Atypical presentation and airway management of tracheal squamous cell carcinoma

Primary tracheal squamous cell carcinoma is a rare malignancy that presents with non-specific respiratory symptoms, leading to delayed diagnosis and misattribution to more common cardiopulmonary conditions.We report a woman in her early 60s with a 10-month history of exertional and positional dyspnoea, throat constriction and episodic cough. Initial pulmonary workup, chest radiography and flexible laryngoscopy were unrevealing. Neck imaging ultimately demonstrated a 2 cm proximal tracheal mass causing approximately 50% luminal narrowing. She underwent direct laryngoscopy with biopsy and debulking under coordinated airway management, followed by definitive segmental tracheal resection.Histopathology confirmed keratinising squamous cell carcinoma with negative margins and no lymphovascular invasion. The postoperative course was uncomplicated, with preserved vocal fold mobility and well-healed tracheal anastomosis on follow-up bronchoscopy. This case highlights the importance of maintaining a broad differential diagnosis in unexplained dyspnoea and emphasises early imaging and multidisciplinary airway planning to optimise outcomes in rare tracheal malignancies.