Subglottic Metastasis of Adenoid Cystic Carcinoma from an Anterior Tangue Primary

Abstract

A 69-year-old lady, whose clinical course included previous pulmonary and cutaneous metastases, presented six years subsequent to primary excision and radiotherapy for left anterior tongue adenoid cystic carcinoma. Computed tomography neck, chest, and abdomen performed for pulmonary metastatic monitoring, incidentally detected a subglottic soft tissue swelling. Microlaryngoscopy and carbon dioxide laser excision completely removed this subglottic polypoidal mass. Histology confirmed respiratory-type mucosa invaded and ulcerated by adenoid cystic carcinoma with perineural invasion. Adenoid cystic carcinoma is locally invasive and only accounts for 1% of all head and neck malignancies. Hematogenous spread to lung, bone and liver are common, conversely regional lymph node metastases are rare. Despite this, due to the proximity of the primary and metastasis, the complex lymphatic connection between these sites may play a crucial role in this case.