Adenoid Cystic Carcinoma Of Trachea Research Articles

CODE BLUE in a patient with tracheal stent: Are we fully equipped?

Sir, Airway stents have long been used to maintain luminal integrity of compromised airway in case of obstruction and malignancy.[1] The complications associated with airway stent placement are malposition, haemorrhage, airway rupture during placement, migration, impaction, formation of granulation tissue, and stent fracture.[2] We present here a challenging case of an airway emergency in a patient with a tracheal stent inserted for a malignancy. A 29-year-old woman diagnosed with adenoid cystic carcinoma of trachea 2 years back had undergone debulking of tumor, tracheal stenting with a metallic stent, and chemo-radiotherapy elsewhere. On the second day of admission, CODE BLUE was activated in view of acute onset biphasic stridor, with air hunger and low oxygen saturation. Despite resuscitation measures, the patient had persistent tachycardia, tachypnea, and hypoxia with non-rebreathing mask (15 L/min of O2). A review of Computed Tomography (CT) neck revealed a tracheal narrowing 1.7 cm distal to vocal cords with narrowest diameter of 6 mm [Figure 1a], complicating an imminent intubation for the patient. She was pre-oxygenated with a non-invasive ventilation mask. Intravenous boluses of fentanyl 75 mcg, muscle relaxant (suxamethonium 100 mg) was given and intubated with a 5.0 mm ID cuffed endotracheal (ET) tube through direct laryngoscopy. A chest x-ray confirmed the position of the ET tube but it fell short of bypassing the tracheal stent, which was reflected in decreased tidal volumes and increased peak pressure. As the length of the 5.0 mm ET tube (23 cm) was not enough to bypass the stent, we had to increase the length by rail roading another 6.5 mm ID tube at the distal end, after removing the connector [Figure 1b]. This step significantly improved the tidal volumes (350-400 ml) without much rise in peak pressure with marked improvement in the oxygenation of patient in the blood gas analysis. Patient underwent bronchoscopic biopsy and excision of mass around the stent after putting on veno-venous extracorporeal membrane oxygenation for oxygenation. Post-procedure ET tube was removed after suctioning and intubated with 7.0 mm ID ET tube for postoperative ventilation and eventually extubated.Figure 1: (a) image showing CECT neck with tracheal stent in situ. (b) image showing the proximal end of 6.5 mm ID tube is cut and railroaded over 5.0 mm ID tube to increase the lengthSecuring airway in an in-hospital CODE blue needs quick thinking and swift action. This case highlights a unique situation where a tracheal stent precluded a “conventional intubation.” A tracheostomy could damage the stent and a supraglottic airway device risked aspiration.[3] A fibre-optic bronchoscope is essential and the best available option to ensure correct position of the tube within the stent or just above the stent. It can also avoid stent-related complications but is not readily available everywhere.[4] No formal guidelines are available in terms of airway management with tracheal stents in situ. A literature search also revealed paucity of data with regard to management in similar case scenarios. Microlaryngeal surgery (MLS) tubes can be made available in the CODE BLUE kits anticipating such scenarios, as they are longer than conventional ET tubes with same internal diameter.[5] This case though uncommon highlights the need to incorporate airway management in cases of tracheal stents as part of our teaching curriculum. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Adjuvant Radiotherapy in Primary Adenoid Cystic Carcinoma of Trachea- A Case Series

Objective: Only 1% of all malignancies of the respiratory system are adenoid cystic carcinoma (ACC) of the trachea. ACC’s clinical course is frequently lengthy. Most patients first experience dyspnea, which looks like asthma or chronic bronchitis. The primary treatment choice is surgical resection followed by radiotherapy due to the small surgical margins of the tumor. When surgery is not an option, most cancers respond to radiotherapy, which frequently produces prolonged periods of remission. Method: We present three cases of primary ACC of the trachea. One case involved a 49-year-old man who had tracheal ACC treated surgically and then with radiation. Another 65-year-old female patient underwent surgical resection and adjuvant radiotherapy to treat her recurrent metastatic posterior thoracic wall tumor. At one month follow-up, our patient showed no evidence of disease, and a 38-year-old male presented with complaints of dry cough, breathlessness, and hemoptysis. Bronchoscopy showed a polypoidal growth obstructing more than 2/3rd of the tracheal lumen. The patient underwent excision of the tracheal tumor followed by adjuvant radiotherapy. Conclusion: Postoperative adjuvant radiotherapy plays an important role in management of ACC and it should be considered in all the patients of ACC to decrease the risk of recurrent disease.

Management of Tracheal Stent Granulations: A Novel Approach

This is a case of a 29 year old female, diagnosed with adenoid cystic carcinoma of trachea who had previously undergone bronchoscopy, de-bulking of the tumour, stenting of trachea with a metallic stent followed by a course of chemo-radiotherapy. She then presented to our hospital with complaints of breathing difficulty. On rigid telescopy of larynx, a metallic stent was visualised below the level of the vocal cords with a mass lesion over it narrowing the airway. Contrast enhanced CT scan of neck and thorax showed a tracheal stent with soft tissue thickening at proximal and distal ends. By using VV-ECMO, in this patient we were able to perform satisfactory airway evaluation, biopsy of mass at upper and lower end of tracheal stent using a rigid bronchoscope with Hopkins telescope and optical forceps and KTP laser assisted excision of granulation tissue with full endoscopic visualisation and without any complications.

Adenoid Cystic Carcinoma of Trachea: Two Case Report

Primary carcinoma of trachea also known as adenoid cystic carcinoma, adenocyst, malignant slyndroma. This tumor mostly occurs in the salivary gland (minor), lacrimal gland, trachea, paranasal sinuses and others. And also can occur in female reproductive tract, Bartholin gland and cervix. Carcinoma trachea is one of the very rare cases. Adenoid cystic carcinoma (ACC) of trachea is one of the very rare cases. This type of carcinoma is very slow growing cancer. Usually patients present with dyspnoea, asthma or bronchitis. After confirmed diagnosis 1st indication is surgery, if patient is not fit for surgery, can go to the laser ablation then Radio therapy. Our two cases of adenoid cystic carcinoma of trachea are, one is 30 years old female patient, her initial diagnosis was May, 2012 and another one 48 old male patient with history of smoking, his initial diagnosis was on July 2003. Both the patients are still alive. Now the female patient has bilateral pulmonary metastasis from September 2017. After treatment carcinoma of trachea can be metastasised to lung, brain, liver or others organs. Usually it happened after 12-15 years from initial diagnosis. However carcinoma of trachea has good prognosis if early diagnosed and treated.
 KYAMC Journal Vol. 10, No.-1, April 2019, Page 60-63

Adenoid cystic carcinoma of trachea: Findings on 18F FDG positron emission tomography-computed tomography

Adenoid cystic carcinoma (ACC) of the trachea is the second most common tumor of trachea after squamous cell carcinomas. It arises from the submucosal layer and predominantly has a rapid locoregional spread. We describe the 18F FDG positron emission tomography-computed tomography findings of a 51-year-old woman, a biopsy-proven case of ACC of trachea who underwent the scan for initial staging.

Primary Adenoid Cystic Carcinoma of Trachea: Managed by Tracheal Resection and Reconstruction

Primary Adenoid Cystic Carcinoma of Trachea: Managed by Tracheal Resection and Reconstruction

気管および主気管支原発の腺様嚢胞癌 : 病理組織学的所見, CT 像, および気管支鏡所見の検討

気管および主気管支原発の腺様嚢胞癌 : 病理組織学的所見, CT 像, および気管支鏡所見の検討

Adenoid cystic carcinoma in trachea: A rare presentation

Primary tracheal tumors are rare. Adenoid cystic carcinoma of trachea is even rarer. It occurs as a polypoidal mass in trachea presenting with dyspnea and respiratory distress due to tracheobronchial obstruction. We report a case of young male presenting with dyspnea for some time. CT scan revealed mass in trachea obliterating its lumen. Histopathological examination conirmed the diagnosis.

Adenoid cystic carcinoma of the trachea: a clinico-pathological analysis

Primary malignant tracheal tumors are not common and adenoid cystic carcinoma (ACC) of trachea is very rare. The diagnosis is often delayed due to the atypica symptoms. We report an extremely rare case of ACC of proximal trachea, in a 55-year-old female who presented with a 12 month history of progressive dyspnea. Laryngoscopy and computed tomography revealed a broad-based polypoidal mass arising from posterior wall of the proximal trachea. Biopsy confirmed the diagnosis of ACC. The patient underwent a complete surgical resection and post operative radiotherapy. Six months follow-up of the patient did not reveal local recurrence or distantmetastases. The literature of tracheal ACC is reviewed.

Inoperable Adenoid Cystic Carcinoma of Trachea: Complete Remission after Multi-modality Treatment

Adenoid cystic carcinoma is a malignant tumour commonly originating from the salivary glands, but can rarely arise from the upper airway and be life threatening when the central airway is compromised. While surgical resection is considered the definitive treatment, adenoid cystic carcinoma of the airway is frequently unresectable for a variety of reasons including tumour size, location, local extension, or patient comorbidities. There is no consensus on the best treatment for locally advanced inoperable adenoid cystic carcinoma of trachea. This case report describes a 32-year-old woman with inoperable adenoid cystic carcinoma of trachea successfully managed in our institution using a multimodality approach: endoscopic stenting followed by 3-dimensional conformal radical radiotherapy. Previous literature on the management of this rare disease is

Adenoid cystic carcinoma of trachea masquerading as papillary thyroid cancer - a case report

Introduction : Thyroid nodules are common clinical entity. Though indolent in nature, they can be invasive too. However, tracheal tumours are relatively rare and come into clinical picture when patients show symptoms of tracheal obstruction. Case report: We report a 45 year old female who presented with cytology proven papillary carcinoma thyroid with clinical and radiological evidence of tracheal involvement. Patient underwent total thyroidectomy along with en bloc segmental tracheal resection with end to end anastomosis. However the pathology revealed adenoid cystic carcinoma of trachea. Conclusion: Adenoid cystic carcinomas of trachea are rare tumors and they can present as thyromegaly secondary to thyroid involvement. Surgeons should have a high index of suspicion for diagnosis. Surgical resection forms the mainstay of treatment.

Adenoid cystic carcinoma of trachea: A rare tumor managed by diode laser and tracheal resection

Introduction: Adenoid cystic carcinoma (ACC) is a rare type of cancer, which mostly occurs in the salivary glands of the head and neck, and has also been reported in other parts including trachea as case reports or small case series. The patient may present as asthma or acute tracheobronchial obstruction and may require urgent management to relive obstruction. It has a propensity to spread along both submucosal and perineural planes which are responsible for late local recurrence even after complete resection. The best results can be obtained by resection with or without adjuvant radiotherapy. Case Report: We report a rare case of endoluminal adenoid cystic carcinoma of the distal trachea presenting with acute tracheal obstruction managed bronchoscopically with high power diode laser followed by segmental resection of trachea and radiotherapy with 18 months of follow-up with no evidence of recurrence. Conclusion: There are only very few reports available for the use of diode laser with flexible bronchoscope in tracheobronchial adenoid cystic carcinoma. However, rarity of such tumors makes it impossible to obtain such data. This technique, in such rare tumors, is safe with almost no or limited morbidity from our experience and available data.

Adenoid Cystic Carcinoma of Trachea Treated with Tumor Curettage and Adjuvant Intensity Modulated Radiation Therapy

Primary tracheal tumors are rare, accounting for only 0.2% of all thoracic cancers. Adenoid cystic carcinoma (ACC) is the second most common tracheal malignancy. Most ACC patients present with dyspnea, and the symptoms often mimic those of asthma or chronic bronchitis. We report the case of a 79-year-old female patient who presented with dyspnea and wheezing, but showed poor response to bronchodilator treatment. Bronchoscopy revealed a lobulated tumor over the lower third of the trachea, and biopsy revealed adenoid cystic carcinoma. Tumor curettage followed by intensity modulated radiation therapy was performed, and the patient eventually recovered. This case demonstrates that such less invasive management also leads to a favorable outcome.

Immunohistochemical analysis of CA19-9, SLX, and CA125 in adenoid cystic carcinoma of trachea and bronchus

We examined the usefulness of 3 carbohydrate antigens, CA19-9, CA125, and SLX, as tumor markers in adenoid cystic carcinoma of the trachea and bronchus, immunohistochemically and clinically. CA19-9 and SLX were detected immunohistochemically in normal tracheal and bronchial glands, but CA125 was not detected. Bronchial secretions obtained from 7 patients without cancer contained high levels of these 3 carbohydrate antigens. There was positive immunohistochemical staining for CA19-9, CA125, and SLX in 5 of 9, 1 of 9, and 3 of 8 patients with tracheal or bronchial adenoid cystic carcinoma, respectively. In a case of bronchial adenoid cystic carcinoma in whom pretreatment serum CA19-9 showed a very high level, this marker changed in parallel with the clinical course. These results suggest the possibility that CA19-9 and SLX could be used as useful markers in patients with tracheal and bronchial adenoid cystic carcinoma.

Adenoid Cystic Carcinoma of Trachea Treated with Adjuvant Hypofractionated Tomotherapy. Case Report and Literature Review

Adenoid cystic carcinoma, also called cylindroma, is the second most common histological type of tracheal malignancy but represents 1% of all respiratory tract cancers. We report a case of a 59-year-old patient submitted to an incomplete resection of the trachea and subsequently treated with adjuvant tomotherapy. There have been no reports in the literature regarding intensity-modulated radiation therapy with linac or tomotherapy systems in adenoid cystic carcinoma of the trachea. The present clinical case demonstrates the feasibility of adjuvant intensity-modulated radiation therapy techniques for optimizing the dose coverage of the tumor bed while sparing surrounding normal tissues. A dosimetric comparison between the tomotherapy plan and a 3-dimensional conformal radiotherapy plan is also reported. We demonstrate that tomotherapy permits an increase in the dose per fraction without important acute adverse effects. At 24 months' follow-up, our patient shows no evidence of disease with negative histological findings.

Adenoid cystic carcinoma of trachea

Adenoid cystic carcinoma is a rare but distinct salivary gland-type malignant neoplasm. We present a case, in which the mass progressed to cause almost complete obstruction, before it was diagnosed.

Primary adenoid cystic carcinoma of the cervical trachea mimicking thyroid tumor: CT evaluation.

Our goal was to describe the CT characteristics of adenoid cystic carcinomas of the trachea mimicking thyroid tumors. Computed tomography of four patients with pathologically proved adenoid cystic carcinomas extending into the thyroid gland was retrospectively reviewed. One case was also examined with MR. The masses encircling the trachea and circumferential thickening of the tracheal wall were demonstrated in all four cases. The longitudinal extent of the tracheal wall thickening was also demonstrated in all cases. The tumors had a broad base on the trachea and convex margin on the thyroid gland. They were all homogeneous, generally smoothly marginated, and isoattenuating on postcontrast CT scans. Adenoid cystic carcinomas were usually seen on CT scans as homogeneous masses encircling the posterolateral trachea with thickening of the tracheal wall in the transverse and longitudinal planes. These CT characteristics may be helpful in the differential diagnosis of adenoid cystic carcinomas mimicking thyroid tumors.

Two Cases of Adenoid Cystic Carcinoma of Trachea

Adenoid cystic carcinoma formerly called cylindroma is rare tracheal tumor. Characteristics of adenoid cystic carcinoma are infiltrative nature with local recurrence tendency and long natural course of the disease. Adenoid cystic carcinomas develop most commonly in the trachea. Primary resection and end-to-end anastomosis of the involved airway are treatment of choice. And postoperative radiation therapy might be useful, particularly when the surgical margins are not ample. We report two cases of adenoid cystic carcinoma of trachea diagnosed by flow-volume curve.

Self-expanding metal stent for tracheobronchial strictures.

To determine the role of expandable metal stent (Wallstent) in treating tracheobronchial strictures, 12 patients with recurrent symptoms of airway obstruction due to either benign or malignant strictures were studied. The seven benign strictures were anastomotic stricture following sleeve resection (2) and single lung transplant (1), tracheal amyloidosis (1), idiopathic chondritis (2), and post-tracheostomy stricture (1). The five malignant strictures were due to recurrent adenoid cystic carcinoma of trachea (1), large-cell carcinoma of lung (1), recurrent laryngeal squamous carcinoma (1), squamous carcinoma of the trachea (1), and malignant melanoma (1). The placement of stents was performed under rigid bronchoscopic guidance with no complications. All patients with benign strictures derived subjective and functional improvement with stenting. No evidence of restenosis within the stented segment in six of the seven benign strictures was found within up to 24 months. Repeated diathermy resection was required in the patient with recurrent amyloidosis through the distal end of the stent. Among the malignant strictures, symptomatic relief was achieved in four of the five patients. One metal stent migrated proximally and was replaced by a Montgomery T tube. One patient with relief of stridor died at 4 months due to carcinomatosis. Tumour ingrowth through the metal stent remains problematic in two patients. However, the incidence of palliative interventions required has markedly reduced after stenting.

Tracheo-innominate artery fistula after terminal or mural tracheostomy; Arterial balloon catheter used to stop innominate arterial blood flow

A 42 year-old woman underwent terminal or mural tracheostomy for adenoid cystic carcinoma of trachea in October 1982. She had used tracheal tube for stenosis of the orifice since then. In August 1988, massive bleeding occured through the tracheal tube which was controlled by cuff inflation. She was diagnosed as tracheo-innominate artery fistula by arteriography of innominate artery. For purpose of decrease of risk of massive bleeding during operation, we used arterial balloon catheter to stop innominate arterial blood flow. Although recurrence of adenoid cystic carcinoma prevented perfect control of bleeding, we could get good operative field in the greater part of operation by stopping innominate arterial blood flow with arterial balloon catheter. Using arterial balloon catheter to stop innominate arterial blood flow is useful in operation of tracheo-innominate artery fistula.