Abstract Introduction Glomus tumors are neoplastic lesions that arise from the modified smooth muscle that exists at the interface between arterial and venous systems. Glomus tumors can be histologically divided into three subcategories: classic glomus, glomangiomas, and glomangiomyomas. Glomangiomas account for 20% of all glomus tumor and glomangiomas that arise in the trachea are exceedingly rare. To our knowledge, only six prior tracheal glomangiomas have been reported. This case is the seventh. Case Report A 63-year-old male with no significant past medical history presented with approximately 1 year chronic cough, intermittent small volume hemoptysis, and upper-airway wheeze. He was initially treated with bronchodilators for presumed asthma. After minimal improvement, spirometry was performed and reveal a fixed central airway obstruction. Computed Tomography (CT) of the neck and soft tissue revealed a polypoid lobulated soft tissue mass occupying the mid trachea. Bronchoscopy redemonstrated the polypoid mass, which was laser excised during this initial bronchoscopy and the specimen was sent for pathology. Pathology report was consistent with a glomangioma. The patient had near complete resolutions of his symptoms (cough, wheeze, hemoptysis) following the resection. He was referred to thoracic surgery for further management. The patient was offered tracheal resection and reconstruction. A pre-op endoscopic ultrasound (EUS) showed a remaining 2cm mass in the trachea that abutted the esophagus, but with a clear tissue plane between the mass and the esophagus. Repeat bronchoscopy showed ∼20% narrowing in the area where the tumor was resected with a small remaining mucosal lesion vs scar tissue. The patient ultimately elected to forego a surgical treatment in favor of serial CT scans +/- bronchoscopy or EUS as needed to assess for recurrence. Discussion Tracheal glomangiomas are exceedingly rare with only 6 prior cases reported in the literature. Tracheal resection is the favored management to avoid local recurrence. Endoscopic resection is another reported alternative management that is typically reserved for cases where the lesion is confined without extension, has been histologically confirmed benign, or the patient prefers not to undergo surgery. To our knowledge, bronchoscopic resection with serial imaging has not been implemented as a primary management of a tracheal glomangioma. Conclusion Tracheal glomangiomas are very rare and there is sparse diversity in the attempted management. This case represents a novel approach for managing this rare disease. This abstract is funded by: none
Schlueter et al. (Fri,) studied this question.