Tracheal Glomus Tumor: A Case Report and Review of the Literature

Abstract

Glomus tumors are rare neoplasms that typically occur within the dermis or subcutis of the subungual space. Primary glomus tumors of the thorax are exceedingly uncommon, thus standard-of-care management is lacking. In this report we describe the management of a patient presenting with a symptomatic glomus tumor of the posterior trachea, and provide a comprehensive review including all documented tracheal glomus tumor reports.

Keywords: Glomus tumor; surgery; trachea.

Figure 1.

a) Computed tomography angiogram of the chest demonstrating a 2.6×2.3×1 cm intraluminal tracheal mass arising from the posterior wall of the trachea just above the carina. Significant narrowing of the tracheal lumen was noted. b) ¹⁸FDG-Positron Emission Tomography revealing a solitary hypermetabolic, 2.2×1.8 cm mass arising from the posterior wall of the trachea and just above the level of the azygous vein. No lesions suspicious metastases were noted. c) Pharyngoesophagram demonstrating smooth extrinsic compression on the right lateral aspect of the proximal thoracic esophagus suggestive of a mediastinal mass.

Figure 2.

Bronchoscopy revealing clinically significant narrowing of the trachea with views from the (a) proximal trachea, (b) distal trachea and (c) carina. d) Endoscopic ultrasound revealing a 2.3 cm retrotracheal mass. Silastic Y-stent was placed covering the lesion with (e) overlap in the proximal trachea, (f) overlap in left mainstem bronchus and (g) fenestration to the right mainstem bronchus.

Figure 3.

Via right thoracotomy, the pleura overlying the tumor was excised. The glomus (Gl) tumor was firmly adherent to the trachea (Tr) and vagus (V), and it was displacing the esophagus (Eso) by mass effect. The right main bronchus (RMB) was distal and uninvolved.

Figure 4.

Following resection, the patch repair (PR) of the trachea (TR) could be visualized. The vagus (V) nerve was displaced anteriorly, and the esophagus (Eso) was located posteriorly. The right main bronchus (RMB) was located distally and could easily be visualized because the azygous vein was divided during the course of the operation.

Figure 5.

a) Hematoxylin and eosin staining of mediastinal mass revealing nests of clear epithelioid cells intimately associated with branching vascular channels. The neoplastic cells lack nuclear pleomorphism and appreciable mitotic activity. No necrosis, vascular, lymphatic or perineural invasion was identified. b) Immunohistochemical staining demonstrating diffuse immunoreactivity for smooth muscle actin.