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OJHAS Vol. 10, Issue 4:
(Oct-Dec 2011) |
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Tracheal Carcinoma |
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Ashok K Chauhan, Senior Professor
and Unit Head, Department of Radiation Oncology,
Paramjeet Kaur,
Assistant Professor, Department of Radiation Oncology,
Gajender Singh, Assistant Professor
Department of Pathology,
Satyvir Kishore Mathur, Senior Professor,
Department of Pathology,
Pt. BDS PGIMS, Rohtak, Haryana. |
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Address for Correspondence |
Assistant Professor,
Department of Radiation
Oncology,
Pt. BDS PGIMS,
Rohtak, Haryana, India.
E-mail:
dr_paramjit_g@yahoo.co.in |
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Chauhan AK, Kaur P, Singh G, Mathur SK. Tracheal Carcinoma. Online J Health Allied Scs.
2011;10(4):10 |
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Submitted: Aug 16, 2011; Accepted: Jan
4, 2012; Published: Jan 15, 2012 |
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| Abstract: |
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Adenoid cystic carcinoma of the trachea is a rare primary tracheal malignancy.
Obstructive symptoms such as dyspnoea, hoarseness of voice, dysphasia
are commonly seen symptoms. Combined modality treatments including surgery
and radiation therapy are considered as optimal treatment for these
tumours. A case of adenoid cystic carcinoma in a 35 years old male patient
who was treated successfully by surgical excision and external beam
radiation therapy is presented.
Key Words:
Adenoid cystic carcinoma;
Tracheal tumours; Radiotherapy.
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Primary
tracheal tumours are extremely rare, comprising approximately 0.1%-0.4%
of all diagnosed malignancies.[1] The most common histology for a primary
tracheal tumour is squamous cell carcinoma which constitutes 60%-90%
of cases: adenoid cystic carcinoma (ACC) accounts for 20-25% of all
tracheal tumours and 80% of all tracheobronchial gland tumours.[2-4] Adenoid cystic Carcinoma of trachea usually presents at a
relatively younger age and affects males and females equally. We present
this case due to the rarity of condition and the lack of data about
definitive management, outcome survival in such cases. The present case
was treated successfully with combined modality treatment comprising
surgery and radiation therapy.
A 35 years male
developed gradually increasing complaints of breathlessness and cough
of 3-4 year duration, but he did not seek any medical assistance until stridor developed.
There was no
history of dysphagia, or of pain in the neck or elsewhere. General physical
examination was unremarkable. On examination of the respiratory system,
the upper airways were normal. On auscultation the patient had wheeze.
Abdomen examination was normal. The hematological and biochemical profiles
were normal. The chest radiograph was normal. Fiberoptic bronchoscopic
examination showed a growth in the trachea at the level of the manubrium
sterni on right side and the growth was seen projecting into the tracheal
lumen and obstructing it by more than half. The patient underwent resection
of the growth and of the trachea. At operation a 3x3 cm intraluminal
growth was seen in trachea, infiltrating into pretracheal tissue. Histopathological
examination showed an adenoid cystic carcinoma invading the tracheal
wall and paratracheal tissue. [Fig 1, 2] The distal and proximal margins
were found to have tumour infiltration microscopically. The CT scans
of the chest and abdomen, the radionuclide bone scan and the serum alkaline
phosphatase estimation were performed to rule out extra thoracic metastases.
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Fig 1: Photomicrograph
showing tumor cells forming cribriform pattern with overlying normal
endotracheal mucosa. H&E 100X |
Fig 2:
Photomicrograph showing
tumor cells infiltrating underlying stroma. H&E 100x |
Radiotherapy
using anterior and posterior portals was applied to the lower neck and
chest and delivered in a dose of 45 Gy in 25 fractions with the intention of
preventing local recurrence of the disease.
The Patient
completed the treatment, and since then has been on regular follow up
with no evidence of disease recurrence after one and half years
of treatment.
Billroth in
1859 first reported the clinical
and pathologic features of adenoid cystic carcinoma of the trachea.[5] Adenoid cystic carcinoma of the trachea most frequently originates
in the trachea or main stem of bronchi, producing obstructive and associated
symptoms like wheezing, progressive dyspnoea, stridor and cough. Surgical
intervention is the initial strategy for primary tracheal tumours, in
the form of complete resection of the tumour is the mainstay of treatment
[6] complete resection is defined as no remaining gross, palpable, or
microscopic tumours.[7]
Review of the
literature showed five year survival ranging from 66% to 100%
and 10 year survival ranging from 51%-62% for these tumour regardless
of the treatment.[8,9]
Radiation therapy
is usually recommended as adjuvant setting. The dose of radiation depends
upon the bulk of the tumour. Results from reported series showed resection
plus adjuvant radiation had better outcomes.[10] The role of chemotherapy in AC
is undefined.
In conclusion,
adenoid cystic
carcinoma of trachea is a rare primary tracheal malignancy, with obstructive
symptoms such as dyspnoea, hoarseness of voice, and dysphasia being the commonly
seen symptoms. Combined modality
treatments including surgery and radiation therapy are optimal treatment
for these tumours.
-
Housten HE, Payne
WS, Harrison EG, et al. Primary cancers of trachea. Arch Surg 1969;
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LB, Devesa SS. Lung cancer. Cancer 1995; 75:191-202.
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S, Pettersson G. Tracheal Cancer in Denmark: a nationwide study. Eur
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neoplasms in: Dail DH, Hammar SP, ed Pulmonary Pathology. New York:
Springer – Verlag; 1994. pp1123-78.
- Billroth T. Beobachtungen
über geschwülsteder Speicheldrüsen. Virchows Arch Pathol Anat 1859;17:357-375.
- Azar T, Abdulkarim
FW, Tucker HM. Adenoid cystic carcinoma of trachea. Laryngoscope. 1998;108:1297-1300.
- Regnard JF, Fourquier
P, Levasseur P. Results and prognostic factors in resection of primary
tracheal tumors : a multicentre retrospective study. J Thorac Cardiovasc
Surg 1996;111:808-814.
- Maziak DE, Todd
TRJ, Keshavjee SH, et al. Adenoid cystic carcinoma of the airway: thirty
two year experience. J Thorac Cardiovas Surg 1996;112:1522-1532.
- Grill HC. Management
of Tracheal tumors. Am J Surg 1982;143:697-699.
- Chow DC, Komaki
R, Libshitz HI, et al. Treatment of primary neoplasms of the trachea.
The role of radiation therapy. Cancer 1993;71(10):2946-2952.
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