Adenoid cystic carcinoma of the airway: thirty-two-year experience.

METHODS: We have reviewed our experience in 38 patients with adenoid cystic carcinoma of the upper airway seen between 1963 and 1995. The mean age was 44.8 years (15 to 80 years) with a male/female ratio of 1:1.1. Thirty-two of the 38 patients were treated by resection and reconstruction (primary anastomosis 28; Marlex mesh prosthesis 4). Twenty-six of the 32 patients undergoing resection received adjuvant radiotherapy. Six patients with unresectable tumors were treated primarily with radiotherapy only. RESULTS: Pathologic examination revealed local invasion beyond the wall of the trachea in all patients. In a majority, microscopic extension was found in submucosal and perineural lymphatics, well beyond the grossly visible or palpable limits of the tumor. Lymphatic metastases were relatively uncommon, occurring in only five of 32 (19%) patients undergoing resection. Metachronous hematogenous metastases occurred in 17 of 38 patients (44%). Thirteen of these 38 patients (33%) had pulmonary metastases. Sixteen of 32 resections were complete and potentially curative. There were two deaths within 30 days of operation. The mean survival in the 14 patients undergoing complete resection was 9.8 years (12 months to 29 years). Sixteen of 32 resections were incomplete (residual tumor at the airway margin on final pathologic examination), with one operative death occurring in this group. The mean survival in the 15 surviving patients was 7.5 years (4 months to 21 years). Six patients were treated with primary radiation only and had a mean survival of 6.2 years (2 months to 14.3 years). In the patients with pulmonary metastases, mean survival was 37 months (4 months to 7 years) from the time of diagnosis of the pulmonary metastasis until their death. CONCLUSION: Adenoid cystic carcinoma of the upper airway is a rare tumor, which is locally invasive and frequently amenable to resection. Although late local recurrence after resection is a feature of this tumor (up to 29 years), excellent long-term palliation is commonly achieved after both complete and incomplete resection. There was a small difference in survival between patients having complete and incomplete resection. Long periods of control can be obtained with radiotherapy alone. The best results, in this series of patients, were obtained by resection. Adjuvant radiotherapy is assumed to favorably influence survival.

A study of cell membrane structure.

Neoplastic transformation has been associated with a variety of structural changes, among which are changes in membrane carbohydrates. Not much is known, though, e.g., how early in the tumourogenic event these changes take place and what effect these changes have on cell growth, invasion, and ability to metastasize. We were able to identify the B-D-Gal(1-3)DGal-NAc as a membrane carbohydrate component present in malignant laryngeal tissue, but not on adjacent normal mucous membrane. This carbohydrate structure was found to be present in metastatic as well as in nonmetastatic tumours. It was also found in well-differentiated as well as poorly differentiated carcinomas. We suggest that changes in carbohydrate components on the cell membrane of the laryngeal cancer cell are an early event in tumour progression and probably are not related to the degree of invasion or the ability to metastasize.

Lectin binding characteristics of laryngeal cancer.

Previous reports have shown specific binding characteristics of peanut lectin to a variety of lymphatic and epithelial tumors. This study demonstrates the presence of lectin binding sites on cell membrane of laryngeal cancer cells, but not on adjacent normal epithelial linings. It also demonstrates the presence of glycoconjugates responsible for lectin adherence in fetal larynges. The Thomsen-Friedenreich antigen is a glycoprotein structure participating in the structure of the MN blood group antigen. It is also the structure that binds the peanut agglutinin. Perhaps this antigen, which we found on fetal larynges as well as on malignant laryngeal epithelial lining, is another oncodevelopmental antigen.

Paraganglioma of the larynx.

A patient with a laryngeal paraganglioma is presented in which overtly malignant behavior occurred despite a four-year period of symptoms prior to diagnosis. A review of the world literature reveals 52 reported cases of laryngeal paragangliomas. The incidence of malignancy in these neoplasms is often underestimated, as at least 25% of reported cases exhibited a clinically malignant natural history. We believe that the treatment of laryngeal paragangliomas should be based on the assumption that all tumors have a potential for malignant growth. Wide-field surgical excision is the applicable treatment for tumors still localized to the larynx. The results of radical neck dissection for established nodal disease are discouraging. In those patients with palpable lymph nodes, widespread dissemination has usually taken place.

Cavernous hemangioma of the external ear canal.

Cavernous hemangiomas are benign tumors of blood vessel origin. Cavernous hemangiomas arising from the tympanic membrane with or without involvement of the skin of the deep external auditory canal may occur in rare cases. In this paper, the clinical and pathological findings in the first recorded case of a patient with a cavernous hemangioma arising from the skin of the deep external canal with no involvement of the tympanic membrane are presented.

Eccrine hidrocystoma of the external ear canal: a case report.

Eccrine hidrocystomas are essentially sweat gland retention cysts located in the dermis. Clinically, an eccrine hidrocystoma presents as a small, translucent cystic swelling (often having a bluish hue), and measuring from 1 to 3 mm in diameter. The clinical and histopathological features of an eccrine hidrocystoma of the external auditory canal are presented, and the morphologic differences between an eccrine and an apocrine hidrocystoma are discussed.