A Rare Nasopharyngeal Adenoid Cystic Carcinoma: Case Report and Literature Review

Abstract

Unusual clinical course Background:Adenoid cystic carcinoma (ACC) is a malignant tumor that involves the salivary glands and is rarely seen in the nasopharynx. It is characterized by pain, a high rate of recurrence, and poor survival rate and poor prognosis as it tends to invade the perineurium. Due to the ambiguity of patient presentations, most patients present at a late stage, at which point metastasis has already occurred. Case Report:The patient in this case report was an otherwise healthy 56-year-old male smoker who presented to the clinic in March 2022 complaining of nasal obstruction, mouth breathing, recurrent epistaxis, headache, and facial pain. He reported significant weight loss in the past 6 months. The nasal scope showed nasopharyngeal fullness and biopsy-confirmed ACC exhibiting tubular, solid, and focal cribriform growth patterns. Further work-up showed an advanced form of nasopharyngeal ACC with intracranial extension and lung metastasis. The patient received concurrent radiotherapy and chemotherapy. After 6 months, the patient reported an improvement in the pain, and repeated images showed regression of the tumor size. Conclusions:ACC is a malignant disease that is rarely seen in the nasopharynx. Currently, the most commonly agreed upon management for resectable ACCs in the literature is through surgical resection with adjuvant radiotherapy. However, most of the reported cases received radiation and chemotherapy due to the difficulty and risk of radical surgical excision of nasopharyngeal malignant tumors. Patients should be followed up to rule out any local recurrence or distant metastasis.

Abducens Nerve Neuropraxia due to Acute Bacterial Rhinosinusitis: Case Report and Literature Review

“…Te average duration of resolution for neuropraxia was 38.3 days (Table 1). Early intervention was found to be the most important factor in a favorable outcome and complete recovery, as delayed, proper intervention was associated with residual nerve damage [39].…”

Complete clinical response to chemoradiation in adenoid cystic carcinoma of the base of tongue: Case report of a rare tumor in a rare location

“…18 Especially perineural invasion (PNI) is considered a poor prognostic factor as it is sometimes believed to be the fourth pathway of metastasis after hematogenous spread, lymphatic spread, and direct invasion of the adjacent organs by the tumor. 19 …”

“…Alsubaie et al. 19 reported a literature review on nasopharyngeal ACC, in which the majority of patients were treated with definitive radiotherapy with or without chemotherapy to avoid the morbidity of surgery. Another case report by Rai et al.…”

“…18 Especially perineural invasion (PNI) is considered a poor prognostic factor as it is sometimes believed to be the fourth pathway of metastasis after hematogenous spread, lymphatic spread, and direct invasion of the adjacent organs by the tumor. 19 Considering the slow growth and indolent course of ACC, it is assumed that these tumors are relatively radio resistant. Therefore, Surgery was developed as the mainstay of treatment for almost all head and neck ACC patients.…”

“…4 However, in most cases, for the resection of tumors, extensive surgeries are needed, leading to significant morbidity in swallowing, speech, and quality of life for the patients. Alsubaie et al 19 reported a literature review on nasopharyngeal ACC, in which the majority of patients were treated with definitive radiotherapy with or without chemotherapy to avoid the morbidity of surgery. Another case report by Rai et al was related to a 78-year-old man with ACC of the base of his tongue who declined any surgical intervention.…”