Recurrent adenoid cystic carcinoma in the liver: a repeated laparoscopic surgical approach

Abstract

Adenoid cystic carcinoma (ACC) is characterized by a particularly aggressive behavior even many years after resection of primary tumor. The evolution of metastasis dramatically affects the final outcome but resection should always be evaluated. Herein is described a case of aggressive ACC of the parotid gland in a 30-year-old female. She developed local recurrence and lung metastases; then, she also developed two liver metastasis 112 and 132 months after the resection of the primitive cancer of the parotid gland. Both lesions were successfully managed by a laparoscopic approach. Intra-abdominal adhesions after the first surgery were mild, allowing an easier access for the second laparoscopic liver resection. At 1 year follow-up, the patient is liver disease free with a stable lung disease. To our knowledge, this is the first report of a double laparoscopic liver resection for parotid gland's ACC metachronous metastases. Patients with resected ACC need a strict and lifelong follow-up after the resection of the primitive cancer. Also for ACC, a laparoscopic approach to liver metastasis should always be considered as a viable alternative to open surgery. In our experience of over 90 cases, laparoscopic surgery causes less adhesions, allowing an easier approach for repeated resections.

A Rare Case of Primary Adenoid Cystic Carcinoma of Lung

“…6 These malignant tumours often have an indolent course over years but have propensity for metastasis to other organs, lungs being the commonest site followed by liver. 7,8 Spread along perineural lymphatics resulting in multiple local recurrence is unique to adenoid cystic carcinoma. Rarely, primary adenoid cystic carcinoma can also occur in other sites like breast, skin, lacrimal glands, external auditory canal, uterine cervix, upper gastrointestinal tract, lung and bones.…”

Possible local treatment for liver metastases of adenoid cystic carcinoma (ACC): single-centre experience and literature review

“…However, if liver metastases were accompanied by metastases at other sites, additional factors need to be considered. The definition of resectability might not be limited to isolated liver metastases because multiple liver metastases can also be surgically treated ( 15 ), even recurrent liver metastases ( 5 ). The extent of resection and the function of the remnant liver should be considered, and a multidisciplinary team should be involved in evaluating the treatment options.…”

“…Ten patients were found to have lung metastases before liver metastases. The other 13 case reports in PubMed were reviewed in Table 2 (5,8,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

“…Distant metastasis (DM) eventually occurs in as many as 40% of patients ( 3 ); with a 36-months follow-up, distant metastases developed in 25 (30.5%) of 82 patients ( 4 ). Despite the primary low-grade malignant nature of primary ACC, the survival rate of ACC is rather low, with a 10-year survival rate of less than 50%, which is due to distant metastases ( 5 ). Therefore, it is important to prevent metastases and improve the effectiveness of treatment for metastases of ACC.…”

A Single Liver Metastasis From Adenoid Cystic Carcinoma of the Parotid Gland: Case Report

“…Scuderi et al 11 reported one case of recurrent liver metastasis that was efficiently achieved by a laparoscopic approach. The patient remained disease-free for 1 year after the surgical resection.…”