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Weekly Chest CasesArchive of Old Cases

Case No : 1447 Date 2025-07-14

  • Courtesy of Seung-Jin Yoo, Yo Won Choi / Hanyang University Medical Center
  • Age/Sex 61 / F
  • Chief ComplaintHoarseness
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Adenoid cystic carcinoma
Radiologic Findings
Fig 1. Axial CT scan shows mildly enhancing, irregular circumferential wall thickening of trachea at the thoracic inlet level.
Fig 2-3. Coronal reformatted CT image and 3D volume rendering image of the trachea,shows long segmental wall thickening of trachea with polypoid mass, with luminal narrowing of trachea.
Fig. 4 and contrast-enhanced T1-weighted Dixon water-only image show extensive longitudinal extension of the tumor, with a longitudinal diameter of 6cm, a polypoid lesion from right lateral wall of the trachea with luminal narrowing.
Fig 5. Bronchoscopy reveals a polypoid lesion of the trachea with circumferential hyperemic changes along the mucosa.
Brief Review
Adenoid cystic carcinoma (ACC) is the most common salivary gland malignancy arising within airways, most often affecting the trachea or central bronchi. Smoking is not an etiologic risk factor, the sex distribution is equal, and a younger patient population is typically affected, with almost one half of patients less than 30 years of age. As ACC arises within the submucosa, the mucosa typically remains intact and hemoptysis is relatively uncommon. Therefore, presenting symptoms are more often related to airway narrowing (dyspnea, cough, stridor, wheezing, and few cases manifest as an incidental finding. The prognosis is intermediate (5 year survival rate of 52%–80%), given the high frequency of positive surgical margins from submucosal and perineural spread, resulting in local recurrence.
The typical CT finding of ACC is a soft tissue mass, commonly located in the proximal half of the trachea, and more frequently along the posterolateral wall. The tumor typically demonstrates an extensive submucosal and transmural spread and manifests with circumferential and infiltrative growth, extensive longitudinal growth, transmural growth, poorly defined borders, and mild enhancement. Metastatic disease is infrequent, affecting 10% or less. The cephalocaudal extent of the tumor may be underestimated at CT, therefore evaluation with 3D or multiplanar reconstruction is required.
References
1. Girvin, Francis, et al. Malignant and benign tracheobronchial neoplasms: comprehensive review with radiologic, bronchoscopic, and pathologic correlation. Radiographics 2023 43:9.
2. Choi MJ, Kang H. CT Findings of Central Airway Lesions Causing Airway Stenosis-Visualization and Quantification: A Pictorial Essay. Taehan Yongsang Uihakhoe Chi. 2021 Nov;82(6):1441-1476.
Keywords

No. of Applicants : 74

▶ Correct Answer : 43/74,  58.1%
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Korea (South) DONG-HO BANG
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Teikyo University Hospital , Japan CHIAKI SATO
  • - Chonbuk National University Hospital , Korea (South) EUNCHONG LEE
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - Chonbuk National University Hospital , Korea (South) YONG HWAN JO
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - , Korea (South) KANGHWI LEE
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Radiology fellow , United States KARTHIK RAYASAM
  • - Other , Korea (South) CHAEHUN LIM
  • - Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
  • - , Korea (South) HEONSEOK LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - , Japan MASAMICHI IWAI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - , Korea (South) DAWON PARK
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Kyoto University , Japan SHO KOYASU
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
  • - Fukuoka university , Japan KEISUKE SATO
  • - Chonbuk National University Hospital , Korea (South) SUBIN LEE
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ehime University , Japan TOMOHISA OKADA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 16/74,  21.6%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Oita university , Japan AYUMI KAMEI
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Chonnam National University Hospital , Korea (South) HYUNG-JOO OH
  • - Mie university , Japan SHIKO OKABE
  • - GHICL , France MANUEL TOLEDANO
  • - Regina Elena Hospital, Department of Radiology, Rome , Italy ROBERTO CASTELLANA
  • - , Japan MATSUNO MAI
  • - Kobe Children , Japan SHUHEI NORIMOTO
  • - Shiga University of Medical Science , Japan RYO UEMURA
  • - , Japan JUN YOSHIDA
▶ Semi-Correct Answer : 3/74,  4.1%
  • - , Italy PAOLO BALDASSARI
  • - QATIF CENTRAL HOSPITAL , Saudi Arabia HANI M ALSALAM
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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