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. 2006 Jan 5;124(1):26-30.
doi: 10.1590/s1516-31802006000100006. Epub 2006 Apr 3.

Management of salivary gland adenoid cystic carcinoma: institutional experience of a case series

Alfio José Tincani  1 , André Del Negro, Priscila Pereira Costa Araújo, Hugo Kenzo Akashi, Antonio Santos Martins, Albina Milani Altemani, Gilson Barreto
Affiliations

Management of salivary gland adenoid cystic carcinoma: institutional experience of a case series

Alfio José Tincani et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context and objective: Salivary gland tumor management requires long-term follow-up because of tumor indolence and possible late recurrence and distant metastasis. Adenoid cystic carcinoma (ACC) accounts for 10-15% of such tumors. The aim here was to evaluate surgical and clinical management, staging and follow-up of ACC patients in one academic institution.

Design and setting: Retrospective study at Head and Neck Service, Universidade Estadual de Campinas.

Methods: Data on 21 patients treated between 1993 and 2003 were reviewed. Management utilized clinical staging, histology and imaging. Major salivary gland tumor extent was routinely assessed by preoperative ultrasonography. Diagnosis, surgery type, margin type (negative/positive), postoperative radiotherapy and recurrence (presence/absence) were evaluated.

Results: There were eleven major salivary gland tumors (52.3%), seven submandibular and four parotid. Ten patients (47.7%) had minor salivary gland ACC (all in palate), while the submandibular was the most frequently affected major one. Diagnoses were mostly via fine-needle aspiration (FNA) and incision biopsy. Frozen sections were used for six patients. There was good ultrasound/FNA correlation. Sixteen (76%) had postoperative radiotherapy. One (4.7%) died from ACC and five now have recurrent disease: three (14.2%) locoregional and two (9.5%) distant metastases.

Conclusion: Adenoid cystic carcinoma has locally aggressive behavior. In 21 cases, of ACC, the facial nerve was preserved in all except in the few with gross tumor involvement. Treatment was defined from physical examination, imaging, staging and histology.

CONTEXTO E OBJETIVO:: Tumores de glândulas salivares exigem acompanhamento clínico por longos períodos devido à evolução indolente dessas neoplasias e à possibilidade tardia de recidivas locais e metástases a distância. O carcinoma adenóide cístico (CAC) compreende 10% a 15% dos tumores de glândulas salivares. O objetivo deste trabalho é analisar a conduta terapêutica, o estadiamento e o acompanhamento de pacientes com CAC em cabeça e pescoço em instituição de ensino.

TIPO DE ESTUDO E LOCAL:: Estudo retrospectivo realizado no Serviço de Cirurgia de Cabeça e Pescoço, Universidade Estadual de Campinas.

MÉTODOS:: Revemos o tratamento do CAC de 21 pacientes tratados entre 1993 e 2003. Os pacientes foram estadiados conforme os critérios clínicos da União Internacional Contra o Câncer (UICC) de 1998 e o tratamento foi baseado na avaliação clínica e imagenológica.

RESULTADOS:: 11 tumores estavam localizados nas glândulas salivares maiores (52,3%), sendo sete em glândula submandibular e quatro em parótida. Em 10 pacientes (47,7%), os tumores estavam em glândulas salivares menores (todos em palato). Quando ocorreram em glândula salivar maior, a submandibular foi a mais acometida. O diagnóstico foi realizado quase sempre por punção aspirativa por agulha fina (PAAF) ou biópsia. Biópsia por congelação no intraoperatório foi realizada em seis pacientes. Obtivemos boa correlação entre o ultra-som e a PAAF. Em 16 pacientes (76%), a radioterapia pós-operatória foi realizada. Um dos pacientes (4,7%) foi a óbito pelo CAC e cinco tiveram recidivas da doença, sendo três locoregionais (14,2%) e dois (9,5%) por metástases a distância.

CONCLUSÃO:: Carcinoma adenóide cístico apresenta comportamento agressivo localizado. Em 21 casos, o nervo facial foi preservado, exceto nos raros pacientes com invasão grosseira pelo tumor. O tratamento baseou-se no exame físico, exames de imagem, estágio do tumor e diferenciação histológica.

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Conflict of interest statement

Conflicts of interest: Not declared

Figures

Figure 1
Figure 1. Histology of adenoid cystic carcinoma subtypes (tubular and cribriform) and perineural invasion (400 x magnification and hematoxylin-eosin staining).
Figure 2
Figure 2. Invasion of the central nervous system by adenoid cystic carcinoma as shown in magnetic resonance imaging.
See this image and copyright information in PMC

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