Adenoid cystic carcinoma of the tracheobronchial tree
Adenoid cystic carcinomas of the tracheobronchial tree are a type of low-grade tracheal tumor. They are considered to be the second most common primary tumor of the trachea.
They are usually first recognized in patients in their 4th and 5th decades. There is no recognized gender predilection.
Symptoms in patients with adenoid cystic carcinoma are usually related to airway obstruction and therefore includes dyspnea, cough, stridor, wheezing, and hemoptysis.
The tumors may be histologically classified into tubular, cribriform, and solid subtypes 6. The tumors are usually low grade but may occasionally undergo high-grade transformation 7.
There is no association with cigarette smoking or with other carcinogens. 9
Adenoid cystic carcinomas usually arise in the lower trachea. Less commonly they are found in the mainstem bronchi (where carcinoid tumors are much more common), lobar bronchi and, rarely, in the segmental bronchi and extrathoracic trachea.
On chest CT, these tumors have a notable tendency toward submucosal extension and typically manifest as:
- intraluminal mass of soft-tissue attenuation with extension through the tracheal wall, or
- diffuse or circumferential wall thickening of the trachea, a soft-tissue mass filling the airway, or
- homogeneous mass encircling the trachea with wall thickening in the transverse and longitudinal planes
The longitudinal extent of the tumors is greater than their axial extent and the tumors usually involve more than 180° of the airway circumference.
They can be variable in shape ranging from polypoid to broad-based. Their margins are also variable and range from smooth to lobulated to irregular. Intratumoral calcification is rare.
- 1. Kwak SH, Lee KS, Chung MJ et-al. Adenoid cystic carcinoma of the airways: helical CT and histopathologic correlation. AJR Am J Roentgenol. 2004;183 (2): 277-81. doi:10.2214/ajr.183.2.1830277 - Pubmed citation
- 2. Hajdu SI, Huvos AG, Goodner JT et-al. Carcinoma of the trachea. Clinicopathologic study of 41 cases. Cancer. 1970;25 (6): 1448-56. Pubmed citation
- 3. Kim TS, Lee KS, Han J et-al. Sialadenoid tumors of the respiratory tract: radiologic-pathologic correlation. AJR Am J Roentgenol. 2001;177 (5): 1145-50. Pubmed citation
- 4. Lin C. Adenoid cystic carcinoma of the trachea and bronchus – a clinicopathologic study with DNA flow cytometric analysis and oncogene expression. Eur J Cardiothorac Surg. 2002;22 (4): 621-625. Eur J Cardiothorac Surg (full text) - doi:10.1016/S1010-7940(02)00406-2
- 5. Nomori H, Kaseda S, Kobayashi K et-al. Adenoid cystic carcinoma of the trachea and main-stem bronchus. A clinical, histopathologic, and immunohistochemical study. J. Thorac. Cardiovasc. Surg. 1988;96 (2): 271-7. Pubmed citation
- 6. Ishida T, Nishino T, Oka T et-al. Adenoid cystic carcinoma of the tracheobronchial tree: clinicopathology and immunohistochemistry. J Surg Oncol. 1989;41 (1): 52-9. Pubmed citation
- 7. Seethala RR, Hunt JL, Baloch ZW et-al. Adenoid cystic carcinoma with high-grade transformation: a report of 11 cases and a review of the literature. Am. J. Surg. Pathol. 2007;31 (11): 1683-94. doi:10.1097/PAS.0b013e3180dc928c - Pubmed citation
- 8. Jeong SY, Lee KS, Han J, Kim BT, Kim TS, Shim YM, Kim J. Integrated PET/CT of salivary gland type carcinoma of the lung in 12 patients. AJR. American journal of roentgenology. 189 (6): 1407-13. doi:10.2214/AJR.07.2652 - Pubmed
- 9. William D. Travis, World Health Organization, International Agency for Research on Cancer, International Academy of Pathology. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. ISBN: 9789283224181