
==== Front
Respirol Case Rep
Respirol Case Rep
10.1002/(ISSN)2051-3380
RCR2
Respirology Case Reports
2051-3380
John Wiley & Sons, Ltd Chichester, UK

10.1002/rcr2.70024
RCR270024
Clinical Image
Clinical Image
A rare case of tracheal squamous cell carcinoma presented with critical airway obstruction
TRACHEAL TUMOUR WITH AIRWAY OBSTRUCTION
Ho et al.
Ho Chen‐Yu https://orcid.org/0009-0003-5252-1238
1
Liu Yu‐Wei 2
Lai Wei‐An 3
Chen Chia‐Min 4
Wu Kuan‐Li https://orcid.org/0000-0001-6662-6522
4 5 klwu@kmu.edu.tw

1 School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
2 Division of Thoracic Surgery, Department of Surgery Kaohsiung Medical University Hospital, Kaohsiung Medical University Kaohsiung Taiwan
3 Department of Pathology Kaohsiung Medical University Hospital, Kaohsiung Medical University Kaohsiung Taiwan
4 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine Kaohsiung Medical University Hospital, Kaohsiung Medical University Kaohsiung Taiwan
5 School of Post Baccalaureat Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
* Correspondence
Kuan‐Li Wu, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Kaohsiung 807, Taiwan.
Email: klwu@kmu.edu.tw

17 9 2024
9 2024
12 9 10.1002/rcr2.v12.9 e7002408 8 2024
05 9 2024
© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Key message

Tracheal squamous cell carcinoma is a rare and potentially fatal thoracic cancer mimicking common airway disorders. Accurate diagnosis requires a detailed history, thorough physical examination, and high clinical suspicion.

We present an educational clinical image showcasing a rare case of tracheal squamous cell carcinoma characterized by central wheeze and critical airway obstruction. Given its rarity and the potential for being overlooked on chest plain films, we believe this case will significantly enhance clinical awareness. Our report, highlighting this uncommon yet fatal diagnosis with common presentations.

asthma
squamous cell carcinoma
tracheal tumour
wheezing
source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:17.09.2024
Ho C‐Y , Liu Y‐W , Lai W‐A , Chen C‐M , Wu K‐L . A rare case of tracheal squamous cell carcinoma presented with critical airway obstruction. Respirology Case Reports. 2024;12 (9 ):e70024. 10.1002/rcr2.70024

Associate Editor: Belinda Miller
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pmcCLINICAL IMAGE

A 77‐year‐old female presented with progressive shortness of breath, persistent cough, wheezing, and exertional dyspnea for 1 month. A non‐smoker diagnosed with asthma 2 years ago, her symptoms had worsened despite regular use of inhaled bronchodilators and corticosteroids.

Upon arrival, she presented with bilateral wheezing, most prominent at the mid‐sternal area, an oxygen saturation of 87%, and acute respiratory acidosis. A chest x‐ray revealed a hazy opacity in the lower trachea, raising suspicion of a central tracheal lesion (Figure 1A). A subsequent CT scan confirmed a lobulated mass with critical airway obstruction of the lower trachea (Figure 1B,C).

FIGURE 1 (A) A chest x‐ray showed a hazy opacity obscuring the lower trachea border. (B) Coronal view of the chest computed tomography confirmed a lower tracheal mass causing critical airway obstruction. (C) Sagittal view of the lower tracheal tumour. (D) The histology sections reveal hyperplastic and pleomorphic neoplastic cells arranged in an infiltrative pattern (upper panel) with focal immunoreactivity for p40 staining (lower panel). (E) Pulmonary function tests were conducted before and after the tracheal stent placement. The asterisks denote the tracheal tumour, while the arrowhead indicates the location of the tracheal stent.

The patient declined surgical tracheoplasty, opting for bronchoscopic tumour laser ablation with tracheal stent placement instead. Pathology confirmed primary tracheal squamous cell carcinoma (Figure 1D). She was extubated promptly with recovered spirometric parameters (Figure 1E). Further palliative chemotherapy with radiotherapy was initiated.

Primary tracheal squamous cell carcinoma is a rare thoracic cancer that often mimics symptoms of common airway disorders like asthma or chronic obstructive pulmonary disease, leading to diagnostic delays. 1 Early diagnosis requires thorough physical exams and high clinical suspicion.

AUTHOR CONTRIBUTIONS

Chen‐Yu Ho and Kuan‐Li Wu were responsible for patient management and initial manuscript drafting. Wei‐An Lai prepared the histologic photos. Chia‐Min Chen contributed by editing and processing the clinical images. Yu‐Wei Liu provided critical revisions to the report. All authors have reviewed and approved the final version of the manuscript.

CONFLICT OF INTEREST STATEMENT

None declared.

ETHICS STATEMENT

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
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REFERENCE

1 Diaz‐Mendoza J , Debiane L , Peralta AR , Simoff M . Tracheal tumors. Curr Opin Pulm Med. 2019;25 :336–343.30973357
