We have a 50 years old female with a 17 years old history of chronic myeloid leukaemia. She has significant stridor. Fibre optic bronchoscopy showed an easily bleeding mid tracheal tumor occluding kore than half of the tracheal lumen Biopsy was not conclusive. What is the best approach to manage such case?
thoracotomy with heart lung bypass will be the best approach for total resection and possible ene to end anastomosis
You need CT with venous contrast to see if there is some invasion of structures beyond trachea. Then, you must be sure if the tumor is a primary tracheal neoplasm (mucoepidermoid carcinoma and adenoid cystic carcinoma are the most common), endotracheal metastasis (most common are: melanoma, kidney, breast cancer, colon), invasion by a tumor near trachea (you will see it through CT), or endotracheal mass from leukaemia. The best indication for tracheal resection and anastomosis are the primary tumors of trachea. The others should be treated by endoscopic resection. If you are not sure after initial biopsy (it is not so rare situation....) I strongly recommend to perform an endoscopic resection. If you are afraid of bleeding, I recommend to use a rigid bronchoscope, cautery (or laser) and core biopsy. Be sure that there is no coagulation problems.
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