Chest
Volume 125, Issue 3, March 2004, Pages 1160-1165
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Selected Reports
Tracheobronchial Adenoid Cystic Carcinoma: A Clinicopathologic Study of 14 cases

https://doi.org/10.1378/chest.125.3.1160Get rights and content

Study objectives

To investigate the clinicopathologic features of primary tracheobronchial adenoid cystic carcinoma (ACC), and to examine kit protein (CD117) expression, and a possible correlation between the histologic grade and Ki-67 positivity.

Design

Retrospective 10-year study (from 1992 to 2001).

Setting

Referral center for interventional pulmonology.

Patients

Fourteen patients referred to our institution for laser resection of tracheal or endobronchial tumors.

Interventions

Twelve patients were treated primarily by laser resection via bronchoscopy with subsequent radiation therapy. The remaining two patients had tracheal resection with postoperative radiation and radiation therapy alone.

Results

Fourteen patients (5 men and 9 women) had an average age of 44 years at diagnosis (age range, 29 to 57 years). Five of 14 patients were smokers (average smoking history, 28.5 pack-years), 8 were nonsmokers, and the smoking history was unknown in 1 patient. Major symptoms at presentation included cough (57.1%), dyspnea (71.4%), and hoarseness (14.3%). Two patients (14.3%) presented with respiratory failure. Eleven patients (78.6%) had one or more recurrences, and 4 patients (28.6%) had metastases, primarily to the lungs. The average time to either recurrence or metastasis was 4.6 years after the initial diagnosis. Five patients (35.7%), all of whom had recurrences and/or metastasis during the course of their disease, died of their disease (average time, 8.2 years). Thirteen of 13 cases stained for CD117 were positive in the tumor cell cytoplasm with membranous accentuation. Our cases included 8 grade I tumors, 4 grade II tumors, and 2 grade III tumors, which did not correlate with the degree of Ki-67 positivity.

Conclusions

Tracheobronchial ACCs in our study were more common in women and nonsmokers who presented with nonspecific respiratory symptoms and followed a clinical course generally comparable to that of tumors in the salivary glands. CD117 expression was present in all cases tested, and Ki-67 stain results did not correlate with the tumor grade.

Section snippets

Case Selection and Histopathologic Review

All cases with a diagnosis of ACC in the tracheobronchial tree were retrospectively identified from the surgical pathology file during the period from 1992 to 2001 at the University of California San Diego Medical Center. All patients in the present study were treated at our Pulmonary Special Procedures Unit, which specializes in treating obstructive airway diseases with Nd-YAG laser photoresection via rigid bronchoscopy. Two pathologists (EA and ESY) examined all the hematoxylin-eosin-stained

Clinical Features

The clinical characteristics of each patient are summarized in Table 1. Five patients (35.7%) were men and 9 (64.3%) were women, with a presenting age at diagnosis ranging from 29 to 53 years (average age, 44 years). Five patients (35.7%) were smokers (average smoking history, 28.5 pack-years), 8 patients (57.1%) were nonsmokers, and the smoking history was unknown in 1 case. Major symptoms at the time of presentation included cough in 8 patients (57.1%), dyspnea in 10 patients (71.4%), and

Discussion

We report the clinicopathologic features of 14 ACC cases occurring in the tracheobronchial tree. In the past 20 years, the use of lasers for treating endobronchial disease has been tested and accepted as an important therapeutic modality for obstructive endobronchial or tracheal lesions.26 Although the primary role of laser resection in oncology patients is a palliative one, this technique may allow a prolonged survival when combined with other therapies.27 Most of our patients underwent

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