Wu Hsing-Hsien, Jao Yeun Tarl Fresner Ng, Wu Ming-Ho
Department of Thoracic Surgery, Tainan Municipal Hospital, Tainan, Taiwan.
Department of Critical Care Medicine, Tainan Municipal Hospital, Tainan, Taiwan.
Am J Case Rep. 2014 Oct 26;15:459-65. doi: 10.12659/AJCR.891191.
Glomus tumors are usually found over the dermis of the extremities, particularly over the subungual region of the fingers, and occurrence in the trachea is an extremely rare event. To date, only 29 cases of tracheal and 2 main bronchus glomus tumors have been reported in the English literature. Our patient is the first ever reported case in Taiwan that was managed by spiral tracheoplasty.
A 58-year-old woman was admitted to our hospital because of hemoptysis. Computed tomographic (CT) scan revealed a mass over the posterior wall of the trachea. Surgical resection with spiral tracheoplasty was performed due to uncontrolled bleeding and airway compromise. Histopathology and immunostaining confirmed a glomus tumor. Postoperative course was unremarkable and she was discharged in improved condition after 9 days of hospital stay.
Although chronic symptom presentation is the rule for tracheal glomus tumors, airway obstruction and bleeding are life-threatening presentations. Histopathological examination and staining are important to differentiate it from hemangiopericytoma or carcinoid tumors. Spiral tracheoplasty after tangential resection may be tried, as this preserves more tracheal tissue, decreases tension, and prevents postoperative leakage at the anastomotic site.
血管球瘤通常见于四肢真皮层,尤其是手指的甲下区域,而发生于气管者极为罕见。迄今为止,英文文献中仅报道了29例气管及2例主支气管血管球瘤。我们的患者是台湾首例接受螺旋气管成形术治疗的病例。
一名58岁女性因咯血入住我院。计算机断层扫描(CT)显示气管后壁有一肿块。由于出血无法控制且气道受压,遂行螺旋气管成形术手术切除。组织病理学及免疫染色确诊为血管球瘤。术后过程顺利,住院9天后病情好转出院。
尽管气管血管球瘤通常表现为慢性症状,但气道梗阻和出血是危及生命的表现。组织病理学检查及染色对于将其与血管外皮细胞瘤或类癌肿瘤相鉴别很重要。可尝试在切线切除后行螺旋气管成形术,因为这样可保留更多气管组织,降低张力,并防止吻合口术后漏血。