Adenoid cystic carcinoma of the larynx: Case report and review of literature

Abstract

Adenoid cystic carcinoma (ACC) is a rare malignant neoplasm arising in both major and minor salivary glands. It represents approximately 1% of all head and neck cancers and about 10% of salivary gland tumors. Laryngeal adenoid cystic carcinoma (LACC) is a rare entity that most frequently arises in the subglottic region. It is characterized by slow progression, perineuronal invasion, frequent local recurrences and delayed distant metastasis. Surgical resection remains the gold standard for the treatment of ACC; however, the role of adjuvant radiotherapy and prophylactic neck dissection remains uncertain and is widely debated in the literature. This case report describes a 60-year-old male patient who presented with progressive dysphagia and worsening dyspnea. Clinical evaluation, including computed tomography (CT), revealed a lesion involving the left glottic and supraglottic regions. Biopsy obtained via direct laryngoscopy confirmed the diagnosis of laryngeal adenoid cystic carcinoma (LACC). The patient subsequently underwent total laryngectomy with adjuvant radiotherapy.

Keywords: Adenoid cystic carcinoma; Dyspnea; Laryngectomy; Neck dissection; Perineuronal invasion; Subglottic area.

Fig. 1

Imaging CT in axial and coronal coupe, showing an irregular process in the glottic and supra-glottic level, reaching the anterior commissure (red arrow). There is no extension to the subglottic area (yellow arrow) or cervical lymph nodes.

Fig. 2

(A) Adenoid cystic carcinoma with predominant cribriform patterns (Red arrow), along with a tubular (Green arrow) and, at a lesser extent, a solid pattern (Blue Arrow). The tumor largely infiltrates the underlying thyroid cartilage. (Hematoxylin-Eosin-Saffron coloration, Magnification x4) (B) Medium power view showing the invasion of thyroid cartilage by the tumor (Hematoxylin-Eosin-Saffron coloration, Magnification x10) (C) The cribriform areas are mainly made of modified myoepithelial cells with indistinct cell borders, amphophilic cytoplasm and uniform round (Blue arrow), The tubular areas are double layered, with luminal ductal cells, (Green arrow) (Hematoxylin-Eosin-Saffron coloration, Magnification x40).