Correct!
1. Bronchoscopy
All of the procedures listed would be capable of performing tissue sampling for this lesion, but clearly bronchoscopy allows the most direct and least invasive route to establish a diagnosis.
The patient underwent bronchoscopy (Figure 7).
Figure 7. Bronchoscopy shows a mass along the left lateral tracheal wall extending into and narrowing the tracheal lumen.
Biopsies obtained during this procedure indicated the diagnosis of chondrosarcoma. The patient elected to undergo combined endoluminal resection using cupped forceps and a KTP laser with a partial sternotomy (Figure 8) to address the extraluminal component.
Figure 8. Image during the open resection through partial sternotomy shows the lesion.
A stent was placed through the affected area at the completion of the procedure (Figure 9).
Figure 9. Bronchoscopic image at the completion of the endoluminal resection portion of the procedure following stent placement.
The final pathological diagnosis was low-grade tracheal chondrosarcoma (Figure 10).
Figure 10. Resected low-grade chondrosarcoma. A: Resected gross specimen measured 6.5 cm. B: Low-power histopathological specimen shows a pink-staining, think, fibrous capsule encompassing the majority of the surface of the lesion, extending deeply into the lesion creating distinct lobules composed of hyaline cartilage. C: High-power histopathological specimen shows typical chondrocytes with moderately atypical nuclei and partial cytoplasmic vacuolization with a low mitotic index. An abundance of cartilaginous matrix between cells is consistent with a low-grade lesion.
Diagnosis: Tracheal chondrosarcoma
References