A Case of Tracheal Adenoid Cystic Carcinoma Leading to Horner Syndrome and Right Upper Extremity Paralysis Due to Brachial Plexus Metastasis

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 46; no. 2; pp. 79 - 84
• Main Authors: Yamaoka, Kouji, Demura, Yoshiki, Toyota, Yuji, Oi, Masahiro, Tada, Toshihiko, Sasaki, Kei, Kurokawa, Kousuke
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.03.2024; 特定非営利活動法人 日本呼吸器内視鏡学会
• Subjects: Adenoid cystic carcinoma; Brachial plexus; Horner syndrome; ホルネル症候群; 腕神経叢; 腺様囊胞癌
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.46.2_79

Background. Among patients with a primary malignant tumor of the trachea, those with tracheal adenoid cystic carcinoma have a relatively good prognosis. However, perineural invasion beyond gross tumor boundaries has been noted in a few cases. The most common tumor metastasis is hematogenous. Case. A 73-year-old man visited a physician because of a decreased swallowing function and paralysis of the right upper extremity. Horner syndrome on the right side was also noted, and the patient was referred to our department under suspicion of Pancoast syndrome. Chest computed tomography showed a tracheal mass 3 cm in diameter, whereas cervical magnetic resonance imaging indicated a contiguous neuromatous lesion extending from the C5-8 and T1 nerve roots to the brachial plexus on the right side. A bronchoscopic biopsy of the tracheal mass led to a histopathological diagnosis of adenoid cystic carcinoma. Examination of a biopsy specimen from the brachial plexus lesion also indicated adenoid cystic carcinoma, and a diagnosis of distant metastasis from the primary tracheal lesion was determined. The patient was provided the best supportive care. Death from malignancy occurred approximately two years after the diagnosis. Conclusion. We encountered a rare case of tracheal adenoid cystic carcinoma with metastasis to the brachial plexus that caused Horner syndrome and right upper extremity paralysis.