Carcinoid tumors
Carcinoid tumors
Develop from the argyrophillic Kulchitsky’s cells that are
present in the airway mucosa
Neuroendocrine tumor categorized
Grade I : typical carcinoid
Grade II : atypical carcinoid
Grade III : small or large cell undifferentitated
neuroendocrine carcinoma
Carcinoid tumors
Typical carcinoid (>atypical carcinoids 10 times)
Slow growth
Infrequent metastasize
Atypical carcinoid
Aggressive behavior
Characteristic malignant histologic features
(Nuclear abnormalities, Mitotic activity, Necrosis)
At the time of diagnosis : LN or distant metastases
Small cell of the trachea
Rare
Unresectable at diagnosis
Carcinoid tumors
Diagnosis
Histologic comfirmation
Bronchoscopy with bx :
obtain tissue
Tendency to bleeding
Rigid bronchoscope :
Prefer in operative room
Appearance describe as “mulberry-like”
Polypoid intraluminal
Smooth, pink cut surface
Carcinoid tumors
Treatment
Tracheal carcinoids w/o mediastinal LN involvement
 Surgical resection
Aggressive atypical carcinoids
 Response to CMT and RT
Small cell CA of the trachea  extreamly poor prognosis
 Combined chemotherapy and radiation
Mucoepidermoid carcinoma
Mucoepidermoid carcinoma
Derived from minor salivary gland tissue of the
proximal tracheobronchial tree
Bronchoscopy appear : pink, polypoid masses 
Can be confused with a carcinoid tumor
Cummings, 4 th ed.
Mucoepidermoid carcinoma
Classified as low or high
grade based on
Mitotic acitvity
Level of necrosis
Nuclear pleomorphism
Mucoepidermoid carcinoma
Low-grade tumors : behave in a benign fashion
High-grade tumors : progress rapidly
Treatment : surgical resection
5-year survival
100% ; completely resected tumor
no patients surviving 5 years ; unresectable tumors
Secondary Tracheal Tumors
Secondary Tracheal Tumors
Arise either from :
Direct extension from the primary tumor
• more common
• most common from tumors of the lung, esophagus, thyroid,
mediastinum, and head and neck
• only lung and thyroid have any chance for cure with sx resection
Metastatic spread to the airways
• renal cell carcinoma, sarcomas, breast cancer, and colon cancer
• rarely tumors of the uterus, testes, and adrenal
• incurable and treated palliatively
Secondary Tracheal Tumors
CA thyroid involve trachea
Optimal surgical management -> controversial
Some favor -> thyroidectomy + shaving the tumor off the
trachea
5-year survival rate
78% ; complete resection
44% ; incompletely resection
Secondary Tracheal Tumors
CA lung invade trachea
aggressive tracheal and carinal resections in patients
without mediastinal lymph node involvement
CA esophagus, mediastinal, H&N invade trachea
not considered for surgical resection (poor outcome)
palliative (radiotherapy, chemotherapy, stents, and
other endoscopic techniques)
DIAGNOSIS
Symptoms & Signs
Often not diagnosed until months or years after the onset of
symptoms
Lumen of the airway narrowed ~75% -> produce symptoms
(most common symptom : exertional dyspnea;
other : stridor, wheezing ,cough, difficulty clearing secretions,
recurrent pneumonia, hemoptysis, and hoarseness)
Initial symptoms often mimic as asthma or chronic bronchitis
Physical Examination
Unrevealing
Significant narrowing of the airway
Stridor, wheezing, bronchial breath sounds
Increased accessory muscle use
Signs of obstructive pneumonia
Subtle alteration in the timber of the voice
Radiographic evaluation
CXR
Findings (PA & lateral CXR)
 presence of a mass
 narrowing
 distortion or disruption of
the tracheal air column
Radiographic evaluation
CT SCAN
Excellent for assess mediastinal tumor extension
and nodal or metastatic disease