Tracheopathia osteochondroplastica (TO) is a rare, slowly progressing lesion, characterised by the presence of cartilaginous and bony submucosal nodules projecting into the lumen of the trachea, larynx and major bronchi [148, 279, 295, 355]. Most cases are recognised at autopsy, but may be also suspected due to problems of endotracheal intubation [186].

The aetiology and pathogenesis remain uncertain. Chronic infections, chemical and mechanical irritations, metabolic disorders, ecchondrosis, exostosis and metaplasia of the elastic tissue are thought to be causal factors [279, 295, 355, 356]. TO appears predominantly in late adult life, but may be seen in childhood and early adult life [148, 295]. TO with minimal expressions may often be overlooked. Typical florid cases narrow the airways and cause a dry cough, dyspnoea, hoarseness and recurrent infections [356]. Laryngobronchoscopic examination is decisive for the diagnosis. Elevated, hard, whitish nodules bulge into the lumen with the appearance of a stalactite cave. The posterior wall of the trachea is usually spared [186, 279]. An intralaryngeal location of TO is very rare; as a rule it appears in the subglottic region [355], exceptionally around the arytenoids [279].

Histologically, submucosal nodules of cartilage and lamellar bone with marrow spaces are characteristic findings, usually in relation to the underlying cartilage. Calcifications, ossifications and fatty marrow formations may be seen within the nodules [295]. Bone mor-phogenetic protein-2 and transforming growth factor beta, the potent inducers of new bone formation, have been recently detected in TO immunohistochemical-ly and may have some decisive roles in the pathogenesis [356]. Surgical treatment has been recommended only in symptomatic patients [35, 186, 250].

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