Department of Endocrine Surgery, Nippon Medical School.
Department of Cytology, Kanaji Thyroid Hospital.
J Nippon Med Sch. 2022 Aug 27;89(4):460-465. doi: 10.1272/jnms.JNMS.2022_89-207. Epub 2021 Apr 19.
Adenoid cystic carcinoma of the trachea (ACCT) is a rare cancer; ACCT with thyroid invasion is particularly rare. We first suspected anaplastic thyroid carcinoma (ATC) but diagnosed ACC after performing fine-needle aspiration cytology (FNAC). Tracheal origin was confirmed postoperatively.
A 77-year-old woman presented to our hospital with acute inspiratory dyspnea requiring emergency tracheotomy. Physical examination revealed swelling of the right anterior neck and a hard, immobile mass. Computed tomography (CT) and ultrasonography (US) showed tumor extension to the right thyroid lobe and between the first and third tracheal rings, which caused severe stenosis of the lumen. We performed FNAC. Clinical findings were highly suggestive of ACCT with thyroid invasion. She underwent total laryngectomy, cervical esophagectomy, and thyroidectomy with bilateral selective neck dissection at another hospital. The tumor was located in the right posterior wall of the trachea and extended into the right thyroid gland. Pathological examination showed infiltrative carcinomatous proliferation with tubular and cribriform patterns. The tumor was classified as pT4N1. A definite diagnosis was made after histopathological analysis of the surgical specimen confirmed ACCT. The tumor was positive for FABP7, a putative prognostic marker of ACC, and metastasized to the lungs 3 years after surgery.
ACCT with thyroid invasion is an extremely rare malignant neoplasm. FNAC was useful for differentiating ACCT from other diagnoses and enabled appropriate surgical treatment.
气管腺样囊性癌（ACCT）是一种罕见的癌症；甲状腺侵犯的 ACCT 更为罕见。我们最初怀疑为间变性甲状腺癌（ATC），但在进行细针抽吸细胞学检查（FNAC）后诊断为 ACC。术后证实为气管起源。
一名 77 岁女性因急性吸气性呼吸困难就诊，需要紧急行气管切开术。体格检查发现右侧颈前肿胀，有一坚硬、固定的肿块。计算机断层扫描（CT）和超声检查（US）显示肿瘤延伸至右侧甲状腺叶和第一至第三气管环之间，导致管腔严重狭窄。我们进行了 FNAC。临床发现高度提示甲状腺侵犯的 ACCT。她在另一家医院接受了全喉切除术、颈段食管切除术和甲状腺切除术，并进行了双侧选择性颈淋巴结清扫术。肿瘤位于气管右后壁，延伸至右侧甲状腺。病理检查显示浸润性癌性增殖，具有管状和筛状模式。肿瘤被分类为 pT4N1。手术标本的组织病理学分析证实为 ACCT 后，做出了明确的诊断。肿瘤对 FABP7 阳性，FABP7 是 ACC 的一个潜在预后标志物，并且在手术后 3 年发生肺转移。
甲状腺侵犯的 ACCT 是一种极其罕见的恶性肿瘤。FNAC 有助于将 ACCT 与其他诊断区分开来，并能进行适当的手术治疗。
