Cystic Adenoid Carcinoma Of The Trachea: A Rare Case Of Asymptomatic Tracheal Tumor

Abstract

Aim: To present the imaging appearance of tracheal adenoid cystic carcinoma according to the different imaging modalities (ultrasound, computed tomography and magnetic resonance imaging).
Method: We present the case of a 60-year-old patient, without symptoms guiding the diagnosis, in whom the diagnosis was suspected on CT scan imaging.
Results: The patient was explored by CT angiography of the supra-aortic trunks as part of the etiologic investigation of an ischemic vascular accident. The examination objectified a tissular mass centered on the tracheoesophageal axis lateralized to the left invading the laryngeal cartilages and the left lobe of the thyroid.
A cervical ultrasound was performed showing a heterogeneous hypoechoic area of the left lobe of the thyroid with no detected nodule. Fine needle aspiration of the suspicious area was performed, showing a tumoral lesion with basaloid cells evoking the diagnosis of adenoid cystic carcinoma.
In order to assess the tumor extension and the patient's operability, a cervical MRI was performed given its better resolution in contrast.
A bronchial fibroscopy was indicated showing a tracheal circumferential infiltrative stenosis with biopsies confirming the diagnosis.
Conclusion: Adenoid cystic carcinomas of the trachea are rare tumors. Tracheobronchial endoscopy combined with biopsies allow the diagnosis of certainty. Cross-sectional imaging (CT and MRI) plays a key role in locoregional and distant extension assessment, thus guiding therapeutic management.