PMC8948477_01
Diagnostic workup
. (A) Stroboscopy photo of the proximal cauliflower tracheal tumour. (B) Axial computed tomography scan of the proximal tracheal tumour. (C) Coronal computed tomography scan of the proximal tracheal tumour
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F1
Stroboscopy showed a subglottic tumour  and computed tomography (CT) scan confirmed a tumour in  the proximal trachea causing more than 95% obstruction of the  lumen with extraluminal extension (Figs 1A, 1B and 1C).
Cryoablation, intraoperative image, and histology. (A) Proximal tracheal tumour after 3 times cryoablation with a tracheostomy tube in place. (B) Intraoperative image with proximal margin. (C) Intraoperative image with distal margin. (D) Intraoperative image of sleeve tracheal resection. (E) Cribriform and tubular pattern (H&E, 40x magnification). (F) Dual population of ductal and myoepithelial cells associated with myxoid globules (40x magnification)
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F2
Subsequently, partial cryoablation was done twice  with an interval of two weeks (Fig. 2A). The pathological analysis  showed low-grade ACC with a dominant cribriform pattern (Figs 2E and 2F). The proximal posterior margin at the level of the post  cricoid cartilage was very close to the tumour (Figs 2B, 2C and 2D). 
Postoperative bronchoscopy. (A and B) Early post-operation bronchoscopy. (C and D) Six months post operation and radiotherapy
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F3
Re-bronchoscopy  done early (Figs 3A and B) and 6 months  (Figs 3C and 3D) post radiotherapy showed  a normal healing trachea.