ABS90: Chronic cough as the sole initial manifestation of epidermoid carcinoma of the trachea

Abstract

Aims:

The study of chronic cough is necessary to establish the adequate diagnostic, and treatment if it's possible.

Design:

History: A 47-year-old man presented with an 3-weeks history of a chronic cough. Smoker of 80 pack-years. Examination revealed disminution of respiratory murmur, no fever and little sputum.

Methods:

Radiography, Laboratory data, Computerised tomography, bronchoscopy and biopsy were obtained.

Results:

Radiography: Middle lobe syndrome Computerised Tomography: Pedunculated tracheal mass emanating from the right tracheal wall. A lower Paratracheal and retrovascular node of 7×5cm (1996 AJCC-UICC Classification regional lymph node stations for lung (Trachea) cancer staging) Flexible bronchoscopy: Which revealed a sessile tracheal mass emanating from the right tracheal wall, approximately 2cm upper to the carina of the trachea. A biopsy was obtained Biopsy: Intermediate-grade Tracheal Epidermoid Carcinoma Laboratory data: Leukocytosis (22.500) with Neutrophilic reaction (91’3%) and raising erythrocyte sedimentation rate and C-reactive Protein (6’2 mg/dl) Diagnostic: Epidermoid Carcinoma of lung (Trachea) IIIb (T4N2M0)

Discussion:

The patient with Epidermoid Carcinoma of the trachea typically presents with dyspnoea, chronic cough, or haemoptysis. Occasionally, this type of tumor is found on a routine chest radiograph of an asymptomatic patient. Intermediate-grade tumors represent the bridge between low-and high-grade tumors; and tend to be more locally destructive and may be more likely to recur.

Conclusions:

1- Chronic cough, especially in chronic smokers, must be studied

2- Epidermoid carcinoma of the trachea is a cause of chronic cough by irritation of the airways not contemplated at the protocols of Griffit 1996

3- Treatment of tracheal epidermoid carcinoma is primarily surgical, with complete en bloc resection recommended

4- Lymphadenectomy is individualized in each case according to the extend and histologic features of the tumor. It would not be recommended for low-or intermediate-grade tumors

5- The tumor was classified as intermediate grade, and adjuvant external beam radiotherapy was recommended and performed specially in this patient with superior vena cava syndrome.

Conflict of interest and funding

None.