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Year : 2019  |  Volume : 34  |  Issue : 3  |  Page : 249-250  

Adenoid cystic carcinoma of trachea: Findings on 18F FDG positron emission tomography-computed tomography


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication20-Jun-2019

Correspondence Address:
Prof. Rakesh Kumar
Head, Division of Diagnostic Nuclear Medicine, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_172_18

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   Abstract 


Adenoid cystic carcinoma (ACC) of the trachea is the second most common tumor of trachea after squamous cell carcinomas. It arises from the submucosal layer and predominantly has a rapid locoregional spread. We describe the 18F FDG positron emission tomography-computed tomography findings of a 51-year-old woman, a biopsy-proven case of ACC of trachea who underwent the scan for initial staging.

Keywords: Adenoid cystic carcinoma, FDG positron emission tomography-computed tomography, trachea


How to cite this article:
Tripathy S, Shamim SA, Behera A, Bal C, Kumar R. Adenoid cystic carcinoma of trachea: Findings on 18F FDG positron emission tomography-computed tomography. Indian J Nucl Med 2019;34:249-50

How to cite this URL:
Tripathy S, Shamim SA, Behera A, Bal C, Kumar R. Adenoid cystic carcinoma of trachea: Findings on 18F FDG positron emission tomography-computed tomography. Indian J Nucl Med [serial online] 2019 [cited 2019 Nov 13];34:249-50. Available from: http://www.ijnm.in/text.asp?2019/34/3/249/260749



A 51-year old woman presented with chief complaints of nonproductive cough with dyspnea for the past 6 months to pulmonology outpatient department. On suspicion of bronchogenic carcinoma,18F FDG positron emission tomography-computed tomography (PET-CT) was advised to look for sites of metabolically active disease. Maximum intensity projection images of the scan showed focal area of FDG uptake in the mediastinal region [Figure 1]a, solid blue arrow]. [Figure 1]b [solid white arrow] represents the axial chest CT image showing an extraluminal lesion measuring approximately 1.4 cm × 1.4 cm arising from the trachea just before its bifurcation and also involving the carina. The lesion showed increased FDG uptake in the fused transaxial PET-CT images [Figure 1]c, solid red arrow]. [Figure 1]d [solid yellow arrow] and e [solid green arrow] represents coronal and sagittal fused 18F FDG PET-CT images respectively, showing increased FDG uptake in the tracheal lesion. No distant metastasis was recorded on PET-CT scan and the patient underwent surgery and histopathology was diagnostic of primary adenoid cystic carcinoma (ACC) of the trachea.
Figure 1: (a) Maximum intensity projection images of the 18F FDG positron emission tomography-computed tomography scan showing focal area of FDG uptake in the mediastinal region (solid blue arrow). (b) Axial chest computed tomographic image showing a lesion 1.4 cm × 1.4 cm arising from trachea (solid white arrow). (c) Tracheal lesion show increased FDG uptake in the fused transaxial positron emission tomography-computed tomography images (solid red arrow). (d) Fused coronal 18F FDG positron emission tomography-computed tomography image showing increased FDG uptake in the tracheal lesion (solid yellow arrow). (e) Fused sagittal 18F FDG positron emission tomography-computed tomography image showing increased FDG uptake intratracheal lesion (solid green arrow)

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Tracheal ACC originates from the submucosal glands of the airway are often misdiagnosed as asthma or bronchitis and accounts for about 10%–20% of the malignant tracheal tumor.[1],[2] Due to rarity of this neoplasm in general population, there are not many published reports highlighting the utility of PET-CT in this type of tumor. Although some reports suggest that there is no special tumor site predilection,[3] Huo et al. in their series found lower one third of trachea to be one of the favored sites.[4] Metastases to cervical lymph nodes are a rare event; ACC spreads through a hematogenous route with distant metastases, especially to lungs, brain, bone and liver.[5],[6] In our case, we had a localized disease with no nodal or visceral metastases; however, keeping in view its tendency to metastasize initially as well as late up to 15 years after the initial diagnosis,[7] the authors advocate use of 18F FDG PET-CT in workup algorithm of ACCs, especially for restaging purpose.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bonner Millar LP, Stripp D, Cooper JD, Both S, James P, Rengan R, et al. Definitive radiotherapy for unresected adenoid cystic carcinoma of the trachea. Chest 2012;141:1323-6.  Back to cited text no. 1
    
2.
Gaissert HA, Mark EJ. Tracheobronchial gland tumors. Cancer Control 2006;13:286-94.  Back to cited text no. 2
    
3.
Zhao Y, Zhao H, Fan L, Shi J. Adenoid cystic carcinoma in the bronchus behaves more aggressively than its tracheal counterpart. Ann Thorac Surg 2013;96:1998-2004.  Back to cited text no. 3
    
4.
Huo Z, Meng Y, Wu H, Shen J, Bi Y, Luo Y, et al. Adenoid cystic carcinoma of the tracheobronchial tree: Clinicopathologic and immunohistochemical studies of 21 cases. Int J Clin Exp Pathol 2014;7:7527-35.  Back to cited text no. 4
    
5.
Ko JJ, Siever JE, Hao D, Simpson R, Lau HY. Adenoid cystic carcinoma of head and neck: Clinical predictors of outcome from a Canadian centre. Curr Oncol 2016;23:26-33.  Back to cited text no. 5
    
6.
Sa YJ, Sim SB, Kim TJ, Moon SW, Park CB. Late-developing tongue adenoid cystic carcinoma after pulmonary metastasectomy: A case report. World J Surg Oncol 2014;12:102.  Back to cited text no. 6
    
7.
Matsuba HM, Simpson JR, Mauney M, Thawley SE. Adenoid cystic salivary gland carcinoma: A clinicopathologic correlation. Head Neck Surg 1986;8:200-4.  Back to cited text no. 7
    


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