A 50 year old female presented to our institute with complaints of foreign body sensation in oral cavity, the patient was evaluated by ENT department and there was a mass in oropharynx and right tonsillar region, the growth was biopsied and reported as carcinoma ex pleomorphic adenoma. The patient was offered surgical treatment but refused and started on paclitaxel based chemotherapy but the mass continued to grow and it lead to such a point that it was causing occlusion in the nasal cavity as well as oral cavity leading to feeding and breathing difficulty as seen in Figure 1A. 

Pleomorphic adenoma is a benign tumor typically found in the salivary glands. Its occurrence in the trachea is rare and often overlooked due to low clinical suspicion, despite respiratory symptoms. We report the case of a 47-year-old Caucasian woman, active smoker with a 34 pack-year history, and a diagnosis of non-allergic asthma for 15 years, with progressive worsening control despite medical therapy.