Journal of Clinical and Diagnostic Research (Oct 2024)
A Case of Adenoid Cystic Carcinoma of Submadibular Salivary Gland: An Aggressive Neoplasm with Multiple Recurrences
Abstract
Adenoid Cystic Carcinoma (ACC) is an uncommon form of malignant neoplasm of the salivary gland. ACC is a rare epithelial, slow-growing yet aggressive neoplasm with a remarkable capacity for recurrence. It most commonly develops in the salivary glands or other regions of the head and neck. Hereby, authors present a case of a 72-year-old female who presented with a rapidly enlarging swelling in the right submandibular region, which had recurred three times. Histopathological examination reported it as ACC grade II. ACC is known for its ability to invade perineurally, its high frequency of local and distant recurrence and its poor long-term prognosis. In the present case, the treatment provided was complete surgical resection. The patient underwent wide surgical excision of the lesion with appropriate margins, as well as a completion neck dissection of level IA. The histopathological diagnosis is based on tissue examination findings that exhibit typical histologic features. The presence and percentage of solid architecture reflect clinical outcomes and should be reported in the pathology report. Current diagnostics mainly rely on histomorphology, along with immunohistochemistry and cytogenetics. Poor prognostic factors include large tumour size, solid growth pattern, positive surgical margins, nodal status, nuclear atypia, high mitotic activity, high-grade transformation, lymphovascular invasion and tumour necrosis. The patient was kept on regular follow-up and there was no recurrence or metastasis noted over two years. ACC remains extremely difficult to treat due to its high recurrence and metastasis rates. The authors are presenting a case of right submandibular gland ACC for its rarity, multiple recurrences, aggressive clinical behaviour and associated radiological and histopathological findings.
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