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One the basis of personal observation and a review of recent literature (which is somewhat sparse), the authors describe the characteristics of adenoid cystic carcinoma of the breast which is a very unusual tumor. They stress the diagnostic difficulties which frequently make it necessary to use histochemical or immuno-histochemical diagnostic techniques which have been widely developed.
Four adenoid cystic carcinomas of salivary gland were studied by immunohistochemistry and immunoelectron microscopy with anti-actin, myosin, S-100 protein and GFAP antibodies. The results showed that neoplastic myoepithelial cells in these tumors gave positive reactions for actin, myosin and S-100 protein antibodies and negative reactions for GFAP antibody. The neoplastic myoepithelial cells lined the cyst-like spaces and surrounded the periphery of the epithelial nests. Neoplastic ductal epithelial cells were negative for the above mentioned antibodies. The differentiation tendencies and immunofeatures of neoplastic myoepithelial cells were discussed.
A case of a patient with this extremely rare tumor is described. Adenoid cystic carcinoma of the prostate should be considered as a subtype of prostate adenocarcinoma. Since this tumor can be associated with a prostatic adenocarcinoma, it should be regarded as malignant.
Adenoid cystic carcinoma constitute around 0.4 to 1.7% of all carcinomas of cervix. It generally presents in elderly age group, however few cases in younger age have also been reported. Majority of cases present in early stage. Though concluding statement regarding the results cannot be made from the cases accumulated from the various reported series, nonetheless this review shows that radiotherapy too is effective in early stage and even in stage I results with radiotherapy appear better than surgery. In advanced stage outcome is invariably poor. In early stage main pattern of failure is distant metastasis. Both local and distant failure are observed in stage III and IV. Though lung is the commonest site of metastases (51%), abdominal cavity and brain are also found to be involved in some cases. Limited experience shows effectiveness of high doses of cisplatin and multiagent chemotherapy. Cases of early stage disease having risk for metastases and local failure should be identified and managed with multimodality treatment using surgery for bulky disease with post-operative radiotherapy and chemotherapy. In advanced stages combination of chemotherapy and radiotherapy is required. Exenterative surgery for central failure has been used effectively. Overall no evidence of disease rate is found to be about 48%, with mean follow-up of 39 months.
Tumors of the ceruminous glands can affect the auricula and periauricular skin and should be included in the differential diagnosis of lesions of these regions. Correct management of these tumors depends on precise histopathologic classification and diagnosis of their extension. We report a case of cystic adenoid carcinoma of the external auditory canal. Signs and symptoms, histopathology, and treatment of these lesions as reported in the literature are reviewed.
The cellular DNA content of 28 cases of salivary adenoid cystic carcinoma (SACC) were quantified with the flow cytometric analysis. The result showed that majority of SACC (22/28) were diploidy tumors. No significant correlation between the cellular DNA content and the histopathologic appearances, the cellular DNA content and the clinical behavior of SACC was found.
19 patients with adenoid cystic carcinoma of the minor and major salivary glands were analysed clinicopathologically. Majority (8) of the tumours originated in the parotid gland. The palate was the most common location among the tumour of the minor salivary glands. The tumours were classified by their histology patterns into three groups: I tubular and cribriform pattern, II cribriform with less than 30% of solid pattern, III solid forms. A positive correlation between increasing grade and aggressive behavior was not observed in our study. All patients were treated with surgery. Eight of them received postsurgical radiation therapy. Recurrence of disease at the primary site occurred in 5 of 19 patients. Distant metastases developed in 3 patients. An adequate surgical excision of the tumour yields optimal local control and survival rates.
Adenoid cystic carcinoma (AdCC) is characterized by low mitogenic activity, high invasiveness, and vigorous production and accumulation of extracellular matrix (ECM). As it does in vivo, a cell line (ACCS) derived from a human AdCC grows very slowly and displays potential for production of a large amount of ECM. ACCS cells also produce a significant amount of proteolytic enzymes, including urokinase-type plasminogen activator (uPA), and M(r) 72,000 and 92,000 gelatinases. These cells can degrade considerable amounts of ECM elaborated by normal mesenchymal cells, including rat muscle cells and human fibroblasts, mainly through a uPA-plasmin cascade. However, ECM elaborated by ACCS cells themselves is resistant to degradation by either the tumor cells or purified uPA in the presence of plasminogen, whereas the degradation rates of ACCS ECM and mesenchymal ECM by plasmin are comparable. Treatment of ECM with glycine (pH 2.7), which removes plasminogen activator inhibitor from the matrix, results in an increase in the rate of ACCS ECM degradation by uPA. Moreover, fibrin agarose reverse zymography, autoradiography, and immunoblotting showed a high level of plasminogen activator inhibitor type 1 in ACCS ECM. These findings suggest that the plasminogen activator inhibitor type 1 in ECM produced by AdCC cells may play a role in preventing matrix destruction by the tumor itself, and thus the ECM components of tumor origin are stably accumulated in the intercellular spaces and may support or promote the growth of AdCC cells, which have primitively low growth activity.
We report on a patient with primary pulmonary adenoid cystic carcinoma presenting with Pancoast syndrome. Pancoast syndrome has not previously been described with this tumour. Other unusual features of this case include the peripheral origin and mediastinal involvement, with lack of proximal endobronchial spread.
The type II alveolar epithelial cell is one of two pluripotential stem cell phenotypes in normal mammalian lung morphogenesis; cells manifesting this phenotype have been found to constitute bronchioloalveolar regions of canine adenocarcinomas. We now studied type II cell expression in canine acinar adenocarcinomas and adenoid cystic (bronchial gland) carcinomas, using the same bronchogenic carcinoma model (subcutaneous bronchial autografts treated with 3-methylcholanthrene). Distinctive features of type II cells are the approximately cuboid cell shape, large and roundish nucleus, immunofluorescent staining of the cytoplasm for the surfactant protein SP-A, and presence of multilamellar bodies or their precursory forms. Cells with these type II cell characteristics were found in the basal epithelial layer of all tumor lesions and in upper layers as far as the lumen, singly or in clusters; they were also found in early invasive carcinomatous lesions but not in bronchial glands or bronchial epithelium before carcinogen exposure. Immunoblots of tumor homogenates showed reactive proteins within size classes of SP-A (28 to 36 kd) or its dimeric form (56 to 72 kd). These findings and those previously reported are consistent with the concept that chemical carcinogenesis in the adult bronchial epithelium may lead to type II cell carcinomas of varying glandular (acinar, adenoidcystic or bronchioloalveolar) growth patterns.
Eight years after removal of an adenoid cystic carcinoma (ACC = cylindroma) of the parotid gland, a female patient of 41 years of age developed isolated multiple lung metastases. She died three years later in the course of a respiratory insufficiency. Basing on this typical case record, the very rare ACC is presented, which has a tendency to pulmonary metastasising. The pathology, course of the disease, treatment and indication for performing a lung transplant in similar cases are discussed.
Two cases of laryngeal adenoid cystic carcinoma (1 supraglottic, 1 subglottic) are reported, particular attention being paid to diagnosis and treatment. The literature on this topic has been reviewed, in order to describe the natural course and the different treatments of this tumour. The authors underline the difficulty in evaluating the effectiveness of treatment, due to the insufficient follow-up in most published cases.
Adenoid cystic carcinoma represents approximately 20% of tumours of the minor salivary glands. It can originate in the sphenoidal sinus and invade the sella turcica. The authors describe a patient in whom a tumour of this type was shown by computed tomography.
A series of 160 consecutive patients undergoing tonsil and adenoid surgery for upper airway obstruction is reported. The ages ranged from 8 months to 13 years. Sixty-seven percent were 2, 3, or 4 years of age. All were routinely admitted overnight postoperatively. Forty-five (28%) remained in the hospital longer than one night (2 to 20 days). Postoperative respiratory problems were the reason for prolonged hospital stay in 30 of these 45 patients. Preoperative "danger-signals" of potential postoperative respiratory problems were: a history of severe obstructive symptoms with apnea and moderate or strongly positive sleep study, daytime somnolence, need for urgent T&A, and cardiomegaly. Risk factors present in a smaller number of patients were obesity, congenital stenosis of airways, and bronchopulmonary dysplasia. We suggest that children with these danger signals not be considered as candidates for outpatient T&A surgery.
Adenoid cystic carcinoma of the esophagus with multiple liver metastases was found in a 77-year-old Japanese female in October, 1991. Combination chemotherapy, including etoposide (VP-16) and tegafur (FT) allowed the patient to survive for approximately a year after the onset of the initial symptoms. During her course of treatment, the patient improved greatly with minimal toxicity, and declines in the elevated levels of GOT and LDH were also noted. Since no other therapy, such as surgery or radiation, was given to the patient, the response to chemotherapy as well as the survival advantage for the patient have been evaluated.
We present 4 cases of adenoid cystic carcinoma from different locations (parotid, submaxillary, larynx and auditory duct) and we underline the supraglottic origin of one of them. We point out the good clinical behaviour of this carcinoma, with a long tested survival, more than 5 years, in 2 of our cases. All of them showed morphological features independently of the sitting.
In this study, 32 pleomorphic adenomas (PAs) and seven adenoid cystic carcinomas (ACCs) were analysed for the evaluation of proliferating cell nuclear antigen (PCNA) indices and flow cytometric variables. Our aim was to assess any possible relationship between these parameters and the clinico-pathological variables and to clarify their histogenesis and reasons for their biological differences. The tumours were divided into three groups, mainly epithelial (E), myxoid (M) and chondroid (C); PCNA labelling index (LI) and weighted mean index (WI) and the WI/LI ratio were analysed in the predominant components; a single PCNA index, weighted by the percentage of each component, was also calculated. Only WI/LI was found to be significantly different in the three components, while PCNA single index did not show either significant differences by sex, age, site and size, or any correlation with the S phase fraction. A significant difference was found between PAs and ACCs by site (P < 0.01) and DNA ploidy (P < 0.05); furthermore, all PCNA indices (single index) were significantly lower in PAs than in ACCs.
An update review of the published data (13 références) concerning primary central mandibular adenoid cystic carcinoma is presented. Those tumors are exceptionally located within mandible: the diagnostic could be evocated in case of body or angle radiolucency of the mandible. The most frequent diagnosis appeared to be an osteolytic odontogenic cyst. Surgical analysis has shown a very friable and low density solid tumor next to mandibular nerve. This pathology has a quiet and long term development (mainly pulmonary metastasis many years later). The best treatment consisted in bone resection. Even though, his origin of this type of carcinoma is still unknown: a consistent hypothesis is made of ectopic embryologic inclusions or of neoplastic mutation of odontogenic cysts.