Cancer Res Treat.  2007 Dec;39(4):185-188.

Palliative Radiotherapy in a Patient with Pulmonary Adenoid Cystic Carcinoma

• Kim BK

Abstract

Primary adenoid cystic carcinoma in the lung is very rare, so its clinicopathologic characteristics have usually been extrapolated from the salivary disease. However, the clinical courses of pulmonary adenoid cystic carcinomas may be different from those of salivary disease, and individual differences may also exist. I report here on a case of a patient who was initially diagnosed as pulmonary adenoid cystic carcinoma with liver metastases and the tumor showed extreme radiosensitivity, but it also underwent an aggressive clinical course. Adenoid cystic carcinoma is usually known to be a slowly growing tumor, but it may rapidly disseminate, like in this patient. Therefore, the factors predicting aggressive behavior should be determined and the treatment might be individualized according to the primary sites and on the patient's basis.

Keyword

Pulmonary adenoid cystic carcinoma; Radiosensitivity; Prognostic factor

MeSH Terms

Adenoids*
Carcinoma, Adenoid Cystic*
Humans
Individuality
Liver
Lung
Neoplasm Metastasis
Radiation Tolerance
Radiotherapy*

Figure

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  Fig. 1 Initial CT findings. (A, B) On chest CT, a mass obstructing the right upper lobar bronchus was detected and it caused atelectasis of the right upper lobe. A 2.5 cm sized lymph node was also detected at the right paratracheal nodal station. (C, D) Multiple hepatic metastases were detected at the time of the initial diagnosis.

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  Fig. 2 Chest CT findings after thoracic radiotherapy. (A) Immediate post-radiotherapy. The chest CT scan, which was performed 2 weeks after radiotherapy, showed a markedly decreased RUL mass and right lower paratracheal lymph node (<1 cm). (B) 9 months after thoracic radiotherapy. There was no evidence of disease recurrence at the previously irradiated sites, with only asymptomatic radiation pneumonitis being seen. There were multiple, newly detected pulmonary metastases.

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  Fig. 3 Rapidly progressing multiple bone metastases. (A) 1 month after thoracic radiotherapy. (B) 4 months after thoracic radiotherapy. (C) 6 months after thoracic radiotherapy. Bone metastases were initially diagnosed at 1 month after thoracic irradiation and then these lesions rapidly progressed. After 6.5 months, the bone metastases had progressed to the whole spine, except for the previously irradiated upper thoracic spine, and the progression also involved the pelvis, femur and sternum.

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