Adenoid Cystic Carcinoma with Intracranial Extension: Report of Three Cases

Abstract

Adenoid cystic carcinoma (cylindroma) usually arises from the salivary, lacrimal, or other exocrine glands, and is rarely encountered by neurosurgeons. The authors describe three cases involving intracranial extension. An intraorbital tumor in a 71-year-old man extended directly into the epidural space of the frontal base and destroyed the orbital roof. In a 53-year-old woman, the tumor arose from the area adjacent to the eustachian tube and invaded the Gasserian ganglion. In the third patient, a 58-year-old man, the tumor originated in the maxillary sinus and extended directly into the middle cranial fossa. In all these cases, the tumors were removed to the fullest extent possible. Although residual tumor was markedly reduced by radiation therapy, recurrence and metastases occurred within a few years. Thus, adenoid cystic carcinoma appears to be radiosensitive, but not curable by irradiation. In treating a recurrent tumor in one patient, we applied the so-called “two-route” chemotherapy (cisplatin and its antidote) in combination with radiation therapy. The tumor responded well to this therapy, although multiple pulmonary and bone metastases eventually led to the patient's death.

Adenoid Cystic Carcinoma of the Cavernous Region-Case Report-

“…The most common route is via contiguous perineural invasion. [1][2][3]6) In addition, three routes have been reported for the intracranial invasion of salivary gland ACCs: the eustachian tube (in the peritubal space), 1,[5][6][7] the mandibular and maxillary nerves, and the internal carotid artery. 3,5) In the present case, the tumor was located in the right Meckel's cave and cavernous sinus with invasion of the foramen rotundum, foramen ovale, and superior orbital fissure.…”

“…[1][2][3]5) The optimum treatment for ACC is radical surgical resection. 1,3,5,7) However, total resection is almost impossible because of the invasive character, 5) and most ACCs (42%) recur within the first 3 years. [3][4][5] Radiation therapy is effective and has been used successfully to reduce the tumor mass.…”

“…[3][4][5] Radiation therapy is effective and has been used successfully to reduce the tumor mass. 3,5,7) Even if local control is achieved, distant metastasis 1,7) occurs in as many as 39% of cases, 5) most often in the liver, bone, and lung. 2,4) The prognosis remains poor, with a survival of less than 50% at 5 years and 20% at 10 years.…”

“…1,6) Most ACCs arise in the major and minor salivary glands, nasopharynx, and lacrimal glands, but also arise from the upper respiratory tract, the lungs, the mammary gland, the skin, the mastoid air cell, and the genital tract. [1][2][3][5][6][7] ACCs account for 11% 5) or 25-30% 4) of epithelial neoplasms in the lacrimal gland. The incidence of intracranial invasion varies from 4% [1][2][3]5,6) to 22%.…”

“…The incidence of intracranial invasion varies from 4% [1][2][3]5,6) to 22%. 7) Most reported intracranial ACCs are located at the base of the skull. Two major regions of intracranial invasion are the optic chiasm and the gasserian ganglion.…”