Tracheal Adenoid Cystic Carcinoma Successfully Treated With the Combined Core Out Technique, Cryoextraction, and Argon Plasma Coagulation: A Case Report

We report the case of a 67-year-old male who presented with mild dyspnea two years ago, with increasing intensity, cough, and stridor on exertion. He underwent outpatient evaluation and received treatment for recurrent episodes of bronchitis and acute exacerbations of chronic obstructive pulmonary disease. His current medication included tiotropium 18 mu g per day and salmeterol/fluticasone 50/500 mu g twice daily. The patient received a short course of prednisolone at 40 mg per day for five days before admission. The physical examination showed a central stridor during both inspiration and expiration. Chest radiograph showed a normal lung parenchyma and no hilar enlargement. Spirometry revealed fixed airway obstruction. CT scan of the thorax revealed a 2.4 x 2.7 cm lobulated mass abutting the right side of the lower trachea with nearly complete obstruction. Due to the large tumor causing significant central airway obstruction, the medical team opted to remove the central airway mass through rigid bronchoscopy. Argon plasma coagulation was used to facilitate mass shrinkage. Mechanical mass removal was performed using a rigid bronchoscope. At the end of the treatment, re-evaluation by bronchoscopy exhibited no remaining mass. Histologic examination confirmed the diagnosis of a tracheal adenoid cystic carcinoma. No recurrence of the tumor was noted during 12 months of follow-up.