Adenoid Cystic Carcinoma of the Larynx Presenting as a Thyroid Mass and Brief Literature Review

Shirian, Sadegh; Maghbool, Maryam; Aledavood, Azita; Negahban, Shahrzad; Khademi, Bijan; Daneshbod, Yahya

doi:10.1159/000464271

Cited by 9 publications

(2 citation statements)

References 14 publications

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“…The most common site is minor salivary glands, followed by parotid, submandibular, and sublingual glands 1‐4 . However, the tumors may arise in other organs such as lacrimal glands, nasal and paranasal sinuses, larynx and trachea, breast, skin, and vulva 2,3,5‐12 …”

Section: Introductionmentioning

confidence: 99%

Adenoid cystic carcinoma cytology: Salivary gland and nonsalivary gland

Chowsilpa

An²,

Maleki

2020

Diagnostic Cytopathology

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Objectives: Adenoid cystic carcinoma (ACCA) is an uncommon primary malignancy of salivary glands and rarely nonsalivary tissue. This study aims to evaluate the diagnostic accuracy of ACCA on fine needle aspiration (FNA) material and the associated challenges. Methods: A search on electronic pathology database from 2006 to 2016 at The Johns Hopkins Hospital found 83 cytology specimens diagnosed as ACCA, 49 with histology follow-up. Results: Fifty-two females and 31 males were found ranging from 37 to 95 years old (mean 62.5). The tumor size was 1 to 11.5 cm (mean 3.4). FNAs were performed on 46 salivary glands (54.88%), 12 head and neck masses (14.45%), 9 lymph nodes (10.84%), 9 tracheas/lungs (10.84%), 4 vaginal/perineum/gluteal masses (4.82%), and one for each kidney, liver and abdominal/pelvic mass (1.21%). 83 FNA diagnoses revealed 3 nondiagnostics (3.61%), 20 neoplasms with unspecified features (24.10%), 30 basaloid neoplasms (36.14%), 18 ACCA (21.69%), and 12 other malignancies (14.46%). The accuracy of FNA in diagnosis of ACCA comparing to histologic follow-up in 49 cases was 87.5% sensitivity, 66.67% specificity, with 92.11% positive predictive value and 54.55% negative predictive value. The most common mimicker was pleomorphic adenoma. Conclusion: ACCA can be diagnosed not only in the salivary gland FNAs, but also respiratory tract, intra-abdominal, kidney, and gynecologic regions. FNA is a preferred technique to assess mass lesions. However, a diagnosis of ACCA on FNA material should be rendered with caution since there are benign and malignant neoplasms with overlapping features. Awareness of prior medical history and ancillary studies can improve the diagnosis. K E Y W O R D S adenoid cystic carcinoma, basaloid neoplasm, fine needle aspiration, nonsalivary gland adenoid cystic carcinoma, the Milan system for reporting salivary gland cytopathology 1 | INTRODUCTION Adenoid cystic carcinoma (ACCA) is an uncommon malignancy. It accounts for approximately 1% of all head and neck tumors and is a well-known salivary gland malignancy. The most common site is minor salivary glands, followed by parotid, submandibular, and sublingual glands. 1-4 However, the tumors may arise in other organs such as lacrimal glands, nasal and paranasal sinuses, larynx and trachea, breast, skin, and vulva. 2,3,5-12 Patients are in middle age or older during the initial presentation of the tumor, with high frequency in fifth and sixth decades. 2-4 Males and females are affected equally, 2 but some studies reported female

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Section: Introductionmentioning

confidence: 99%

Adenoid cystic carcinoma cytology: Salivary gland and nonsalivary gland

Chowsilpa

An²,

Maleki

2020

Diagnostic Cytopathology

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“…Clinical and paraclinical investigation didn't identified clearly if the starting point was thyroidian or laryngotracheal. In our knowledge, only 10 cases were reported in the literature with this unusual presentation [9]. In our case, the tumor was subglottic without invasion of neither vocal cords nor trachea.…”

Section: Discussionmentioning

confidence: 68%

Rare location of head and neck adenoid cystic carcinoma

et al. 2019

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Adenoid Cystic Carcinoma of larynx is extremely rare location. We herein describe an unusual clinical and radiological presentation of ACCL and review recent literature. We report a case of a 38-year-old woman with history of asthma, presented to our department with acute inspiratory dyspnea that required an emergency tracheotomy. Physical examination revealed a large anterior cervical mass without any lymphadenopathy suspecting thyroid origin. Cervical Computed Scan showed a tumor process between the thyroid lobe, the left edge of the subglottic area and first tracheal rings filling all the lumen, discussing either a laryngo-tracheal or thyroid origin. The patient underwent a panendoscopy under general anesthesia that confirmed a subglottic extension of the tumor and multiples biopsies showed a malignant salivary origin of the mass. After multidisciplinary discussion, the patient underwent total laryngectomy and thyroidectomy with bilateral selective neck dissections (levels II- IV). Anatomopathological examination confirmed the laryngeal location of Adenoid Cystic Carcinoma classified pT4aN0R0. Adjuvant radiation therapy was indicated. In our knowledge, only 10 cases were reported in the literature with this unusual presentation. Moreover, the case we report is in the subglottic floor without invasion of neither vocal cords nor trachea. Total laryngectomy with neck dissection remains the recommended therapeutic procedure for locally advanced ACCL. Adverse features such as close or positive margins, T3-4, intermediate or high grade neural and perineural spread, lymphatic or vascular invasion or lymph node metastases should indicate adjuvant treatment to improve the outcome. The lack of randomized multicentric study, implies the management of ACCL by skilled multidisciplinary team, to suggest adequate personalized treatment.

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