Metastasis of adenoid cystic carcinoma from a submandibular gland to the larynx

The present article discusses the first reported case of adenoid cystic carcinoma (ACC) metastasis from a submandibular gland to the larynx. Both treatments of distant metastasis of ACC and secondary laryngeal tumor are challenging. Despite its slow progression, ACC is associated with high rates of local recurrence, distant metastasis, and poor prognosis. Patients with secondary laryngeal cancer often have other concurrent metastatic lesions. Therefore, treatment selection should consider the biological behavior of the tumor and characteristics of the laryngeal lesion, along with the general condition and quality of life of the patient. The patient (55-year-old female) had a history of ACC of the right submandibular gland, removed surgically 9 years prior to the present consultation. Follow-up showed multiple pulmonary metastases. The patient complained of dysphonia lasting 3 months. Following the diagnosis of ACC metastasis to the larynx (supraglottic) and a neck lymph node via biopsy, we performed partial laryngectomy, left neck dissection, and tracheotomy. Histopathological examination showed an increase in the tumor grade over time. Two months after discharge, there was no obvious local recurrence or increase in lung metastasis.     

Clinicopathologic predictors and impact of distant metastasis from adenoid cystic carcinoma of the head and neck

BACKGROUND: Adenoid cystic carcinoma (ACC) is a unique tumor characterized by frequent and delayed distant metastasis (DM) with uncommon regional lymph node metastasis. OBJECTIVES: To evaluate the factors affecting DM of ACC and survival after appearance of DM. DESIGN: A retrospective analysis of 94 cases of ACC from 1979 through 2001. SETTING: Academic tertiary referral center. RESULTS: Distant metastasis of ACC occurred in 46 patients and developed more frequently in patients with tumors of the solid histologic subtype than in patients with tubular or cribriform subtypes. Distant metastasis occurred less frequently in the minor salivary glands of the sinonasal tract than in major salivary glands or in other minor salivary glands, and development of DM was not affected by tumor stage. Disease-specific 5- and 10-year survival rates were 88% and 72% for patients without DM, respectively, and 76% and 48% for those with DM (P =.02). Regarding the site of DM and its impact on outcomes, 30 patients had lung metastasis alone; 5 patients, bone metastasis alone; and 6 patients developed both lung and bone metastasis. Median survival times after appearance of DM among patients with isolated lung metastases and those with bone metastases with or without lung involvement were 54 and 21 months, respectively (P =.04). CONCLUSIONS: Development of DM in ACC can be predicted by solid histologic subtype and major salivary gland or oral/pharyngeal rather than sinonasal primary site. Those patients with bone involvement with or without lung metastases had worse outcomes than those with pulmonary metastasis only.     

Adenoid cystic carcinoma of the sinonasal tract: treatment results

OBJECTIVES: Malignancies arising from the sinonasal tract, which includes the nose, paranasal sinuses, and nasopharynx, are uncommon. Although adenoid cystic carcinoma (ACC) is the second most common cancer occurring in the sinonasal tract, only few studies have been reported. This retrospective review was performed to identify the clinical features and treatment outcomes of sinonasal ACC. METHODS: Thirty-five patients diagnosed and treated for ACC of the sinonasal tract were included in this study. Medical records, radiographs, and pathologic slides were retrospectively reviewed. RESULTS: In two thirds of the patients, the maxillary sinus was the site of origin and cribriform was the most common histologic subtype (61%). Seventy-one percent of the patients had advanced disease (T3, T4) at the time of diagnosis. Five-year overall survival rate was 86% and treatment failure occurred in 18 patients (51%). Five-year local recurrence rate and distant metastasis rate were 30% and 25%, respectively. Adjunctive radiotherapy appeared to reduce local recurrence. Presence of distant metastasis correlated with decreased 5-year survival (P = .001). Five-year survival rate after development of distant metastasis or local recurrence were 17% and 58%, respectively. CONCLUSIONS: Based on our findings, we suggest that sinonasal ACC be treated by a combined modality of radical surgery followed by postoperative radiation. The prognosis of sinonasal ACC seems to be determined by the presence of distant metastasis.     

Adenoid cystic carcinoma of the larynx: a report of six cases with review of the literature

Conclusion: Adenoid cystic carcinoma (ACC) in the larynx is an extremely rare entity. Although the 5-year disease-specific survival rates for laryngeal ACC are high, distant metastasis might occur up to more than 5 years post treatment. Therefore patients with ACC require long-term follow-up. Objective: To summarize the characteristics of laryngeal ACC by analyzing six cases in a single center. Methods: This was a retrospective analysis of six patients with laryngeal ACC who were treated in Beijing Tongren Hospital between 1998 and 2013. Results: The mean age at diagnosis was 44 years, ranging from 15 to 61 years. Dyspnea was the most common complaint. All patients underwent combined-modality treatment with surgical resection and external beam radiation. The range of follow-up time varied from 1 to 7 years (median 5 years). Follow-up inspections indicated that none of them had local or regional recurrence. Distant metastasis occurred in 33.7% (2/6) of the patients, with one lung metastasis 5 years after operation and one liver metastasis 4 years after operation.     

喉癌的远处转移和相关因素分析

目的　分析与喉癌远处转移显著相关的因素。方法　回顾 1 990～ 1 995年于中山大学肿瘤防治中心住院治疗的 2 77例喉癌患者 ,对随访中 1 8例出现远处转移的患者进行总结 ,明确喉癌远处转移的发生率、发生部位、时间以及预后情况。同时应用单因素Kaplan Meier和多因素Cox模型分析 2 77例喉癌远处转移的相关因素。结果　喉癌远处转移的发生率为 6 5 % (1 8/ 2 77) ,肺转移占83 3 % (1 5/ 1 8) ,肝转移 1 6 7% (3/ 1 8) ,3例肺转移合并骨转移 (其中椎骨 1例 ,肋骨 1例 ,以及多发性骨转移者 1例 )。 2例初诊入院时即发现远处转移 ,其余患者从初诊入院治疗到发现远处转移的时间间隔为 1～ 1 0 3个月 ,间隔中位时间为 7个月。喉癌远处转移患者的 3年和 5年累计生存率分别为2 3 8%和 1 1 9%。出现远处转移距死亡的间隔时间介于 2～ 77个月 ,间隔中位时间为 4 6个月。喉癌出现肝转移的预后最差 ,最长仅为 4 6个月。对 2 77例喉癌进行单因素Kaplan Meier分析显示病理诊断、鳞状细胞癌病理分化程度、N分期以及临床分期是影响喉癌远处转移的显著因素。多因素Cox模型分析仅有N分期是喉癌远处转移的显著因素 (Wald=7 889,P =0 0 0 5)。结论　喉癌存在一定比率的远处转移 ,主要发生在肺 ,而且预后很差。非鳞状细胞癌     

鼻腔腺样囊性癌42例临床分析

目的:探讨鼻腔腺样囊性癌的临床特点、治疗方法、预后以及影响预后的因素.方法:回顾分析42例鼻腔腺样囊性癌的临床资料,采用Kaplan-Meier法和Log-rank检验模型进行生存分析和预后因素检验.结果:总5、10、15、20年累积生存率和无瘤生存率分别为88.1%、54.4%、35.4%、35.4%和60.0%、5...     

晚期鼻腔鼻窦腺样囊性癌12例临床分析

目的总结原发于鼻腔鼻窦的晚期腺样囊性癌(ACC)的临床特征,探讨切缘病检结果以及复发或转移与预后的关系。方法回顾性分析12例晚期鼻腔鼻窦ACC患者的临床资料、治疗方法及预后。其中T3和T4期病变患者各6例,均无局部淋巴结及全身转移。首次治疗均以手术为主,9例联合术后放疗,4例联合化疗,复发及转移的治疗方式各异,仍以再手术为主。结果在20次首发及复发病灶的手术中,切缘阳性率高(75%,15/20),切缘阳性者生存时间最长达32年;随访期间局部复发7例(2例合并远处转移),单纯远处转移1例,局部复发并远处转移患者最长生存达32年。结论晚期鼻腔鼻窦ACC手术切缘阳性率高,局部复发率高,但局部复发或远处转移后仍能带瘤生存较长时间,在行根治性手术以及复发或转移治疗决策时应充分考虑患者的生存质量。     

鼻咽癌自然远处转移与放疗后远处转移的对比分析

目的：探讨鼻咽癌远处转移发生的时间规律。方法：对确诊后未经根治性治疗即已远处转移的患者（自然转移组）103例及放疗开始后出现远处转移的患者（放疗后转移组）138例的临床资料及远处转移发生的时间进行对比分析。结果：自然转移组从首发症状至发生远处转移的时间平均为10．78个月（95％CI：8．68～12．88个月）,放疗后转移组为20．77个月,其差异有统计学意义（P〈0．01）;自然转移组远处转移发生于2年内者占91．26％,而放疗后转移组至第4年才达到93．48％;自然转移组1、2年内发生远处转移比放疗后转移组分别高34．41％和28．94％;自然转移组远处转移100％发生于5年内,放疗后转移组远处转移有2．9％超过5年。自然转移组和放疗后转移组患者的性别、首发症状发生率,差异无统计学意义（P〉0．05）,但放疗后转移组患者年龄偏小,T、N分期偏早（P〈0．05）。结论：放疗后转移者发生远处转移的时间比未经放疗而自然转移者至少推迟1～2年,可能与患者年龄偏小、病期偏早有关。     

A massive adenoid cystic carcinoma of nasal septum progressed into the skull base

Background

Adenoid cystic carcinoma (ACC) is a malignant tumor commonly occurring in the major salivary glands. ACC of the nasal septum is exceeding rare.

Methods

The case of a 42-year-old woman with ACC of the nasal septum is presented. Her chief complaint was nasal obstruction and dysosmia for two month. CT and MRI demonstrated a massive mass occupying the nasal septum infiltrating the palate, vomeronasal, anterior skull base, and dura mater. Combined anterior cranial surgery, endoscopic intranasal surgery, and transpalatal surgery were selected due to the size and location of the tumor. A negative surgical margin was achieved without cosmetic deformity or functional disorder.

Results

She had postoperative radiotherapy with no recurrence or distant metastasis during the follow-up period.

Conclusion

The tumor location and the perineural spread pattern should be considered to determine the treatment plan for septum ACC. Post operative radiation is now generally recommended. ACC has a high incidence of local recurrence and distant metastasis rate; therefore, long-term follow-up is necessary.     

A clinical study of post-cricoid carcinoma

CONCLUSION: The local control rate following surgery was very high in patients with post-cricoid carcinoma; however, many of the patients undergoing surgery later developed distant metastasis. Therefore, establishment of chemotherapeutic regimens for preventing distant metastasis is desirable. OBJECTIVES: To define the clinical course of the cancer, the problems that might be associated with its treatment, and the future course of treatment of this cancer at our hospital. PATIENTS AND METHODS: This study included 21 patients with post-cricoid carcinoma who had undergone primary treatment at our hospital between 1989 and 2004. The present study was designed to retrospectively investigate the therapeutic outcome of post-cricoid carcinoma at our hospital. RESULTS: The 5-year cause-specific survival rate was 52%. All the patients who eventually died did so within 3 years of the treatment. Seven patients had distant metastases, representing a higher frequency as compared with that of patients with recurrence of the primary focus and cervical lymph node metastasis. All of these patients who had been treated by surgery died of the cancer.     

Distant metastases from thyroid and parathyroid cancer.

Thyroid cancer represents a unique biological tumor where even with the high incidence of distant metastases, the overall prognosis is not as poor as many other human cancers. The overall long-term survival in patients presenting initially with distant metastasis is approximately 50%. The overall incidence of distant metastases varies between 10 and 35%, depending upon the histology. The overall incidence is directly related to various histologies - being least in papillary thyroid carcinoma (10%) and highest in Hürthle cell tumor (33%). The incidence of distant metastases is also very high in patients with medullary and anaplastic thyroid cancer. The incidence of distant metastases at the time of initial presentation in differentiated thyroid cancer is approximately 4%. In high-risk patients - especially in patients with extrathyroidal extension or massive nodal metastasis - the distant metastases can be evaluated after total thyroidectomy with radioactive iodine ablation. Pulmonary metastases are very common in young individuals, but they are extremely well treated and the mortality from distant metastases in this group is very low. However, distant metastases in patients with poorly-differentiated carcinoma have a poor prognosis. In high-risk patients, generally a total thyroidectomy should be undertaken so that the patient can undergo radioactive iodine dosimetry and ablation as indicated. The surveillance in patients with thyroid cancer includes: close clinical follow-up, chest X-ray, and radioactive iodine dosimetry. Thyroglobulin is commonly used as a prognostic marker in patients having undergone total thyroidectomy. The incidence of distant metastases in medullary thyroid cancer is high, mainly to the lung and liver. Persistent hypercalcitonemia is an indication of regional or distant metastases. A variety of diagnostic tests are helpful, such as octreotide scanning, computed tomography scan, magnetic resonance imaging and positron emission tomography scan. Laparoscopy to evaluate the surface of the liver is also an important investigation to detect distant metastases. The incidence of distant metastases is very high in patients with anaplastic thyroid cancer, but most of the time the outcome depends on the locoregional recurrence and massive disease in the central compartment. The parathyroid cancer is quite rare, less than 1%, in patients undergoing parathyroidectomy. The diagnosis of parathyroid cancer is made by pathological features but the most certain method of diagnosis of a malignant tumor of the parathyroid is the identification of secondary deposits. The incidence of distant metastasis is difficult to determine due to the rarity of this condition, but the most common site is the lung. Patients with distant metastasis have recurrent progressive hypercalcemia along with high parathormone level.     

外耳道腺样囊性癌的远处转移及预后分析

目的 探讨外耳道腺样囊性癌远处转移的相关危险因素及其对预后的影响.方法 回顾性分析22例江苏省人民医院2007年6月至2019年3月行原发灶根治手术且病理确诊为外耳道腺样囊性癌患者的临床和随访信息,单因素及多因素回归分析远处转移的危险因素及其对预后的影响.结果 患者远处转移率为40.9％,其中肺转移发生率最高,达66....     

Noncervical lymph node metastasis from head and neck cancer.

Nonregional lymph node dissemination must be classified as distant metastasis but axillary and mediastinal metastases can be part of a regional dissemination of the disease. Metastases to lymph nodes of the upper mediastinum are very common among patients with subglottic, hypopharynx and thyroid carcinomas. Axillary metastases are found at autopsy in 2-9% of the patients who died of head and neck squamous cell carcinoma (SCC) and are frequently associated with skin implantation in aggressive recurrent head and neck carcinomas. The possible explanations for this location of metastasis were retrograde dissemination due to lymph system blockage, further tumor dissemination after a parastomal recurrence, hematogenous dissemination, and metastasis from a second primary tumor. Patients with distant metastasis have been considered incurable and only palliative treatment was instituted. Treatment planning for cases with axillary metastasis must take in consideration the likelihood of other regional recurrences and/or distant metastasis. Also, the presence of a second primary tumor must be ruled out. Whenever axilla is the only site of cancer recurrence, a standard axillary dissection must be considered. Upper mediastinal metastases from subglottic and hypopharyngeal cancer are managed by paratracheal and mediastinal dissection through the neck and postoperative radiotherapy.     

喉水平垂直部分切除术治疗晚期喉癌

目的　评价喉水平垂直部分切除术治疗晚期 (T3 ,T4 )喉癌的效果。方法　回顾性分析1984～ 1994年采用该术式治疗的 5 7例T3 、T4 病例的生存率和喉功能保留情况。结果　本组病例 3年生存率为 70 % (40 / 5 7) ,5年生存率为 6 4% (32 / 5 0 )。本组患者均保留了发音功能 ,需带管呼吸者 4例 ,拔管率为 93% (5 3/ 5 7) ,经过鼻饲和使用带气囊气管套管锻炼 ,患者均可经口进食。清楚死亡原因的病例共 14例 :局部复发死亡 4例 ,颈淋巴结转移死亡 4例 ,远隔转移死亡 4例 ,非肿瘤原因死亡 2例。失访 4例。结论　只要适应证选择的合理 ,该术式对一部分T3 、T4 喉癌的治疗即可根治肿瘤 ,又可保留喉的功能 ,单纯的高龄因素不是该术式的禁忌证。     

Two sites of head and neck squamous cell carcinoma: utility of loss of heterozygosity

OBJECTIVES: The prevalence of distant metastasis and second primary tumors is increasing with improved locoregional control in patients with head and neck squamous cell carcinoma. Traditionally, clinicopathologic evidence has been the gold standard used to distinguish distant metastasis from second primary tumors. We report a case in which loss of heterozygosity testing was used to clarify the clonal relationship between the 2 sites of head and neck squamous cell carcinoma. METHODS: A patient with squamous cell carcinoma in the larynx and mandible underwent loss of heterozygosity testing. RESULTS: The loss of heterozygosity testing confirmed that the mandibular cancer was a metastatic presentation of the laryngeal squamous cell carcinoma. CONCLUSIONS: We conclude that loss of heterozygosity testing can be useful in differentiating distant metastasis from second primary cancers in patients with 2 sites of head and neck squamous cell carcinoma, consequently providing important prognostic and staging information.     

Distant metastases to the parotid gland--review of the literature and report of own two cases

Metastatic tumors to the parotid gland are very uncommon and it accounts for 8% of all cancers of parotid gland. The parotid gland and its lymph nodes are possible sites of metastases from head and neck cancers. However, metastasis from distant primary neoplasm below clavicle is possible, too. The authors presented the two cases of distant metastases to the parotid gland. The women with breast cancer and metastases to the parotid gland 11 years after surgery, radio- and chemotherapy of breast cancer. She died 7 months after parotid surgery of systemically advanced disease. The man with metastasis of malignant melanoma of unknown primary site. He underwent total parotid surgery with the tumor and lymph nodes. He died 7 months after surgery. In spite of intensive exam the primary location of the melanoma was unknown. The authors described pathophysiology of distant metastases to the parotid gland with special attention to possibilities of treatment and survival.     

Management of the neck in cancer of the larynx.

In the Department of Otolaryngology at the University of Pittsburgh School of Medicine, cancer of the larynx is usually treated by primary surgery. Radiotherapy is used as adjuvant treatment in certain patients who have cancer that has adverse histologic features such as perineural, vascular, and/or cartilage invasion. With this approach, patients rarely develop local recurrence. Patient survival is therefore unlikely to be improved by changes to the management of the primary tumor. Survival may, however, be improved by reducing the incidence of recurrence in the neck, as well as distant. Hence, we have adopted an aggressive surgical approach to the cN+ as well as the N0 neck. The theoretical basis for this aggressive surgical approach to the neck will be considered under the following headings: staging, regional control, distant metastasis, survival, choice of neck dissection, and the pathologically positive elective neck dissection.     

Conjunctival melanoma: the role of conservative surgery and radiotherapy in regional metastatic disease

OBJECTIVE: To evaluate prognostic factors and determine the role of conservative surgery and radiotherapy in managing metastatic conjunctival malignant melanoma (MM) involving preauricular/submandibular lymph nodes. METHOD: A retrospective analysis (1990-2003) of clinical and histopathologic data from 12 patients presenting with regional metastases after failed local treatment for conjunctival MM. Patients received a common, multispecialty, conservative management approach: wide local excision, topical cryotherapy or radiotherapy to conjunctival MM (orbital exenteration for more advanced local disease), lumpectomy, and adjuvant "ring" radiotherapy of regional metastases, with chemotherapy for distant metastases. RESULTS: Median age at primary diagnosis was 51 (range 28-86) years with equal sex predilection. Six of the 12 patients had primary tumors of the bulbar conjunctiva; the remainder arose in the palpebral conjunctiva, the caruncle, or the fornix. Of 11 originating in primary acquired melanosis (PAM), 2 were amelanotic. Epithelioid tumor cells were noted histologically in seven of eight specimens in which cell type could be determined. Eight tumors metastasised to preauricular nodes, three to submandibular and one to both, with a median interval of 23 (range 12-108) months after primary diagnosis. After conservative surgery and "ring irradiation," 7 of 12 patients remained free of regional nodal relapse at median interval of 16 (range 3-126) months. Five patients developed regional nodal recurrence at median interval of 11 (range 6-13) months, 3 of whom were within radiotherapy portals. Eight patients developed distant metastasis at median interval of 44 (range 22-138) months. Eleven patients had tumor-related death. The mean Kaplan-Meier adjusted survival time after primary diagnosis was 76 months with death ensuing postregional metastasis within a median 18 (range 4-127) months. The sole survivor's follow-up duration was 56 months. CONCLUSION: Locoregional metastasis after treatment for conjunctival MM is associated with a poor prognosis. Both epithelioid tumor cells and PAM are associated with disseminating disease and poorer outcome. Literature review has failed to demonstrate advantages of mutilating radical surgery over a conservative approach in this rare disease.     

Cervical metastasis from squamous cell carcinoma of the maxillary alveolus and hard palate

OBJECTIVES: Squamous cell carcinoma has a predilection for regional lymphatic metastasis. The occurrence of occult cervical metastases from squamous cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed many patients who have returned after resection of a primary cancer in these sites with a delayed cervical metastasis. Some of these patients have died of regional or distant metastasis despite control of their primary cancer. METHODS: We have studied 26 patients with squamous cell carcinoma of the maxillary alveolar ridge and hard palate to define incidence of cervical metastasis. RESULTS: Overall incidence of cervical metastasis was: clinical 2 of 26 (7.6%) and occult 7 of 26 (27%) for a total of 9 of 26 (34.6%). The 5-year disease-specific survival was 13 of 22 (59%). Surgery for regional failure was successful in 66% (6 of 9). Radiation was administered after surgery in eight of nine patients. CONCLUSION: Cervical metastasis from cancer of the palate and alveolar ridge is significant. Regional surgery for recurrent disease usually requires radical or modified radical neck dissection. Selective elective neck dissection should be offered to patients with cancer of the hard palate and alveolar ridge. It affords the patient and the treatment team valuable histologic information, which may help to guide therapy and reduce the potential need for future hospitalization, chemoradiation, and more radical surgery.     

Adenoid cystic carcinoma of the salivary glands: a 20-year review with long-term follow-up

The behavior of adenoid cystic carcinoma (ACC) of the salivary glands has been shown to be unpredictable in terms of local and distant spread and mortality. We retrospectively studied 35 operations in 34 patients who had had a pathologic diagnosis of ACC of the salivary glands and who had been treated over a 20-year period and followed for a minimum of 10 years. We analyzed the effect that different factors had on outcomes. The site of origin appeared to be an important factor in survival rates; survival among patients with tumors that had originated in the parotid gland was fairly good, while survival among those with tumors that originated in the minor salivary glands was significantly worse. TNM staging was another significant factor in survival. Other poor prognostic indicators were local spread, nodal positivity, distant metastasis, and local and regional recurrence. Radiation and chemotherapy did not appear to be beneficial for patients with advanced disease. We recommend radical surgery with complete resection for all patients with ACC of the salivary glands and a careful assessment of the neck in patients with minor salivary gland tumors.