Neurotrophic spread of both neuroblastoma and adenoid cystic carcinoma in the maxillofacial district: common aspects of pre- and postsurgical adjuvant treatment. Multidisciplinary study.

We have studied a common aspect of both adenoid cystic carcinoma (ACC) and neuroblastoma (NB) with the purpose of finding the optimal medical and surgical treatment. This article is based on a case study involving 22 cases of ACC and NB performed at the University of Rome La Sapienza from 1993 to 2001. Of the 22 cases, 17 were diagnosed with ACC and 5 with NB. ACC largely involved the maxillae, having been detected in this location in eight cases. Two of these patients, one affected by ACC and the other affected by NB, received neoadjuvant treatment, whereas 14 were affected by ACC, and 3 with NB received adjuvant treatment. Despite the fact that the two neoplasms have different embryogenic structures, they share common aspects. Both spread invasively through the perineural sheets, and both are responsive to radiotherapy or chemotherapy. The common biologic behavior and the similar response that both show to neoadjuvant radiotherapy or chemotherapy may suggest a way to develop a more effective treatment protocol. The aim of this article is to suggest a line of research along that path.

[Lymph node metastasis of adenoid cystic carcinoma]. / Metastasi linfonodali nel carcinoma adeno-cistico.

BACKGROUND: The adenocystic carcinoma (ACC) of the head and of the neck is rather uncommon. It is characterized by a very slow biological behaviour, which leads to locoregional recurrences and distant metastasis. Most reports concentrate on the unpredictable long-term behaviour of this tumor, whereas lymph nodes metastasis are not usually discussed in detail. The aim of this study was to evaluate the difficulties connected with the lymph node metastasis in ACC. METHODS: A group of 33 patients from 1980 to 1998, was observed. These patients have been subjected to surgical treatment in the Maxillo-Facial Surgery Department of the Policlinico-Umberto I of Rome. RESULTS: Among 33 patients with ACC, 10 patients (30%) revealed, initially or during observation, cervical lymph node metastasis, which is a most common event in male subjects (70%). The lymph node involvement is much more common in carcinomas localized in the parotid and in the sublingual glands with a solid rather than a tubular histologic pattern. Direct correlation between age and metastasis lymph node involvement have not been documented. CONCLUSIONS: Surgery for node disease has a very little impact on the locoregional and on the distant metastasis evolution of the tumor. Thus, our protocol of treatment of lymph nodes metastatic lesions follows the trend of most of the international authors, considering that the neck dissection should be performed only with a lymph adenopathy clinically evident or strongly suspected.