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ABSTRACT Schwannomas commonly develop in the cervical region, 25% - 45% of cases are diagnosed in this anatomical region. Tracheal neurogenic tumors are exceedingly rare and can be misdiagnosed as invasive thyroid carcinomas or other infiltrating malignancies when present at the level of the thyroid gland. Here, we present a case of synchronous benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma in a patient who was initially hospitalized for COVID-19. The patient presented with dyspnea that was later found to be caused by tracheal extension of a cervical tumor. Surgical excision was performed, and the surgical team proceeded with segmental tracheal resection, removal of the cervical mass, and total thyroidectomy. The specimen was sent for pathological analysis, which revealed synchronous findings of a benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma. The literature on this subject, together with the present case report, suggests that neurogenic tumors should be included in the differential diagnosis of obstructing tracheal cervical masses. Surgical excision is the first-line of treatment for benign cervical schwannomas.

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Las neoplasias de la tráquea son poco comunes, siendo más infrecuente aún el linfoma de células B no Hodgkin a este nivel. La presentación clínica de esta entidad es muy variable y sus síntomas son muy inespecíficos, simulando varias enfermedades, generando así un diagnóstico tardío. Actualmente se dispone de varias ayudas diagnósticas que permiten descartar otras patologías y confirmar la neoplasia traqueal, además la biopsia es fundamental para llegar al diagnóstico final y así instaurar el manejo en estadios tempranos, para impactar en la morbimortalidad. A continuación presentamos el caso de una paciente con linfoma de células B no Hodgkin como causa de obstrucción traqueal.

Tracheal neoplasms are uncommon, with non-Hodgkin B-cell lymphoma being even rarer at this level. The clinical presentation of this entity is highly variable and its symptoms are very non-specific, simulating several diseases, thus generating a late diagnosis. Currently, there are several diagnostic aids that allow us to rule out other pathologies and confirm tracheal neoplasia, in addition, biopsy is essential to reach the final diagnosis and thus establish management in early stages to impact morbidity and mortality. We present the case of a patient with non-Hodgkin's B-cell lymphoma as a cause of tracheal obstruction.

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Introducción. Los tumores glómicos provienen de los cuerpos glómicos, que son estructuras con función de termorregulación y se encuentran distribuidas por todo el cuerpo humano, principalmente a nivel distal de las extremidades, donde es común encontrar lesiones características, aunque hay reportes de casos que se presentaron como neoformación en localizaciones más inusuales. Su etiología aun es desconocida. No se sospechan en muchos pacientes y el diagnostico se realiza de manera incidental, por estudios imagenológicos o anatomopatológicos. Caso clínico. Paciente femenina de 66 años, con presencia de tumor glómico en vía aérea, diagnosticado por histopatología e inmunohistoquímica, que fue sometido a resección quirúrgica, con buena evolución posterior. Discusión. Esta presentación atípica de tumor glómico en vía aérea se manifiesta principalmente con síntomas y signos relacionados con obstrucción de la vía aérea. El manejo oportuno es primordial y el diagnóstico definitivo es por histopatología e inmunohistoquímica, donde se observan las características de las células glómicas, estructuras vasculares, músculo liso y la positividad en la inmunotinción de marcadores como actina del músculo liso, CD34, y actina específica del músculo, entre otras. Conclusión. Los tumores glómicos son neoformaciones benignas raras, con presentación más común en zonas distales. Su aparición depende de factores intrínsecos y extrínsecos de los pacientes. Su tasa de recidiva es muy baja en comparación de otros tumores

Introduction. Glomus tumors originate from glomus bodies, which are structures with thermoregulatory function and are distributed throughout the human body, mainly at the distal level of the extremities where it is common to find these characteristic lesions. Although, there are case reports of neoformation presentations with more unusual locations. Their etiology is still unknown. Many times when there is evidence of lesions in atypical areas they are not suspected in many patients and the diagnosis is made incidentally by imaging and/or anatomopathological studies. Clinical case. A 66-year-old female patient with the presence of a glomus tumor in the airway diagnosed by histopathology and immunohistochemistry, underwent surgical resection and presented good evolution after surgery. Discussion. This atypical presentation of glomus tumor in the airway presents mainly with symptoms and signs related to airway obstruction. Timely management is paramount in these patients, and the definitive diagnosis is by histopathology and immunohistochemistry where the presence of the characteristics of glomus cells, vascular structures, smooth muscle and immunostaining positivity towards some markers such as smooth muscle actin, CD34, muscle specific actin, among others, are seen. Conclusion. This type of tumors are rare benign neoformations, with common presentations in distal areas. Their appearance depends on intrinsic and extrinsic factors of the patients and their recurrence rate is very low compared to other tumors

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Los carcinomas adenoides quísticos son tumores extremadamente raros, para los cuales la cirugía es el pilar terapéutico; sin embargo, el abordaje quirúrgico puede estar contraindicado en función del tamaño tumoral, el compromiso de estructuras adyacentes o enfermedades concurrentes. En estos casos, la radioterapia externa definitiva puede ofrecer un adecuado control tumoral y alivio de síntomas. El presente reporte de caso describe un paciente con un tumor irregular que rodea la circunferencia de la tráquea, el cual genera disminución de la luz traqueal, en quién se decidió realizar una reducción de volumen de la lesión tumoral con argón plasma, seguido de colocación de un stent en Y (traqueal, bronquial izquierdo y bronquial derecho) y, posteriormente, realizar un tratamiento definitivo con radioterapia externa con técnica de intensidad modulada a dosis de 60 Gy en fraccionamiento de 2 Gy. Tres meses después del tratamiento, el paciente se presenta sin evidencia radiológica de adenopatías en la base del cuello o axila, con un stent endotraqueal permeable, sin estenosis y con una disminución del volumen tumoral, por lo que fue posible el retiro del stent.

Adenoid cystic carcinomas are extremely rare tumors, for which surgery is the mainstay of therapy; however, the surgical approach may be contradictory depending on tumor size, involvement of adjacent structures or concurrent diseases. In these cases, definitive external beam radiation therapy can offer adequate tumor control and symptom relief. The present case report describes a patient with an irregular tumor that surrounds the circumference of the trachea, causing a decrease in the tracheal lumen, in whom it was decided to perform a volume reduction of tumor with argon plasma, followed by placement of a Y-stent (tracheal, left bronchial and right bronchial), and subsequent definitive treatment with external radiotherapy with intensity modulated technique at doses of 60 Gy in 2 Gy fractionation. Three months after treatment, the patient presents without radiological evidence of lymphadenopathy at the base of the neck or axilla, with a patent endotracheal stent, with no stenosis and a decrease in tumor volume, for which the removal of the Stent was feasilble.

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SUMMARY Our case report shows the complexity of dealing with tracheal tumors, highlighting the importance of the method used for staging. In this report, endoscopic ultrasound (EUS) was crucial to identify the involvement of the esophageal muscular propria in a tracheal tumor and change the surgical planning of the case. Staging this kind of tumor represents a challenge for physicians. There is no evidence in the literature on which methods represent the gold standard for T staging.

RESUMO Neste relato de caso mostramos a complexidade em lidar com tumores traqueais, destacando a importância do método usado para estadiamento. Neste relato, a ecoendoscopia (EUS) foi fundamental para identificar o envolvimento da camada muscular própria esofágica por um tumor traqueal e alterar o planejamento cirúrgico do caso. O estadiamento desse tipo de tumor representa um desafio para os médicos. Não há evidências na literatura sobre quais métodos representam o padrão ouro para o estadiamento T.

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El carcinoma tiroideo originado en tejido tiroideo ectópico es una entidad clínica poco común; son lesiones que se presentan generalmente como una masa en la línea media, que se desarrolla a partir de un remanente del conducto tirogloso. El hallazgo de una lesión maligna en un verdadero tejido tiroideo aberrante es inusual. Ante su poca frecuencia, se presenta el caso de una paciente en quien se diagnosticó un carcinoma papilar primario derivado de tejido tiroideo ectópico en tráquea.

Thyroid carcinoma arising from an ectopic thyroid tissue is an uncommon clinical entity. These lesions usually present as a mass in the midline that develops from a thyroglossal duct remainder. The finding of a malignant lesion in true aberrant thyroid tissue is unusual. Given the strangeness of this condition we present the case of a patient in which the diagnosis conducted a primary papillary carcinoma arising from ectopic thyroid tissue in the trachea.

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CONTEXT: Mucosa-associated lymphoid tissue (MALT) lymphomas are most commonly found in the stomach, lungs, orbital soft tissue, salivary glands and thyroid. Involvement of the trachea is extremely rare. CASE REPORT: This report describes a rare case of MALT lymphoma of the trachea in a 71-year-old woman who presented with a one-year history of coughing, dyspnea, hoarseness and weight loss. There was an infiltrative lesion in the mid-trachea. The anatomopathological diagnosis was only made from the fifth endoscopic biopsy attempt. Immunochemotherapy consisting of rituximab, cyclophosphamide, vincristine and prednisone (R-COP) induced complete remission of the symptoms and endoscopic lesion. CONCLUSIONS: MALT lymphoma of the trachea is extremely rare and indolent disease. It has to be considered in the differential diagnosis of airway lesions. It is crucial to obtain an anatomopathological diagnosis from a specialized pathologist. Immunochemotherapy with R-COP induced complete remission of the disease.

CONTEXTO: Linfomas de tecido linfoide associado à mucosa (TLAM) são mais comumente encontrados no estômago, pulmões, órbita, glandulas salivares e tireoide. O envolvimento da traqueia é extremamente raro. RELATO DE CASO: Relato de caso raro de linfoma TLAM de traqueia, em mulher de 71 anos com tosse, dispneia, rouquidão e emagrecimento há um ano. Detectou-se lesão infiltrativa na porção média da traquéia. O diagnóstico anatomopatológico só foi obtido na biópsia do quinto procedimento endoscópico. A imunoquimioterapia R-COP (rituximabe, ciclofosfamida, vincristina e prednisona) induziu remissão completa dos sintomas e da lesão endoscópica. CONCLUSÕES: Linfoma TLAM de traqueia é uma doença indolente e extremamente rara, que deve ser considerada no diagnóstico diferencial das lesões de vias aéreas. O diagnóstico anatomopatológico por um patologista experimentado é fundamental. Imunoquimioterapia com R-COP levou à remissão completa da doença.

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Os tumores de traqueia são raros e podem ser de difícil diagnóstico, por mimetizarem outras afecções pulmonares de caráter obstrutivo, como asma e DPOC. Relatamos um caso de lipoma de traqueia em uma paciente que fora tratada para asma e DPOC, sem resposta adequada, até apresentar complicações infecciosas. A presença do tumor foi sugerida por TC de tórax e confirmada por fibrobroncoscopia. A paciente foi submetida à ressecção endoscópica do tumor; porém, evoluiu para o óbito por pneumonia e choque séptico.

Tracheal tumors are rare and can be difficult to diagnose due to their capacity to mimic other obstructive lung diseases, such as asthma and COPD. We report the case of a female patient with a tracheal tumor. She had previously been treated for asthma and COPD, with little response to the treatment. The onset of infectious complications prompted further investigation. Chest CT images suggested the presence of a tumor, which was confirmed by fiberoptic bronchoscopy. The tumor was endoscopically resected. However, the patient evolved to death due to pneumonia and septic shock.

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OBJETIVO: Apresentar os achados em tomografia computadorizada (TC) de tórax em pacientes com papilomatose laringotraqueobrônquica. MÉTODOS: Foram estudadas, retrospectivamente, as TCs de oito pacientes, cinco masculinos e três femininos, com idades variando de 5 a 18 anos, com média de 10,5 anos. Os exames foram analisados por dois radiologistas, de forma independente, e as decisões finais foram obtidas por consenso. RESULTADOS: Os achados mais comuns nas TCs foram as lesões nodulares da traquéia e os nódulos pulmonares, muitos com escavação. CONCLUSÕES: O aspecto tomográfico mais freqüentemente observado nos casos de papilomatose laringotraqueobrônquica foi a associação de lesões polipóides de traquéia com múltiplos nódulos pulmonares, vários deles escavados.

OBJECTIVE: To present the findings of computed tomography (CT) scans of the chest in patients with laryngotracheobronchial papillomatosis. METHODS: We retrospectively analyzed CT scans of eight patients, five males and three females, ranging from 5 to 18 years of age with a mean age of 10.5 years. Images were independently reviewed by two radiologists. In discrepant cases, a consensus was reached. RESULTS: The most common CT findings were intratracheal polypoid lesions and pulmonary nodules, many of which were cavitated. CONCLUSIONS: In patients with laryngotracheobronchial papillomatosis, the most common tomographic finding was the combination of intratracheal polypoid lesions and multiple pulmonary nodules, many of which were cavitated.

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