Laryngeal Preservation in Managing Advanced Tracheal Adenoid Cystic Carcinoma

Abstract

A 37-year-old male athlete was diagnosed with primary tracheal adenoid cystic carcinoma following investigation for dyspnea, wheeze, and eventual stridor. Preoperative bronchoscopy revealed a highly vascular tumor 4 cm distal to the cricoid with no gross disease extending to the carina. Imaging revealed circumferential tracheal irregularity immediately inferior to the cricoid, with no definite cricoid invasion. Locoregional extension of disease was noted invading the thyroid and abutment of the carotid approximately 180°. Intraoperative findings identified tracheal mucosal disease extending distal to the carina and proximally at the cricothyroid joints where bilateral functional recurrent nerves were preserved. A decision made to preserve the larynx given the inability to fully resect distal tracheal disease. A 5 cm sleeve resection of the trachea was made with a cricotracheal anastomosis following suprahyoidal muscle release and laryngeal drop-down. The patient was treated with adjuvant radiotherapy including platinum based chemotherapy in an effort to maximise local control. PET scanning three months after therapy revealed no FDG uptake locally or distally.

Primary adenoid cystic carcinoma of the trachea with thyroid invasion: a case report and literature review

“…Including our case, this report reviews a total of ten cases of primary ACC with thyroid invasion ( Table 1 ). 5 , 6 , 19 – 24 These ten cases included four male (40%) and six female patients (60%). Their ages ranged from 17 to 68 years, with the average age being 49.8 years.…”

Fine‐needle aspiration cytology of an adenoid cystic carcinoma of trachea: Common tumor in uncommon location

“…Immunostains performed in our case also showed CD 117 positivity in the myoepithelial cells. The immunochemistry was not performed in the other cases in Table . Our case had an unusual location for ACC.…”

“…These 11 cases include five male (45%) and six female patients (54.5%) from 17 to 85 years in age (average 53.8 years). Six patients presented with dyspnea, four had cough, two experienced hoarseness of voice, one developed wheezing and stridor, one presented with dysphagia, and one experienced vomiting . Idowu et al noted the interpretation of metachromatic material (hyaline or basement membrane) as ropy colloid in the context of a thyroid aspiration in one of his cases .…”

Adenoid Cystic Carcinoma of Trachea

“…Surgical resection is the mainstay of treatment as these patients almost always present with airway compromise, and thus, securing it becomes paramount. Tumor resection with end-to-end anastomosis achieved by laryngeal release and lower tracheal mobilization results in laryngeal preservation without compromising oncological margin [7]. Surgical complications include tracheoesophageal fistula, pharyngeal or oesophageal leak, anastomotic separation, wound dehiscence, vocal cord paralysis, temporary tracheotomy, dysphagia and pneumonia.…”