Cough and dyspnoea

The patient was a 62-year-old male, white, ex-smoker of 25 years/pack (abstinence 20 years ago). His condition began with mild dyspnoea 2 years ago, with intensity evolution and cough. He was evaluated as an outpatient and was treated for sinusitis and later bronchitis after pulmonary function tests. With worsening of the aforementioned symptoms, he sought prompt care (PA), with hospitalization and CT of the chest being indicated, showing an expansive lesion in the anterior wall of the trachea with an extension of approximately 3.1 cm, ending at the level of the carina, measuring 3.4×2.8 cm, with moderate stenosis of the tracheal lumen, with an exophytic component to the mediastinum.

He underwent a bronchoscopy, which confirmed the finding of a vegetative, vascularized and friable lesion to manipulate in a distal portion of the trachea of 1 cm, that of the main carina, causing an important obstruction to airflow. Endotracheal biopsy of multiple fragments and histopathology confirmed by pleomorphic adenoma immunohistochemistry, presented CD117/C-kit (YR145), p63, cytokeratin 5, low molecular weight cytokeratin 8/18 (CK 8/18), S100 positive protein in several cells and Ki-67 (MIB-1) and the reactivity index was estimated to be 8% to 10%.