Tracheal adenoid cystic carcinoma: a case report

Abstract

Introduction: Primary tracheal tumors are rare neoplasms that account for less than 1% of all malignant tumors of the respiratory system. Among them, adenoid cystic carcinoma (ACC) represents approximately 10–20% of malignant tracheal tumors and is characterized by slow growth, local infiltration, and late metastasis. Clinical manifestations are usually nonspecific and related to airway obstruction, often leading to delayed diagnosis and misdiagnosis as more common respiratory diseases. Methods: We present a case report of a 36-year-old male patient treated at the Hospital Universitario Erasmo Meoz (Cúcuta, Colombia) with a two-year history of progressive dyspnea, weight loss, and recent episodes of hemoptysis. Diagnostic evaluation included microbiological tests, non-contrast and contrast-enhanced chest computed tomography (CT), diagnostic bronchoscopy with endoscopic resection of the lesion, and histopathological analysis with immunohistochemistry for definitive diagnosis. Results: Chest CT revealed a 26 mm rounded lesion located on the left lateral wall of the middle third of the trachea, causing approximately 75% obstruction of the tracheal lumen. Bronchoscopy identified a vascularized endotracheal mass located 4 cm below the glottis that produced critical airway obstruction, requiring emergency tracheostomy to secure airway patency. Biopsy confirmed invasive cribriform-predominant adenoid cystic carcinoma. After multidisciplinary evaluation and due to surgical unresectability criteria, the patient received combined oncologic treatment with radiotherapy, demonstrating favorable clinical response and no evidence of residual tracheal lesion on follow-up. Discussion: Tracheal ACC is characterized by slow growth but a strong tendency for submucosal and perineural infiltration, which may lead to severe central airway obstruction and mediastinal complications. Surgical resection remains the treatment of choice when feasible; however, radiotherapy is an effective alternative in unresectable cases. This case highlights the importance of early diagnosis through imaging and endoscopic techniques, as well as the role of multidisciplinary management to optimize clinical outcomes in rare tracheal tumors