Primary peripheral adenoid cystic carcinoma of the lung. A case report

We report a rare case of peripheral adenoid cystic carcinoma of the lung, showing unusual pathological and clinical features, namely rapid growth, local aggressive behaviour, huge tumour size, no endobronchial component or submucosal infiltration, and a rapidly progressive clinical course. Extensive surgery resulted in considerable palliation of symptoms, but not in prolonged survival. The reported case emphasizes the malignant potential of peripheral adenoid cystic carcinoma of the lung.     

Bilateral renal metastases of lung adenoid cystic carcinoma]

A 79-year-old male was admitted for macroscopic hematuria and right back pain. A mass shadow in the right lower lung fields had been present for three years previously with unconfirmed diagnosis. Excretory urogram, ultrasonogram and computed tomographic scan revealed bilateral renal tumors. Selective right renal arteriogram demonstrated a slightly hypervascular mass in the upper pole of the right kidney. Chemotherapy was not effective. Slow but definite malignant progression developed and the patient died two and a half years later. Autopsy finally revealed the adenoid cystic carcinoma of the right lung with bilateral renal metastases. The renal metastasis of this tumor is the first case in Japan to our knowledge.     

A case of adenoid cystic carcinoma of the trachea resected surgically after Nd-YAG laser therapy

A case of primary tracheal tumor ablated by endoscopic Nd-YAG laser prior to tracheal sleeve resection was reported. A 53-year-old man had dry cough, bloody sputum and dyspnea. Bronchoscopic examination revealed polypoid tumor which located 2 cm below the vocal cords and obstructed the airway almost completely. After tumor vaporized by Nd-YAG laser, bronchoscopy type 200 could pass through the tracheal lumen and the length of the lesion was diagnosed within 4 cm. Biopsy specimen was confirmed adenoid cystic carcinoma. Cervical trachea was resected of six tracheal cartilage (first to sixth cartilage) combined with left thyroid lobe under collar incision and median sternotomy. The neck was fixed for ten days by tying the jaw to the anterior chest wall in order to reduce excessive tension to the anastomosis. Pathological examination revealed the tumor residual microscopically, 60 Gy of radiotherapy was conducted.     

Primary adenoid cystic carcinoma of the lung: A clinicopathologic study

Background  Primary adenoid cystic carcinoma (ACC) of lung is a rare but distinctive salivary gland-type malignant epithelial neoplasm. Methods  The clinical and pathological features in seven cases of primary ACC of the lung were reviewed. The age of patients ranged from 48 years to 65 years. All were males and smokers. The tumours arose from submucosal bronchial glands as endobronchial growth measuring 2.6 cm to 3.8 cm in greatest dimension. The presenting symptoms were cough, wheezing, dyspnoea and hemoptysis all related to obstruction to airway passage. The tumours were diagnosed by computed tomography (CT) scan and bronchial biopsy. Histologically three main growth patterns were identified admixed in various proportions: cribriform, tubular and solid. Lobectomy or pneumopnectomy was carried out in all the patients. In one patient chemotherapy was given apart from surgery due to detection of tumour infiltration in adjoining lung at the time of surgery. Follow up studies showed all the patients were well except two died of wide spread metastases. Results  Of the two patients who had died one had a predominantly solid pattern of growth limited to bronchus while the other had a predominant cribriform pattern with local infiltration in the adjoining lung parenchyma. Conclusion  Prognosis of ACC of lung depends on the histological type (predominantly tubular has best prognosis while predominantly solid pattern has worst prognosis) and clinical stage at the time of diagnosis (size of tumour, extent of spread and metastases). Despite their generally slow and indolent growth in other locations, ACC arising in lung may in certain cases be more aggressive.     

Primary adenoid cystic carcinoma of the esophagus

Primary adenoid cystic carcinoma or cylindroma of the esophagus is rare, only 22 cases having been reported previously. The histogenesis of this tumour is disputed, but it is believed to arise from the submucosal glands. A 75-year-old man with a cylindroma of the esophagus underwent radical excision of the tumour and has been clinically disease-free and asymptomatic since his operation in February 1979. Despite the poor results of surgery in the small number of patients reported in the literature, this unusual type of adenocarcinoma of the esophagus should be treated like epidermoid carcinoma--by radical excision.     

Carcinoid and adenoid cystic carcinoma of the bronchus

A careful study of the pharmacology of individual carcinoid tumors may increase our knowledge of such tumors. It may also be rewarding in other fields because of the biological interaction of kinins, serotonin, histamine, prostaglandins, and other agents. The poor correlation of signs and symptoms of the carcinoid syndrome with chemical assay may be due to lack of knowledge. The carcinoid syndrome must be considered a spectrum [130], and its diagnostic criteria should be liberalized.     

Enterogastric reflux following resected and nonresected stomach operations

In 20 controls and 60 patients who underwent partial gastrectomy or vagotomy respectively the bilirubin-contents of the gastric juice was traced and related to pH, intragastric pressure and bacterial contamination. A reflux of bilirubin could be ensured in 70% of the controls. Low bilirubin values could be found in the control group and after selective proximal vagotomy without pyloroplasty; higher values after SPV with pyloroplasty according to Finney, antecolic B-II-resection with ileo-ileostomy and in B-I-resection. Maximal values could be found after retro- and antecolic B-II-resection without ileo-ileostomy. There was a close correlation of these values to bacterial contamination and pH-value, but no correlation existed to the intragastric pressure.     

A case of primary tracheal adenoid cystic carcinoma performed curative surgical resection

A 67-year-old woman who was diagnosed as a relative early primary tracheal adenoid cystic carcinoma by preoperative examination underwent surgical resection. The histopathological extension of this carcinoma into the tracheal wall was much greater than was suggested before operation and 6 tracheal rings was curatively resected circumferentially. Median sternotomy and transection of the left brachiocephalic vein facilitated access to the trachea. To resect the extensive segment of the trachea, the right pulmonary ligament and hilum were mobilized. Additionally Dedo's laryngeal release was performed to lessen the tension at the anastomosis. Then the flap of the pleura and adipose tissue with the right internal mammary artery and vein was wrapped around the anastomosis for revascularization and protection of brachiocephalic artery. The postoperative course was not eventful. The postoperative dysphagia by Dedo's laryngeal release was mild and resolved within 7 days after operation. And the postoperative mammary arteriography showed the vessels around the anastomosis. This wrapping procedure is easy and does not need a laparotomy. So we think it is beneficial for prevention against postoperative complications of tracheoplasty.     

Primitive intracranial adenoid cystic carcinoma. A case report

We report the case of a 50-year-old woman presenting a primitive adenoid cystic carcinoma of the middle part of skull base diagnosed by transphenoidal biopsy. She was treated by exclusive radiation therapy with cobalt 60 1.25 MeV and the dose received was 66 Gy in 33 fractions. Our patient remains alive 50 months after the completion of treatment. Adenoid cystic carcinoma is a slow growing malignant tumor with perineural invasion which arises more frequently from salivary glands. The occurrence of primary intracranial adenoid cystic carcinoma is exceptional. The best treatment is radical surgery followed by radiotherapy. Chemotherapy is rarely used. Prognosis is worse than for salivary glands.     

Radiotherapy for adenoid cystic carcinoma of the palate

This is an analysis of 16 patients with adenoid cystic carcinoma of the palate who were treated with curative intent by radiotherapy alone (9) or surgery and radiotherapy (7). No patient received adjuvant chemotherapy. Follow-up ranged from 3 years to 19 years with 69% of the patients having follow-up of more than 5 years. Two patients in the radiotherapy alone group developed local recurrences, and both have had long-term surgical salvage. No local failures were seen in the combined therapy group. Twelve patients (75%) are alive and disease-free. Two patients died with distant disease, one within each treatment group. One patient in the combined therapy group is alive at 8 years with distant metastases, while one in the radiotherapy alone group died of intercurrent disease at 12 years. No significant complications were seen in either treatment group. The role of radiotherapy in the treatment of adenoid cystic carcinoma of the palate is reviewed.     

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.     

Intracranial adenoid cystic carcinoma of suprasellar region

Summary  Adenoid cystic carcinoma (ACC) is a relatively common head and neck tumor which grows slowly but locally aggressive and prone to recurrence. ACC most commonly arises in the major and minor salivary glands, Some rare cases of intracranial ACC with an unknown primary site have been reported. The authors present the first case of primary intracranial ACC of the suprasellar region. A 34 year-old female presented with one month's duration of visual disturbance and galactorrhea. Magnetic resonance image (MRI) showed intra- and suprasellar mass mimicking a craniopharyngioma. There was no evidence of invasion from an extracranial site. The operative findings showed the mass existed under the arachnoid membrane and seemed to originate from the pituitary stalk. Pathological diagnosis was ACC. After the first operation, local recurrence and CSF dissemination to the lower clivus occurred within two months. Recurrence repeatedly treated by Gamma knife radiosurgery 10 times and 4 times by surgery during a 3 year follow-up period. But total removal of the tumor at the first operation along with radiosurgery may control the lesion and prevent further recurrence.