Oncocytic Glomus Tumor of the Trachea

doi:10.1378/chest.98.4.1021

Chest

Volume 98, Issue 4, October 1990, Pages 1021-1023

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An oncocytic variant of glomus tumor of the trachea occurred in a 47-year-old woman. She experienced intermittent cough and hemoptysis for about three years. Bronchoscopy and chest CT scan showed a small reddish polypoid tumor on the lower end of the trachea. Bronchoscopic biopsy was carefully done and was diagnosed as oncocytoma. A wedge resection of the tumor was done. Tumor cells were characterized by strongly eosinophilic granular cytoplasm on light microscopy and by numerous closely packed round or ovoid mitochondria with prominent tubular cristae on electron microscopy. They were arranged in a sheet around small vessels, as a result of which the biopsy diagnosis of oncocytoma was changed to oncocytic glomus tumor. To our knowledge, this is the first report of an oncocytic glomus tumor arising from the trachea.

Section snippets

CASE REPORT

A 47-year-old woman was admitted to Hanyang University Hospital in February 1989 because of intermittent cough and hemoptysis. She had been well until three years ago, when her symptoms occurred infrequently. Two years later, the hemoptysis became somewhat aggravated. The findings from physical examination were normal except for arrhythmia. The chest x-ray film and results of pulmonary function tests were normal. The ECG showed a few PVCs. Fiberoptic bronchoscopy revealed a small reddish

DISCUSSION

A primary tracheal tumor is one of the rarest tumors,8, 9 and it is often diagnosed late in the clinical course and at an advanced stage. The majority of such tumors are either squamous cell carcinoma (45 percent) or adenoid cystic carcinoma (36 percent), and the minority (11.4 percent) are of mesenchymal origin.¹⁰ Complaints are coughing, hemoptysis, and dyspnea with wheezing. Endoscopic examination remains one of the most reliable means of establishing the diagnosis of a tracheal neoplasm,

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Glomus tumours are distinctive neoplasms arising in the cells of the glomus body. Histologically they resemble modified smooth muscle cells. It usually occurs over the limbs. However, several unusual sites of occurrence have been described. These include the patella, chest wall, bone, heart, stomach, eyelid, lung, rectum, etc. Tracheal tumours have been described.
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The benign form accounts for more than 95% of these lesions, even among referral practices.2 Based on the proportion of glomus cells, vessels, and smooth muscle present, these typical lesions can be further subcategorized as glomus tumor, glomangioma, or glomangiomyoma.6,7 An oncocytic variant has also been described.7
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The trachea is an unusual site for both benign and malignant neoplasms, with glomus tumors among the rarest of all benign lesions. Since the initial report by Hussarek and Rieder [7] in 1950 only 14 cases, including the present case, have been described [1–6]. The principal histologic differential diagnosis of glomus tumors includes carcinoids, hemangiopericytomas, and hemangioendotheliomas [2].
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^†: Instructor of Medicine, Division of Pulmonary Medicine.

^‡: Associate Professor of Medicine, Division of Pulmonary Medicine.

^§: Professor of Medicine and Director, Division of Pulmonary Medicine.

^¶: Associate Professor of Pathology.

^¶: Professor and Chairman, Department of Pathology.

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Chest

Oncocytic Glomus Tumor of the Trachea

Section snippets

CASE REPORT

DISCUSSION

Br J Dis Chest

J Thorac Surg

Le glomus neuromyoarterial des regions tactiles et ses tumours

Lyon Chir

Soft tissue tumours

Glomustumor der Luftrohre

Krebsarzt

Glomangioma of the trachea

Cancer

One very rare and one new tracheal tumour found by electron microscopy: glomus tumour and acinic cell tumour resembling carcinoid tumours by light microscopy

Thorax

Glomus tumor of the trachea: immunohistochemical and electron microscopic studies

Pathol Res Pract