Inflammatory myofibroblastic tumor is a rare tumor of mesenchymal origin. A case of intratracheal inflammatory myofibroblastic tumor in a male child was reported. The clinical characteristics, diagnosis, treatment and prognosis of the disease were reviewed based on the literature, and a differential diagnosis between inflammatory myofibroblastic tumor and hamartoma was performed to ultimately confirm the nature of the tumor in the child.
Humans ; Child ; Male ; Trachea/pathology* ; Granuloma, Plasma Cell/diagnosis* ; Prognosis ; Diagnosis, Differential ; Tomography, X-Ray Computed

Objective: To evaluate the efficacy of surgical treatment of papillary thyroid carcinoma (PTC) involving larynx and trachea. Methods: A total of 1 436 cases of thyroid malignant tumors were admitted to the Department of Otolaryngology, Qilu Hospital of Shandong University from 2004 to 2019, including 110 cases of PTC involving larynx and trachea, and of which 105 cases with complete follow-up data were retrospectively analyzed. There were 42 males and 63 females, with a male/female ratio of 1∶1.5, aged from 28 to 81 years. All lesions involved trachea, including 11 cases involving both trachea and larynx. Of those 83 cases underwent laryngeal and airway wall tumor excision, and 22 cases underwent radical tumor excision plus laryngeal and trachea repair. Extubation rate was analyzed and the postoperative survival curve of patients was analyzed by Kaplan-Meier method. Results: Among 105 cases, 16 cases underwent tracheotomy and 12 cases were successfully extubated. The overall 3- 5- and 10-year survival rates were 100.0%, 86.4% and 72.5%, and the disease-free survival rates were 93.1%, 81.6% and 57.7%, respectively. There was significant difference in survival curve between the two groups (χ²=4.21, P=0.040). The 5-year and 10-year survival rates were 94.6% and 77.3% in laryngeal and tracheal tumor exclusion group, and 85.7% and 51.4% in the radical tumor resection group. There was no significant difference in the survival curves between the two groups (χ²=3.50, P=0.061). Conclusion: PTC patients with laryngeal and tracheal involvement can achieve long survival and good quality of life through reasonable surgical treatment.
Female ; Humans ; Larynx/surgery* ; Male ; Neoplasm Invasiveness ; Quality of Life ; Retrospective Studies ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/pathology* ; Trachea/surgery*

Aged ; Extracorporeal Membrane Oxygenation ; methods ; Female ; Hemoptysis ; pathology ; surgery ; Humans ; Silicones ; chemistry ; Stents ; Trachea ; pathology ; surgery

Objective To improve our knowledge of primary benign tracheobronchial tumors and increase the early diagnosis rate. Method The clinical and imaging features of 22 patients with benign tracheobronchial tumors were retrospectively analyzed. The lesions were surgically or pathologically confirmed as schwannomas(n=2),lipomas(n=3),hamartomas(n=3),leiomyomas(n=9),inflammatory myofibroblastoma(n=1),and pleomorphic adenomas(n=2).The early symptoms were concealed and atypical,accompanied by misdiagnoses at different time points.The tumors were located at trachea in 5 patients and at bronchus in 17 patients.All lesions manifested as intraluminal growth with mild to moderate enhancement,without thickening of the tracheobronchial wall.They had smooth margins and wide basements.The lesions were cast-shaped and occluded the lumen in 3 cases;in the remaining 19 cases,the lesions appeared as round or oval nodules. Conclusions Primary benign tracheobronchial tumors are rare.Patients with repeated cough and expectoration that respond poorly to treatment should be screened for benign tracheobronchial tumors.On CT,the benign tracheobronchial tumors are small intraluminal nodules with the smooth surface and wide basement,without thickening of the wall.
Bronchi ; diagnostic imaging ; pathology ; Bronchial Neoplasms ; diagnostic imaging ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed ; Trachea ; diagnostic imaging ; pathology

PURPOSE: Adenoid cystic carcinoma (ACC) of the trachea and bronchus is a rare tumor. Although MYB-NFIB oncogene fusion and Notch1 mutation have been identified in ACC, little is known about the expression and clinical significance of Notch1 and its target gene fatty acid binding protein 7 (FABP7) in tracheobronchial ACC. MATERIALS AND METHODS: Primary tracheobronchial ACC that were resected between 1998 and 2014 were identified through the pathology and oncology database from five thoracic oncology centers in China. A tissue array was constructed from the patients’ samples and the expressions of Notch1 and FABP7 were evaluated by immunohistochemistry. The association between the expression of both markers and survival was determined. RESULTS: Overexpression of Notch1 and FABP7, detected in 37.8% and 38.3% of 368 patients with tracheobronchial ACC, respectively, was an independent prognostic indicator for recurrencefree survival (RFS) by multivariable Cox proportional hazard model (p=0.032 and p=0.048, respectively). Overexpression of Notch1, but not of FABP7, predicted overall survival (OS) (p=0.018). When categorized into four groups according to coexpression of Notch1 and FABP7, patients with overexpression of both Notch1 and FABP7 belonged to the group with the shortest RFS and OS (p=0.01 and p=0.048, respectively). CONCLUSION: Expression of Notch1 and FABP7, and coexpression of Notch1 and FABP7, is strongly associated with poor survival in resected tracheobronchial ACC. These data are consistent with the hypothesis that poor differentiation of tracheobronchial ACC correlates with the activation of Notch signaling.
Adenoids* ; Bronchi ; Carcinoma, Adenoid Cystic* ; Carrier Proteins* ; China ; Humans ; Immunohistochemistry ; Oncogene Fusion ; Pathology ; Prognosis ; Proportional Hazards Models ; Retrospective Studies* ; Trachea

57-year-old male was admitted to hospital for severe headache and seizure attacks on November 6th, 2016. After radiology and spinal fluid examination, he was diagnosed with viral encephalitis and treated with antiviral medicine, antibiotics and mannitol, but he was in sustained unconsciousness and weak in expectorating. The patient was given oxygen through artificial nasal after bedside tracheotomy. At 1:00 am on January 12th, 2016, there was a sudden drop in blood pressure, heart rate and oxygen saturation with left lung breath sounds slightly lower than the other side. The patient was connected to a ventilator with tidal volume of 300-500 mL and airway pressure of 16-24 cmH₂O (1 cmH₂O=0.098 kPa). In the meanwhile, the left side sponge of artificial nasal was found missing. Bedside chest X-ray showed no significant atelectasis. At that time the evidence of airway foreign body aspiration was not sufficient, so no urgent bronchoscopy was performed. At 9:00 am on January 14th, 2016, there was another sudden decline in oxygen saturation with diminished left lung breath sounds and decreased left thoracic activity. Since left atelectasis could not be ruled out, bedside bronchoscopy was performed. In the operation, two sponge-like objects were found at the left main bronchus and the opening of left upper lobe bronchial. Foreign body forceps were used to remove them. The foreign bodies were proved to be the left sponge of artificial nasal afterwards. Symptoms and signs caused by aspiration of foreign body in adults were widely various and depending on the nature of the foreign body, site, time and whether there was infection or not. Foreign body aspiration caused by artificial nasal sponge was rare in clinical practice. This case was a living reminder to perform bronchoscopy when foreign body aspiration was suspected. For the unconscious and elderly patient, whose history of foreign body aspiration usually could not be clearly provided, when atelectasis was suspected, bronchoscopy should be performed progressively, and more effective measures should be taken to prevent sponge of artificial nasal displacement.
Adult ; Aged ; Bronchi ; Bronchoscopy ; Female ; Foreign Bodies ; Humans ; Infant ; Lung/pathology* ; Male ; Middle Aged ; Nose ; Respiratory Sounds ; Surgical Sponges ; Trachea

Riedel's thyroiditis is a rare fibrotic condition that results in the destruction of the thyroid and infiltration into surrounding tissues. The exact etiology is not yet clear, although systemic fibrosing disorder, a variant of Hashimoto's thyroiditis, a primary inflammatory disorder of the thyroid, and even a manifestation of end-stage subacute thyroiditis has been suggested. Although various treatments have been applied, no definitive treatment has yet been established. We report a case of Riedel's thyroiditis treated without complications using microscopic surgery. A 54-year-old man visited our clinic presenting with neck tightness and a left neck mass. A gun biopsy revealed a benign thyroid mass, although the radiologic findings showed a malignant thyroid tumor with invasion into the trachea and strap muscles. The patient underwent a left hemi-thyroidectomy and shaving of the trachea, esophagus and recurrent laryngeal nerve under microscopy. The final pathology revealed Riedel's thyroiditis combined with Hashimoto's thyroiditis. The patient had symptomatic relief without vocal fold paralysis and hypocalcemia. Surgical treatment using microscopic dissection can be considered to be one of treatment option for Riedel's thyroiditis.
Biopsy ; Esophagus ; Humans ; Hypocalcemia ; Microscopy ; Microsurgery ; Middle Aged ; Muscles ; Neck ; Paralysis ; Pathology ; Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroiditis* ; Thyroiditis, Subacute ; Trachea ; Vocal Cords

OBJECTIVETo investigate the effect of KyoT2 on the proliferation and migration of airway smooth muscle cells (ASMCs) in mice with asthma.

METHODSOvalbumin (OVA) was used to establish the asthmatic model of airway remodeling in BALB/c mice. ASMCs were isolated and cultured, and primarily cultured ASMCs were used as the control group. The expression of KyoT2 in ASMCs was measured in the control and asthma groups. After the ASMCs from asthmatic mice were transfected with pCMV-Myc (empty vector group) or pCMV-Myc-KyoT2 plasmid with overexpressed KyoT2 (KyoT2 expression group) for 48 hours, RT-PCR and Western blot were used to measure the mRNA and protein expression of KyoT2, the MTT assay and BrdU assay were used to measure the proliferation of ASMCs, and Transwell assay was used to measure the migration of ASMCs. Western blot was used to determine the effect of KyoT2 overexpression on the protein expression of RBP-Jκ, PTEN, and AKT.

RESULTSCompared with the control group, the asthma group had significantly downregulated expression of KyoT2 in ASMCs, and the KyoT2 expression group had significantly upregulated expression of KyoT2 in ASMCs (P<0.05). Compared with the empty vector group, overexpressed KyoT2 significantly inhibited cell proliferation and migration, downregulated the expression of RBP-Jκ and AKT, and upregulated the expression of PTEN.

CONCLUSIONSOverexpressed KyoT2 can inhibit the proliferation and migration of ASMCs through the negative regulation of RBP-Jκ/PTEN/AKT signaling pathway.

Animals ; Asthma ; pathology ; Cell Movement ; Cell Proliferation ; Female ; Intracellular Signaling Peptides and Proteins ; physiology ; LIM Domain Proteins ; physiology ; Mice ; Mice, Inbred BALB C ; Muscle Proteins ; physiology ; Myocytes, Smooth Muscle ; physiology ; PTEN Phosphohydrolase ; physiology ; Trachea ; pathology

BACKGROUNDCurrently available silicone and metallic stents for tracheal stenosis are associated with many problems. Granulation proliferation is one of the main complications. The present study aimed to evaluate the efficacy of paclitaxel drug-eluting tracheal stent in reducing granulation tissue formation in a canine model, as well as the pharmacokinetic features and safety profiles of the coated drug.

METHODSEight beagles were randomly divided into a control group (bare-metal stent group, n = 4) and an experimental group (paclitaxel-eluting stent group, n = 4). The observation period was 5 months. One beagle in both groups was sacrificed at the end of the 1st and 3rd months, respectively. The last two beagles in both groups were sacrificed at the end of 5th month. The proliferation of granulation tissue and changes in tracheal mucosa were compared between the two groups. Blood routine and liver and kidney function were monitored to evaluate the safety of the paclitaxel-eluting stent. The elution method and high-performance liquid chromatography were used to characterize the rate of in vivo release of paclitaxel from the stent.

RESULTSCompared with the control group, the proliferation of granulation tissue in the experimental group was significantly reduced. The drug release of paclitaxel-eluting stent was the fastest in the 1st month after implantation (up to 70.9%). Then, the release slowed down gradually. By the 5th month, the release reached up to 98.5%. During the observation period, a high concentration of the drug in the trachea (in the stented and adjacent unstented areas) and lung tissue was not noted, and the blood test showed no side effect.

CONCLUSIONSThe paclitaxel-eluting stent could safely reduce the granulation tissue formation after stent implantation in vivo, suggesting that the paclitaxel-eluting tracheal stent might be considered for potential use in humans in the future.

Animals ; Bronchoscopy ; Disease Models, Animal ; Dogs ; Drug-Eluting Stents ; Granulation Tissue ; drug effects ; Microscopy, Electron, Scanning ; Paclitaxel ; therapeutic use ; Trachea ; pathology ; Tracheal Stenosis ; drug therapy ; surgery

INTRODUCTIONAnaesthetists may be called upon to emergently secure the airway of a laterally positioned patient. Intubating a patient's trachea in the lateral position may be difficult due to unfamiliarity. This exploratory study aimed to investigate the success rate of lateral intubation performed by novices in a controlled setting.

METHODSIn this observational study, all patients who presented for elective surgery requiring the lateral position with planned lateral intubation at Singapore General Hospital were included. The trainee assigned to each patient had no prior indication of the proposed lateral intubation until the start of the case. Verbal instructions were given before the start of and during the procedure. The consultant anaesthetist in attendance could intervene at any point to prevent patient harm or if the trainee requested assistance. Time to intubation, adjuncts used and complications encountered were recorded.

RESULTSA total of 44 consecutive patients were included in this study. The trainees completed 42 of the 44 lateral intubations, with 41 being successfully performed on the first attempt. All patients were intubated successfully in a lateral position within two attempts. The mean duration of intubation was 57.3 ± 36.4 seconds. There was no difference between left and right lateral intubation. Other than one episode of transient desaturation on pulse oximetry, there were no complications.

CONCLUSIONLateral intubation by trainees had a high success rate when supervised by an experienced operator. Intubation of patients in unconventional positions using routine airway equipment should be included in airway training for trainees.

Anesthesia ; Anesthesiology ; education ; Elective Surgical Procedures ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; education ; Patient Positioning ; Posture ; Singapore ; Trachea ; pathology