Tracheal Adenoid Cystic Carcinoma Successfully Treated With the Combined Core Out Technique, Cryoextraction, and Argon Plasma Coagulation: A Case Report

Abstract

We report the case of a 67-year-old male who presented with mild dyspnea two years ago, with increasing intensity, cough, and stridor on exertion. He underwent outpatient evaluation and received treatment for recurrent episodes of bronchitis and acute exacerbations of chronic obstructive pulmonary disease. His current medication included tiotropium 18 µg per day and salmeterol/fluticasone 50/500 µg twice daily. The patient received a short course of prednisolone at 40 mg per day for five days before admission. The physical examination showed a central stridor during both inspiration and expiration. Chest radiograph showed a normal lung parenchyma and no hilar enlargement. Spirometry revealed fixed airway obstruction. CT scan of the thorax revealed a 2.4 × 2.7 cm lobulated mass abutting the right side of the lower trachea with nearly complete obstruction. Due to the large tumor causing significant central airway obstruction, the medical team opted to remove the central airway mass through rigid bronchoscopy. Argon plasma coagulation was used to facilitate mass shrinkage. Mechanical mass removal was performed using a rigid bronchoscope. At the end of the treatment, re-evaluation by bronchoscopy exhibited no remaining mass. Histologic examination confirmed the diagnosis of a tracheal adenoid cystic carcinoma. No recurrence of the tumor was noted during 12 months of follow-up.

Keywords: adenoid cystic carcinoma; malignant airway obstruction; pulmonary adenoid cystic carcinoma; tracheal adenoid cystic carcinoma; tracheal tumor.

Figure 1. CT of the chest demonstrating a 2.4 × 2.7 cm lobulated mass abutting the right side of the lower trachea with nearly complete obstruction (A: axial view, B: coronal view).

Figure 2. (A) Bronchoscopy showing a large lobulated mass at the right side of the tracheal wall with nearly complete tracheal lumen, (B) after immediate total tumor removal, (C) 12 months follow-up of bronchoscopy demonstrating healing of the excision site without evidence of tumor recurrence.

Figure 3. Pathologic macroscopic examination of the biopsy revealing a lobulated mass of 2.1 × 2.4 cm, microscopic examination of the biphasic salivary gland tumor composed of ductal and myoepithelial cells (hematoxylin and eosin (H&E) ×40) (A). The cribriform pattern is composed of predominantly myoepithelial cells with myxoid or hyalinized globules compatible with the diagnosis of a tracheal adenoid cystic carcinoma, cribriform subtype (H&E ×100) (B).