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Case Reports
. 2025 May 22;17(5):e84599.
doi: 10.7759/cureus.84599. eCollection 2025 May.

Imaging Features of Primary Intraosseous Adenoid Cystic Carcinoma of the Mandible: A Case Report

Sharma Munusamy  1 , Nivashini Ponnampalam  1 , Amali Ahmad  1
Affiliations
Case Reports

Imaging Features of Primary Intraosseous Adenoid Cystic Carcinoma of the Mandible: A Case Report

Sharma Munusamy et al. Cureus. .

Abstract

Intraosseous adenoid cystic carcinoma (ACC) of the mandible is an exceedingly rare malignancy. Its subtle onset and aggressive biological behavior, characterized by perineural invasion, present significant diagnostic and therapeutic challenges. We present a case involving a 68-year-old male who experienced persistent pain and swelling in the right hemimandible. Imaging studies using computed tomography (CT) revealed an ill-defined, osteolytic lesion affecting the right hemimandible, leading to cortical destruction. Magnetic resonance imaging (MRI) exhibited an enhancing mass in the right hemimandible, along with evidence of perineural spread along the inferior alveolar nerve. Histopathological analysis confirmed the diagnosis of adenoid cystic carcinoma, displaying a predominant cribriform pattern. The patient subsequently underwent segmental mandibulectomy, followed by adjuvant radiotherapy. This case highlights the essential roles of CT and MRI in the early detection, characterization, and surgical planning for intraosseous ACC. It is crucial for radiologists and clinicians to maintain a high index of suspicion when assessing destructive mandibular lesions, especially those that exhibit perineural spread. Timely diagnosis and a multidisciplinary management approach are vital for optimizing outcomes in this aggressive tumor.

Keywords: adenoid cystic carcinoma; ct; intraosseous; mandible; mri; perineural invasion.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Contrast-enhanced CT neck images in the coronal plane.
(A) Bone window setting showing the expanded right hemimandible with cortical erosion (red arrow). (B) Soft tissue window setting showing the soft tissue mass extending to the lingual surface of the gingiva (red arrow).
Figure 2
Figure 2. Contrast-enhanced CT neck images in the agittal oblique plane.
(A) Lytic lesion in the right hemimandible exposing the right mandibular canal. (B) Normal left hemimandible with an intact mandibular canal for comparison.
Figure 3
Figure 3. Contrast-enhanced CT neck images in the axial plane at the level of the ramus of the mandible.
(A) Widened right mandibular foramen (red arrow); normal mandibular foramen on the left (green arrow). (B) Soft tissue surrounding (red arrow) the right inferior alveolar nerve. Normal inferior alveolar nerve on the left side (red circle) surrounded by fat (green arrow).
Figure 4
Figure 4. MRI neck axial T1 fat-saturated (T1FS) post gadolinium images.
Enhancing mass (red arrow) at the level of (A) the body of the right hemimandible extending to (B) the ramus of the mandible and (C) mandibular condyle with the involvement of adjacent medial and lateral pterygoid muscles.
Figure 5
Figure 5. MRI neck coronal T1 fat-saturated (T1FS) post gadolinium image.
Bilateral symmetrical appearance of the mandibular division of trigeminal nerves, indicating no intracranial extension of the perineural spread.
See this image and copyright information in PMC

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