Glomus tumor of the trachea managed by spiral tracheoplasty

Abstract

Background: 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.

Figure 1.

(A) Axial CT scan image of the tumor located at the posterior wall of the trachea. (B) Coronal section showing the polypoid tumor over the trachea.

Figure 2.

(A) Preoperative bronchoscopic image of the tumor almost completely obstructing the trachea. (B) Gross appearance of the excised tumor. (C) Bronchoscopic image performed 7 days postoperatively showing mild granulation tissue over the oblique anastomotic site. The trachea is patent and the axis of the distal anastomotic site is not on the same plane as the proximal segment.

Figure 3.

(A) Representative low-power magnification of a cut section of the glomus tumor showing a hypervascular tumor composed of branching, dilated, thick-walled, vascular channels and thin-walled, capillary-like vascular spaces (hematoxylin and eosin, 40×). (B) High-power magnification of the tumor showing lobular arrangements of oval- to-spindle-shaped cells, with abundant eosinophilic cytoplasm and centrally-located rounded nuclei (hematoxylin and eosin, 400×). (C) Immuno-staining showing tumor cells strongly reactive to actin.

Figure 4.

Diagrammatic representation of spiral tracheoplasty after tangential resection of a tracheal tumor. (A) After identifying the tumor, the trachea is separated from the esophagus by about 2 cm to allow for manipulation and exposure of the operative field. (B) This is followed by tangential resection of the tracheal lesion. (C) Both transected tracheal ends are rotated 90 degrees in opposite directions. The proximal end is rotated clockwise and the distal end is rotated counter clockwise. (D) The tracheal ends are then trimmed for irregularities to obtain good apposition. (E) The anastomosis is performed using running sutures.