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- Original Article -

Clinicopathologic Study of Surgically Treated Cases of Tracheobronchial Adenoid Cystic Carcinoma

Junzo Shimizu¹, Makoto Oda², Isao Matsumoto², Yoshihiko Arano¹, Norihiko Ishikawa¹, Kenichiro Saitoh¹, Hiroshi Minato^3
1Department of Surgery, KKR Hokuriku Hospital, Japan, ²Department of Chest Surgery, Kanazawa University School of Medicine, Japan, ³Department of Clinical Pathology, Kanazawa Medical University, Japan

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Objective. We conducted a clinicopathologic study of surgically treated cases of tracheobronchial adenoid cystic carcinoma (ACC). Materials and Methods. Of the 1,909 patients with lung cancer who underwent resection in our hospital and associated institutes during the 28-year period between 1980 and 2007, five (0.3%) were pathologically diagnosed as ACC of the trachea, bronchus and lung. All 5 patients were women aged from 37 to 67 years, with an average age of 50.8 years. Four tumors were located in the larger airways (one in the carina, one in the right main bronchus, one in the left main bronchus, one in the middle lobe bronchus) and one tumor was located in the peripheral lung of left S⁴_b. The following operations were done: bronchoplastic procedures in 3 (carinal resection with double-barreled carinoplasty in 1, sleeve right pneumonectomy in 1, sleeve middle lobectomy in 1), left pneumonectomy in 1, and left upper lobectomy in 1. Results. Three of 5 patients have survived for 172, 144, and 10 months after surgery, respectively, but 2 of the patients died 15 and 95 months after surgery, respectively (The cause of death of one patient was distant metastases to the skin, breast, and lung, and that of the other patient was colon cancer). Conclusion. For local treatment for ACC of the major airway, the best method is considered to be sleeve resection of the trachea or bronchus in an area where airway reconstruction may not be disturbed and to add postoperative irradiation when there is residual carcinoma at the stump. However, it seems controversial to recommend adjuvant radiotherapy in all patients undergoing resection.
key words: Adenoid cystic carcinoma, Tracheobronchial origin, Bronchoplastic procedure, Postoperative radiotherapy

Received: February 27, 2008
Accepted: May 20, 2008

JJLC 48 (4): 261-265, 2008