A complex approach to a complex stenosis

S. Silva*^a (Dr), J. Eusébio^a (Dr), M. Santos^a (Dr), V. Martins^a (Dr), M. Aguiar^a (Dr), F. Todo Bom^a (Dr)

^a Interventional Pulmonology Unit, Pulmonology Department, Hospital Beatriz Ângelo, Loures, PORTUGAL

* sofiamcampossilva@gmail.com

Background

Most tracheal tumors occur by direct invasion of lung and esophagus carcinomas; primary tracheal tumors are rare. More than half are squamous cell carcinoma (SCC), which have a worse prognosis. In unresectable SCC, concurrent chemoradiotherapy (CRT) is the best option; 5-year survival rate is 7%.

Case report

We present a case of a 56-year-old man, 40 pack-year smoker, who came to the emergency room on Oct/2016 referring dyspnea and stridor for 2 months. Thoracic computer tomography revealed significant tracheal obstruction. He underwent rigid bronchoscopy (RB) that showed tracheal occlusion of 80% by tumoral mass and was submitted to debulking with recanalization of 70%. Biopsies confirmed SCC and patient was staged as IIIB. CRT was started with clinical and endoscopic improvement.

After 6 months, he developed a symptomatic and complex grade III radiation stenosis, with 8 cm of length and progressive dilations with local methylprednisolone were performed. Biopsies and restaging were negative. Patient performed several dilations with significant benefit; but after 2 years, a new worsening lead to the need of surgical resection of three tracheal rings with an end-to-end anastomosis.

On March/2020, patient had lung recurrence and started chemotherapy. Sixteen months after surgery, patient had worsening dyspnea and a new simple web stenosis with 3 mm appeared on anastomosis site. A cut and dilation were made, followed by dilation with mitomycin application with improvement.

Patient is under second-line immunotherapy and with an excellent performance status, six years after the diagnosis, with partial response and stability of tracheal lumen with known caliber of 12 mm.

Conclusion

Our patient had multiple tracheal pathology from multiple etiologies over time: tumoral, sequalae from radiation and benign stenosis in the site of surgical intervention, requiring multicentric approach. Tracheal tumors are complex and require multidisciplinary discussion and treatment.

Disclosure of funding source(s): none