대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 312 Date 2003-10-18

  • Courtesy of Seo-Hyun Kwak, M.D., Kyung Soo Lee, M.D. / Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • Age/Sex 33 / M
  • Chief ComplaintThroat discomfort for 9-7 years
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Adenoid cystic carcinoma, trachea
Radiologic Findings
Chest posteroanterior radiograph shows intraluminal mass obliterating midtracheal segment along left tracheal wall. Axial noncontrast CT scan obtained at level of thoracic inlet demonstrates polypoid and infiltrative tumor growth originating from left lateral tracheal wall. Parasagittal reformatted CT scan shows polypoid tracheal mass.
Brief Review
Adenoid cystic carcinoma is a low-grade malignancy that arises from the epithelium of the glands lining the mucosa of the upper and lower respiratory tract. It is the most common carcinoma of minor salivary tissue but rarely affects the trachea. Of respiratory tract adenoid cystic carcinomas, <1% arise in the trachea. The age of patients with adenoid cystic carcinoma of the trachea ranges from the third to the ninth decade of life, with the average age being the mid 40s. There is no sexual or radial predilection and no association with cigarette smoking. Hoarseness may occur if the tumor is located in the proximal trachea and involves the glottis, or when there is invasion of the recurrent laryngeal nerve. Microscopically, the neoplasm is composed of sheets of small, uniform cells, often arranged ih a cribriform of tubular pattern. This pattern prompted the former name for this tumor, cylindroma. A histologically solid patern, devoid of cystic spaces, is reported to be associated with a more locally aggressive neoplasm. Adenoid cystic carcinomas are nonencapsulated and are locally invasive, exhibiting a tendency to spread submucosally, along perineural spaces or along the perineural lymphatics. Grossly they appear polypoid or borad-based and infiltrating, and the tumor’s surface may be smooth or ulcerated. Typicaly, adenoid cystic carcinomas arise from the posterolateral wall of the lower two thirds of the tracea. Radiological findings of adenoid cytic carcinoma are similar to those of squamous cell carcinoma. An intraluminal filling defect with irregular, smooth, or lobulated contours is most common. The attachment to the tracheal wall may be broad or pedunculated. Circumferential invasion creates an appearance of tracheal stenosis. Invasion into the mediastinum may cause a paratracheal mass, whereas extension into a main bronchus may cause atelectasis or pneumonia or both. CT findings are encircling infiltration or intraluminal growth of the tracheal wall in the transverse and longitudinal planes. The treatment of adenoid cystic carcinoma involves surgical resection and anastomosis when possible.
References
1. McCarthy MJ et al. Tumors of the trachea. J Thorac Imaging 1995;10:180-198

2. Na DG, Han HM, Kim KH, Chang KH, and Yeon KM. Primary adenoic cystic carcinoma of the cervical trachea mimicking thyroid tumor : CT evaluation. J Comput Assist Tomogr 1995;19:559-563
3. Spizarny DL, Schepard JO, Mcloud TC, et al. CT of adenoic cystic carcinoma of the trachea. AJR 1986;146:1129-1132
Keywords
Airway, Malignant tumor,

No. of Applicants : 29

▶ Correct Answer : 14/29,  48.3%
  • - Busan Armed Force Hospital, Busan, Korea Young-Min Cho
  • - Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
  • - Chungju Saeroun hospital, Korea Cheolkyu Jung
  • - Chung Li Ten-Chen Hospital,Taiwan Kui-Lin Zheng
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Mallinckrodt Institute of Radiology, USA Jin Mo Goo
  • - Ohio State University Med Cntr, Ohio, USA Sumit Seth
  • - Pusan National University Hospital, Pusan, Korea Hye-Jeung Choo
  • - Pusan National University Hospital, Pusan, Korea Soo Jin Kim
  • - Radiology Department UZ Gent, Belgium Kristof De Cuyper
  • - Seoul National University Hospital, Korea Jung-Gi Im
  • - Shin Kong Wu Ho-Su Memorial Hsopital, Taipei, Taiwan Chen-Chun Lin
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
▶ Semi-Correct Answer : 13/29,  44.8%
  • - Annecy Hospital, France Gilles Genin
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Cheongju St. Mary Hospital, Korea Jeong-Geun Yi
  • - Chungju Hospital, Konkuk University, Korea Chang Hee Lee
  • - CHU Nancy-Brabois, France Denis Regent
  • - CIM Saint Dizier, France JC Leclerc
  • - Ewha Women's University Hospital, Korea Sung Shine Shim
  • - Geneva Hospital, Switzerland Dumont Philippe
  • - Kyunghee University Hospital, Korea Kyung Ran Ko
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
  • - Upasana Hospital, Kollam, India Joy A Thomas
  • - Yechon Kwon's Hospital, Korea Yu Jang Pyun
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