Abstract
Opportunities when otolaryngology/head and neck surgeons encounter tracheal cancer are rare. Patients presenting primary symptoms like tracheal stenosis, stridor or bloody sputum are often treated as cases of bronchitis or bronchial asthma. Therefore, diagnosis comes too late and often has an unhappy outcome. Here we report a case of adenoid cystic carcinoma of the trachea found by a health checkup. A 39-year-old woman showed an abnormal thoracic shadow and was referred to the department of respiratory surgery of a university hospital. Tuberous shadows in the anterior mediastinum and right anterior neck were found by chest CT. Using fine needle aspiration cytology, the mass of the anterior mediastinum was diagnosed as thymoma and the mass of the right anterior neck as adenoid cystic carcinoma. Intraluminal tumor invasion between the subglottic space and the seventh tracheal ring was ascertained using NBI (narrow band imaging) fiberscopy. The specimen obtained was also adenoid cystic carcinoma. PET/CT study showed accumulation of FDG in the anterior mediastinum and the dorsal part of the right thyroid lobe. The main tracheal tumor arising from the right wall and penetrating the tracheal rings was clearly depicted on MRI. Curative resection of this tumor started from the lower part of the seventh tracheal ring, where no tumorous lesion was observed under bronchoscopy. However, the ablative margin was positive. The margin was decided by repeating frozen sectioning, but additional resection of three more rings was necessary. The right recurrent laryngeal nerve (RLN) was rolled up in the tumor. The sacrificed RLN was reconstructed by anastomosing the ansa cervicalis nerve to the distal end of the RLN found under the thyroid cartilage. Invasion to the esophagus showed over all layers. However, the esophagus was preserved under microscope by leaving only the mucosal layer for more than 3 cm. Finally, the resection of the airway extended from the bottom end of the vocal cord to the tenth tracheal ring. The trachea was reconstructed in three stages using the deltopectoral flap with nasal septal cartilage embedded. One and half years later, no findings suggested a recurrence. Phonation is excellent, with maximum phonation time of 20 seconds. Deglutition function is also excellent, without any sign of silent aspiration.
