Oral Pathology Short Case 2 - 35 Years Female – Nodular lesion in the floor of the mouth

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 Answer : Adenoid cystic Carcinoma





Salivary gland malignancy slow-growing relentless salivary gland malignancy composed of epithelial and myoepithelial neoplastic cells that form various patterns

F : M = 1.5 : 1

4.4 % of all salivary gland tumours

Median patient age 57 years 

Swiss cheese appearance

MYB translocation

3 types – Cribriform, Tubular, Solid

Perineural and intraneural invasion – 30 %

Comedo type necrosis in solid type – ACC – Resembles Basal Cell Ca

Grade I, II, III 5 year survival drastic difference but 15-year survival almost equal


Histopathology

Cribriform

Nests of tumour cell interrupted by 

Sharply punched out spaces filled with basophilic matrix




Small Angulated hyperchromatic nuclei

Perineural invasion

Tubular

Bi layered tubules with true lamina

Scant cytoplasm

Small Angulated hyperchromatic nuclei

Solid

Sheets of tumour cell

Without lumen

May consist of epithelial-myoepithelial elements


Immunohistochemistry – CD 117 inner epithelial cells, P63, SMA- Peripheral myoepithelial cells, Recent – MYB

Close relations histopathologically

  • Pleomorphic adenoma

  • Polymorphous adenocarcinoma

  • Epithelial myoepithelial ca

  • Basal cell adeno ca


Clinical

Painful, tender, Cranial N lesions – Facial palsy, Minor glands ulcerate

Prognosis – High local recurrence rate

LN involvement of uncommon

Distant metastasis reported in > 50%

10-year survival – 50-70 %

Tubular,Cribriform – Good prognosis

Solid – Poor prognosis


Treatment 

Radical resection

Radiotherapy is essential 


Presentation of a deep lobe tumour 

  • Parapharyngeal bulge

  • Dumbell tumour

Surgical approach to parapharyngeal space 

  • Midline mandibulotomy – mandibular swing

  • Lateral mandibulotomy – mandibular swing

What is the maxillary procedure similar to mandibular swing ?

  • Maxillary swing procedure – Wei procedure 


Further reading :

Wei WI, Lam KH, Sham JS. New approach to the nasopharynx: the maxillary swing approach. Head Neck. 1991 May-Jun;13(3):200-7. doi: 10.1002/hed.2880130306. PMID: 2037471.

https://pubmed.ncbi.nlm.nih.gov/2037471/


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