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Weekly Chest CasesCases by Disease Category

Case No : 1285 Date 2022-06-07

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  • Courtesy of Jung Hee Hong, Jin Hee Lee, Jin Young Kim / Keimyung University Dongsan Medical Center
  • Age/Sex 65 / F
  • Chief Complaintpre-operation work-up for pituitary adenoma
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Tracheal adenoid cystic carcinoma
Radiologic Findings
Figs 1. Chest PA shows a small nodule in cervical trachea.
Fig 2-4. Mediastinal window setting of the chest CT scan shows about 9x11x13 mm sized, well-demarcated enhancing polypoid nodule arising from the lateral wall of the cervical trachea.
Fig 5. FDG-PET CT scan reveals a small hypermetabolic nodule in the cervical trachea.
Brief Review
Primary tracheal tumors are rare, with an incidence of only 0.2 per 100,000 persons per year. Adenoid cystic carcinoma (ACC) is the second most common type of tracheal malignancy, preceded by squamous cell carcinoma.
ACC is usually first recognized without sex predilection in patients in their 40s, and smoking does not affect the incidence. Symptoms in patients with adenoid cystic carcinoma are usually related to airway obstruction. Dyspnea, cough, stridor, wheezing, and hemoptysis are the most common complaints. ACC usually arises in the lower trachea. Others are found in the mainstem bronchi; lobar bronchi; or, rarely, in the segmental bronchi and extrathoracic trachea.
On CT, the tumor has a striking tendency toward a 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. ACC in the extrathoracic trachea may directly invade the thyroid gland and tracheal cartilages. Distant metastasis occurs late in the disease course.
References
1. Azar, Taraneh, Fadi W. Abdul
Please refer to
Case 1267 Case 1229 Case 418 Case 89
Keywords

No. of Applicants : 103

▶ Correct Answer : 52/103,  50.5%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - , France ANNE-LAURE LEJEUNE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Canada ASHISH GUPTA
  • - CHCB , France LE GUEN RAPHAEL
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) MINJI KIM
  • - , Korea (South) SUNHYANG LEE
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Other , Korea (South) HYEON IL CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chonbuk National University Hospital , Korea (South) HYUNSOO BAE
  • - Other , Korea (South) CHAEHUN LIM
  • - , Korea (South) YEONG UK HWANG
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , United Arab Emirates NEHAR RANJAN CHAKRABORTY
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Inje University Ilsan Paik Hospital , Korea (South) SOYEUN PARK
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Hanyang University Hospital , Korea (South) SUNJIN RYU
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - , Japan YUMI MAEHARA
  • - , Japan YUKI HAYASHI
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 32/103,  31.1%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Other , Korea (South) HWANGHEE JO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Hallym University Dongtan Medical Center , Korea (South) KYOUNG YEON LEE
  • - , China FANG YING GEN
  • - Osaka University , Japan AKINORI HATA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - HHS , Canada S LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - , United States HIROAKI TAKAHASHI
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Other , Korea (South) SEONG WON JANG
  • - Pusan National University Yangsan Hospital , Korea (South) WOOKON SON
  • - , Japan SOTA MASUOKA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Chungbuk National University Hospital , Korea (South) HYE SOO CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Gyeongsang National University Hospital , Korea (South) BYEONG JU KOO
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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