Adenoid Cystic Carcinoma
Richard Whitlock BSc, Meds '01 University of Toronto
Reviewed By Dale H. Brown MB BCH FRCSC, Associate Professor, Department of Otolaryngology, University of Toronto
What is it?
Adenoid cystic carcinoma is the most common malignant tumour of the submandibular gland. This is an infiltrative malignant tumour that has a characteristic cribiform appearance on histology. The tumour is composed of uniform basaloid cells with scant cytoplasm and regular nuclei.
Clinical Features
- Equal gender distribution
- Typically present in 4th decade
- Enlarging mass
- Pain in 50%
- Facial palsy in 25%
- High incidence of perineural invasion, hallmark of adenoid cystic carcinoma
- Lytic areas in bone
- Mets in 30-40%
Investigations
Physical exam including:
- Palpate the glands
- Use bimanual palpation in the floor of the mouth
- Imaging
- Fine needle aspiration biopsy
Management
3 treatment approaches:
- Complete excision with partial temporal bone excision if CN VII trunk involved
- Total parotidectomy, CN VII excision, masseter muscle excision, ascending ramus of mandible and partial temporal bone excision, radical neck dissection
- Combined therapy: complete excision, post-op radiotherapy
5 year survival 80-90%; late recurrences
References
- Granick M., Hanna III D., Management of Salivary Gland Lesions. Williams & Wilkins, Baltimore, 1992.
- Thackray A.C., Sobin L.H., International Histological Classification of Tumours No.7: Histological Typing of Salivary Gland Tumours. World Health Organization, Geneva, 1972.
- Rice D., Surgery of the Salivary Glands. B.C. Decker Inc., Toronto, 1982.
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