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Tracheal neoplasms in children
D P Desai1, L D Holinger, F Gonzalez-Crussi
1Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine, USA.
Insights
Primary tracheal neoplasms are rare in children. Many are misdiagnosed as asthma, highlighting the need for high suspicion and prompt bronchoscopy for accurate diagnosis of these rare airway tumors.
Area of Science:
- Pediatric Oncology
- Respiratory Medicine
- Surgical Pathology
Background:
- Primary tracheal neoplasms are exceptionally rare in the pediatric population.
- This study aims to characterize these rare lesions in children through a comprehensive literature review and case reports.
Observation:
- A review of 36 pediatric cases over 30 years revealed 64% benign and 36% malignant lesions.
- A significant finding was that 56% of cases were initially misdiagnosed, often as asthma.
- The posterior membranous wall of the cervical trachea was the most common tumor site, with 39% causing >50% luminal obstruction at diagnosis.
Findings:
- Benign and malignant primary tracheal neoplasms present unique challenges in pediatric diagnosis.
- Misdiagnosis as asthma is common, delaying appropriate management.
- Tracheal tumors can cause significant airway obstruction, necessitating prompt intervention.
Implications:
- Emphasizes the critical need for a high index of suspicion for pediatric tracheal neoplasms.
- Highlights the importance of efficient diagnostic workup, including bronchoscopy, for timely diagnosis.
- Informing differential diagnosis and management strategies for pediatric airway masses.
Abstract:
Primary tracheal neoplasms are extremely rare lesions in the pediatric age group. This study reviews the English-language literature to better characterize these lesions in children and reports 2 additional patients. Reports of only 36 infants and children through adolescence with primary tracheal neoplasms were discovered after an exhaustive literature review of the last 30 years. The data are analyzed with regard to pathology, demographics, symptomatology, site, and percent luminal obstruction. We report 2 additional patients with photographic documentation, imaging studies, and histopathology. Of the 36 previously reported lesions, 64% were characterized as benign and 36% as malignant. Fifty-six percent of all lesions were initially misdiagnosed as asthma. The most common site was the posterior membranous wall of the cervical trachea. In 14 (39%) of the 36 patients, the lesions obstructed more than 50% of the lumen at the time of diagnosis. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion and conducting an efficient workup, including definitive evaluation by bronchoscopy. The evaluation and the differential diagnosis of tracheal neoplasms in the pediatric population is discussed.