ADENOID CYSTIC CARCINOMA TRACHEA UNUSUAL CASE

Abstract

Adenoid cystic carcinoma of the lower respiratory tract is a rare indolent
neoplasm with prolonged survival, propensity for recurrences and metastasis years after initial
therapy(1). We report the presentation, treatment and outcome an uncommon tumor adenoid cystic
carcinoma of trachea.METHOD We collected retrospective data about our patient, treated in 2007
from our Hospital Information system. RESULTS 40 year old gentleman presented with the
complaints of cough and progressive dyspnea of 9 months duration and hoarseness for 1 month
duration. Bronchoscopy showed shiny soft polypoid lesion almost completely obstructing the tracheal
lumen. MRI of the neck showed there was a mid-tracheal growth from 4 cm to 5.7 cm of carina
partially obstructing the lumen with peri-tracheal fat planes involvement and few peritracheal nodes.
He underwent tracheal resection with primary anastomosis. Histopathology specimen was reported
as Intermediate to high grade adenoid cystic carcinoma with perineural invasion, infiltrating entire
thickness with extension into soft tissue involving the margins. He subsequently received
postoperative adjuvant radiation therapy using Cobalt 60 beam and a dose of 40 Gy in 20 fractions to
midplane by AP-PA technique during phase 1 and 20 Gy in 10 fractions to tumor volume with oblique
pair beams during phase 2. He tolerated the treatment well. He was disease free till August 2015 (8
years of follow up). CONCLUSION ACC of the trachea is a rare presentation of an indolent neoplasm
.Successful tumor control with optimal conventional techniques still holds promise in the current era of
conformal techniques.The challenge is to find the best therapeutic regimen aiming for a true cure and
also to discover the best systemic therapy by expounding on molecular studies leading to targeted
cell therapy to address a currently notable chemoresistant cancer. A multicenter long-term study
including ACC of the head and neck region will be desirable.