Adenoid cystic carcinoma of the airway: Thirty-two-year experience

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Presentation transcript:

Adenoid cystic carcinoma of the airway: Thirty-two-year experience Donna E. Maziak, MDCM, Thomas R.J. Todd, MD, Shafique H. Keshavjee, MD, Timothy L. Winton, MD, Peter Van Nostrand, MD, F.Griffith Pearson, MD The Journal of Thoracic and Cardiovascular Surgery Volume 112, Issue 6, Pages 1522-1532 (December 1996) DOI: 10.1016/S0022-5223(96)70011-9 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Chest radiograph of patient with 5 cm tracheal lesion extending into the carina and left main bronchus. This x-ray film was interpreted as showing no abnormalities. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Gross appearance of a resected specimen of adenoid cystic carcinoma. The overlying mucosa is intact and the gross margins of the tumor appear circumscribed. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 A, Photomicrograph illustrating the extensive microscopic spread of adenoid cystic carcinoma. The spread occurs both longitudinally and circumferentially and is neither visible to nor palpable by the operating surgeon. Tr, Trachea. B, Photomicrograph illustrating adenoid cystic carcinoma, spreading longitudinally on the outer surface of the trachea, in the perineural lymphatic spaces. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 A, Photomicrograph illustrating the extensive microscopic spread of adenoid cystic carcinoma. The spread occurs both longitudinally and circumferentially and is neither visible to nor palpable by the operating surgeon. Tr, Trachea. B, Photomicrograph illustrating adenoid cystic carcinoma, spreading longitudinally on the outer surface of the trachea, in the perineural lymphatic spaces. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Actuarial survival curve comparing the results of complete and incomplete resection. Dashed line, Complete resection (15 patients at risk); solid line, incomplete resection (14 patients at risk). The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Actuarial survival curve in 32 patients treated by primary resection. Because of three operative deaths, 29 patients were at risk. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Tumor in the upper mediastinal trachea of a 15-year-old girl. The tumor was resected and replaced with a cylinder of Marlex mesh in 1963. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 A contrast tracheogram in the same patient, 4 years after prosthetic replacement. The prosthetic airway is indicated by the black arrow and is widely patent. Beginning at 4 ½ years, progressive narrowing developed at the upper ends of the prosthesis. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 8 A, In 1968, 5 years after the initial resection, the patient was again operated on. The prosthesis and adjacent tracheal ends were resected. B, The airway was reconstructed by primary anastomosis. Release procedures were used at the upper and lower ends of the airway. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1522-1532DOI: (10.1016/S0022-5223(96)70011-9) Copyright © 1996 Mosby, Inc. Terms and Conditions