SESSION TYPE: Airway Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Adenoid Cystic Carcinoma (ACC), also known as cylindroma, is a rare primary tracheal tumor, which comprises 0.1 - 0.2% of all lung cancers (1). Histologically, the majority of the tracheal tumors are squamous cell carcinomas, but ACC and mucoepidermoid carcinoma are seen in rare instances. We report a unique case of an elderly woman with wheezing who was found to have ACC.
CASE PRESENTATION: 88 year old female, former smoker with history of COPD, CHF and atrial fibrillation presented with shortness of breath and cough for 4 weeks .Physical examination was notable for labored breathing and bilateral wheezing. Patient was treated initially for a COPD exacerbation with intravenous steroid and nebulizers without improvement. Chest x-ray showed a right mid lung density and CAT scan of the chest showed a nodular 2.4 cm mass protruding into the trachea and a 4 cm solid opacity in the right mid-lung. Patient underwent flexible bronchoscopy and was found to have large endotracheal mass. Fine needle aspiration cytology revealed neoplasm of minor salivary gland, favoring ACC. The mass subsequently was removed via rigid bronchoscopy and the patient was discharged home .
DISCUSSION: ACC is the 2nd most common primary tracheal neoplasm. It usually arises in the proximal one-third or distal one-third of the trachea and has no association with tobacco exposure (2). ACC has a slow growing and prolonged clinical course; it is considered to be a low-grade malignancy and identical to ACC of the salivary glands (3). Most ACCs are discovered in middle age with no gender predilection .The common presenting symptoms of cough, dyspnea, hoarseness and wheezing are usually related to the size and location of the mass (3). Surgery is the standard treatment of tracheal tumors if possible and the rate of recurrence after resection is high. The tumor is relatively radiosensitive and post-operative radiotherapy may have some effect on local control but treatment does not affect overall survival rate.
CONCLUSIONS: Our patient demonstrates a rare case of ACC (cylindroma) of the trachea that was initially mis-diagnosed and treated for COPD exacerbations. Physicians should be aware of ACC of the trachea as a rare cause of persistent airway obstruction.
1) Ahn Y, Chang H, Lim YS, et al. Primary tracheal tumors: review of 37 cases. J Thorac Oncol 2009; 4:635
2) Maziak DE, Todd TR, Keshavjee SH, et al. Adenoid cystic carcinoma of the airway: thirty-two-year experience. J Thorac Cardiovasc Surg 1996; 112:1522
3) Webb BD, Walsh GL, Roberts DB, Sturgis EM. Primary tracheal malignant neoplasms: the University of Texas MD Anderson Cancer Center experience. J Am Coll Surg 2006; 202:237
DISCLOSURE: The following authors have nothing to disclose: Emile Klada, Ruchi Bansal, Juan George, Lavanya Irugulapati, Thomas Russi
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