Delayed diagnosis of adenoid cystic carcinoma of the trachea

Adenoid cystic carcinoma (ACC) is a salivary gland tumour that may involve the respiratory tract and can cause symptoms that mimic benign conditions, such as chronic obstructive pulmonary disease and asthma. Standard of treatment consists of surgical resection, but radiation therapy may also be appropriate for incomplete and unresectable tumours. A Hispanic woman in her 40s presented with 2 years of progressive throat pain, dyspnea and cough during meals. CT revealed a polypoid tracheal mass 1.6×1.2×1.7 cm and asymmetric submucosal enhancement and thickening with severe luminal narrowing, which was concerning for malignancy. Rigid bronchoscopy revealed greater than 80% occlusion of the trachea, and biopsy confirmed the diagnosis of ACC with tubular and cribriform patterns. The patient underwent tracheal resection with reanastomosis followed by postoperative adjuvant radiotherapy. Over 1 year later, the patient remains symptom-free and without recurrence of ACC.