17 September 2019 : Case report
Challenging differential diagnosis, Rare diseaseEveline Montessi Nicolini1AB, Jorge Montessi1AB, João Paulo Vieira1AB, Guilherme de Abreu Rodrigues1AB, Víctor de Oliveira Costa2EF*, Fabrício Machado Teixeira2EF, Mariana de Oliveira Kassis2EF
Am J Case Rep 2019; 20:1373-1377
BACKGROUND: Adenoid cystic carcinoma of trachea (ACCT) is an unusual low-grade tumor from the tracheal and bronchial wall glands. The histological structure and biological behavior of ACCT are similar to that of tumors found in the salivary glands. ACCT occurs most commonly in the upper trachea, being found in the articular cartilage in the posterior aspect of the trachea.
CASE REPORT: We describe the case of a 62-year-old male ex-smoker 25 years/pack (abstinence 20 years ago), who began with mild dyspnea 2 years ago, with intense evolution and cough. He was evaluated as an outpatient and was treated for sinusitis and later bronchitis after pulmonary function tests. With the worsening of the aforementioned symptoms, he sought prompt care, with hospitalization and computed tomography (CT) of the chest being indicated, showing an expansive lesion in the anterior wall of the trachea with an extension of approximately 3.1 cm, ending at the level of the carina, measuring 3.4×2.8 cm, with moderate stenosis of the tracheal lumen, with an exophytic component to the mediastinum. Bronchoscopy of the lesion was done, and later immunohistochemistry showed a probable pleomorphic adenoma. However, in a new analysis, after the removal of the surgical specimen, it was observed that it was a ACCT.
CONCLUSIONS: ACCT is a rare tumor that should be diagnosed as soon as possible in order to ensure its best prognosis. Moreover, it is evident that the analysis of the surgical specimen is sovereign to immunohistochemistry with regard to histological typing.
Keywords: Carcinoma, Adenoid Cystic, Immunohistochemistry, Trachea, Bronchoscopy, Cough, Dyspnea, Middle Aged, Tomography, X-Ray Computed, Tracheal Neoplasms
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