Clinicopathological correlation of adenoid cystic carcinoma: A notorious masquerader and clinical paradox

Clinicopathological correlation of adenoid cystic carcinoma: A notorious masquerader and clinical paradox

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Background: Adenoid cystic carcinoma (ACC) is an uncommon tumor with nonspecific clinicoradiological features thereby masquerading other nonneoplastic and neoplastic entities.Materials and Methods: Cases of ACC were retrospectively reviewed over a period of 4 years.The clinical details of these patients including fine-needle aspiration cytology (FNAC) and imaging findings were retrieved.

Diagnosis was confirmed on histomorphology and supplemented Embroidery Kits with immunohistochemistry (IHC).Results: Thirty cases of ACC were included in the study.Mean patient age was 55.

5 years with a slight female preponderance.Among the 30 ACCs, 10 (33.4%) were located in submandibular gland, 7 (23.

4%) in parotid gland, 6 (20%) in sublingual gland, 2 (6.7%) in lung and one each (3.33%) in nasal cavity, breast, cervix, lip, and skin of face.

Preoperative imaging was suggestive of malignancy in 29 cases while a single case of parotid gland ACC was misdiagnosed as benign salivary gland neoplasm.FNAC was performed in 29 cases with a diagnostic accuracy of 82.7%.

Histopathological examination showed characteristic features of ACC in all cases with perineural invasion Boxers seen in 7 cases.On IHC, positivity for cytokeratin was seen in all cases, cluster of differentiation 117 in 24 cases, thyroid transcription factor-1 in two cases and human epidermal growth factor receptor/neu in two cases.All cases were negative for estrogen receptor and progesterone receptor IHC.

Mean Ki-67 score was 47.8%.Conclusion: ACCs are notorious tumors showing slow growth kinetics with propensity for perineural invasion, late recurrences, and distant metastasis.

It should be kept in mind as a differential diagnosis at unusual sites other than salivary glands.