ABSTRACT
Adenoid cystic carcinoma (ACC) is an infrequent malignant neoplasm that originates most commonly in the major and minor salivary glands of the head and neck region. This study provides new information on head and neck ACC with cervical lymph node metastasis. Of 616 patients who underwent primary tumour resection from 1995 to 2008 in the authors' hospital, 62 cases with cervical lymph node metastasis were analyzed. The general incidence of cervical lymph node metastasis in ACC was approximately 10%. The base of tongue, mobile tongue and mouth floor were the most frequent sites of lymph nodes metastasis, with incidences of 19.2%, 17.6% and 15.3%, respectively. Most cases occurred via a classic 'tunnel-style' metastasis and the level Ib and II regions were the most frequently involved. Primary site and lymphovascular invasion were significantly associated with lymph node metastasis. High patient mortality was significantly correlated with lymph node positive cases. The tongue-mouth floor complex has a high propensity for cervical lymph node metastasis, which occurs through a classic 'tunnel-style' metastasis. Peritumoral lymphovascular invasion could be taken as strong predictor for lymph node metastasis, which ultimately leads to poor prognosis of ACC patient. Selective neck dissection should be considered in such cases.
Subject(s)
Carcinoma, Adenoid Cystic/secondary , Lymphatic Metastasis/pathology , Salivary Gland Neoplasms/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Adenoid Cystic/epidemiology , Case-Control Studies , Child , China/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Mouth Floor/pathology , Neck/pathology , Neoadjuvant Therapy/statistics & numerical data , Neoplasm Invasiveness , Parotid Neoplasms/epidemiology , Parotid Neoplasms/pathology , Retrospective Studies , Salivary Gland Neoplasms/pathology , Salivary Glands, Minor/pathology , Submandibular Gland Neoplasms/epidemiology , Submandibular Gland Neoplasms/pathology , Survival Rate , Tongue Neoplasms/secondary , Young AdultABSTRACT
OBJECTIVE: The aim of this study was to examine the anti-invasion effect of Shikonin on human high-metastatic adenoid cystic carcinoma (ACC-M) cells and to explain the possible molecular mechanism involved. METHODS: The ACC-M cells were treated with Shikonin (0, 2.5, 5, 10 µM) for 24 h. The protein levels and gelatinolytic activities of MMP-2 and MMP-9 were analyzed using Western blot and Gelatin zymography test, respectively. Matrigel invasion assays were used to investigate tumor invasive potential and electromobility shift assays were used to determine the activity of NF-κB. RESULTS: The invasiveness of ACC-M cells was reduced in a dose dependent manner following 24-h treatment of up to 10 µM of the Shikonin at which concentration no cytotoxicity occurred. The protein levels and gelatinolytic activities of MMP-9 were significantly suppressed by increasing Shikonin concentrations. The down-regulation of MMP-9 appeared to be via the inactivation of NF-κB as the treatment with Shikonin suppressed the protein level of phosphate-IkBa, which was accompanied by a decrease in DNA-binding level of the factor. CONCLUSIONS: Shikonin inhibits tumor invasion via downregulation of MMP-9 expression in ACC-M cells. Pharmacologic inhibition of the NF-κB-mediated MMP-9 expression by Shikonin might be a powerful treatment option for ACC patients in future.
