Two Roads to Diagnose Primary Esophageal Adenoid Cystic Carcinoma in the Mediastinum.

Adenoid cystic carcinoma (ACC) is a malignant epithelial tumor that predominantly originates in the salivary glands of the head and neck. However, ACC arising in the thoracic cavity is a rare entity. Diagnosis of primary esophageal ACC (EACC) involves use of gastrointestinal endoscopic ultrasound fine-needle aspiration; however a low diagnostic yield has been reported in the literature. We describe an uncommon presentation of EACC debuting with predominant airway obstructive symptoms and diagnosed through endobronchial ultrasound-guided fine-needle aspiration. We propose the use of an endobronchial sonographic approach to diagnose EACC and other esophageal malignant neoplasms with mediastinal involvement and airway proximity.