Introduction:
Tracheal tumors commonly arise as metastasis from neighboring thyroid, esophageal, laryngeal or lung tumors. Primary tracheal tumors are extremely rare with an incidence of 1 in 1,000,000 persons per year. Often presenting with non-specific symptoms, diagnosis is difficult.
Case Report:
A 59-year-old Caucasian male with a history of marijuana abuse, arterial thrombosis, and PVD presented to the ED with productive cough and shortness of breath. He had been treated for acute bronchitis one-week prior to presentation with prednisone and azithromycin. The patient originally had improvement in symptomology with treatment but returned to the ED due increasing dyspnea at rest and a hoarse cough. The patient also complained of an associated eight-pound unintentional weight loss over the past month and inability to express sputum. The patient denied tobacco use but had a history of heavy marijuana use – 10 joints daily for more than 25 years. In the ED, a CT scan of the chest was completed, which showed an irregular soft tissue lesion within the mid to distal trachea. The patient was started on levofloxacin and admitted to the medical service. Pulmonology was consulted and a bronchoscopy with biopsies was performed. During the bronchoscopy, a polypoid endotracheal mass was seen almost obstructing the trachea. Mechanical debulking was completed during the bronchoscopy. Biopsies taken from the mass and right hilar lymph node came back positive for primary squamous cell carcinoma of the trachea. PET scan was completed which showed right supraclavicular, liver, and suprarenal uptake. Patient was referred to radiation oncology for 8 weeks of radiation and medical oncology for 6 weeks of Carboplatinum + Taxol. Chest CT completed 7 weeks after treatment showed resolution of the tracheal mass.
Discussion:
Primary tracheal tumors are very rare. Two thirds of these tumors are secondary to squamous cell or adenoid cystic carcinomas, but the epidemiology of these two histopathologic types is quite different. Squamous cell carcinomas are formed from reserve cells that replace injured cells in the lining of the trachea. Therefore, squamous cell carcinomas are commonly associated with tobacco use, while adenoid cystic carcinomas are more common in non-smokers.
It well documented that smoking tobacco increases the risk of primary tracheal and lung carcinomas, but unfortunately there is a paucity of data evaluating if marijuana use may have the same risk profile. The case presented above is the first in literature to report a case of primary squamous cell carcinoma of the trachea without tobacco use.
Conclusions:
As legalization of recreational marijuana continues across the US, it will be important to evaluate the long-term risks associated with its use including if causality can be made between marijuana use and primary tracheal carcinomas.