Tracheal Adenoid Cystic Carcinoma Treated by Repeated Bronchoscopic Argon Plasma Coagulation as a Palliative Therapy

Abstract

Primary tracheal tumors are uncommon, making up only 0.2% of all respiratory malignancies. Adenoid cystic carcinoma (ACC) is the most common tumor, accounting for about 30% of primary tracheal tumors. It is often difficult to manage these tumors surgically, due to its expansion and submucosal invasion, and furthermore, due to the patient's condition. Thus, it is essential to perform palliative treatment in order to maintain the airway through and to control the progress. Herein, we report a case of ACC treated by repeated bronchoscopic argon plasma coagulation (APC) as palliative therapy. A 71-year-old Japanese male was referred to our hospital's emergency department for dyspnea. Bronchoscopic examination revealed expanded intraluminal obstructive bronchial tumors from the left bronchus to right. The patient had undergone bronchoscopic APC treatment several times. The obstruction was improved, and no worsening was seen for 26 months. Repeated bronchoscopic APC as a palliative therapy is promising and useful therapy without heavy adverse reactions to control the tumor growth.

Impact of Interventional Bronchoscopy on Long-Term Survival in Patients with Primary Tracheal Adenoid Cystic Carcinoma: A Single-Center Experience

“…APC or BD may be considered if the lumen is narrowed, the risk of asphyxia is high, or symptoms worsen. A previous report showed that APC was repeated without side effects in a patient with primary left bronchial ACC that invaded the right bronchus and was difficult to resect surgically, with no worsening of symptoms for 26 months [ 5 ]. In our study, the combination of chemotherapy and interventional bronchoscopy suppressed the progression of local recurrence and resulted in long-term survival in patients with locally recurrent TACC.…”

“…TACC recurrence can occur locally or distantly [ 4 ], and tracheal obstruction due to tumor growth is the most problematic aspect of local recurrence. The utility of interventional bronchoscopy as a palliative treatment to improve tracheal obstruction has been reported [ 5 ]. It has been suggested that combining chemotherapy with interventional bronchoscopy may result in long-term survival.…”

Lung metastases from cutaneous adenoid cystic carcinoma 23 years after initial treatment

“…Primary ACC in trachea and lungs is uncommon, accounting for less than 0.2% of lung carcinomas, and classified into 4 types, semipedunculated type (type I), intra-extra luminal type (type II), expansive infiltrating type (type III), and peripheral type (type IV) [7]. The relatively low incidence of primary ACC type IV in lungs may be associated closely with distribution of glandular cells, which decline from proximal to distal airways [8].…”