Adenoid Cystic Carcinoma of the Trachea: A Case Report

Tracheal adenoid cystic carcinoma presenting as a locally advanced thyroid gland carcinoma

Tracheal adenoid cystic carcinoma is a rare malignancy. We report the case of a 65-year-old male who presented to our department due to a 3-month history of mild dysphagia without other associated symptoms. The neck, laryngeal, and hypopharyngeal examinations were normal. Ultrasound showed hypertrophy and marked hypoechogenicity of the left thyroid lobe without suspicious nodules. Fine needle aspiration of the hypoechogenic area revealed an adenoid cystic carcinoma. A tracheal origin was then suspected and it was confirmed by a flexible bronchoscopy that showed a tumor located in the proximal tracheal reducing its lumen by 50%. The biopsy confirmed the diagnosis of tracheal adenoid cystic carcinoma. We performed a computed tomography scan showing a mass at the angle between the trachea and esophagus infiltrating the left thyroid gland. Magnetic resonance imaging confirmed the tumor's important local and regionregional extension at the thyroid gland, esophagus, larynx, and mediastinum. The tumor was judged as unresectable and the patient received radiotherapy and an endotracheal sent. After a follow-up period of 2 years, the tumor remained stable, and the patient received This study aims to determine the clinical, radiological, and therapeutic aspects of advanced adenoid cystic carcinoma.

Pulmonary Adenoid Cystic Carcinoma Mimicking Asthma-Like Symptoms: A Case Report and Literature Review

Introduction

Pulmonary adenoid cystic carcinoma (PACC) is a rare, low-grade malignant salivary gland-type tumor characterized by a dormant onset and slow progression, often leading to misdiagnosis. Due to its rarity, limited cases have been reported in the literature. This report aimed to enhance clinicians' understanding of this infrequent disease.

Case Presentation

We present the case of a 41-year-old female patient diagnosed with PACC. Our report provides a comprehensive analysis of the patient's imaging, pathology, and treatment, with a particular focus on immunohistochemical results. Importantly, we emphasize the significance of considering foreign bodies and tumors in the bronchus when encountering asthma-like symptoms unresponsive to conventional treatments. Due to the uncertain etiology and pathophysiology of PACC, there are currently no established guidelines for chemotherapy and radiotherapy.

Conclusion

PACC predominantly manifests as bronchial lesions without significant clinical heterogeneity. Therefore, it is crucial to consider foreign bodies and tumors in the bronchus when dealing with asthma-like symptoms, especially in patients without chronic lung disease who do not respond to anti-infective, antispasmodic, and antiasthmatic treatments. Additionally, meticulous examination of lesions is essential for timely diagnosis and intervention, ultimately improving patient survival rates.

Patterns of Care and Outcomes of Primary Adenoid Cystic Carcinoma of the Trachea

OBJECTIVE

Primary tracheal malignancies are relatively rare cancers, representing 0.1% to 0.4% of all malignancies. Adenoid cystic carcinoma (ACC) is the second most common histology of primary tracheal malignancy, after squamous cell carcinoma. This study aims to analyze demographic characteristics and potential influencing factors on survival of tracheal ACC (TACC).

METHODS

This was a retrospective cohort study utilizing the National Cancer Database (NCDB). The NCDB was queried for all cases of TACC diagnosed from 2004 to 2016 (n = 394). Kaplan-Meier (KM) and Cox proportional-hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes.

RESULTS

Median age of diagnosis was 56 (IQR: 44.75-66.00). Females were affected slightly more than males (53.8% vs 46.2%). The most prevalent tumor diameter range was 20 to 39 mm (34.8%) followed by greater than 40 mm in diameter (17.8%). Median overall survival (OS) was 9.72 years with a 5- and 10-year OS of 70% and 47.5%, respectively. Localized disease was not associated with a survival benefit over invasive disease (P = .388). The most common intervention was surgery combined with radiation therapy (RT) at 46.2%, followed by surgery alone (16.8%), and standalone RT (8.9%). When adjusting for confounders, surgical resection was independently associated with improved OS (HR 0.461, 95% CI 0.225-0.946). Tumor size greater than 40 mm was independently associated with worse OS (HR 2.808; 95% CI 1.096-7.194).

CONCLUSION

Our data suggests that surgical resection, possibly in conjunction with radiation therapy, is associated with improved survival, and tumor larger than 40 mm are associated with worse survival.

Primary thymic carcinoma with adenoid cystic carcinoma-like features: A case report and literature review

RATIONALE

Thymic carcinoma with adenoid cystic carcinoma-like features is a special subtype of thymic adenocarcinoma, and the occurrence of this condition is extremely rare. Herein, we report a case of primary thymic carcinoma with adenoid cystic carcinoma-like features in a young man.

PATIENT CONCERNS

A 38-year-old man had an incidental finding of space-occupying lesion in the anterior mediastinum during a routine health examination. The patient complained of occasional mild chest tightness during hot weather but had no obvious cough, sputum, chest pain, or fever. Contrast-enhanced computed tomography scan of the chest revealed a space-occupying lesion in the anterior mediastinum, which is likely benign.

DIAGNOSIS

The lesion was diagnosed as a primary thymic carcinoma with adenoid cystic carcinoma-like features.

INTERVENTION

The patient underwent thoracoscopic resection of left anterior mediastinal mass and enlarged resection of thymectomy and mediastinal fat in our hospital.

OUTCOMES

The postoperative course was uneventful.

LESSONS

The tissue characteristic of this tumor was extremely similar to that of adenoid cystic carcinoma. A precise pathological examination is extremely important to prevent misdiagnoses of the lesion as adenoid cystic carcinoma or other thymic tumors. Immunohistochemical staining is extremely useful for the pathological and differential diagnoses of this tumor.