Upper airway tumors encompass a wide variety of epithelial and soft tissue neoplasms that are relatively rare and usually malignant. Squamous cell and adenoid cystic carcinomas are the most common. Definitive diagnosis is often delayed because the symptoms associated with upper airway tumors are similar to those of more common pulmonary disorders such as chronic obstructive pulmonary disease. Although less invasive palliative treatment modalities are available, surgical resection with airway reconstruction usually offers the best chance for an excellent long-term prognosis. Figure 60-1 shows the normal upper airway anatomy.
Anatomy of the upper airway.
Neoplasms can arise from any of the tissues present in the trachea and mainstem bronchi. These tissues include the columnar ciliated mucosa, the submucosa (which contains a significant number of mucous glands), cartilage, and connective tissues. Accordingly, the types of upper airway tumors are numerous (Table 60-1). Tumors are classified as benign or malignant and epithelial or soft tissue in origin. Lesions are evenly distributed throughout the length of the trachea.
Table 60-1Upper Airway Tumors |Favorite Table|Download (.pdf) Table 60-1Upper Airway Tumors
| ||BENIGN ||MALIGNANT |
|Epithelial ||Papilloma |
Mucous gland adenoma
|Squamous cell carcinoma |
Adenoid cystic carcinoma
Small cell carcinoma
Combined small cell carcinoma
Large cell carcinoma
Large cell neuroendocrine carcinoma
Acinic cell carcinoma
Malignant salivary gland-type mixed tumors
Spindle cell carcinoma
Giant cell carcinoma
|Soft tissue ||Chondroma |
Granular cell tumor
Malignant fibrous histiocytoma
|Miscellaneous ||Inflammatory pseudotumor |
Inflammatory myofibroblastic tumor
|Malignant lymphoma |
Primary pulmonary melanoma
In adults, most upper airway tumors are malignant.1-4 Extremely rare, their incidence is much lower than carcinomas of the larynx and lung. In fact, upper airway tumors account for fewer than 0.2% of all respiratory tract malignancies.5 The malignant epithelial tumors squamous cell carcinomas (SCCs) and adenoid cystic carcinomas (ACCs) are the most common primary tracheal malignancies, followed by carcinoid and mucoepidermoid carcinomas.1-4,6-12 Benign tumors represent a wide variety of histologic types. The most common are squamous papilloma, pleomorphic adenoma, and benign cartilaginous tumors.3
Although SCC usually occurs in lobar and segmental bronchi, it is the most common neoplasm of the trachea and mainstem bronchi.3,8,13 SCC of the trachea occurs most commonly in males between the ages of 50 and 70 years and is associated with cigarette smoking.2,3,14 SCC has papillary and basaloid variants ...