Syncope due to tracheal adenoid cystic carcinoma

Abstract

We present a case of a 34-year-old male who presented with syncope secondary to a large adenoid cystic carcinoma (ACC) of the distal trachea. A computed tomography and flexible bronchoscopy showed almost complete occlusion of the distal trachea. Resection with curative intent was performed, but resection margins were unfortunately not clear. The patient was subsequently offered adjuvant radiotherapy. Tracheal tumours comprise a small proportion of respiratory tract neoplasm, accounting for only about 2% of airway malignancies. Squamous cell carcinoma is the most common tracheal tumour, followed by ACC. Symptoms are usually attributable to the intraluminal component of the tumour causing an obstruction of the airway, resulting in stridor, dyspnoea, wheezing, haemoptysis, and cough. Syncope as a presenting symptom is exceedingly rare.

Keywords: Adenoid cystic carcinoma; radiotherapy; surgery; tracheal tumour.

Figure 1

(A) The computed tomography scan showing almost complete obstruction of the distal trachea; (B) the endobronchial view seen on flexible bronchoscopy with the patient sitting—note the vascularity of the tumour; (C) the resected tumour; and (D) adenoid cystic carcinoma with a cribriform and tubular growth pattern infiltrates beyond the level of the tracheal cartilage into the peritracheal soft tissue (bottom left). Normal submucosal seromucous glands are present on the right (haematoxylin and eosin, original magnification 40×).

Figure 2

The surveillance bronchoscopy unfortunately showed local recurrence of the disease (arrows)