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and chondroblastoma of the trachea had no recurrence after complete resection with primary anastomosis. A low-grade, bulky chondrosarcoma treated by resection developed multiple, slow-growing pulmonary metastases over many years, but had no tracheal recurrence.

Hemangioma of the airway occurs, especially in children, in the subglottic region of the airway.37 Half of these children also have hemangiomas elsewhere. The lesions are generally characterized by proliferative endothelial cells. Although lesions regress with age, they may require treatment because of their location either in the lumen of the airway or as an extrinsic compressive mass. Lymphangioma can on rare occasions similarly obstruct the trachea by pressure. Biopsy is to be avoided. A conservative approach is advised. Treatment has included temporizing tracheostomy to await regression, laser, corticosteroids, and in the past, irradiation. Laser therapy generally leads to remission.38,39 Interferon has shown effect but neurological complications may occur.40

figure 7-10 Chondral tracheal tumors. Benign chondroma causing nearly total obstruction, in a 69-year-old musician who suffered dyspnea and stridor for 9 months before diagnosis of obstruction by flow volume loop. Tomograms show in A, anteroposterior and B, lateral views, how completely the lesion filled the tracheal lumen. C, The cut surgical specimen shows tumor originating from the anterior tracheal wall and abutting the membranous wall. D, Roentgenogram shows a slowly progressive low-grade chondrosarcoma, which originated in the tracheal wall, markedly displacing the trachea, brachiocephalic vein, and filling the upper mediastinum.

figure 7-10 Chondral tracheal tumors. Benign chondroma causing nearly total obstruction, in a 69-year-old musician who suffered dyspnea and stridor for 9 months before diagnosis of obstruction by flow volume loop. Tomograms show in A, anteroposterior and B, lateral views, how completely the lesion filled the tracheal lumen. C, The cut surgical specimen shows tumor originating from the anterior tracheal wall and abutting the membranous wall. D, Roentgenogram shows a slowly progressive low-grade chondrosarcoma, which originated in the tracheal wall, markedly displacing the trachea, brachiocephalic vein, and filling the upper mediastinum.

An extremely rare lesion, but quite different, is arteriovenous vascular malformation in the anterior and middle mediastinum, which may present within the tracheal lumen as an obstructive lesion (Figure 7-12). These are not mediastinal hemangiomas, which are most often quite discrete.40,41 The arteriovenous vascular malformation is fed by multiple arteries and entwines the mediastinum with a network of vasculature.40,42 Such malformations are presumed to be congenital and not true tumors. Unless thrombosis has occurred, the vascular endothelium is quiescent, rather than proliferative as in hemangiomas.

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