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Weekly Chest CasesArchive of Old Cases

Case No : 950 Date 2016-01-11

  • Courtesy of Jung Hwa Hwang / Soonchunhyang University Seoul Hospital
  • Age/Sex 47 / F
  • Chief ComplaintDry cough (onset, 6 months ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Adenoid cystic carcinoma of the left main bronchus
Radiologic Findings
A chest PA radiograph reveals no remarkable finding in the lungs, mediastinum and pleura. On contrast enhanced chest CT scan of axial and coronal reformation, irregular enhancing wall thickening with intraluminal protrusion is noted in distal left main bronchus. Mild air trapping is seen in left upper lobe on lung window scan.
Increased uptake is seen in the lesion of left main bronchus on FDG PET-CT scan (SUVmax 3.29). On bronchoscopy, submucosal mass with endobronchial protrusion was identified and which was associated with mucosal nodularity. Bronchoscopic biopsy specimen revealed poorly differentiated carcinoma with focal glandular growth pattern and adenoid cystic carcinoma was confirmed with immunohistochemistry.
Brief Review
Adenoid cystic carcinoma (ACC) is the most common type of lung cancer of salivary gland origin in the central airway. ACC has an equal sex distribution and commonly occurs in the 4th and 5th decades of life. ACC tends to occur in the central airways such as the trachea, main bronchus, or lobar bronchus and a peripheral or segmental location is uncommon. ACC has a striking tendency toward submucosal extension and manifests with circumferential and infiltrative growth. The longitudinal extent of the tumor is greater than its transaxial extent.
Chest radiographs are usually interpreted as normal findings. However, intraluminal filling defect with irregular, smooth, or lobulated contours of the airways can be identified and the extraluminal component may be visualized if it is large enough to distort the normal mediastinal contour. On CT, the tumor has a striking tendency toward submucosal extension that manifests as an intraluminal mass of soft tissue attenuation with extension through the airway wall, a diffuse or circumferential airway wall thickening, a soft tissue mass filling the airway, or a homogeneous mass encircling the airway with wall thickening. On PET-CT scan, variable FDG uptake has been reported depending on the grade of tumor differentiation. Distant metastasis occurs late in the disease course. Metastasis is very unusual and regional lymph node metastasis may be present in up to 10% of the primary tumors at the time of diagnosis.
Please refer to
Case 115, Case 209, Case 312, Case 418, Case 804, Case 878,
KSTR imaging conference cases 2010 Sprng  Case 1 ,
KSTR Imaging conference 2010 Summer  Case 10,
References
Kwak SH, Lee KS, Chung MJ, Jeong YJ, Kim GY, Kwon OJ. Adenoid cystic carcinoma of the airways: helical CT and histopathologic correlation. AJR 2004;183:277–281
Park CM, Goo JM, Lee HJ, Kim MA, Lee CH, Kang MJ. Tumors in the tracheobronchial tree: CT and FDG PET features. RadioGraphics 2009; 29:55–71
Keywords
Airway, Malignant tumor,

No. of Applicants : 89

▶ Correct Answer : 33/89,  37.1%
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - XMU affiliated No.1 Hospital , China Qing Qiang Guo
  • - Kyoto University , Japan Akihiko Sakata
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Gangneung Asan hospital Radiology , Korea (South) Sang Lee
  • - university of montreal , Canada Andrei Gorgos I
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan medical center , Korea (South) Jaewook Lee
  • - Niigata University , Japan Atsushi Uehara
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - asan medical center , Korea (South) yunsun song
  • - , Korea (South)
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - , Korea (South) BAEK YOOLIM
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - University of Tsukuba Hospital , Japan Shioto Oda
  • - Ibaraki-gazou-shindan , Japan Shoichi Katoh
  • - Medicheck health care , Korea (South) Chae Lim
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - University of Tsukuba , Japan Toshitaka Ishiguro
▶ Correct Answer as Differential Diagnosis : 17/89,  19.1%
  • - Soonchunhyang University Seoul Hospital , Korea (South) Boda Nam
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - GHICL , France manuel toledano
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Centre Imagerie de Fribourg , Switzerland Benoit RIZK
  • - Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Shinmatsudo Central General Hospital , Japan Taku Tajima
  • - University of Tsukuba, Dept of Radiologt , Japan Manabu Minami
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Asan , Korea (South) Sania ALBlushi
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
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