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Case Report
1 Department of Thoracic Surgery, Hospital de Base do Distrito Federal (HBDF), BrasÃlia, DF, Brazil.
* Correspondence: leonardo_rodrigues_00@hotmail.com.
Citation: Souza LRF. Glomus Tumor in the Tracheal Region: Case Report. 2025 Jan-Dec;05(1):bjcr28.
https://doi.org/10.52600/2763- 583X.bjcr.2025.5.1.bjcr28
Received: 9 September 2024
Accepted: 6 September 2024
Published: 17 October 2024
Copyright: This work is licensed un- der a Creative Commons Attribution
4.0 International License (CC BY 4.0).
Glomus tumors are perivascular tumors, with the primary site being the nail bed, although they may also be present in the hand, wrist, forearm, and foot, and less fre- quently in the chest wall, bone, stomach, colon, nerves, nose, trachea, and mediastinum [1]. These are perivascular tumors whose cells resemble modified smooth muscle cells of the glomus body [2]. In the context of a glomus tumor in the trachea, they may be distrib- uted throughout the trachea; however, they are typically more localized in the lower third of the trachea, with lesions on the posterior tracheal wall. Most are endoluminal, but ex- tratracheal cases have been reported [3].
The clinical manifestations of glomus tumors in the trachea depend on the location, the size of the lesion, and how much the lesion obstructs the tracheal diameter. Milder cases may present with coughing and dyspnea, often easily mistaken for asthma, while more severe cases can include hemoptysis and stridor due to airflow obstruction, necessi- tating further investigation [4]. They are also associated with pneumonia due to secretion buildup in the tracheobronchial tree [5].
Tracheal tumors are extremely rare, representing only 0.3% of all tumors [4]. Only 10 to 20% of primary tracheal tumors are benign, including glomus tumors. Most have a mesenchymal origin, with around 50% occurring in the lower third of the trachea and 25% in the middle and upper thirds. They are pedunculated, unlike malignant tumors. Squa- mous cell papillomas are the most common, entering the differential diagnosis alongside malignant tumors, such as squamous cell carcinoma, which is the most common tumor found in the trachea [6].
In this article, we present a case of a glomus tumor in the trachea, highlighting its symptoms, diagnostic methods, and appropriate treatment.
Brazilian Journal of Case Reports 2025, 5, 1, bjcr28 www.bjcasereports.com.br
Male, Caucasian, 53 years old, presented to the Emergency Room of the Hospital de Base do Distrito Federal due to moderate exertional dyspnea. During the physical exami- nation, the patient was in regular general condition, anicteric, acyanotic, afebrile, with a normal cardiac assessment, but with mild stridor, tachypnea (respiratory rate around 22 breaths per minute, and oxygen saturation of 92%), abdomen without abnormalities, lower limbs without edema, and laboratory tests without notable findings. During the anamnesis, the patient reported having systemic arterial hypertension, treated with cap- topril, and gastroesophageal reflux disease, treated with daily omeprazole. He denied al- cohol consumption, smoking, and previous surgeries. He also reported excessive throat clearing, with a sensation of something stuck in the trachea for approximately 3 months, which had been worsening.
A chest computed tomography (CT) scan was performed during the patient’s admis- sion to the emergency room, revealing parietal thickening of the right posterolateral wall of the upper thoracic trachea, about 5.4 cm from the carina, involving the adventitia. Ad- ditionally, a polypoid component was observed projecting into the tracheal lumen, caus- ing a luminal reduction of approximately 50%, with a lesion extension of 1.6 cm.
Following this finding on the CT scan, bronchoscopy with cryotherapy was chosen to resect the tumor, aiming to relieve symptoms and obtain a diagnosis of the vegetative lesion observed on the tomography. An incisional biopsy was performed, with the mate- rial sent for pathological and immunohistochemical analysis of the lesion, along with a reduction in the area of luminal obstruction, which improved the patient's symptoms.
Biopsy samples obtained by cryotherapy.
Through the images, we observe the presence of the bleeding lesion near the carina (Figure 1A). In Figure 1B, we see the cryotherapy being performed for lesion resection, and in Figure 1C, the material removed via cryotherapy, which was sent for pathological analysis and immunohistochemistry. The patient remained hospitalized for an additional day for hematimetric control and to assess the improvement of respiratory symptoms postoperatively, being discharged on the second day with a referral for follow-up in the thoracic surgery outpatient clinic. At the post-surgical outpatient consultation, immuno- histochemistry confirmed that the lesion was a glomus tumor. Follow-up CT scans in the outpatient clinic revealed that, even after the procedure, the lesion continued to grow. The latest report indicated signs of partial resection of the lesion located in the right posterol- ateral wall of the thoracic trachea, with part of the posterior component still present, meas- uring approximately 1.8 x 0.8 cm.
Surgical treatment of the lesion was performed on 02/10/2023, approximately one year after the initial bronchoscopy with cryotherapy. The procedure consisted of a medi- astinal tracheoplasty, with a right posterolateral thoracotomy of approximately 10 cm. The entire mediastinal pleura was opened, and the azygos vein was ligated for better tracheal
exposure. A 1.5 cm length of the trachea was resected, with disease-free margins. The tra- cheal suture was performed with separate 3.0 PDS stitches, and a number 30 chest tube was inserted to monitor for a possible tracheal fistula. Some steps of the surgery are rec- orded in Figure 2. After the procedure, the patient remained hospitalized for another 7 days, was discharged, and referred for outpatient follow-up.
Glomus tumors are uncommon, accounting for only 2% of soft tissue tumors. They are typically found in the fingers, hands, and feet. However, a rarer site of involvement is the airways, both upper and lower, and even the lungs [7]. Glomera are responsible for controlling body temperature at the skin’s surface [8]. Glomus tumors are mesenchymal tumors, believed to be related to smooth muscle cells [7].
Regarding tracheal tumors, they are extremely rare, with an incidence rate of 0.2 per 100,000 inhabitants, making them approximately 180 times rarer than lung cancers [4]. These tumors can be distributed throughout the trachea, but are generally located in the lower third, with lesions on the posterior tracheal wall. Most are endoluminal, although extratracheal cases have been reported [3]. Their symptoms can mimic asthma, leading to misdiagnoses until the condition reaches more severe stages. The most common symp- toms are cough and dyspnea (depending on the degree of tracheal lumen compromise), as well as stridor, which can be easily confused with other pulmonary pathologies, such as asthma and chronic tracheobronchitis [6].
Situations in which tracheal tumors mimic asthma include: (1) short-term improve- ment with oral corticosteroid treatment (due to the reduction of edema surrounding the tumor); (2) pedunculated tumors may exert a ball-valve effect, causing pulmonary hyper- inflation [6]. Cough and expectoration are common due to the accumulation of endotra- cheal secretions caused by tumor obstruction, leading to significant air turbulence in the trachea, predisposing to hemoptysis, which occurs in about 30% of cases and may cause airway obstruction by clots, representing a life-threatening risk for the patient [6].
The main differential diagnoses, besides the previously mentioned carcinoid tumor, include paragangliomas and hemangiomas, requiring differentiation through histopatho- logical and immunohistochemical examination of the specimen [9]. Tracheal tumors can be classified as benign or malignant, originating from epithelial cells, tracheal glands, and mesenchymal cells [4]. For diagnosing this condition, a contrast-enhanced chest CT scan is used to assess the tracheal lesion, its location, size, tissue invasion, and the presence or absence of pulmonary metastasis. Depending on the tumor’s location and size, spirometry
may range from normal to a mildly restrictive pattern. After the tracheal tumor evalua- tion, bronchoscopy is necessary, as it is the only method capable of confirming the diag- nosis reliably, allowing for lesion localization and assessing its extent [7].
In terms of treatment, surgery is the first choice, either through mediastinal tracheo- plasty or endoluminal treatment. If mediastinal tracheoplasty is chosen, the affected tra- cheal rings can be removed, followed by primary anastomosis. Endoluminal treatment may be an option for patients who do not wish to undergo a more invasive procedure or who are at high surgical risk, provided the lesion is restricted and does not involve the tracheal wall [10]. Of the 31 cases described in the literature, most underwent surgical resection followed by reconstruction, with only nine patients receiving endoscopic resec- tion combined with laser ablation [10].
Although rare, glomus tumors represent an important consideration in the differen- tial diagnosis of tracheal lesions, especially in patients with persistent respiratory symp- toms such as cough, dyspnea, and stridor. The presented case illustrates how careful eval- uation and proper investigation are crucial for the correct diagnosis and effective man- agement of this condition. Biopsy confirmation, along with surgical treatment, proved to be an effective approach, not only allowing for tumor removal but also significantly im- proving the patient's quality of life. The literature indicates that, despite being predomi- nantly benign, early identification and treatment of glomus tumors are crucial to avoid severe complications and ensure a good prognosis. Therefore, it is essential for healthcare professionals to be aware of the manifestations and importance of an accurate diagnosis to optimize patient care.
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Masson P. Le glomus neuromyoartériel des régions tactiles et ses tumeurs. Lyon Chir. 1924;21:257-261.
Sakr L, Palaniappan R, Payan M, et al. Tracheal glomus tumor: a multidisciplinary approach to management. Respir Care. 2011;56(3):342-346.
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Masoum SH, Jafarian AH, Attar AR, Attaran D, Afghani R, Noghabi AJ. Glomus tumor of the trachea. Asian Cardiovasc Thorac Ann. 2015;23(3):325-327.
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Relato de Caso
1 Departamento de Cirurgia Torácica, Hospital de Base do Distrito Federal (HBDF), BrasÃlia, DF, Brasil.
* Correspondência: leonardo_rodrigues_00@hotmail.com.
Citação: Souza LRF. Tumor Glômico em Região Traqueal: Relato de Caso. Brazilian Journal of Case Reports. 20- 25 Jan-Dec;05(1):bjcr28.
https://doi.org/10.52600/2763- 583X.bjcr.2025.5.1.bjcr28
Recebido: 9 Setembro 2024
Aceito: 6 Outubro 2024
Publicado: 17 Outubro 2024
Copyright: This work is licensed un- der a Creative Commons Attribution
4.0 International License (CC BY 4.0).
Tumores glômicos são tumores perivasculares, tendo como principal sÃtio a região ungueal, embora também possam estar presentes na mão, punho, antebraço e pé, e menos frequentemente na parede torácica, osso, estômago, cólon, nervos, nariz, traqueia e medi- astino [1]. São tumores perivasculares cujas células se assemelham a células musculares lisas modificadas do corpo glômico [2]. No contexto de tumor glômico na traqueia, eles podem estar distribuÃdos ao longo de toda a traqueia, no entanto, são habitualmente mais localizados no terço inferior da traqueia, com lesões na parede posterior traqueal. A mai- oria é endoluminal, mas há relatos de casos extratraqueais [3].
As manifestações clÃnicas dos tumores glômicos na traqueia dependem da localiza- ção, do tamanho da lesão e de quanto a lesão oclui o diâmetro da traqueia. Casos mais leves podem apresentar tosse e dispneia, sendo facilmente confundidos com o diagnóstico de asma, enquanto casos mais graves podem incluir hemoptise e estridor devido à obs- trução do fluxo de ar, fatos que demandam uma investigação mais detalhada [4]. Também estão associados a quadros de pneumonia, devido ao acúmulo de secreção na árvore tra- queobrônquica [5].
Os tumores traqueais são extremamente raros, representando 0,3% de todos os tu- mores [4]. Apenas 10 a 20% dos tumores primários da traqueia são benignos, incluindo o tumor glômico. A maioria tem origem mesenquimatosa, sendo que cerca de 50% ocorrem no terço inferior da traqueia e 25% no terço médio e superior. São pediculados, ao contrá- rio dos tumores malignos. Os papilomas de células escamosas são os mais comuns, en- trando no diagnóstico diferencial junto com tumores malignos, como o carcinoma de cé- lulas escamosas, que é o tumor mais comum encontrado na traqueia [6].
Neste artigo, apresentamos um caso de tumor glômico na traqueia, destacando seus sintomas, os meios para o diagnóstico adequado e o tratamento correto.
Brazilian Journal of Case Reports 2025, 5, 1, bjcr28 www.bjcasereports.com.br
Homem, branco, 53 anos, compareceu ao Pronto Socorro do Hospital de Base do Dis- trito Federal devido à presença de dispneia aos esforços moderados. Durante o exame fÃsico, constatou-se estado geral regular, anictérico, acianótico, afebril, avaliação cardÃaca sem alterações, com presença de leve estridor, taquipneico (FR em torno de 22 IRPM e SatO2 de 92%), abdome sem alterações, membros inferiores sem edemas, e exames labo- ratoriais sem achados dignos de nota. Durante a anamnese, o paciente relatou ser portador de hipertensão arterial sistêmica, em uso de captopril, e doença do refluxo gastroesofá- gico, em uso diário de omeprazol. Negava etilismo, tabagismo e cirurgias prévias. Relatou ainda um pigarro excessivo, com sensação de algo preso na traqueia há aproximadamente 3 meses, que vinha piorando.
Foi realizada tomografia computadorizada (TC) de tórax durante a admissão do pa- ciente na emergência, que revelou espessamento parietal da parede póstero-lateral direita da traqueia torácica superior, a cerca de 5,4 cm da carina, comprometendo a túnica adven- tÃcia. Além disso, observou-se um componente polipoide projetando-se para o interior da luz traqueal, determinando uma redução luminal de cerca de 50%, com extensão da lesão de 1,6 cm.
Após esse achado na TC, optou-se por realizar broncoscopia com proposta de criote- rapia para ressecção tumoral, a fim de aliviar os sintomas e obter um diagnóstico da lesão vegetante evidenciada na tomografia. Foi realizada biópsia incisional, com envio de ma- terial para análise patológica e imuno-histoquÃmica da lesão, além de redução da área de obstrução luminal, o que melhorou os sintomas do paciente.
Através das imagens, observamos a presença da lesão sangrante próxima à carina (Figura 1A). Na Figura 1B, vemos a realização da crioterapia para ressecção da lesão, e na Figura 1C, o material retirado pela crioterapia, que foi enviado para análise patológica e realização de imuno-histoquÃmica. O paciente permaneceu internado por mais um dia para controle hematimétrico e avaliação da melhora dos sintomas respiratórios no pós- operatório, recebendo alta no segundo dia, com encaminhamento para acompanhamento no ambulatório de cirurgia torácica. Na consulta ambulatorial pós-cirúrgica, a imuno-his- toquÃmica confirmou que a lesão era um tumor glômico. Em tomografias de controle no ambulatório, observou-se que, mesmo após o procedimento, a lesão apresentava cresci- mento. O último laudo indicava sinais de ressecção parcial da lesão situada na parede póstero-lateral direita da traqueia torácica, com parte do componente posterior ainda pre- sente, medindo cerca de 1,8 x 0,8 cm.
Foi realizado tratamento cirúrgico da lesão em 02/10/2023, aproximadamente um ano após a primeira broncoscopia com crioterapia. O procedimento consistiu em uma
traqueoplastia mediastinal, com toracotomia póstero-lateral direita de aproximadamente 10 cm. Toda a pleura mediastinal foi aberta, e a veia ázigos foi ligada para melhor exposi- ção da traqueia. Ressecaram-se 1,5 cm de comprimento da traqueia, com margens livres de doença. A sutura traqueal foi realizada com pontos separados de PDS 3.0, e um dreno torácico número 30 foi inserido para vigilância de possÃvel fÃstula traqueal. Alguns passos da cirurgia foram registrados na figura 2. Após o procedimento, o paciente permaneceu internado por mais 7 dias, recebendo alta hospitalar e sendo encaminhado para o acom- panhamento ambulatorial.