J Korean Soc Endocrinol.  2005 Jun;20(3):273-277. 10.3803/jkes.2005.20.3.273.

A Case of Tracheal Adenoid Cystic Carcinoma Presenting with Diffuse Goiter

• Kang HC
• Kim SK
• Kang SH
• Kim KM
• Hong SI
• Chung DJ
• Chung MY
• Lee JK
• Lim SC
• Lee JH

• KMID: 2200568
• DOI: http://doi.org/10.3803/jkes.2005.20.3.273

Abstract

A goiter is among the most common presenting symptoms of patients with thyroid diseases and is usually caused by intrinsic thyroid problems. While direct invasion of the trachea by aggressive thyroid tumors is a well-known phenomenon, the reverse situation, that is, a primary tracheal neoplasm invading by direct extension into the thyroid gland, presenting with a goiter is very rare. Here, a case of a tracheal adenoid cystic carcinoma(ACC), presenting with a diffuse goiter, is reported. A 47-year-old woman presented with slowly growing anterior neck swelling. A physical examination showed a diffuse firm goiter. The patient was euthyroiditic, and serum negative for thyroid autoantibodies. Thyroid ultrasonography and neck CT revealed a doughnut-shaped mass, encircling the trachea and displacing the thyroid anteriorly. Ultrasonography-guided fine needle aspiration(FNA) was compatible with an ACC, and a subsequent surgical resection confirmed the diagnosis. Although the occurrence of a tracheal ACC invading the thyroid is rare, this case highlights the need to be aware of unusual lesions arising in the region of the thyroid. This knowledge will help in making the correct cytological diagnosis when these lesions are sampled by FNA

MeSH Terms

Adenoids*
Autoantibodies
Carcinoma, Adenoid Cystic*
Diagnosis
Female
Goiter*
Humans
Middle Aged
Neck
Needles
Physical Examination
Thyroid Diseases
Thyroid Gland
Trachea
Tracheal Neoplasms
Ultrasonography
Autoantibodies

Figure

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  Fig. 1 99m-Technetium thyroid scan taken 3 years ago shows normal thyroid gland

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  Fig. 2 Mild diffuse goiter is evident in anterior portion of the neck

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  Fig. 3 Thyroid ultrasonograms. A transverse scan over the isthmus shows a well-defined horseshoe-shaped hypoechoic mass (arrow in panel A). A longitudinal scan shows the extent of the lesion (panel B). Some lobular portions are observed along the tumor margin (arrowheads in panel B)

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  Fig. 4 Fine-needle aspiration cytology shows classic hyaline globules and tight clusters of basaloid cells (Pap, ×400)

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  Fig. 5 A doughnut-shaped low density lesion encircling the trachea contrasts well with the iodine-rich thyroid gland in a pre-contrast neck CT scan (arrow in panel A). A post-contrast neck CT scan well delineates the mass (arrow in panel B)

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  Fig. 6 Histology confirms the diagnosis of adenoid cystic carcinoma. The tumor cells have a bland, uniform appearance. Tubular structures with bicellular layers are also noted (H & E, ×200)

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