Adenoid cystic carcinoma arising from minor salivary glands of palate involving maxillary sinus.

Adenoid cystic carcinoma (ACC) was first described by Billroth in 1856 and was called ‘cylindroma’ due to its characteristic histological appearance. ACC is the most common malignant neoplasm of the lacrimal gland, and the second most common type of carcinoma arising in the salivary glands, following mucoepidermoid carcinoma. Palate is the most commonly affected site followed by parotid gland, submandibular gland, antrum & tongue. Characteristic features include aggressive, slow growth, with insidious destruction of surrounding tissues, perineural invasion, prolonged clinical course and the tendency for delayed onset of the distant metastases which worsens the prognosis. Long term survival can be achieved particularly with combined surgery and radiotherapy. The most common pattern is the cribriform architecture. Histopathology is the gold standard for the diagnosis of ACC. CT & MRI are considered to be of almost similar significance in detection of perineural spread with preference to MRI because of its high soft tissue contrast. Here we have mentioned a case of Adenoid Cystic carcinoma arising from minor salivary glands of palate.

Assessment of perineural infiltration and spread of oral squamous cell carcinoma: A clinicohistopathologic study.

Background : As the tumor spreads through the pathway of least resistance, the present study was carried out to evaluate the presence of perineural infiltration and spread of oral squamous cell carcinoma (OSCC) along the perineural spaces in gingivobuccal sulcus tumors infiltrating into the mandible. AIMS and objectives : (1) To investigate the incidence of perineural invasion of OSCC along the inferior alveolar nerve and (2) to investigate the neurovascular bundle as a potential route of spread of OSCC. Materials and Methods : Twenty-six patients with histopathologically proven OSCC of the gingivobuccal sulcus with radiographic infiltration of the mandible were included. The surgical specimens were decalcified and serially sectioned. Each section was stained with hematoxylin and eosin and was screened for the presence of perineural invasion and spread. Results : Twenty-five specimens showed perineural infiltration but none of the cases showed perineural spread along the inferior alveolar canal. Also, not all cases showed any neurologic deficit. Follow-up of these cases showed early recurrence (6-8 months) in the study group. Conclusion : Perineural infiltration is present in OSCC but perineural spread along the inferior alveolar canal is absent. It is a bad prognostic indicator.

C avernous Sinus Involvement of Adenoid Cystic Carcinoma of Lacrimal Gland

Adenoid cystic carcinoma is slow growing, but locally aggressive and thus prone to recurrence with late distant metastasis. Intracranial involvement of adenoid cystic carcinoma is rare but most of theses cases are thought to extend directly or by perineural spread from lesions in adjacent structures, such as the paranasal sinuses, nasopharynx, salivary glands, or from the lacrimal glands. And hematogenous metastasis is rare. Adenoid cystic carcinoma of the lacrimal glands is known to comprise 30% of epithelial neoplasms of the lacrimal gland, but its cavernous sinus involvement with perineural extension has never been reported in Korea. A cavernous sinus mass was found in a 43-year-old man presenting ophthalmoplegia and facial palsy. The mass was later diagnosed as metastatic adenoid cystic carcinoma of the lacrimal gland, whose size was decreased after radiation. Thus we report the case with a brief review of literature.

Multiple Metastases of the Adenoid Cystic Carcinoma Associated with Intracranial Metastasis

OBJECTIVE: Adenoid cystic carcinoma is a relatively slowly growing malignant tumor. Probably at least 40-50% of patients eventually develop distant metastases. We present the natural history and treatment modality of this malignancy from our experience and review of literature. METHODS: We report a case of a 30-year-old man who complained of a headache, facial pain and hearing disturbance in the right ear. Physical examination revealed soft, protruded mass and narrowed external auditory canal. The cranial MRI showed a well defined mass in the extradural middle cranial fossa. RESULTS: The patient underwent subtotal resection of the lesion after tumor embolization was performed. The pathological diagnosis was adenoid cystic carcinoma. The patient received postoperative radiation therapy(56Gy) resulting in a complete neurological recovery. Fifteen months later, the patient was readmitted for severe back pain. Bone scan disclosed hot uptakes at the upper cervical spine, the 4th lumbar vertebra, and the pelvic area. These areas were irradiated(40Gy) and the presenting symptoms were relieved. Twenty months later, he complained of respiratory difficulty and was found to have a multiple nodule(s) in the lung. He was given 10 cycles of chemotherapy but discharged because of unresponsivencess and development of new lesions. Brain MRI and bone scan were checked 10 months after his discharge due to more aggravated lung metastasis although local tumor was controlled. Adjuvant radiation therapy(18Gy) was performed and he continued to be functional independently, although he was no longer working as a registered nurse. Two months later, dyspnea and hemoptysis were more improved and chest X-ray showed decreased mass. During the follow up period, he complained of intercostal pain, chest X-ray showed more aggregated lung mass. Chest CT scan showed multiple lung metastases and liver metastasis. In spite of adjuvant radiotherapy, the patient died of multiple systemic metastases 47 months after the first operation. CONCLUSION: Surgery is essential in the treatment of adenoid cystic carcinoma. Radiotherapy has gained acceptance as a palliative therapy, as it reduces tumor bulk and relieves symptoms. The combined treatment do not, however, prevent further recurrence and distance metastasis.