Adenoid cystic carcinoma originates from the glands in the tracheobronchial mucosa and its primary treatment is complete surgical resection.

A 43-year-old male patient presented to our clinic with the complaints of cough, phlegm and haemoptysis continuing for the last 2 years. In his physical examination, a decrease in breath sounds was found in his left hemithorax during auscultation. As chest x-ray showed a left hilar enlargement, a thoracic computed tomography was taken which revealed a mass 17x21 mm in size extending from the lateral side of the lower left tracheal wall into the left main bronchus, considerably constricting the lumen. A biopsy was taken from the lesion during fiberoptic bronchoscopy and its histopathologic examination led to the diagnosis of Adenoid cystic carcinoma.

The patient was operated under general anaesthesia using right posterolateral thoracotomy which involved carinal resection and anastomosis of the distal side of the trachea with the right main bronchus end-to-end, and of the right intermediary bronchus with the left main bronchus end-to-side. Since surgical margin positivity was found in histopathologic examination, he was prescribed adjuvant radiotherapy. The patient is still asymptomatic after a 2-year follow-up.

Although negative surgical margins may not be achieved in locally advanced adenoid cystic carcinoma, resection of the tumor through complex surgical procedures with the addition of adjuvant radiotherapy enables long term survival.