대한흉부영상의학회 Weekly Chest Cases

Case No : 878 Date 2014-08-25

Courtesy of Kyeho Lee / Dankook University Hospital
Age/Sex 39 / F
Chief ComplaintVoice change, dyspnea

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Diagnosis With Brief Discussion

Diagnosis: Adenoid Cystic Carcinoma
Radiologic Findings: Initial chest PA shows smooth narrowing of left main bronchus.
Chest CT shows enhancing homogeneous endobronchial mass involving carina to left main bronchus with marked narrowing of left main bronchus.
On bronchoscopy, endobronchial lesion appeared as a hypervascular submucosal mass nearly completely obstructing left main bronchus. Bronchoscopic biopsy was performed and was consistent with adenoid cystic carcinoma.
Brief Review: Adenoid cystic carcinoma generally occurs in the salivary glands. Pulmonary adenoid cystic carcinomas are rare, originating from submucosal glands of the airway and the majority developing in the lower trachea and mainstem bronchi. It is known to have no definite association with smoking and is prevalent in the 4th and 5th decade. Clinical manifestations are usually related to airway obstruction such as dyspnea, cough, stridor and wheezing.
On CT, adenoid cystic carcinoma appears as an intraluminal mass of soft tissue attenuation and has a tendency toward submucosal extension. The tumor may appear as a circumferential wall thickening, a homogeneous mass encircling the trachea or a soft tissue mass filling the airway. Longitudinal extent is usually greater than axial extent.
Adenoid cystic carcinoma is generally regarded as a slow growing, low grade malignancy, which has a tendency for local recurrence. Surgical resection should be performed whenever possible and in inoperable cases, radiotherapy and chemotherapy can be considered. Distant metastasis is usually absent until the late stage and metastasis to the lung is the most common.
References: 1. Kwak SH, Lee KS, Chung MJ et al. Adenoid Cystic Carcinoma of the Airways: Helical CT and Hisopathologic Correlation. AJR AM J Roentgenol. 2004;183:273-281
Keywords: Airway, Malignant tumor,

No. of Applicants : 63

▶ Correct Answer : 13/63, 20.6%

- Niigata City General Hospital , Japan Takao Kiguchi
- Scans world , India Philson Mukkada
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- SNUH , Korea (South) Eui Jin Hwang
- university of montreal , Canada Andrei Gorgos I
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Asan Medical Center , Korea (South) Hyung Jung Koo
- Asan Medical Center , Korea (South) Jooae Choe
- MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
- 異⑸ , Korea (South) Yunhee Jang
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 18/63, 28.6%

- The University of Tokyo Hospital , Japan Toshihiro Furuta
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- Seoul National University Hospital , Korea (South) Sang Min Lee
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Onomichi municipal hospital , Japan Hirofumi Mifune
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Kanto Rosai Hospital , Japan tomoko sako
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Ibaraki-gazou-shindan , Japan Shoichi Katoh
- Kizawa Memorial Hospital , Japan Yo Kaneko
- IRSA La Rochelle , France Denis Chabassiere
- McGill University Health Center , Canada Alexandre Semionov
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Onomichi municipal hospital , Japan Toshiyuki Komaki
- Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Gifu Central Hospital , Japan Haruo Watanabe
- Private sector , Greece Vasilios Tzilas

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 878 Date 2014-08-25

Discussion

No. of Applicants : 63