This article has Open Peer Review reports available.
Leiomyoma of the Trachea: a case report
© Kitada et al. 2015
Received: 24 November 2014
Accepted: 28 May 2015
Published: 31 May 2015
We present a surgical case of a rare primary tracheal tumor. In a 44-year-old asymptomatic man, computed tomography (CT), performed as part of health check-up, revealed a tumor measuring 1.5 cm in diameter in the mediastinal trachea. Biopsy failed to yield a definitive diagnosis, but the tumor tended to grow rapidly; therefore, surgery was performed. Five tracheal rings were resected through median sternotomy, followed by interrupted suture with 3–0 absorbable thread. The postoperative course has been favorable with no evidence of recurrence. The pathological diagnosis was leiomyoma. We report this case with literature review.
Primary tracheal tumor is a relatively rare condition. More than 90 % of all cases of primary tracheal tumor are malignant, and benign leiomyomas account for approximately 1 % of such tumors [1–3]. When a tumor forms in the trachea, it grows and thereby causes airway obstruction symptoms such as asphyxia. Therefore, treatment needs to be initiated immediately after detection. We present a surgical case of primary tracheal tumor that was detected through health check-up.
Primary tracheal tumor is a relatively rare disease. Of all cases of primary tracheal tumor, more than 90 % are malignant tumors, such as adenoid cystic carcinoma and squamous cell carcinoma, and tracheal leiomyomas are said to account for approximately 1 % of such lesions [1–3]. Additionally, leiomyomas occurring in the respiratory tract are reported to account for approximately 2 % of all cases of benign lung tumors . Depending on the anatomical site of occurrence, leiomyomas of the respiratory tract can be classified as pulmonary parenchymal or tracheobronchial type. Pulmonary leiomyomas are asymptomatic, and they are often detected via routine health check-up. A preoperative diagnosis is therefore difficult to make, and surgical resection of the tumor is often required to establish a diagnosis. There are also cases of pulmonary metastasizing leiomyoma originating from uterine fibroids . On the contrary, when a tracheobronchial leiomyoma is detected, it is rarely asymptomatic, unlike in this case, and patients often present with coughing, breathing difficulty, bloody sputum, and bronchitis prior to being diagnosed. When a leiomyoma occurs in the trachea in particular, enlargement of the tumor can lead to breathing difficulty and possibly asphyxia depending on the tumor progression. This is why treatment needs to be initiated immediately after detection. To make a definitive diagnosis of a tracheal tumor, bronchoscopic biopsy can be used. However, as it is a submucosal tumor and there is a potential risk for airway obstruction caused by bleeding, bronchoscopy is difficult to perform in some cases, which may require an intraoperative pathological diagnosis.
Removal of the tumor is the basic treatment, but the question is whether to take a surgical or endoscopic approach. In recent years, some reports have been published on resected cases of relatively small, pedunculated tumors in which a high frequency snare [3, 6] or Yttrium Aluminum Garnet (YAG) laser [7, 8] was used. In broad-based tumors, however, these methods can potentially result in bleeding, rupture of the membranous portion, or residual tumor, and therefore, surgical resection is often selected. There is a report describing that surgery for a pulmonary leiomyoma often includes pneumectomy . Although some patients with primary tracheal leiomyomas reportedly undergo tumor removal through tracheotomy , the surgical procedure usually consists of tracheal segmental resection and direct anastomosis . To ligate the trachea, an absorbable polypropylene suture is reportedly used in many cases. Unlike malignant tumors, extensive resection is not required, and thus, mobilization of the trachea and other associated procedures are not performed.
We reported a case of primary tracheal leiomyoma, a rare disease, in which we performed tracheal segmental resection and anastomosis.
Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in Chief of this journal.
- White SH, Ibrahim NB, Forrester-Wood CP, Jeyasingham K. Leiomyomas of the lower respiratory tract. Thorax. 1985;40(4):306–11.View ArticlePubMedPubMed CentralGoogle Scholar
- Grillo HC, Mathisen DJ. Primary tracheal tumors: treatment and results. Ann Thorac Surg. 1990;49(1):69–77.View ArticlePubMedGoogle Scholar
- Bharadwaj SC, Unruh HW. Leiomyoma of the trachea. Ann Thorac Surg. 2012;93:669–70.View ArticlePubMedGoogle Scholar
- Macchiarini P. Primary tracheal tumours. Lancet Oncol. 2006;7(1):83–91.View ArticlePubMedGoogle Scholar
- Rao AV, Wilson J, Sylvester K. Pulmonary benign metastasizing leiomyoma following hysterectomy: a clinicopathologic correlation. J Thorac Oncol. 2008;3(6):674–6.View ArticlePubMedGoogle Scholar
- Kwon YS, Kim H, Koh WJ, Suh GY, Chung MP, Kwon OJ, et al. Clinical characteristics and efficacy of bronchoscopic intervention for tracheobronchial leiomyoma. Respirology. 2008;13(6):908–12.View ArticlePubMedGoogle Scholar
- Tamura M, Murata T, Kurumaya H, Ohta Y. Leiomyoma of an accessory tracheal bronchus. Ann Thorac Surg. 2004;78(6):2163–5.View ArticlePubMedGoogle Scholar
- Park JS, Lee M, Kim HK, Choi YS, Kim K, Kim J, et al. Primary leiomyoma of the trachea, bronchus, and pulmonary parenchyma–a single-institutional experience. Eur J Cardiothorac Surg. 2012;41(1):41–5.View ArticlePubMedGoogle Scholar
- Ayabe H, Tsuji H, Tagawa Y, Tomita M, Tsuda N, Chen J. Endobronchial leiomyoma: report of a case treated by bronchoplasty and a review of the literature. Surg Today. 1995;25(12):1057–60.View ArticlePubMedGoogle Scholar
- Sugiyama M, Yoshino I, Shoji F, Hamatake M, Yohena T, Osoegawa A, et al. Endotracheal surgery for leiomyoma of the trachea. Ann Thorac Cardiovasc Surg. 2009;15(3):206–8.PubMedGoogle Scholar
- Kaseda K, Anraku M, Goto T, Ohtsuka T, Kohno M, Izumi Y, et al. Successful surgical resection of leiomyoma obstructing the trachea. Gen Thorac Cardiovasc Surg. 2013;61(8):476–8.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.