Tracheal Adenoid Cystic Carcinoma Presented with Chronic Asthma Diagnosed by Bronchial Washing Cytology

Abstract

Adenoid cystic carcinoma is a tumor that mainly arises from salivary glands and is present rarely in airways with nonspecific symptoms. Diagnosis based on bronchial washing cytology is rarely reported because this tumor is usually lined by normal mucosa. A 35-year-old woman was referred to our center as a case of unresponsive asthma and hemoptysis for the past year. CT scan showed tracheal mass. Bronchoscopy was done followed by bronchial washing cytology and biopsy. Cytology smears revealed sheets and three-dimensional clusters of small cells, and some of them arranged around hyaline mucoid globules. Cell block and biopsy showed classic pathological findings of adenoid cystic carcinoma. Adenoid cystic carcinoma of the airways can be manifested with nonspecific symptoms and should be considered in the differential diagnosis of airway diseases and asthma. This tumor is rarely seen in the bronchial washing specimen. Characteristic cytological findings and using cell block preparation differentiate adenoid cystic carcinoma from other tumors.

Figure 1

Cytology smears. (a) Sheets, three-dimensional clusters, and dispersed cells with hyaline materials (Papanicolaou stain, ×100). (b) Clusters of neoplastic cells surrounding hyaline globules (Papanicolaou stain, ×400).

Figure 2

Cell block slide. (a) Tubular-like structure and cribriform pattern with acidophilic materials (H&E stain, ×100). (b) Small nests and strands of tumor cells (H&E stain, ×400).

Figure 3

Endobronchial biopsy. (a) Bronchial mucosa contains infiltrative neoplastic lesions with tubular and cribriform patterns (H&E stain, ×100). (b) Tubular and cribriform structures of the neoplasm (H&E stain, ×400).