Pleomorphic Adenoma of the Trachea: A Case Report
A 59-year-old male was referred to our hospital due to a three-month history of dyspnea on exertion. He was a current smoker with a 45-year history of smoking 2 packs of cigarettes per day. He had no past medical history except for pulmonary tuberculosis two years prior. On physical examination, the sound of his right lung was decreased with crackles but he did not have lymphadenopathy or weight loss. Laboratory findings were unremarkable except that the pulmonary function test revealed a moderately obstructive lung defect. Chest X-ray showed reactivation of pulmonary tuberculosis in the upper lung field and a round mass shadow in the mid-tracheal area (). A computed tomography (CT) scan showed a 2.2 cm-sized homogenous mass originating from the left lateral inner wall of the trachea, and active pulmonary tuberculosis with cavitation in the right upper lobe and in the superior segment of the right lower lobe (). Flexible bronchoscopy revealed a broad-based, polypoid mass obstructing 75% of the lumen in the left lateral wall. The mass was 5 cm above the carina, without endobronchial lesion (). We decided to surgically remove the lesion after initial management for pulmonary tuberculosis since airway obstrucion could occur during the bronchoscopic procedure owing to rich vascularity on the tumor surface.\nThe patient underwent right thoracotomy with segmental resection and end-to-end anastomosis. Four tracheal rings were excised along with the tumor. The excised tumor appeared as a single well-demarcated solid, polypoid mass, measuring 2×2 cm in size. The mass was completely covered by intact mucosa without any visible sign of hemorrhage or necrosis. On microscopic examination, the mass was composed of epithelial and myoepithelial cells in the chondromyxoid stroma (). There was no definitive cellular pleomorphism and mitotic figures. The surgical margins of the resected trachea were free of tumor. Immunohistochemically, the epithelial cells were positive for cytokeratin, cytokeratin 19 and epithelial membrane antigen (EMA). The myoepithelial cells were immunoreactive for cytokeratin, S100 protein, and p63 (). Overall, these findings were suggestive of a pleomorphic adenoma involving the mid trachea. The postoperative course was uneventful, and the patient has been asymptomatic and in good health for 5 years after the surgery.