Primary cutaneous adenoid cystic carcinoma of the neck presenting as a rapidly growing posterior triangle neck mass

Abstract

A woman in her 70s presented to a tertiary otorhinolaryngology outpatient department with a 25-year history of right-sided subcutaneous neck lesion that had steadily grown over the preceding 6 months, now with skin involvement. The patient was asymptomatic except for some mild tenderness. The 3 × 3 cm mass lay fixed to deep tissues adjacent to the sternocleidomastoid muscle, though no associated lymphadenopathy was found on palpation, with imaging confirming no regional or distant metastases. Biopsy confirmed the lesion to be primary cutaneous adenoid cystic carcinoma, a malignancy not previously described as a primary on the neck, which was treated by wide local excision after multidisciplinary team discussion. The lesion was completely excised with negative margins, and after surveillance over 3 years, the patient is still well with no signs of recurrence.

Keywords: Dermatology; Ear, nose and throat/otolaryngology; Otolaryngology / ENT; Skin cancer.

Figure 1

Original presentation of cutaneous neck lesion.

Figure 2

(A, B) Right-sided posterior neck lesion confined to skin and soft tissue as visualised on CT scan.

Figure 3

Schematic diagram to show the location of skin lesion on neck. (Illustrated by Miss Sophie Wilkinson.)

Figure 4

H&E ×100. Islands of tumour with punched out spaces filled with basophilic mucoid material.

Figure 5

H&E ×200. Perineural invasion in subcutis.