Primary large-cell neuroendocrine carcinoma of the trachea

The clinical characteristics of large-cell neuroendocrine carcinoma (LCNEC) as a primary tracheal tumour are unclear due to its rarity. We report the case of a man in his 70s who presented with dyspnoea. Further imaging revealed an intratracheal tumour. The tumour was bronchoscopically debulked to secure the airway, resulting in immediate relief of his dyspnoea. A small lesion in the left main bronchus was also detected. The pathological diagnosis was LCNEC. Positron emission tomography suggested that the trachea was the primary site. Incidental COVID-19 infection delayed his second bronchoscopy for 1 month. It revealed regrowth of the residual lesion in the trachea with multiple disseminated lesions in the airways. This patient is currently undergoing chemotherapy. Primary tracheal LCNEC is a very rare disease that may be an aggressive malignant tumour; a localised tumour may already be in an advanced stage. Systemic evaluation of potential metastases should be considered.