Adenocystic carcinoma of the trachea

Case contributed by Dr Ian Bickle

Presentation

Middle aged female. Three week history of left paramidline neck lump. Symptomatic on exercising. Clinically thought to be a thyroid nodule. External compression of tracheal on the left at level of thoracic inlet. Remainder of fibroscopy normal.

Patient Data

Age: 43
Gender: Female
Modality: Photo

irregular external compression on the left side of the upper trachea (at the level of the thyroid gland).

Modality: Ultrasound

Rim of low soft tissue related to the left side of the trachea wall between 12 and 5 O'clock.

This is medial to and separate from the thyroid gland.

Normal thyroid gland.

 

Modality: CT

1.9cm soft tissue thickening of the left tracheal wall between 12 and 6 o'clock, at the level of the inferior thyroid gland. This is separate from the thyroid gland which is normal in appearance.

Luminal narrowing to 4 mm at this level.

Single 9 mm left submental lymph node. No other cervical lymphadenopathy.

The remainder the tracheobronchial tree is normal.

Lungs clear.

No mediastinal lymphadenopathy.
 

FNAC performed under ultrasound guidance

Modality: Pathology

Reporting giving the diagnosis from the ultrasound guided FNAC.

Case Discussion

This patient with shortness of breath on exertion and a firm nodule in the midline of the neck proved to have a upper tracheal wall based lesion.

The chief differentials in this scenario are a primary tumour and inflammatory conditions.  Both are uncommon.

Adenoid cystic carcinomas of the tracheobronchial tree are low-grade tumours. They are the 2nd most common primary tumour of the trachea, after squamous cell carcinoma, albeit all are uncommon.

Adenocystic carcinomas may occur in the salivary glands, airways and breast.

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Case Information

rID: 47677
Case created: 29th Aug 2016
Last edited: 7th Dec 2016
System: Head & Neck
Inclusion in quiz mode: Included

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