Tracheal airway obstruction induced by a large glomangioma: discussion of management and literature review

Abstract

Glomus tumours (GTs) are rare benign neoplasms arising from modified smooth muscle cells (SMCs) surrounding arteriovenous anastomosis. Typically, these tumours are found in the distal portion of the digits, especially under the fingernails. A GTs originating from the trachea is extremely rare. We are presenting the case of a Caucasian man in his early 80s, presenting with upper airway obstruction and massive bleeding caused by a large tracheal tumour to which final diagnosis of glomangioma of the trachea was retained. Methods of diagnostics, management and follow-up are documented. The incidence of GTs accounts about 1.6% of soft tissue tumours, and they are mainly located in dermal and subcutaneous tissue but can be equally find throughout the body. However, tracheal glomus tumours are the most clinically significant as they can be malignant and cause life-threatening condition through central airway obstruction. Histological analysis provides certainty of diagnosis, and surgical resection is the main treatment option.

Keywords: ear, nose and throat/otolaryngology; endoscopy; oncology; radiology.

Figure 1. (A) Endoscopic view shows the tumour with highly narrowing of the tracheal luminal. (B) Axial CT scan with arterial phase shows the hypervascularity of the tumour. (C) Sagittal CT scan shows the distal extension of the tracheal tumour. (D) Post radiation therapy axial CT scan shows significant reduction of the tumour size.

Figure 2. Microscopic slides: (A) Solid proliferation of monotonous small round glomus cells with round central uniform nuclei. (B) Palely eosinophilic cytoplasm with sharply defined cell borders. (C) Distribution of cells around open vascular lumina and edematous surrounding stroma. (D and E) Immunopositivity for smooth muscle markers (alpha-actin and caldesmon), but not for pancytokeratin, neuroendocrine marker or S11 protein.