BACKGROUND: Tracheal tumors are often misdiagnosed as asthma and are treated with inhaled steroids and bronchodilators without resolution. CASE PRESENTATION: Here, a patient with tracheal adenoid cystic carcinoma who had been previously diagnosed with difficult asthma was reported. The possibility of the presence of localized airway obstruction was raised when the flow-volume curve suggesting fixed airway obstruction, was obtained. CONCLUSION: The presenting case report emphasizes the fact that not all wheezes are asthma. It is critical to bear in mind that if a patient does not respond to appropriate anti-asthma therapy, localized obstructions should be ruled out before establishing the diagnosis of asthma

AI Tastepe

Cuneyt Kurul

FG Pearson

Haluk Turktas

HC Grillo

JM Pando Pinto

K Tayama

MS Allen

Nurdan Kokturk

PS Stack

RW Parrish

Sedat Demircan

UY Turay

English

PubMed

Springer - Publisher Connector

BioMed CentralBMC Pulmonary Medicine
ssOpen AcceCase report
Tracheal adenoid cystic carcinoma masquerading asthma: A case 
report
Nurdan Kokturk*1, Sedat Demircan2, Cuneyt Kurul2 and Haluk Turktas1
Address: 1Gazi University School of Medicine, Department of Pulmonary Medicine, Ankara, Turkey and 2Gazi University School of Medicine, 
Department of Thoracic Surgery, Ankara, Turkey
Email: Nurdan Kokturk* - nkokturk@gazi.edu.tr; Sedat Demircan - sedatd@gazi.edu.tr; Cuneyt Kurul - ckurul@hotmail.com; 
Haluk Turktas - haluktur@superonline.com
* Corresponding author    
Abstract
Background: Tracheal tumors are often misdiagnosed as asthma and are treated with inhaled
steroids and bronchodilators without resolution.
Case Presentation: Here, a patient with tracheal adenoid cystic carcinoma who had been
previously diagnosed with difficult asthma was reported. The possibility of the presence of localized
airway obstruction was raised when the flow-volume curve suggesting fixed airway obstruction,
was obtained.
Conclusion: The presenting case report emphasizes the fact that not all wheezes are asthma. It is
critical to bear in mind that if a patient does not respond to appropriate anti-asthma therapy,
localized obstructions should be ruled out before establishing the diagnosis of asthma.
Background
Tracheal tumors are uncommon and often overlooked
until they reach to an advanced stage. The presenting
symptoms are typically prolonged cough and wheezing
that can be misdiagnosed as asthma [1]. Therefore, mak-
ing precise diagnosis of tracheal tumor may be extremely
challenging.
Here, a patient with tracheal adenoid cystic carcinoma
who had been previously diagnosed with difficult asthma
was reported.
Case presentation
A 29 year-old man was referred to our hospital with a 2-
year history of paroxysmal attacks of dyspnea, dry cough
and wheezing. He had smoked 2 packs/day cigarettes for
3 years and has been ex-smoker for 5 years. He experi-
enced frequent sudden-onset coughing episodes followed
by the development of dyspnea and wheezing a year ago.
He was previously diagnosed with difficult asthma and
treated with high dose inhaled corticosteroids (1600 µg
budesonide) and bronchodilators. Since he was unre-
sponsive to the therapy, he has applied to several institu-
tions for multiple times to seek medical attention.
On admission, no stridor, wheezing and cyanosis were
present and the general appearance was good. Vital signs
were as follows: temperature 37°C, respiratory rate 20/
min, pulse 96 beats/min, blood pressure 140/70 mmHg.
The chest examination was unremarkable. The results of
the routine laboratory analysis, including complete blood
cell count, chemistry, arterial blood gas, urinalysis and
chest x-ray were within normal ranges. On spirometric
examination, flow-volume curve displayed suggestive
Published: 19 October 2004
BMC Pulmonary Medicine 2004, 4:10 doi:10.1186/1471-2466-4-10
Received: 23 May 2004
Accepted: 19 October 2004
This article is available from: http://www.biomedcentral.com/1471-2466/4/10
© 2004 Kokturk et al; licensee BioMed Central Ltd. 
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 4
(page number not for citation purposes)
BMC Pulmonary Medicine 2004, 4:10 http://www.biomedcentral.com/1471-2466/4/10fixed airway obstruction. Forced vital capacity (FVC) was
122 % of predicted, forced expiratory volume in one sec-
ond (FEV1) was 31 % of predicted and FEV1/FVC was 21
% (Figure 1). In order to exclude the possibility of upper
airway obstruction, a work-up of computerized tomogra-
phy (CT) of the chest and fiberoptic bronchoscopy (FOB)
was obtained. The CT scan illustrated a solid, polipoid
intratracheal mass originating from the right side of the
trachea at 4 centimeter proximal of the carina (Figure 2a).
FOB revealed a smooth, round mass of 2 cm in diameter
originating from the right lateral side of the trachea. The
lesion was occupying approximately 50 % of the lumen
(Figure 3). It localized at 4th centimeter distal to larynx.
Histopathological diagnosis was adenoid cystic carci-
noma of the trachea.
The patient underwent resection surgery. At the opera-
tional site, there were severe adhesions between the medi-
astinal surface and the trachea. Therefore, a conservative
surgery was performed. The tumor was seen on the right
anterolateral wall of the trachea being expanded submu-
cosally from the carina to the proximal end of the trachea.
The patient underwent adjuvant radiation therapy after
the operation. CT scan of the neck revealed resolution of
the tumor (Figure 2b). Now, 3 months after the operation,
the patient has remained well.
Conclusions
Primary tracheal tumors are rare with the incidence of less
than 0.1 % [2,3]. The majority of tracheal tumors in adults
are malignant and the most common ones are squamous
cell carcinoma and adenoid cystic carcinoma (cylin-
droma). Tumors of the larynx and lungs are respectively,
75 and 180 times more common than malignant tracheal
tumors [3,4]. Benign tracheal tumors such as lipoma,
Flow-volume curve displays suggestive fixed airway obstructionigure 1
Flow-volume curve displays suggestive fixed airway 
obstruction
a) Chest CT scan displays a polypoid mass occupying 50 % of the lumenFigure 2
a) Chest CT scan displays a polypoid mass occupying 50 % of 
the lumen. b) Control CT scan displays resolution of the 
tumorPage 2 of 4
(page number not for citation purposes)
BMC Pulmonary Medicine 2004, 4:10 http://www.biomedcentral.com/1471-2466/4/10hamartoma and neurilemmoma are much more rare than
malignant tracheal tumors [2,5,6].
Clinical manifestations of tracheal tumors are developed
as a consequence of tumor bulk and location. Patients
with tracheal tumor often have exertional shortness of
breath, prolonged cough or a new onset of wheezing,
which is frequently misdiagnosed as asthma. Patients are
usually initially managed accordingly. However, tumor
may occlude 75 % of the lumen before leading symptoms.
In the literature, most of the reports highlight that there is
always a remarkable delay of establishing accurate diag-
nosis as a result of misdiagnosis of asthma [1,5,7]. Pear-
son et al have reported a 2-month to 2-year delay in
diagnosis in their series from Toronto General Hospital
[8]. Therefore, adult-onset asthma that increases the sever-
ity despite the adequate therapy should alert one to the
possibility of a central obstructing lesion [1]. In such
patients, a flow-volume curve may provide extremely val-
uable data and may lead the clinician toward accurate
diagnosis.
Another diagnostic challenge of tracheal tumor is the fact
that it can occasionally be visualized by plain chest X-ray.
CT scan of the chest or magnetic resonance imaging may
yield more valuable data on the site and length of the tra-
cheal lesion [1]. The cornerstone diagnostic modality is
bronchoscopy [1].
In the presenting report, the patient had been mistakenly
diagnosed with difficult asthma because of the presence of
uncontrolled asthmatic symptoms and poor lung func-
tions despite the use of high doses corticosteroids. Never-
theless, the flow-volume curve typically displayed
localized fixed obstruction of central airways. This led us
to have a work-up of CT scan and FOB to rule out upper
airway obstructions.
Adenoid cystic carcinomas are smooth, firm, and well-cir-
cumscribed lesions. These tumors grow extremely slowly.
Patients have been known to survive for 10 to 15 years
with multiple lung metastases. Spread tends to occur sub-
mucosally [1].
The optimal therapeutic approach is surgical resection
and reconstruction. The surgeon should be aware of the
fact that the apparent gross margin of the tumor is usually
still involved with the tumor cells so that the resection
should be done at least 1 cm beyond the gross tumor mar-
gin. Postoperative irradiation was recommended by most
of the authors [1,9]. Long-term postoperative follow-up is
important to discover recurrences.
In this case, postoperative irradiation on curative doses
has been applied for a month. Control bronchoscopic
examination revealed near-complete remission.
The presenting case report emphasizes the fact that not all
wheezes are asthma. It is critical to bear in mind that if a
patient does not respond to appropriate anti-asthma ther-
apy, localized airway obstructions should be rule out
before establishing the diagnosis of asthma.
Competing interest
The author(s) declare that they have no competing
interests.
Authors' contributions
HT has seen the patient and made the diagnosis of tra-
cheal obstruction, participated in the design of the manu-
script. NK has seen the patient in the clinical, followed the
patient and drafted the manuscript. SD and CK have per-
formed the surgery and followed the patient. All authors
read and approved the final manuscript.
Acknowledgements
The patient who has been illustrated in this report has given a signed writ-
ten consent for the publication of the study.
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Bronchoscopic examination reveals polypoid mass originating from trachea with a 50 % obstruction of the lumenFigure 3
Bronchoscopic examination reveals polypoid mass originating 
from trachea with a 50 % obstruction of the lumen.Page 3 of 4
(page number not for citation purposes)
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Pre-publication history
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Tracheal adenoid cystic carcinoma masquerading asthma: A case report

Abstract Background Tracheal tumors are often misdiagnosed as asthma and are treated with inhaled steroids and bronchodilators without resolution. Case Presentation Here, a patient with tracheal adenoid cystic carcinoma who had been previously diagnosed with difficult asthma was reported. The possibility of the presence of localized airway obstruction was raised when the flow-volume curve suggesting fixed airway obstruction, was obtained. Conclusion The presenting case report emphasizes the fact that not all wheezes are asthma. It is critical to bear in mind that if a patient does not respond to appropriate anti-asthma therapy, localized obstructions should be ruled out before establishing the diagnosis of asthma.</p

Kurul Cuneyt

Demircan Sedat

Kokturk Nurdan

Turktas Haluk

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Demirag F: Surgical Treatment of Tracheal Hamartoma. Scand Cardiovasc J

Erdogan Y: A Case Of Tracheal Neurilemmoma Treated As Bronchial Asthma. Turkish Respir J

Experience With Primary Neoplasms Of The Trachea And Carina. J Thorac Cardiovasc Surg

Fennerty AG: Tracheal Obstruction Presenting As Asthma. Postgrad Med J

Malignant Tracheal Tumors. Mayo Clin Proc

Primary Tracheal Tumors: Treatment and Results. Ann Thorac Surg

Tracheal Lipoma Obstructing The Right Main Bronchus: Report Of A Case. Surg Today

Tracheal Neurilemmoma: Case Report and Review Of The Literature. Head And Neck

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Tracheal adenoid cystic carcinoma masquerading asthma: A case report

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