We present a case of an adenoid cystic carcinoma (ACC) located in the upper trachea, which resulted in significant airway blockage, that was unsuitable for surgical removal due to concerns about functional impairment. Instead, endotracheal enucleation via rigid bronchoscopy was performed initially, followed by the injection of a novel tumor ablation agent known as para-toluenesulfonamide (PTS). We detail the dosing regimen, effectiveness evaluation, and post-treatment follow-up. The study highlights the potential of PTS injection as a viable alternative treatment option for patients with ACC who cannot undergo surgical resection and feasibility of lipiodol to monitor treatment effect. This research adds to the existing knowledge on ACC treatment and provides new therapeutic possibilities for patients with tracheal ACC.
INTRODUCTION
Adenoid cystic carcinoma (ACC) is a rare malignancy that originates in glandular tissues, including the salivary glands and respiratory tract.1 The standard treatment is surgical resection,2, 3 often followed by adjuvant radiation therapy. However, the role of radiotherapy in ACC management remains unclear due to limited reports, and surgical resection may not always be feasible due to various factors, including large size, hard-to-reach location, invasiveness to nearby neurovascular structures, concerns to functional impairment, and comorbidities.
In this case report, we present a patient with tracheal ACC near the vocal cords, just 1.5 cm below, making surgical resection impractical due to functional concerns. Instead, we opted for endotracheal enucleation via rigid bronchoscopy, followed by injection of a novel tumor ablation agent para-toluenesulfonamide (PTS) to treat the residual and extraluminal portion of the tumor.