Lung Pathology: Fellow Case Report Poster - Lung Pathology |

A Curious Case of Adenoid Cystic Carcinoma in the Lung FREE TO VIEW

Amin Pasha, MD; Muhammad Ehtesham, MD
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St John Providence-Providence Park Hospital, Southfield, MI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):777A. doi:10.1016/j.chest.2016.08.873
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SESSION TITLE: Fellow Case Report Poster - Lung Pathology

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Adenoid Cystic Carcinoma (ACC) is a malignant epithelial neoplasm that predominantly arises from salivary glands. Rarely, primary ACC can arise from the central airways such as the trachea and main bronchus. Pulmonary ACC is more aggressive, presents at higher clinical stage and is often difficult to resect due to its central location.

CASE PRESENTATION: A 40 year old Caucasian female presented with dry cough since one year. Over the previous two days, she developed fevers, night sweats and sputum production. She was a lifetime non-smoker. She was previously treated with bronchodilators and steroids for a presumptive diagnosis of asthma. Chest x-ray revealed a 13 * 7 cm anterior mediastinal mass. Subsequent CT chest revealed an 11 * 7.7 cm left anterior mediastinal mass suspicious for lymphoma. CT-guided biopsy of the mass was negative for malignancy. Upon further review the mass was diagnosed as collapsed left upper lobe. Bronchoscopy revealed a smooth vascular endobronchial mass occluding the left upper lobe. Biopsy of the mass revealed ACC. Subsequent PET-CT scan revealed a large hypermetabolic mass in the medial left upper lobe, invading the anterior mediastinum and extending towards the hilum. She was discharged home with antibiotics for post-obstructive pneumonia and surgical followup.

DISCUSSION: ACC is the second most common type of salivary gland tumor in the bronchial tree after Mucoepidermoid carcinoma. Majority of cases occur in the fifth decade of life with a male preponderance. Smoking is not associated with ACC. Due to the central location in 90% of cases, the presenting symptoms are of bronchial obstruction such as dyspnea, cough and wheezing. The histological patterns seen are cribriform, tubular or solid. Our patient had a combination of cribriform and tubular pattern. Surgery remains the treatment of choice with a 10 year survival rate of approximately 50% in operable cases.

CONCLUSIONS: ACC is the second most common type of salivary gland tumor in the bronchial tree. The presenting symptoms are of bronchial obstruction such as dyspnea, cough and wheezing. Surgery remains the treatment of choice and more extensive invasion is often found during surgery, making it difficult to resect completely.

Reference #1: Hu et al: Primary Adenoid Cystic Carcinoma of the Peripheral Lungs. Oncology Letters 9: 1475-1481, 2015

Reference #2: Falk et al: Primary Pulmonary Salivary Gland-type Tumors: A Review and Update. Adv Anat Pathol Volume 23, Number 1, January 2016

DISCLOSURE: The following authors have nothing to disclose: Amin Pasha, Muhammad Ehtesham

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