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
irregular external compression on the left side of the upper trachea (at the level of the thyroid gland).
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.
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 US guidance
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 tumor and inflammatory conditions. Both are uncommon.
Adenoid cystic carcinomas of the tracheobronchial tree are low-grade tumors. They are the 2nd most common primary tumor 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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