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A-53-Year-Old-Man-With-a-Bronchial-Mass-and-Multip
A-53-Year-Old-Man-With-a-Bronchial-Mass-and-Multip
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This case report presents a 53-year-old man who experienced back pain, numbness, and weakness in his extremities over three months, alongside a significant weight loss of 11 kg. He had no respiratory symptoms and denied smoking or drug use. Imaging revealed multiple lytic bone lesions suggestive of metastases, and a CT scan showed a 2.4-cm necrotic mass in the subcarinal mediastinum extending into the left mainstem bronchus. Further examination through bronchoscopy identified a highly vascular tumor. Biopsy results revealed the presence of adenoid cystic carcinoma of the lung (ACCL), a rare type of neoplasm constituting 0.04% to 0.2% of lung tumors.<br /><br />Adenoid cystic carcinoma originates primarily in salivary glands and appears as lytic lesions in the bone with paratracheal involvement in the lungs. ACCLs often present as endobronchial masses, which can cause symptoms like shortness of breath and coughing. Diagnosis generally requires a bronchoscopy and biopsy. The histological appearance of these tumors includes cribriform, tubular, and solid growth patterns, with specific immunohistochemical markers aiding in differentiation from other tumors.<br /><br />Due to the rarity of primary pulmonary ACC, treatment protocols are not well defined. Complete surgical resection is preferred if feasible, leading to better prognosis with a 10-year survival rate of 45% to 70%. In cases with metastases or where surgery isn't viable, chemotherapy and radiation therapy are considered, but such treatments have varying efficacy.<br /><br />In this case, given the widespread metastasis affecting the patient's brain and bone structures, surgical intervention was deemed unsuitable. The patient's treatment plan included radiotherapy targeting spinal lesions and chemotherapy with carboplatin and paclitaxel. This report underscores the complexity and challenges in managing rare pulmonary tumors like ACCL.
Keywords
adenoid cystic carcinoma
lung tumors
metastases
bronchoscopy
imaging
necrotic mass
chemotherapy
radiotherapy
surgical resection
pulmonary neoplasm
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