Delayed Diagnosis of Primary Bronchial Adenoid Cystic Carcinoma Presenting as Central Airway Obstruction: A Case Report

Bronchial adenoid cystic carcinoma (ACC) is a rare malignant tumor originating from salivary gland-type tissues of the tracheobronchial tree. It usually occurs in relatively young patients and is not strongly associated with tobacco exposure. Despite its slow-growing nature, ACC can behave aggressively locally, leading to significant airway obstruction. We report the case of a 47-year-old woman exposed to wood smoke who presented with progressive exertional dyspnea and unquantified weight loss. Chest computed tomography revealed a right hilar infiltrative lesion completely obstructing the right main bronchus, causing right lung atelectasis. Bronchoscopic evaluation demonstrated a highly vascularized endobronchial tumor. Histopathological examination confirmed ACC with cribriform pattern and perineural invasion. Pulmonary function tests indicated suitability for surgery. Considering the anatomical extent and absence of distant metastasis, the patient underwent right pneumonectomy with carinal resection. This case emphasizes the diagnostic challenges of ACC, the rationale for radical surgery in anatomically constrained tumors, and the importance of long-term multidisciplinary follow-up due to the risk of late local recurrence and delayed metastasis. Early recognition of persistent central airway symptoms is critical for optimizing patient outcomes.