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Fine needle aspiration diagnosis of a pulmonary metastasis from a cutaneous adenoid cystic carcinoma. A case report.

BACKGROUND: Primary cutaneous adenoid cystic carcinomas (CACC) rarely metastasize to the lung. The few documented cases have been diagnosed by surgical biopsy. CASE: An 82-year-old female presented with an enlarging lung mass 15 years after being diagnosed with CACC. The diagnosis of metastatic adenoid cystic carcinoma was made following a computed tomography-guided fine needle aspiration (FNA) biopsy. CONCLUSION: Metastatic CACC in the lung can be diagnosed by FNA. Knowledge of the patient's clinical history and morphologic variants of CACC is important in making the diagnosis.

Aged↗

Stimulation of adenoidal lymphocytes by Alloiococcus otitidis.

Otitis media with effusion (OME) is characterized by persistent effusion in the middle ear cavity and by chronic inflammation in the middle ear mucosa. Alloiococcus otitidis, a gram-positive aerobic bacterium, has been isolated in middle ear effusion, and by means of sensitive polymerase chain reaction detection assays it has been detected in as many as 20% of middle ear aspirates of patients with OME. Because A otitidis may freely interact with leukocytes in the middle ear effusion, it may potentially modulate the inflammatory reaction in OME. To study the nature of these interactions, we applied an in vitro assay in which killed A otitidis bacteria were incubated with peripheral blood and adenoidal mononuclear cells. The expression of the proliferation-associated surface marker CD69 was then measured in B lymphocytes and in CD4+ helper and CD8+ cytotoxic-suppressor T lymphocytes by means of multicolor flow cytometry. Alloiococcus otitidis induced the expression of CD69 in both peripheral blood and adenoidal T and B cells. Among the T cells, the cytotoxic-suppressor T lymphocytes were preferentially activated. It was also tested whether A otitidis would have an effect in another cytotoxic and immunoregulatory system, namely, the induction of natural killer cell activity in peripheral blood mononuclear cells. However, the effect was minimal compared with that of Salmonella minnesota or Staphylococcus aureus. The results show that A otitidis has a unique immunostimulatory capacity in vitro that is mainly confined to CD8+ T lymphocytes.

Adenoids↗

Adenoid cystic carcinoma of the base of the tongue.

A retrospective review of 14 patients with adenoid cystic carcinoma of the tongue treated between 1955 and 1997 was performed. Treatment consisted of surgery (n = 2), radiotherapy (n = 2), chemotherapy (n = 1), or combination therapy (n = 9). The 2-, 5-, and 10-year absolute survival rates were 92%, 79%, and 63%, respectively. Seventy-five percent of the patients who died of cancer succumbed to distant metastases. However, long-term survival was common despite a high incidence of local and distant recurrence. The presence of positive surgical margins, the incidence of regional metastases, the incidence of perineural invasion, the initial stage of disease, and the eventual development of locoregional recurrence and distant metastases did not significantly alter the survival rate. Surgical extirpation combined with postoperative radiotherapy is advocated for the treatment of adenoid cystic carcinoma of the tongue. Given the indolent nature of this disease process, surgery should be directed toward conservation of speech and swallowing function.

Adult↗

Bacterial interference of penicillin-sensitive and -resistant Streptococcus pneumoniae by Streptococcus oralis in an adenoid organ culture: implications for the treatment of recurrent upper respiratory tract infections in children and adults.

OBJECTIVES: The role of the viridans group of streptococci (Streptococcus oralis) in the prevention of colonization with Streptococcus pneumoniae was investigated in an adenoid organ culture system. METHODS: The adenoids from 10 patients who were undergoing adenoidectomy for either hypertrophy or recurrent otitis media were used. RESULTS: Streptococcus oralis Parker and S. oralis Booth (two organisms isolated from the nasopharynges of patients undergoing adenoidectomy only and patients undergoing adenoidectomy and bilateral tympanostomy with tubes, respectively) uniformly inhibited both penicillin-sensitive and penicillin-resistant S. pneumoniae. Although both strains of S. oralis inhibited the growth of both S. pneumoniae strains, strain Parker provided more complete inhibition than did strain Booth. CONCLUSIONS: The results indicate that some strains of S. oralis may inhibit the growth of the most serious pathogens in the nasopharynx. It is therefore possible that colonization of inhibitory strains of viridans streptococci may be used in the nasopharynx as a relatively safe and inexpensive approach to prevention of recurrent otitis media in some children and of recurrent suppurative sinusitis in both children and adults.

Adenoids↗

Tissue culture of human adult adenoids and of middle eear mucosa.

The increased number of mucus producing cells as well as the presence of stratified squamous epithelium in pathological and experimental middle ear conditions, point towards the possibility of metaplastic changes of the middle ear mucosa, similar to the metaplastic capabilities of respiratory mucosae in general, as observed clinically or provoked experimentally. The purpose of this study was to develop a model of postembryonic human respiratory mucosae, in vitro, for the study of triggering or inducing factors involved in its normal and metaplastic differentiation. Explants from adenoids and middle ear mucosa were cultured, both as organ cultures and monolayers, for periods of up to two weeks, and their developmental characteristics were studied and described. Over 50% of the explants showed mitosis, epithelial and monolayer growth, ciliary activity and differentiation into ciliated and into mucus-producing cells. Adenoid explants were grown in air without and with added 5% CO2. Under the latter conditions, the proportion of explants and monolayers showing ciliary activity was 50% greater. It is concluded that this model might be suitable for further studies of the factors which control cyto-differentiation in mucociliary epithelia. Maintaining its growth for a longer period would, however, be desirable.

Adenoids↗

Neck dissection for laryngeal adenoid cystic carcinoma: is it indicated?

The authors report six cases of adenoid cystic carcinoma with a view to evaluating the validity of neck dissection in this tumor. Adenoid cystic carcinoma may invade regional lymph nodes by direct extension, but true embolic lymph node metastases are so rare, if they exist at all, that neck dissection may be considered an overtreatment.

Adult↗

In situ analysis of the immune microenvironment of the adenoid in children with and without secretory otitis media.

Using monoclonal antibodies and immunohistochemistry, we compared adenoid tissue from 35 children with or without secretory otitis media. Numerous cells infiltrating the reticular crypt epithelium expressed HLA-DR, as did < 10% of the epithelial cells. Of the antigen-presenting cells, CD1a+ dendritic cells showed intraindividual and interindividual variations; CD68+ macrophages and CD22+ B cells were uniformly distributed. The relative frequencies of CD4+ and CD8+ cells were 6.6 +/- 2.0 versus 2.3 +/- 1.2 (p < .001) in the reticular crypt epithelium and 18 +/- 4.5 versus 1.5 +/- 0.9 (p < .001) in the germinal centers. The IL-2 receptor was expressed on < 0.1% of CD3+ T cells. Over 90% of intraepithelial CD3+ T cells were of the CD45RO+ memory phenotype. The proliferation marker Ki67 was almost exclusively found in the germinal centers. That the analyzed parameters showed a similar pattern in both clinical groups suggests that the presence of secretory otitis media may not correlate to specific alterations in the immune microenvironment of the adenoid.

Adenoids↗

Human adenoidal organ culture: a model to study nontypable Haemophilus influenzae (NTHI) and other bacterial interactions with nasopharyngeal mucosa--implications in otitis media.

Nontypable Haemophilus influenzae (NTHI) has become the predominant cause of both acute suppurative otitis media and chronic otitis media with effusion. It has now been well-demonstrated that both outer membrane proteins and restriction fragment analysis of the bacterial genomes of concomitant nasopharyngeal and middle ear effusion isolates of NTHI are identical. It is therefore of critical importance to understand the mechanisms whereby bacteria that are present in normal healthy children in small numbers become the predominant organism in the nasopharynx in otitis media. The studies presented here suggest that nontypable Haemophilus influenzae can effectively decrease ciliary function as measured by stroboscopic illumination of ciliary beat frequency on human adenoidal organ culture. This organism also produces significant histopathologic and ultrastructural damage to the epithelial cells and cilia of adenoid organ culture, demonstrated by both light microscopy and scanning electron microscopy. The data suggest the following hypothesis: nontypable Haemophilus influenzae can destroy mucociliary function and allow increased bacterial replication in the mucus overlying the nasopharyngeal mucosa. The mucociliary system of the eustachian tube may also be involved in a similar manner, thus allowing bacteria to enter the middle ear space via the eustachian tube.

Adenoids↗

Surgical management of adenoid cystic carcinoma in the parotid gland.

Although adenoid cystic carcinoma may be found in multiple sites in the head and neck as well as other glandular sites throughout the body, nowhere is management of the disease more controversial than in the parotid gland. Here the facial nerve is at risk from both the disease and the treatment. Seventy-five cases of adenoid cystic carcinoma of the parotid were analyzed. Patients were placed in four groups, depending on the type of parotid surgery received as definitive therapy: (1) lateral lobectomy, (2) total parotidectomy, (3) radical parotidectomy without preoperative facial weakness, and (4) radical parotidectomy with preoperative facial weakness. Patients were assessed with regard to staging of the initial lesion, the status of surgical margins, and the use of postoperative radiotherapy. The incidence of local recurrence and distant metastases were also recorded. Survival statistics are presented for each group. Though associated with facial nerve sacrifice, radical parotidectomy appears to offer clear advantages in terms of long-term disease-free survival in patients with T2 and T3 lesions. The residual facial paralysis may be rehabilitated primarily or secondarily to reduce patient morbidity. Four of 16 patients (25%) with preoperative weakness achieved 10-year survival when radical parotidectomy was used. Obtaining clear margins at the initial setting appears to offer improved survival.

Adult↗

Twenty two year survival after incomplete resection of advanced adenoid cystic bronchogenic carcinoma.

In 1972, a 42 year old patient underwent thoracotomy for adenoid cystic carcinoma of the left main-stem bronchus. Pneumonectomy was performed, but the resection was not complete as the tumour had invaded the aortic and tracheal wall. The patient did not receive postoperative radiotherapy. In 1993, the patient was readmitted with severe respiratory insufficiency due to complete endobronchial tumour obstruction of the intermediate bronchus and extensive tumour growth in the mediastinum. Endobronchial laser treatment followed by stent implantation led to immediate symptomatic relief. The tumour then responded well to combined endobronchial and percutaneous radiotherapy. The patient died 7 months after readmission from ileus due to pancreatitis. We conclude that patients with advanced adenoid cystic carcinoma may profit from palliative surgery with respect not only to symptoms but also to duration of life.

Adult↗

Immunohistochemical localization of estradiol, progesterone, and progesterone receptor in human salivary glands and salivary adenoid cystic carcinomas.

Immunohistochemical analyses of estradiol, progesterone and progesterone receptor were carried out in human salivary gland and salivary adenoid cystic carcinoma. Immunoreactivity to estradiol and progesterone was found in cytoplasm of the cells of the excretory duct system within normal salivary glands, whereas the progesterone receptor was restricted to nuclei of the cells where both sex steroids were positive. In addition, we demonstrated the presence of both sex steroids and the receptor for progesterone in salivary adenoid cystic carcinomas. These data indicate that the human salivary gland is one of the target tissues of estrogen. This also suggests the good possibility that tumors which express progesterone receptors will respond to endocrine therapy.

Adult↗

Evaluation of tonsils and adenoids in Sleep Apnea syndrome.

Peripheral Sleep Apnea syndrome has been associated with enlarged tonsils and adenoids as well as other abnormalities which may cause upper airway obstruction in children. A multidisciplinary approach is used at the Step Disorder Center of Cincinnati General Hospital to evaluate the role of tonsils and adenoids in sleep apnea. Polysomnographic techniques combined with cine sleep studies of the upper airway document the degree, site and type of obstruction. This presentation highlights the entity of obstructive sleep apnea and provides a rational clinical approach in the management of these patients.

Adenoids↗

Metastasis of adenoid cystic carcinoma of the mandible to the Gasserian ganglion.

A case of adenoid cystic carcinoma of the mandible in a 47-year-old woman metastasized to the Gasserian ganglion probably through the perineural space of the inferior alveolar nerve. The patient was treated by irradiation after excision of the tumor from the ganglion. She is currently an outpatient in the oral and maxillofacial surgery department; two years and seven months after the first examination, there is no sign of recurrence or metastasis of adenoid cystic carcinoma.

Carcinoma, Adenoid Cystic↗

Rhinovirus infections and adenoidal hypertrophy: do they interact with atopy in children?

Modern diagnostic methods allow the evaluation of the connection between rhinoviruses and atopy. Recent studies suggest that rhinoviruses are present in the adenoids at higher titers than in other specific sites, after inoculation of nasal mucosa or conjunctiva in volunteers. Therefore, it is possible that they might be responsible for specific local changes, while such changes may be influenced by atopy. This review focuses on the interactions between rhinoviral infection, the host's immune status and adenoidal disease.

Adenoids↗

Management of salivary gland adenoid cystic carcinoma: institutional experience of a case series.

CONTEXT AND OBJECTIVE: Salivary gland tumor management requires long-term follow-up because of tumor indolence and possible late recurrence and distant metastasis. Adenoid cystic carcinoma (ACC) accounts for 10-15% of such tumors. The aim here was to evaluate surgical and clinical management, staging and follow-up of ACC patients in one academic institution. DESIGN AND SETTING: Retrospective study at Head and Neck Service, Universidade Estadual de Campinas. METHODS: Data on 21 patients treated between 1993 and 2003 were reviewed. Management utilized clinical staging, histology and imaging. Major salivary gland tumor extent was routinely assessed by preoperative ultrasonography. Diagnosis, surgery type, margin type (negative/positive), postoperative radiotherapy and recurrence (presence/absence) were evaluated. RESULTS: There were eleven major salivary gland tumors (52.3%), seven submandibular and four parotid. Ten patients (47.7%) had minor salivary gland ACC (all in palate), while the submandibular was the most frequently affected major one. Diagnoses were mostly via fine-needle aspiration (FNA) and incision biopsy. Frozen sections were used for six patients. There was good ultrasound/FNA correlation. Sixteen (76%) had postoperative radiotherapy. One (4.7%) died from ACC and five now have recurrent disease: three (14.2%) locoregional and two (9.5%) distant metastases. CONCLUSION: Adenoid cystic carcinoma has locally aggressive behavior. In 21 cases, of ACC, the facial nerve was preserved in all except in the few with gross tumor involvement. Treatment was defined from physical examination, imaging, staging and histology.

Adult↗

A case of adenoid cystic carcinoma of the bronchus producing cancer-associated antigen, CA19-9.

A 73-year-old male was admitted to Hyogo College of Medicine Hospital for further evaluation of chest x-ray abnormalities. Chest roentgenogram taken at admission showed right lower lobe atelectasis and bronchoscopic examination revealed an endobronchial tumor obstructing the left lower lobe bronchus. The biopsy specimen showed cribriform adenoid cystic carcinoma. The serum CA19-9 level was markedly elevated at admission, leading to immunohistochemical analysis of the biopsy specimen. As a result, in the tumor, CA19-9 was positively stained. This is probably the first reported case of adenoid cystic carcinoma of the bronchus which produces CA19-9.

Aged↗

Adenoid cystic carcinoma arising in the intrapulmonary bronchus.

A 63-year-old male was admitted to our hospital because of a coin lesion in the intrapulmonary bronchus. The patient had no symptoms such as cough or sputum. Imaging studies showed that the tumor was present in the S10b,c of the right lung. There was no metastasis or salivary gland tumor. Transbronchial tumor biopsy revealed a primary adenoid cystic carcinoma. The patient underwent a lobectomy, and has been well since the operation. This is an uncommon case of primary adenoid cystic carcinoma arising from the intrapulmonary bronchus.

Bronchial Neoplasms↗

Adenoid cystic carcinoma of the breast: mammographic appearance and pathologic correlation.

OBJECTIVE: The objective of our study was to describe the mammographic features of adenoid cystic carcinoma of the breast and to correlate mammography findings with histopathologic findings. CONCLUSION: Adenoid cystic carcinoma is a rare type of breast neoplasm that usually appears as a slowly enlarging nodule. In spite of its low incidence, recognition is important because early detection ensures good prognosis. On mammography, these tumors often appear as moderately circumscribed, lobulated nodules that are similar to other types of benign and malignant tumors. Therefore, cytologic and histologic evaluations are needed for accurate diagnosis.

Adult↗