lung cancer and EEM simultaneously. There were 4 cases of squamous cell carcinoma, 1 case of adenocarcinoma, and 1 case of small cell lung cancer. One patient had stage IIIb and 5 patients had stage IV. There were 5 cases of central lung cancer and 1 case of peripheral lung cancer. EEM on bronchoscope examination presented as endoluminal nodular or polypoid lesion in 5 patients, and abnormal white bulge in 1 patient. 5 cases metastasized to the contralateral bronchus, 1 case to the ipsilateral bronchus and 1 case to the trachea. The median overall survival was 7.5 months. Totally 13 cases of lung cancer with EEM were retrieved from PubMed database. 12 cases were diagnosed during the follow up after lung cancer resection. There were 8 cases of squamous cell carcinoma and 9 cases of central type. Endotracheal or endobronchial nodules showed in 10 cases and eccentric wall thickening in 2 cases were seen on chest computed tomography (CT), which corresponding to the nodular or polypoid lesion bronchoscopically. 5 cases metastasized to the contralateral bronchus, 10 cases to the trachea and 1 case to the ipsilateral bronchus. CONCLUSIONS: EEM is a rare metastasis of lung cancer, which can occur at the initial diagnosis of lung cancer or after surgical resection. It is often seen in the patients of squamous cell carcinoma with central type in advanced stage. The prognosis is poor.

Rare case of radiation-induced primary tracheal carcinoma.

Primary carcinoma of the trachea is an exceeding rare entity. We present a case of radiation-induced primary squamous cell carcinoma of the trachea in a young woman. The case highlights a diagnostic challenge of this atypical disease entity.

Primary ectopic substernal thyroid cancer with trachea relapse: a case report and opinions of management.

BACKGROUND: Ectopic substernal thyroid is a rare symptom of thyroid disease that entirely results from the developmental defects at early stages of thyroid embryogenesis and during its descent. Cases were seldom reported as primary ectopic substernal thyroid cancer, especially those with severe local invasion and tracheal relapse. CASE PRESENTATION: In this report, the patient presented odynophagia and a sense of progressing swallowing obstruction. She underwent total thyroidectomy and lump resection. However, she refused to use postoperative radioactive iodine or take adjuvant external-beam radiotherapy, except for thyroid hormone replacement therapy. Tracheal relapse was observed after 6 months. Tracheal stent was used to reconstruct the airway twice. CONCLUSIONS: Trachea invasion might be a worse independent predictor of prognosis than any others and should be given particular attention. Furthermore, tracheal stent might be a palliative option for patients with tracheal relapse.

Implantable cardioverter-defibrillators and subsequent cancer risk: a nationwide population-based cohort study.

AIMS: Despite increasing use of implantable cardioverter-defibrillators (ICDs) and reports linking selected bio-implants with cancer, the cancer risk associated with implanted ICDs remains unknown. The objective of our study was to examine cancer risk among ICD recipients. METHODS AND RESULTS: We conducted a population-based cohort study using medical registries covering the entire Danish population. We identified all first-time ICD recipients during the period of 2000-11 and determined their subsequent cancer incidence. Standardized incidence ratios (SIRs) were computed by comparing observed cancer incidence in the ICD cohort with expected cancer incidence based on national incidence rates according to age, sex, and year of diagnosis. A total of 6723 ICD recipients were followed for up to 12 years (median 2.8 years) and contributed a total of 23 254 person-years of follow-up. Compared with the general population, ICD recipients had a slightly elevated overall risk of cancer [SIR = 1.1 (95% confidence interval (CI): 1.0-1.2)]. This was driven by the cancer risk among patients with ischaemic heart disease (IHD) [SIR = 1.1 (95% CI: 1.0-1.3)], which, as expected, was particularly elevated for tobacco-related cancers [SIR = 1.4 (95% CI: 1.2-1.6)]. Importantly, ICD recipients without IHD were not at increased cancer risk [SIR = 1.0 (95% CI: 0.8-1.3)]. CONCLUSION: This nationwide population-based cohort study with up to 12-year follow-up did not indicate a causal relation between ICD implantation and cancer. However, more follow-up data are needed to entirely rule out risks for individual cancer types.

Incidence of upper aerodigestive tract cancer after liver transplantation for alcoholic cirrhosis: a 10-year experience in an Italian center.

INTRODUCTION: The aim of this study was to evaluate the incidence, clinical characteristics, treatment, and outcome of de novo tumors (DNT) of the upper aerodigestive tract in patients with alcoholic cirrhosis after orthotopic liver transplantation (OLT). METHODS: Among 225 consecutive OLT performed between January 2002 and January 2012, a total of 205 patients received a first liver allograft. Eleven (4.9%) patients developed DNT (lung, pancreas, bowel, esophagus, larynx, tongue, tonsil, and lymphoma). Among these, we observed 5 patients with DNT of the upper aerodigestive tract. RESULTS: The 5 patients with DNT of the upper aerodigestive tract underwent OLT for alcoholic cirrhosis. There were 4 men and 1 woman with a mean age at transplantation of 47 years. The mean period of alcohol abuse was 90 months. The tumors occurred after a mean post-transplantation time of 39 months. The immunosuppressive regimen included Tacrolimus, mTOR, mycophenolate mofetil (MMF), and low-dose steroids. We observed 2 cases of squamous cell carcinoma of the esophagus, 1 case of tonsillar cancer, 1 case of larynx carcinoma, and 1 case of tongue carcinoma. All patients underwent surgical excision. After surgery, 4 patients received chemotherapy and 2 patients radiotherapy. At present, among the 5 patients with DNT of the upper aerodigestive tract, only 2 are alive without disease and 1 is alive with a local recurrence. CONCLUSION: The incidence of DNT of the upper aerodigestive tract after OLT is higher among patients receiving a transplant for alcoholic cirrhosis. This could be due to an additional effect of post-transplantation immunosuppression in patients exposed to alcohol before transplantation. We suggest a careful post-transplantation follow-up and more attention to improve early diagnosis.

Disparities in knowledge of mouth or throat cancer among rural Floridians.

OBJECTIVE: The aim of this study was to examine risk factors for reduced mouth or throat cancer (MTC) knowledge using a sample of rural North Floridian adults. METHODS: Telephone interviews were conducted across rural census tracts throughout North Florida in 2009-2010, using a survey adapted for cultural appropriateness. The sample consisted of 2,393 individuals (1,059 males and 1,334 females; 1,681 whites and 712 blacks). FINDINGS: Only 9% of the study respondents indicated they had not heard of MTC; however, only 12% endorsed knowing "a lot." Higher education levels and health literacy indicated they had more MTC knowledge. Among female participants, whites had more knowledge than blacks (OR = 1.9). Among black participants, males had more knowledge than females (OR = 1.7). Conversely, greater concern with MTC was associated with lower education levels, health literacy, and financial status, but higher depression scores. Awareness that excessive sun exposure is a risk factor for MTC was lower than for earlier studies using more urban samples. CONCLUSIONS: This study adds to the literature on MTC knowledge and concern because this sample was drawn exclusively from rural populations in North Florida, a group with the highest MTC morbidity and mortality. An unanticipated finding was that blacks were more concerned than their white rural counterparts. This study was also the first to report that depression was associated with increased concern about MTC. The goal is to persuade at-risk groups to obtain MTC screenings with the goal of reducing disparities in MTC whenever they occur.

Multiple unrelated malignancies following renal transplantation: an evaluation of four cases.

The risk of de novo malignancy is significantly higher in patients who have undergone organ transplantation than in the general population. Long-term immunosuppressive treatment, in addition to age, genetic predisposition and infectious agents, plays a major role in the development of malignancy. Although skin and hemopoietic system cancers are common, atypical presentations of malignancies may occasionally be seen during long-term follow-up in patients with functioning allografts. In this report, four cases, each with more than one different primary malignancy (one patient with three malignancies and three patients with two malignancies), are presented.

Carcinoma of the trachea in a cat.

Non-keratinizing squamous cell carcinoma of the trachea was diagnosed in an 11-year-old domestic shorthaired cat suffering from progressive cough and dyspnoea. The tumour was characterized by immunohistochemical expression of cytokeratins and focal expression of vimentin. The cat was exposed historically to high concentrations of environmental cigarette smoke and this may have been a contributory aetiological factor in the genesis of this tumour.

Multinodular goitre arising in the tracheal lumen: implantation or ectopic?

OBJECTIVES: We report a case of multinodular goitre arising in thyroid tissue within the trachea. This tissue appears to have been implanted at the time of an earlier subtotal thyroidectomy. CASE REPORT: A 79-year-old woman presented with a 12-month history of dyspnoea. Forty years earlier, she had been treated for a follicular adenoma with subtotal thyroidectomy. Investigation revealed tumour in the region of the right lobe of the thyroid, extending into and narrowing the trachea. A biopsy was performed, and the patient underwent excision of the right thyroid lobe tumour and cricotracheal resection with anastomosis. Histopathological findings were consistent with a multinodular goitre arising in thyroid tissue within the tracheal lumen. CONCLUSION: Intra-operative thyroid tissue implantation in the trachea and subsequent goitre development has not previously been described. This case illustrates the need for careful resection of the thyroid in order to maintain the integrity of normal anatomical structures.

[Case of miliary tuberculosis with esophageal perforation and a tracheal inflammatory polyp secondary to mediastinal lymphadenitis causing massive hematemesis and hemosputum].

A 62-year-old man with a history of left nephrectomy due to tuberculosis was referred to our hospital, because chest radiography showed diffuse miliary shadows in the bilateral lung fields, and acid-fast bacilli were detected from his hemosputum after steroid therapy for fever of unknown origin. Chest computed tomography showed mediastinal lymph node enlargement with partial calcification of these lymph nodes together with the presence of air. He was diagnosed with miliary tuberculosis and tuberculous mediastinal lymphadenitis and anti-tuberculosis drug therapy was started. Massive hematemesis occurred 11 days after the start of the treatment. Although gastroendoscopy was performed, the bleeding point could not be identified. The patient's symptoms improved after conservative therapy. Repeat gastroendoscopy showed a submucosal nodule with laceration of the esophageal mucosa, 30 days after admission for the examination of melena and progression of anemia. The episodes occurred because of esophageal perforation secondary to tuberculous mediastinal lymphadenitis. Bronchoscopic examination for hemosputum showed an inflammatory polypoid lesion in the left tracheal wall. These symptoms improved with anti-tuberculosis drug therapy. In our case, mediastinal lymphadenitis progressed to miliary tuberculosis because of endogenous reactivation. We report a rare case of esophageal perforation with a tracheal inflammatory polyp secondary to tuberculous mediastinal lymphadenitis. In cases of tuberculous mediastinal lymphadenitis, if hematemesis or hemosputum is observed, an endoscopic examination should be performed.

Tracheal chondrosarcoma--a rare complication in Maffucci syndrome.

Maffucci syndrome is a rare congenital non-hereditary disease characterised by subcutaneous haemangiomata and multiple enchondromata. We present a case of an intermediate grade myxoid chondrosarcoma of the tracheal cartilage in a 34-year-old man with a history of Maffucci syndrome. Chondrosarcoma of the trachea are extremely rare tumours. A review of the radiological literature reveals approximately 15 previously published cases. No case was found with a history of Maffucci syndrome.

Management of suprastomal tracheal fibroma: introduction of a new technique and comparison with other techniques.

OBJECTIVE: Suprastomal tracheal granuloma/fibroma (SSTGF) is a common cause of failure to decannulate following pediatric tracheostomy. Because larger lesions obstruct the trachea, it is necessary to remove them prior to decannulation. Various methods have been described for the management of these obstructing tracheal lesions, including the KTP laser, Nd-YAG laser, sphenoid punch, optical forceps, microsuspension laryngoscopy with an articulated arm (MSLAA), and external excision. A hollow core guide fiber for the CO(2) laser has been developed that can be advanced to better approximate targeted tissues and minimize thermal spread using a near-contact method. METHODS: A retrospective chart review was performed of 30 children under the age of 7 years (21M, 9F) with SSTGF who underwent treatment by either external excision (n=10), MSLAA (n=10), or CO(2) laser vaporization by fiberoptic laser carrier (n=10). The medical charts were reviewed for excision techniques and outcomes. RESULTS: Mean operative time for external excision was 34.9min (SD=10.2min), for MSLAA was 16.3min (SD=4.8min), and for fiberoptic CO(2) laser carrier was 19.3min (SD=7.1min). Mean hospital time postoperatively for external excision was 24h (SD=510min), for MSLAA was 3.3h (SD=37.7min), and for fiberoptic CO(2) laser carrier was 3.9h (SD=46.3min). Need for additional procedures was seen in 60% of external excision procedures, 70% of MSLAA procedures, and in 30% of fiberoptic CO(2) laser carrier procedures. Immediate postoperative decannulation was possible in 10% of the external excision group, 20% of the MSLAA group, and 40% of the fiberoptic CO(2) laser carrier group. CONCLUSIONS: The new technique of using a fiberoptic carrier for the CO(2) laser to treat children with SSTGF's is comparable to more traditional techniques of SSTGF removal when considering the need for additional procedures, postoperative hospital stay, and percentage of immediate postoperative decannulation and provides another useful tool in the armamentarium of the surgeon in treating SSTGF's.

A method of producing carcinoma in upper aerodigestive tree and esophagus of the Syrian golden hamster using wounding and instillation of N-methylnitrosourea.

Details of a method for producing carcinoma of the aerodigestive tree of the Syrian golden hamster and the use of this model to evaluate putative agents for chemoprevention of these carcinomas are described. The method produces a majority of squamous carcinomas of the trachea and glottis that follow squamous metaplasia of respiratory epithelium. In addition, seen are adenocarcinomas arising in glands of the respiratory tree. Squamous carcinomas of the digestive epithelium arise in primary squamous epithelium. These tumors of digestive epithelium have a growth pattern that differs from that of the respiratory epithelium in that they grow and invade without filling the epithelial layer with tumor cells.

[The use of Nd-Yag laser in the treatment of tracheal tumor in 14 years old child with mukopolisacharydosis type II]. / Zastosowanie lasera Nd-Yag w leczeniu guza tchawicy w przebiegu mukopolisacharydozy u dziecka.

Hunter's Syndrome (MPS II) is a class of hereditary disorder characterized by a deficiency of specific enzyme--iduronate sulphatase required to break down mucopolisacharides and occurs in Poland in one of 100-150 thousand male live births. MPS II may be lethal in the second decade of life as a result of infiltrativ cardiomiopathy leading to irreversible heart failure or upper airway obstruction caused by infiltration, granulation and deformation in trachea or larynx. We report a case of 14-year-old male with Hunter Syndrome who developed tracheal obstruction and was treated with Nd-Yag laser. We discuss the possibility of treatment and our results--improvement in patient's symptomatic and functional status.