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J Thorac Cardiovasc Surg 2006;132:1455-1459
© 2006 The American Association for Thoracic Surgery

Clinical-Pathologic Conference

Clinical-pathologic conference in general thoracic surgery: A malignant peripheral nerve sheath tumor of the trachea

Sonia S. Shah, MD, Demet Karnak, MD1, Shetal N. Shah, MD, Charles Biscotti, MD, Sudish Murthy, MD, PhD*, Atul C. Mehta, MD

Cleveland Clinic, Cleveland, Ohio.

Received for publication April 6, 2006; revisions received June 13, 2006; accepted for publication July 12, 2006.

* Address for reprints: Sudish C. Murthy, MD, PhD, FCCP, Thoracic & Cardiovascular Surgery/FZY, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. (Email: murthys1@ccf.org).

The first 300 words of the full text of this article appear below.


   Case Presentation
 
Dr Shah
A 63-year-old man with a 5-pack-year smoking history presented to our institution for management of progressive dyspnea. He was diagnosed with bronchial asthma yet had not responded to inhaled ß-agonists or oral steroids. His past surgical history was significant for cervical laminectomy 9 years ago and left eye vitrectomy 1 year ago. His medical history was significant for adult-onset diabetes mellitus, hypertension, and hyperlipidemia. He also had remote exposure to tuberculosis and 2 episodes of pneumonia over the past 24 months. Physical examination revealed expiratory, as well as inspiratory, stridor throughout both lung fields without rales or ronchi. Baseline laboratory tests were significant for a blood glucose level of 210 mg/dL, a blood urea nitrogen level of 50 mg/dL, and a creatinine level of 2.4 mg/dL. Forced expiratory volume in 1 second, forced vital capacity, forced expiratory volume in 1 second/forced vital capacity, and diffusion capacity, were 20%, 86%, 70.3%, and 84% of predicted values, respectively. Resting oxygen saturation was normal. Configuration of the flow-volume loop was suggestive of variable intrathoracic upper airway obstruction, with reduction in peak expiratory flow to 22% of predicted value.

Dr Karnak
Dr Shah, could you please describe the radiographic and chest computed tomographic (CT) findings?

Dr Shah
The chest radiograph showed a 2 x 2.5–cm opacity projected over the distal trachea on the frontal view; the lateral view was unremarkable. The noncontrast axial CT image at the level just above the carina (Figure 1) and the reconstructed midline sagittal and coronal image (Figure 2) in soft tissue windows demonstrated a lobulated transmural solid mass involving the distal anterior tracheal wall 1.5 cm proximal to the carina. The 3.2 x 2.2 x 3.2–cm extraluminal pretracheal component was coarsely calcified, whereas the 2.2 x 2.3 x 1.6–cm endobronchial components predominantly exhibited soft tissue density, with only . . . [Full Text of this Article]






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