Clin Exp Otorhinolaryngol.  2014 Sep;7(3):232-235. 10.3342/ceo.2014.7.3.232.

Metachronous Adenoid Cystic Carcinoma in the Peripheral Lung and at Base of the Tongue

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea. irin0207@daum.net

Abstract

Primary lung adenoid cystic carcinoma (ACC) is extremely rare and accounts for approximately 0.1%-0.2% of all lung cancers. ACC of the head and neck has generally been regarded as a slow-growing, low-grade malignancy which has a tendency for local recurrence and frequent distant metastasis. When ACC of the lung is identified, physicians must determine whether it represents distant metastasis or a primary lung cancer. Thyroid transcription factor-1 staining is one of the most useful methods to differentiate primary from metastatic lesions in lung cancer. Herein we report a case of metachronous, not synchronous, ACC at the peripheral lung followed by ACC presentation at the base of the tongue, and review of relevant literatures.

Keyword

Adenoid cystic carcinoma; Metachronous; Second primary neoplasms; Lung neoplasms

MeSH Terms

Carcinoma, Adenoid Cystic*
Head
Lung Neoplasms
Lung*
Neck
Neoplasm Metastasis
Neoplasms, Second Primary
Recurrence
Thyroid Gland
Tongue*

Figure

  • Fig. 1 Fibroscopic finding at the base of the tongue. A 1.0-cm, round, firm, and fixed lesion was identified.

  • Fig. 2 Image findings. (A) Neck computed tomography (CT) contrast-enhanced view (axial): enlarged lymph nodes are identified at bilateral level II neck areas (left, 2.0 cm; right, 1.3 cm). (B) Positron emission tomography-CT: enlarged lymph nodes have increased fluorodeoxyglucose uptake. (C, D) Neck magnetic resonance imaging. T1 gadolinium enhanced view: enlarged lymph nodes at the level II neck area (2-3 cm) were identified (axial) and a 1.5×1.7 cm mass with irregular margins was observed at the base of the tongue (sagittal).

  • Fig. 3 Histopathology (H&E). (A) Adenoid cystic carcinoma, cribriform type (×100). (B) Lingual nerve invasion (×40). (C) Perineural invasion (×40). (D) Lymphatic invasion (×100).

  • Fig. 4 Immunohistochemical staining (×200). Focal positive (brownish color) status was identified in thyroid transcription factor-1 immunohistochemical staining of the peripheral lung specimen.


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