Aksu Kurtuluş, Aktaş Zafer, Aksu Funda, Orsel Osman, Demirağ Funda, Sipit Tuğrul, Firat Güven Selma
Department of Chest Diseases, Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey.
Tuberk Toraks. 2009;57(3):337-41.
A 78-years-old man presented with weight loss, dyspnea, cough and hemoptysis. He was an ex-smoker with a smoking history of 30 pack-years. Imaging studies revealed an endoluminal carinal mass and a tumoral mass arising from the posterior wall of the trachea was observed bronchoscopically. Endoscopic argon plasma coagulation was performed to take biopsies and to regain the airway passage. Recanalisation of the right and left main bronchi and the trachea was achieved together with resection of more than 90% of the tumoural mass. Microscopically, the tumor was composed of fascicular pattern of spindle cells with atypical mitotic figures and nuclear pleomorphism, positively reactive to epithelial membrane antigen supporting a diagnosis of tumour with epithelial differentiation. These findings supported the diagnosis of a spindle cell sarcomatoid carcinoma of trachea. Spindle cell carcinoma cases are reported in many sites, such as head and neck region, larynx, digestive tract, breast, kidney, genital tract, skin and lung, but to our knowledge, not in trachea. Primary malignant tracheal tumours consist mainly of squamous cell carcinoma and adenoid cystic carcinoma and generally have an aggressive course with poor prognosis. We report the first presentation of a spindle cell sarcomatoid carcinoma of trachea together with the clinical course of the patient.
一名78岁男性出现体重减轻、呼吸困难、咳嗽和咯血症状。他既往吸烟，有30包年的吸烟史。影像学检查发现腔内隆突肿物，支气管镜检查观察到气管后壁有一肿瘤性肿物。进行了内镜氩等离子体凝固术以获取活检组织并恢复气道通畅。右主支气管、左主支气管和气管再通，同时切除了超过90%的肿瘤性肿物。显微镜下，肿瘤由具有非典型有丝分裂象和核多形性的梭形细胞束状结构组成，对上皮膜抗原呈阳性反应，支持上皮分化肿瘤的诊断。这些发现支持气管梭形细胞肉瘤样癌的诊断。梭形细胞癌病例在许多部位都有报道，如头颈部、喉、消化道、乳腺、肾脏、生殖道、皮肤和肺，但据我们所知，气管尚未见报道。原发性气管恶性肿瘤主要由鳞状细胞癌和腺样囊性癌组成，通常病程侵袭性强，预后较差。我们报告了首例气管梭形细胞肉瘤样癌病例及该患者的临床病程。
