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A4012 - Rare Case of Adenoid Cystic Carcinoma and the Management of Post-Operative Complications
Author Block: B. Li1, S. Hussain2; 1Pulmonary and Critical Care, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2Pulmonary and Critical Care, Robert Wood Johnson Univ Hosp, New Brunswick, NJ, United States.
Introduction Primary tracheal tumors are very rare accounting for less than 0.5-1% of all malignant tumors with annual incidence rate of 0.1 per 100,000 per year (1). Adenoid cystic carcinoma account for 10-15% of primary tracheal tumor with histology identical to salivary glands (2). We present a case of adenoid cystic carcinoma with post-operative complications. Case Presentation:
A 29 year old female who had been followed for 1.5 years for wheezing and shortness of breath showed no improvement of symptoms despite multiple courses of steroids for presumed asthma. Persistence of symptoms resulted in a computed tomography (CT) of the chest which revealed a mass along the left lateral wall of the trachea extending into the left main stem, with involvement of the carina with 90% luminal obstruction. Patient was referred to our center for bronchoscopy with biopsy and argon plasma coagulation. Pathology showed invasive mucinous adenocarcinoma. The patient was referred to Mass General Hospital, where a left pneumonectomy and removal of the carina and anastomosis of the trachea with the bronchus intermedius was performed. The patient did well post operatively. One month after her surgery, the patient started having mild shortness of breath and presented to us with acute shortness of breath and coughing with wheezing and stridor that improved with Heliox (80/20). CT of the chest showed a focal narrowing at the anastomosis with a diameter of 2.5-3mm concerning for stenosis. Patient underwent bronchoscopy which revealed granulation tissue and mild secretions. These were removed and patient improved for a week but again presented to our hospital with the same symptoms. This time, patient underwent sequential balloon dilation from 6mm to 10mm. Discussion This case not only illustrates a very rare primary tracheal tumor but also the management of post-operative complication of such rare tumors. Complications after tracheal resection and reconstruction includes granulation tissue formation, restenosis of the trachea, anastomotic separation, tracheoesophageal fistula, wound infection, laryngeal edema and glottis dysfunction (3). It is important to closely monitor patients after trachea resection and anastomosis. References: 1. Nouraei SM, Middleton SE, Nouraei SA, et. al. Management and prognosis of primary tracheal cancer: a national analysis. Laryngoscope 2014;124:145.2. Manninen MP, Antila PJ, Pukander JS et. al. Occurrence of tracheal carcinoma in Finland. Acta Otolaryngol 1991;111:1162.3. Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: prevention and treatment. J Thorac Dis 2016;8:S160.