Tracheal Adenocarcinoma Treated with Adjuvant Radiation: A Case Report and Literature Review

Primary adenocarcinoma of the trachea is extremely rare and a standard treatment does not exist due to nonavailability of evidence-based randomized control studies. This paper reports the case of a 60-year-old male, who presented with cough and occasional respiratory distress. Bronchoscopic examination and a computed tomography scan revealed a soft tissue mass in the trachea arising from the posterior tracheal wall. Cytological examination and immunochemistry confirmed primary adenocarcinoma of the trachea. Excision of the tumor followed by three-dimensional conformal radiation therapy was performed, and a dose of 56 Gy was delivered to the primary site. Two and a half years after treatment, the patient has no clinical or radiological evidence of the disease, and no late complication has occurred.

Our 60-year-old diabetic and hypertensive male patient had a 1-month history of cough associated with marked respiratory distress and occasional dyspnea in the right lateral lying position. The patient consulted a chest physician and underwent bronchoscopy, which showed a polypoid growth in the trachea extending to the larynx (fig. 1). A computed tomography (CT) scan revealed irregular soft tissue thickening in the region of the trachea extending up to the adjacent larynx with no soft tissue calcification, and there was no definite lymphadenopathy in the cervical region and no involvement of the underlying bone. A repeat CT scan of the neck (fig. 2) showed evidence of an ill-defined, irregular, nodular, infiltrating soft tissue growth arising from the posterior tracheal wall, bridging the lumen and reaching up to the anterior wall, with an infiltration of about 2.2 × 1.8 cm. The location was opposite the C7-D1 level involving the 5th or 6th tracheal ring, approximately 7 cm proximal to the carina with no significant evidence of cervical and mediastinal lymphadenopathy.

There are many studies showing the benefit of postoperative irradiation therapy in primary tracheal malignancies such as SCCs and ACCs. However, little experience has been shared in the case of primary adenocarcinomas of the trachea, the tumor type described in our report. The prognosis of patients with malignant tumors of the trachea remains gloomy, and long-term median survival of tracheal adenocarcinoma patients undergoing combined modalities is unknown to us. Primary adenocarcinoma of the trachea needs to be diagnosed at an early stage, and combined multimodal approaches may be explored to attain an extended median survival.