대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 1267 Date 2022-02-01

  • Courtesy of Wonju Hong / Seoul National University Hospital
  • Age/Sex 70 / M
  • Chief ComplaintVoice change (onset, 6 months ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Tracheal adenoid cystic carcinoma
Radiologic Findings
Fig 1. Chest radiograph shows no remarkable finding other than post-infectious sequelae with calcified granulomas in both upper lung zones.
Fig 2-3 (axial), 4 (coronal), 5 (sagittal). CT scans reveals 1.7-cm sized soft tissue lesion in tracheoesophageal groove, left upper paratracheal area. Adjacent focal wall thickening of left sided trachea is associated.
Fig 6. On PET-CT, the soft tissue lesion shows mild hypermetabolism with SUVmax 3.4.
Brief Review
There was no significant mucosal abnormality on bronchoscopy. On EBUS-TBNA, soft tissue lesion with heterogeneous echogenicity was observed, and EBUS-bronchoscopic biopsy was done. Pathologic diagnosis was confirmed as “adenoid cystic carcinoma.”

Adenoid cystic carcinoma (ACC) 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%). ACC has an equal sex distribution and commonly occurs in the 4th and 5th decades of life.
ACCs usually arise in the lower trachea, and others are found in the mainstem bronchi, lobar bronchi, or rarely in the segmental bronchi and extrathoracic trachea. ACC have a tendency toward submucosal extension and manifest with circumferential and infiltrative growth. Because of its submucosal origin, it tends to have an intact epithelium and a smooth contour.
On CT, the tumor manifests as an intraluminal mass with extension through the tracheal wall, a diffuse or circumferential wall thickening of the trachea, a soft-tissue mass filing the airway, or a homogenous mass encircling the trachea with wall thickening in the transverse and longitudinal planes. Shapes and margins are variable: polypoid or broad-based and smooth, lobulated, or irregular.
On a previous study, ACC showed variable FDG uptake depending on the grade of differentiation; however, avid (maximum SUV > 6) and homogeneous FDG uptake were found in the high- and intermediate-grade tumors rather than the low-grade tumors.
References
1. Kwak SH, Lee KS, et al. Adenoid Cystic Carcinoma of the Airways: Helical CT and Histopathologic Correlation. AJR 2004;183: 277-281.
2. 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
3. Jeong SY, Lee KS, Han J, et al. Integrated PET/ CT of salivary gland type carcinoma of the lung in 12 patients. AJR Am J Roentgenol 2007;189:1407– 1413.
Please refer to
Case 1229 Case 418 Case 89
Keywords

No. of Applicants : 89

▶ Correct Answer : 18/89,  20.2%
  • - , Japan JUN KANZAWA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - , United Kingdom SAMSON KADE
  • - CHCB , France LE GUEN RAPHAEL
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Columbia asia hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - , Japan SOSUKE HATANO
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - TAKANA HAYASHI
  • - , Japan KAZUMA TERAUCHI
  • - , Japan YUMI MAEHARA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Korea (South) WONJU HONG
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
▶ Correct Answer as Differential Diagnosis : 28/89,  31.5%
  • - , Japan HIROAKI ARAKAWA
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - Manipal HealthMap , India SHASHANK SOOD
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Osaka University , Japan AKINORI HATA
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) SUNHYANG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - , Korea (South) YEONG UK HWANG
  • - , United States HIROAKI TAKAHASHI
  • - , Argentina MARCOS MESTAS NUEZ
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - TB centre kasaragod. , India rikhy krishnan
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Korea (South) NAEUN OH
  • - , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 2/89,  2.2%
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Japan CHIAKI SATO
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

This website is optimized for IE 10 and above.