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Weekly Chest CasesArchive of Old Cases

Case No : 1081 Date 2018-07-17

  • Courtesy of Eun Jin Chae, M.D. / Asan Medical Center, University of Ulsan College of Medicine
  • Age/Sex 45 / F
  • Chief ComplaintPalpable neck mass
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8
  • Figure 9

Diagnosis With Brief Discussion

Diagnosis
Adenoid cystic carcinoma
Radiologic Findings
Fig 1. Chest radiograph shows mass-like increased opacity in mediastinum with thickening of right paratracheal stripe and mild shifting of tracheal lumen to the left side.
Fig 2-4. Low attenuation mass around the trachea, nearly encircling the tracheal circumference. Focal intraluminal protruding lesion at right posterior portion of tracheal lumen (Fig2).
Fig 5. The longitudinal extent of the tumor is greater than its transaxial extent.
Fig 6-9. Mass appears as low signal intensity (SI) on T1 weighted image (WI), high SI on T2 WI and homogenous enhancement. Focal nodular lesion invading intraluminally at the junction of cartilage and posterior membrane is noted, transluminal tumor with intraluminal and extraluminal growth pattern.
Biopsy via ultrasonography at the supraclavicular area revealed adenoid cystic carcinoma.
Brief Review
Adenoid cystic carcinoma, which was formerly named “cylindroma” and “adenocystic carcinoma,” occurs mainly in the salivary glands or central airways, such as the trachea and the main bronchi. It is a low-grade malignancy that is the second most common tracheal malignancy at histology (33%) after squamous cell carcinoma (48%) (1).
Adenoid cystic carcinomas usually arise in the lower trachea. Others are found in the mainstem bronchi; lobar bronchi; or, rarely, in the segmental bronchi and extrathoracic trachea.
The tumor has a striking tendency toward submucosal extension that manifests as an intraluminal mass of soft-tissue attenuation with extension through the tracheal wall, a diffuse or circumferential wall thickening of the trachea, a soft-tissue mass filling the airway, or a homogeneous mass encircling the trachea with wall thickening in the transverse and longitudinal planes (2-5).
The longitudinal extent of the tumor is greater than its transaxial extent (2). The tumors usually involve more than 180º of the airway circumference.
Although the most common site of the tumor in the trachea has been reported to be the posterolateral wall, the anterolateral wall—near the junction of the cartilage and the soft membranous parts of the trachea where mucous glands are most plentiful—may also be a common site of involvement (5).
References
1. Li W, Ellerbroek NA, Libshitz HI. Primary malignant tumors of the trachea: a radiologic and clinical study. Cancer 1990;66:894–899.
2. McCarthy MJ, Rosado-de-Christenson ML. Tumors of the trachea. J Thorac Imaging 1995;10:180–198.
3. Spizarny DL, Shepard JA, McLoud TC, Grillo HC, Dedrick CG. CT of adenoid cystic carcinoma of the trachea. AJR 1986;146:1129–1132
4. Kwak SH, Lee KS, et al. Adenoid Cystic Carcinoma of the Airways: Helical CT and Histopathologic Correlation. AJR 2004;183: 277-281.
5. Kim TS, Lee KS, Han J, Kim EA, Yang PS, Im J-G. Sialadenoid tumors of the respiratory tract: radiologic–pathologic correlation. AJR 2001; 177:1145-1150.
Keywords
Airway, Neoplasm_Malignant,

No. of Applicants : 83

▶ Correct Answer : 14/83,  16.9%
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Other , Korea (South) SEONGSU KANG
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Other , Korea (South) SUNGWON KIM
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - TB centre kasaragod. , India rikhy krishnan
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - , Japan YUMI MAEHARA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
▶ Correct Answer as Differential Diagnosis : 3/83,  3.6%
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - The Jikei university , Japan TAKU GOMI
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
▶ Semi-Correct Answer : 4/83,  4.8%
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - MAGNUM DIAGNOSTICS - Goa INDIA , India PARESH K DESAI
  • - University of New South Wales , Australia RASHID HASHMI
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Current Editor : Eun Jin Chae, MD, PhD. Email:ejinchae@gmail.com

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