|Year : 2019 | Volume
| Issue : 2 | Page : 66-69
Chondroma of the trachea: A rare benign tracheal tumor
Darshan Virendrakumar Doshi, Bhavya Nalinbhai Shah
Head and Neck Cancer Surgery, Head and Neck Cancer Care, Naranpura, Ahmedabad, Gujarat, India
|Date of Submission||21-Feb-2019|
|Date of Acceptance||02-Jun-2020|
|Date of Web Publication||14-Aug-2020|
Darshan Virendrakumar Doshi
Head and Neck Cancer Care, 404 and 408, Dev Arcade, Near Naranpura Railway Crossing, Naranpura, Ahmedabad - 380 013, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Chondroma of the trachea is a rare neoplasm. Primary tracheal neoplasms are most frequently found in the lower one-third of the trachea. The vast majority of tracheal tumors in adults are malignant. More commonly, the trachea may be involved secondarily by direct extension of tumors of the thyroid, esophagus, larynx, or bronchus. Several authors have reported on the potential of chondromas to undergo sarcomatous change and convert into malignant chondrosarcoma. Because of its recognized potential for local recurrence, a localized chondroma of the trachea is best managed by tracheal resection. We present a case of a 65-year-old male presenting with tracheal chondroma which was diagnosed preoperatively using fine-needle aspiration cytology and computed tomography scan and treated by tracheal resection and anastomosis.
Keywords: Benign, chondroma, extremely rare, trachea, tumor
|How to cite this article:|
Doshi DV, Shah BN. Chondroma of the trachea: A rare benign tracheal tumor. J Laryngol Voice 2019;9:66-9
| Introduction|| |
Tumors that arise in the trachea and bronchi are rare. The vast majority of tracheal and bronchial tumors in adults are malignant, but a few are benign. Typically, tracheal involvement is secondary to direct extension by tumors of the thyroid, esophagus, larynx, or bronchus. The most common primary tracheal malignant tumors are squamous cell carcinoma and adenoid cystic carcinoma. Squamous papillomas or fibromas are most often found benign primary tumors of the trachea while adenomas, lipomas and hemangiomas are rare. Chondroma is rarely found benign primary tumor of the trachea. Chondromas are benign cartilaginous tumors that are uncommon in the head-and-neck region. Some exceptional cases affecting the epiglottis, tongue, and larynx have been reported. Till 2005, >300 cases of laryngeal chondroma had been reported, whereas tracheal chondromas cases were only 20. The condition occurs most commonly in older males. The mean age is 40–50 years, and male:female ratio is 5:1. The true incidence of chondromas is unknown, as they have been historically misclassified as hamartomas. The tumor usually appears as an upper airway obstructing syndrome, and endoscopy is essential for establishing the diagnosis. Laser resection can be recommended for the treatment of limited lesions, whereas tracheal resection with end-to-end anastomosis is recommended for more advanced chondroma because it is prone to local recurrence and malignant transformation into chondrosarcoma.
| Case Report|| |
A 65-year-old man presented to our hospital with progressive difficulty in breathing for 2 years and 2 months of history of midline neck swelling. The patient was a bidi smoker for the past 20 years but had stopped smoking 6 months before presenting to the department. His symptoms were aggravated while sleeping. He had developed a dry, irritating cough and exertional dyspnea. He had been treated for asthma without benefit. On examination, the trachea was midline and 3 cm × 3 cm, round, hard, fixed, nontender mass was identified at the suprasternal notch on the left side with retrosternal extension that moved on deglutination. With neck extension, the lower border of swelling was palpable. There was no hemoptysis, dysphagia, or hoarseness. There were obvious stridor and exertional dyspnea. The lungs were otherwise clear. Laryngoscopy revealed normal larynx and pharynx.
Computed tomography scan demonstrated mainly left-sided well-defined 3 cm × 4 cm × 3.5 cm (anteroposterior × transverse × craniocaudal) oval-shaped inhomogeneous soft-tissue density mass lesion with internal calcification involving the cervical trachea causing severe narrowing of the lumen. Inferiorly, it showed minimal retrosternal extension. The findings were suggestive of a primary tracheal mass, chondroid in nature most probably chondroma [Figure 1], [Figure 2], [Figure 3]. Fine-needle aspiration cytology was suggestive of chondroma. Blood report, X-ray chest posteroanterior view, and electrocardiography were normal.
|Figure 1: Coronal section of computed tomography scan neck with contrast showing extent of tracheal chondroma|
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|Figure 2: Axial section of computed tomography scan neck with contrast showing extent of tracheal chondroma|
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|Figure 3: Sagittal section of computed tomography scan neck with contrast showing extent of tracheal chondroma|
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Fiber-optic awake nasal intubation was performed, and a size 5 endotracheal tube was inserted. A size 16Fr Ryles tube was inserted for postoperative feeding. The tumor was explored through an 8-cm horizontal skin incision in the neck in the lower skin crease. A 3 cm × 3.5 cm mass was found arising from the anterolateral left tracheal wall adherent to the lower pole of the left thyroid gland [Figure 4]. It appeared to be well-defined. Approximately 5 cm of the anterolateral tracheal wall on both sides was resected along with tumor. One-centimeter wide posterior wall was left intact. Suprahyoid muscles were released to facilitate the downward mobilization of the larynx [Figure 5], and the tracheal wall was sutured with Vicryl 1 [Figure 6]. The patient recovered well, and the postoperative period remained uneventful. Histological examination showed a benign chondroma. The patient experienced complete relief of his symptoms and resumed work and normal activities after 3 weeks. The patient was regularly followed up for 1 year with no symptoms or signs suggestive of local recurrence.
|Figure 4: A lemon size swelling arising from the anterolateral left tracheal wall adherent to the lower pole of the left thyroid gland|
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|Figure 5: (1) Suprahyoid muscles release to the downward mobilization of the larynx. (2) Defect after excision|
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| Discussion|| |
Chondroma of the trachea is a rare lesion. A true chondroma has often been confused with cartilaginous hamartomas. Both contain cartilage, but the cartilaginous hamartomas also contain the components of lipomatous, lymphoid, and epithelial tissues. These additional tissue elements are absent in true chondroma. It is important to realize, therefore, that a chondroma is a distinct and different neoplasm from the more common cartilage-containing hamartomas. Tracheal chondroma is such a rare lesion that any discussion of its features must borrow from the experience with the more common neighboring chondromas of the larynx and bronchus. The usual chondroma is a round or ovoid smooth mass consisting of semi-translucent cartilage surrounded by a fibrous capsule. It is firm in consistency but may become softened by mucinous degeneration or by bleeding into the growth. Typically, it is slow growing and does not invade surrounding tissue, although it may cause pressure atrophy of contiguous structures.
Although benign in the sense of noninvasive growth and the absence of metastases, it does have a marked tendency to recur locally if inadequately removed. Several authors have mentioned the potential of chondromas to undergo sarcomatous change and convert into malignant chondrosarcoma, but this has not been well-documented. Part of the difficulty may be that the histological distinction between benign and malignant cartilaginous tumors is subtle. In general, multinucleated cells, enlarged nuclei, and poorly organized hypercellularity indicated malignancy. Because they are nourished by lymph, chondromas may reach large sizes even in areas with relatively poor blood supply. In general, their interference with the mechanics of respiration causes these tumors to be discovered before they have attained such extensive growth.
The most widely held theory of the origin of chondromas is that they represent delayed development of cartilaginous elements in embryonic rests which suddenly begin to grow. Our patient demonstrated many features characteristic of tracheal tumors in general. The most frequent initial symptom is an irritating, dry cough unrelieved by symptomatic treatment. Patients may describe a tickling sensation in the throat. There is an insidious onset of dyspnea, exertional at first, then occurring at rest. Typically, stridor or wheezing develops, particularly on expiration. Many patients of tracheal chondroma have medical history of prolonged treatment for asthma. Our patient was also treated for asthma for 2 years. Hemoptysis occasionally occurs, as does dysphagia. Hoarseness usually implies a malignant lesion but may occur, from pressure on or stretching of the recurrent laryngeal nerve. A tracheal lesion often may be better evaluated by lateral views of the neck or overpenetrated films or by oblique views which reveal the entire length of the tracheal air column. Laminagrams offer more definition. A chondroma of the trachea can be diagnosed with certainty only by bronchoscopy and biopsy. It should be remembered, as Grillo has emphasized, that bronchoscopy should be deferred until the time of definitive treatment if the airway is severely compromised to avoid increased secretions and edema that might precipitate life-threatening tracheal obstruction in the period following bronchoscopy. With improved techniques of local tracheal resection, as advanced by Grillo, it now seems both safe and reasonable to advocate curative resection with adequate margins of normal cartilage in the rare case of such tracheal neoplasms. Histologically, the most frequent benign tumors are papillomas and hamartomas; chondromas are uncommon. Chondromas are made entirely of benign mature hyaline cartilage and characteristically lack of internal clefts lined by the alveolar epithelium.
| Conclusion|| |
Tracheal chondroma is a rare differential diagnosis of primary benign tumor of the trachea. According to the published literatures, less than two dozen cases of tracheal chondromas have been reported. Imaging and fine-needle aspiration cytology play an important role in diagnosing tracheal chondroma. Although the condition is benign, it does have a marked tendency to recur locally; therefore, adequate resection with safe margin and end-to-end anastomosis of the trachea is the ideal treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]