Airway compromise due to adenoid cystic carcinoma obstructing the distal trachea: a review of current management and clinical trials

Abstract

An 84-year-old man presented with a 2-month history of intermittent stridor and worsening difficulty in breathing. Chest X-ray and flexible nasendoscopy were unremarkable but following further deterioration a CT scan revealed an obstructing lesion in the distal trachea. Bronchoscopy revealed an infiltrative tumour arising 3 cm above the carina causing 90% obstruction. The mass was biopsied and surgically debrided to leave a patent airway. Histological analysis revealed a diagnosis of adenoid cystic carcinoma. Transthoracic surgical resection was unsuccessful and the patient continues to be effectively managed with periodic bronchoscopic debulking and radiotherapy. This case highlights the diagnostic and therapeutic dilemmas posed by distal tracheal lesions and the need for specialist input for effective management.

Syncope due to tracheal adenoid cystic carcinoma

“…Syncope, however, is not a common presenting complaint. A CT of the chest and bronchoscopy are the modalities of choice for pre‐resection evaluation and diagnosis .…”

“…If the tracheal tumour is non‐resectable, radiotherapy is the modality of choice . The 5‐year survival rate of resectable tracheal ACC has been reported to be up to 52%, with a 10‐year survival rate of 29%.…”

“…Tracheal tumours comprise a small proportion of respiratory tract neoplasms, accounting for only about 2% of airway malignancies . Squamous cell carcinoma is the most common malignant tracheal tumour, followed by adenoid cystic carcinoma (ACC) and other rare tumours such as mucoepidermoid carcinoma, lymphoma, sarcoma, and melanoma .…”

“…ACC arises from glandular secretory cells, which are common in salivary glands. ACC is therefore most often found in the head and neck region but can also arise in the trachea, originating from submucosal seromucous glands . Symptoms are usually attributable to the intraluminal component of the tumour causing an obstruction of the airway, potentially leading to stridor, dyspnoea, wheezing, haemoptysis, and cough .…”

Adenoid cystic carcinoma of the nasal cavity—the great mimicker of chronic rhinitis: A rare case report with literature review

“…Lymph node involvement plays a major role in determining the prognosis of ACC involving the salivary glands. However, it has also been argued that, even in patients with sinonasal ACC, dissection of neck lymph nodes confers improvement in prognosis of the patients [13]. Perineural invasion, surgical margins, and staging also help to determine the prognosis of patients with nasal cavity ACC.…”