Adenoid cystic salivary gland carcinoma: A histopathologic review of treatment failure patterns

Abstract

Seventy-one cases of adenoid cystic salivary gland carcinoma were reviewed according to treatment modality and clinical course. Thirty-six patients (51%) were treated by combined surgery and radiation therapy. The tumors were classified by their histologic patterns into tubular, cribriform, and solid forms. Distant metastases, in 52%, were the most frequent and ominous sources of failure. In 35% of cases, distant metastases developed despite local control at the primary site. In this group, the disease had a more fulminant course with shorter survival. Histopathologically, the cribriform subtype was associated with multiple local recurrences, greater local aggressiveness, and a poorer salvage rate as compared with the tubular subtype. Late onset of local recurrences and distant metastases was especially associated with the cribriform subtype. Overall prognosis in terms of distant metastases and survival was worst for the solid subtype. Control of local disease is best achieved with combined surgery and radiation therapy. The high incidence of distant metastases may not be affected by this regimen. The ultimate outcome of therapy is poorly predicted. Survival appears to be based on the pattern in which distant metastases develop. Overly aggressive and mutilating surgical approaches for these tumors are not recommended in many instances. The need for the development of new, more effective forms of therapy is emphasized.

Adenoid cystic carcinoma: A retrospective clinical review

“…Others have questioned the importance of perineural invasion [22,24]. Our finding of a significant correlation between positive margins and perineural invasion has been reported by others [27].…”

“…Similarly, discouraging results for tumors in this region have been reported by others [3,4,23]. Tumors of the oral cavity and oropharynx, including palatal lesions, demonstrated more favorable recurrence-free outcomes, a finding that has been shown in previous reports as well [8,22]. Neck disease is rare in ACC, and this finding has been common [1,3,24].…”

“…Grade may also serve a role in decision making, as was seen in this series. However, the significance of grade as a marker of outcome has been contested and remains unresolved, with both proponents [8,22] and opponents [1]. In a large series of more than 200 cases reported by Spiro et al [4], lower grade showed a trend toward longer survival, but this trend was not significant.…”

Detection of human papilloma virus and p16 expression in high-grade adenoid cystic carcinoma of the head and neck

“…1 High-grade adenoid cystic carcinoma has a predominantly solid growth pattern and a more aggressive clinical behavior. 2 Dedifferentiation can also occur in adenoid cystic carcinoma, characterized by lowor intermediate-grade tumor, juxtaposed to a poorly differentiated or undifferentiated carcinoma, and is frequently associated with poor clinical outcome. 3 Due to their poorly differentiated nature and predominantly solid growth pattern, high-grade and dedifferentiated adenoid cystic carcinoma may be difficult to distinguish from non-keratinizing squamous cell carcinoma and basaloid squamous cell carcinoma, especially on small biopsy specimens.…”

Unusual Presentations of Adenoid Cystic Carcinoma in Extra-Salivary Gland Subsites in Head and Neck Region: A Case Series

“…Histologically ACC can be categorized into three growth patterns, cribriform, tubular and solid, of which solid variety has worse prognosis due to advanced stage and frequent association with distant metastases [8,9]. Szanto et al [10] graded ACC into three grades, cribriform or tubular (grade I), less than 30% solid (grade II) and greater than 30% solid (grade III).…”