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Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 403
Sinonasal adenoid cystic carcinoma


CP-109, Pitampura, Maurya Enclave, Delhi - 110088, India

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How to cite this article:
Jagmohan P, Sangwan S, Sethi S K, Solanki R S. Sinonasal adenoid cystic carcinoma. Indian J Radiol Imaging 2005;15:403

How to cite this URL:
Jagmohan P, Sangwan S, Sethi S K, Solanki R S. Sinonasal adenoid cystic carcinoma. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Sep 22];15:403. Available from: http://www.ijri.org/text.asp?2005/15/3/403/29166
Sir,

A forty year old male presented to our hospital with a four month history of progressively increasing bilateral nasal obstruction, painful swelling of external nose and epistaxis. Headache, epiphora, rhinorrhea and mouth breathing were associated symptoms. On examination external nasal pyramid was irregularly widened and tender on deep palpation. A globular, red, fleshy mass was seen filling the nasal cavity on anterior rhinoscopy.

Plain radiograph revealed opacified nasal cavity and maxillary sinuses. CT showed features of a malignant nasal neoplasm with presence of a homogenous, expansile, moderately enhancing mass centered at the midline. There was remodelling and erosion of the lateral nasal walls and septum with extension into bilateral ethmoid and left frontal sinuses. Bilateral sphenoid and maxillary sinuses showed non-enhancing opacification probably secondary to obstruction [Figure - 1]. On biopsy a poorly circumscribed tumor was seen composed of simple and complex tubules in fibrous tissue with eosinophilic secretions in tubular lumina, characteristic of tubular type of adenoid cystic carcinoma. Tubules showed an inner layer of cells with eosinophilic cytoplasm and outer layer of basaloid type of cells [Figure - 2].

Adenoid cystic carcinoma is a rare tumor accounting for less than 1% of all head and neck malignancies and 10% of all salivary gland neoplasms [1]. Majority of the tumors arise in the major salivary glands, minor salivary glands of the oral cavity and the mucous glands of the upper respiratory tract. Adenoid cystic carcinomas are characterized by slow growth, multiple recurrences, a long clinical course, early perineural spread and late metastases [2].

Adenoid cystic carcinomas account for 5-15% of all malignant paranasal neoplasms. Of all the adenoid cystic carcinomas of the head and neck, those originating in the sinonasal region have the worst prognosis. Sinonasal neoplasms generally present in the fourth and fifth decades with symptoms of obstruction, rhinorrhea and epistaxis. Duration of symptoms may vary from a few months to years reflecting the slow growth of tumor [1]. Associated dull pain, paresthesias or nerve paralysis due to perineural spread is highly suggestive of adenoid cystic carcinoma. Local recurrences are a part of the natural history of the tumor, majority of which occur in the first 5 years [1]. Distant metastases are seen in 25-40% cases and commonly affect the lung, bone, liver, brain and kidney [2]. Though adenoid cystic carcinoma has a predilection for perineural and hematogenous spread, lymphatic spread is uncommon.

Plain radiograph revealed opacified nasal cavity and maxillary sinuses. CT showed features of a malignant nasal neoplasm with presence of a homogenous, expansile, moderately enhancing mass centered at the midline. There was remodelling and erosion of the lateral nasal walls and septum with extension into bilateral ethmoid and left frontal sinuses. Bilateral sphenoid and maxillary sinuses showed non-enhancing opacification probably secondary to obstruction [Figure - 1]. On biopsy a poorly circumscribed tumor was seen composed of simple and complex tubules in fibrous tissue with eosinophilic secretions in tubular lumina, characteristic of tubular type of adenoid cystic carcinoma. Tubules showed an inner layer of cells with eosinophilic cytoplasm and outer layer of basaloid type of cells [Figure - 2].

Adenoid cystic carcinoma is a rare tumor accounting for less than 1% of all head and neck malignancies and 10% of all salivary gland neoplasms [1]. Majority of the tumors arise in the major salivary glands, minor salivary glands of the oral cavity and the mucous glands of the upper respiratory tract. Adenoid cystic carcinomas are characterized by slow growth, multiple recurrences, a long clinical course, early perineural spread and late metastases [2].

Adenoid cystic carcinomas account for 5-15% of all malignant paranasal neoplasms. Of all the adenoid cystic carcinomas of the head and neck, those originating in the sinonasal region have the worst prognosis. Sinonasal neoplasms generally present in the fourth and fifth decades with symptoms of obstruction, rhinorrhea and epistaxis. Duration of symptoms may vary from a few months to years reflecting the slow growth of tumor [1]. Associated dull pain, paresthesias or nerve paralysis due to perineural spread is highly suggestive of adenoid cystic carcinoma. Local recurrences are a part of the natural history of the tumor, majority of which occur in the first 5 years [1]. Distant metastases are seen in 25-40% cases and commonly affect the lung, bone, liver, brain and kidney [2]. Though adenoid cystic carcinoma has a predilection for perineural and hematogenous spread, lymphatic spread is uncommon.

Radiological investigations include plain radiographs, CTand MRI. Radiological findings are those of a malignantneoplasm, namely a soft tissue mass with pressureerosion and destruction of bony wall. A combination ofboth remodelling and destruction of bone is typical ofadenoid cystic carcinoma [3]. Radiology plays animportant role in defining regional extension and detectingperineural spread, local recurrences and distantmetastases.

Histological examination reveals uniform basaloid cellswith little cytoplasm and regular nuclei arranged in solid,glandular and tubular patterns [2],[4]. Prognostic factorsinclude the location, tumor size, perineural growth,histological appearance and presence of tumor at thesurgical margin. Therapeutic options include local orradical excision and radiotherapy.

 
   References Top

1.Wiseman SM, Popat SR, Rigual NR, etal. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity: A 40-year review of 35 cases. Ear, Nose and Throat Journal 2002; 81: 510-517.  Back to cited text no. 1    
2.Kim KH, Sung MW, Chung PS etal. Adenoid cystic carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1994; 120: 721-726.  Back to cited text no. 2    
3.Valvassori GE, Mafee MF, Carter BL. Imaging of the head and neck. New York: Thieme ,1995: 317.  Back to cited text no. 3    
4.Stell PM. Review: Adenoid cystic carcinoma. Clin Otolaryngol 1986; 11: 267-291  Back to cited text no. 4  [PUBMED]  

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Correspondence Address:
P Jagmohan
CP-109, Pitampura, Maurya Enclave, Delhi - 110088
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29166

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