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Krishnasamy S, Tang CY, Tan PH. Tracheal adenoid cystic carcinoma with microscopic positive margin-how we approached with a systematic analysis review of its management. Indian J Thorac Cardiovasc Surg 2024; 40:332-340. [PMID: 38681715 PMCID: PMC11045698 DOI: 10.1007/s12055-023-01600-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 05/01/2024] Open
Abstract
Purpose Adenoid cystic carcinoma (ACC) of the trachea is a rare malignancy. We report a patient with ACC who underwent multimodal management including tracheal resection. A systematic review was also conducted on tracheal resection for ACC. Methods A literature search was conducted on MEDLINE, Embase, and PubMed using the search terms "trachea AND adenoid cystic carcinoma AND (surgery OR resection)" and articles from 2000 to August 2021 were identified. A total of 29 journal articles were included in the review. Results A total of 403 patients underwent surgery for tracheal ACCs. The mean age was 48.1 years and 54.7% were female. The commonest anatomical location was the lower trachea (46.9%). The mean time from symptom onset to diagnosis was 16.6 months with the commonest symptom being dyspnoea (52%). Fifty-eight percent of the patients had intraluminal growth. Tracheal resection (46.2%) and access via thoracotomy (41.4%) were the commonest procedures described. The mean length of trachea resected was 39.2 mm and the mean tumour size was 31.5 mm. 16.8% of lymph nodes were involved and 73.8% of cases had positive resection margins. The overall complication rate was 1.4-5.4% and the in-hospital mortality rate was 9.8%. The overall survival reported was 61.7% at 5 years and 54.6% at 10 years. Conclusion Surgical resection followed by adjuvant radiotherapy is the mainstay in the treatment of tracheal ACC, notwithstanding the high rates of involved margins. Achieving tension-free anastomosis should be the first priority given the favourable response of adjuvant therapies in reducing recurrence rate and improving overall survival.
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Affiliation(s)
- Sivakumar Krishnasamy
- Department of Surgery, Cardiothoracic Unit, University of Malaya Medical Centre (UMMC), Jalan University, 59100 Kuala Lumpur, Malaysia
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chu-Yik Tang
- Department of Surgery, Cardiothoracic Unit, University of Malaya Medical Centre (UMMC), Jalan University, 59100 Kuala Lumpur, Malaysia
| | - Pheng Hian Tan
- Department of Surgery, Cardiothoracic Unit, University of Malaya Medical Centre (UMMC), Jalan University, 59100 Kuala Lumpur, Malaysia
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2
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Yazaki T, Sonehara K, Araki T, Komatsu M, Tateishi K, Yasuo M, Hanaoka M. Impact of Interventional Bronchoscopy on Long-Term Survival in Patients with Primary Tracheal Adenoid Cystic Carcinoma: A Single-Center Experience. Case Rep Oncol 2024; 17:305-310. [PMID: 38390454 PMCID: PMC10883689 DOI: 10.1159/000535738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 02/24/2024] Open
Abstract
Introduction Primary tracheal adenoid cystic carcinoma (TACC) is a rare low-grade lung cancer of bronchial gland origin. Surgery is the first choice of treatment; however, in cases of recurrence or inoperability, a combination of radiation and chemotherapy is administered as a multimodality treatment. Interventional bronchoscopy is also used as a multidisciplinary treatment; however, its impact on long-term prognosis has not been thoroughly investigated. Case Presentation Eight patients diagnosed with TACC and treated at Shinshu University Hospital between December 2000 and August 2023 were analyzed retrospectively. We investigated the duration of intervention and overall survival (OS) in 3 patients with recurrence who underwent interventional bronchoscopy in combination with chemotherapy and evaluated whether interventional bronchoscopy prolonged the survival. The initial treatment for the 3 patients was surgery in 1 patient and chemoradiotherapy in 2. In all patients, raised lesions were observed in the trachea at the time of recurrence. The duration of interventional bronchoscopy, the time from recurrence of the first-line treatment to death, and OS, which was defined time from induction of the first-line treatment to death, were 69.3/70.7/112.5 months, 179.2/196.1/220.4 months, and 15.4/66.3/104.4 months, respectively. Conclusion Long-term survival benefits may be obtained with concomitant interventional bronchoscopy in combination with chemotherapy in patients with locally recurrent TACC.
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Affiliation(s)
- Tatsuya Yazaki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kei Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Taisuke Araki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanori Yasuo
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Montenegro C, Mattavelli D, Lancini D, Paderno A, Marazzi E, Rampinelli V, Tomasoni M, Piazza C. Treatment and outcomes of minor salivary gland cancers of the larynx and trachea: a systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:365-374. [PMID: 37814980 PMCID: PMC10773543 DOI: 10.14639/0392-100x-n2635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/10/2023] [Indexed: 10/11/2023]
Abstract
Objectives Malignant minor salivary glands carcinomas (MiSGC) of the larynx and trachea are rare tumours and published evidence is sparse. We conducted a systematic review to describe shareable treatment strategies and oncological outcomes of these neoplastic entities. Methods Full text English manuscripts published from January 1st 2000 to December 14th 2022 were included. Data on demographics, treatments and outcomes were collected. A pooled analysis of 5-year overall survival (OS) was performed. Results Seventeen articles and 365 patients met the inclusion criteria. The most common subsites involved were subglottic and distal trachea. Adenoid cystic carcinoma was, by far, the most frequent histotype. The first-choice treatment strategy was surgery (86.8%), while adjuvant treatments were delivered in 57.4% of patients. Only 12.9% were treated with definitive radiotherapy with/without chemotherapy. The mean follow-up was 68.3 months. One hundred nine (34.9%) deaths were recorded and 62.4% were cancer-related. Five-year OS ranged from 20% to 100% and, at pooled analysis, it was 83% (range, 78-87%). Conclusions In case of MiSGC of the larynx and trachea, surgery remains the mainstay of treatment. Adjuvant treatments are frequently delivered. Survival estimates are good overall, but highly heterogeneous.
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Affiliation(s)
- Claudia Montenegro
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Elisa Marazzi
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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4
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Afriyie‐Mensah JS, Gbadamosi H, Darkwah Abrahams AO. A rare mimic of adult-onset asthma: Case report and review of the literature. Respirol Case Rep 2023; 11:e01225. [PMID: 37771847 PMCID: PMC10526117 DOI: 10.1002/rcr2.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
Adult-onset asthma is extremely variable in its phenotypic presentation and has gained notoriety for the overall poorer treatment outcomes even on standard asthma therapy. Tracheal tumours are rare but when present, exhibit asthma-like phenomenon in adult patients posing great diagnostic challenges. We report two adult patients with tracheal adenoid cystic tumours who were initially treated for adult-onset asthma. Patient 1, a 45-year-old man was diagnosed and managed for adult-onset asthma over a 12 months period without satisfactory control of his symptoms. Following a late episode of hemoptysis, a chest Computed Tomography (CT) scan done revealed an occluding tracheal tumour. Patient 2 is a 28-year-old female who was diagnosed with adult-onset asthma for over 2 years with poor symptom control despite optimal asthma therapy. She developed cough-induced subcutaneous emphysema for which a chest CT scan revealed a tracheal mass. The patient had surgery with incomplete resection of tumour and adjuvant radiotherapy.
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Affiliation(s)
| | - Hafisatu Gbadamosi
- Department of RadiologyKorle Bu Teaching HospitalAccraGhana
- Department of RadiologyUniversity of Ghana Medical SchoolAccraGhana
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Pacheco-Ojeda L, Ríos-Deidán C, Cañizares S, Pontón-Villalba P, Moya-Paredes E. Cricotracheal Adenoid Cystic Carcinoma: Insights Into the Diagnosis and Management of an Uncommon Anatomic Variant. Cureus 2022; 14:e30686. [DOI: 10.7759/cureus.30686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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Zhao Y, He G, Zhai Y, Zhou Z, Bi N, Mao Y, Zhang Y, Xiao Z, Gao S, Lv J, Xue Q, Feng Q. Adenoid Cystic Carcinoma of Lobar Bronchial Origin: 20-Year Experience at a Single Institution. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11590-5. [PMID: 35355128 DOI: 10.1245/s10434-022-11590-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pulmonary adenoid cystic carcinoma (ACC) is a rare type of lung malignancy. The prevalence of ACC of lobar bronchial origin is lower than that of other lung malignancies, and studies investigating it are lacking. This study aimed to evaluate survival of patients with ACC of the lobar bronchus after surgical resection and to explore its prognostic factors. METHODS Between January 2000 and December 2019, 35 patients at the National Cancer Center/Cancer Hospital with a diagnosis of ACC of the lobar bronchus were included in the retrospective analysis. RESULTS During a median follow-up period of 61 months (range, 10-194 months), the analysis showed a 5-year overall survival (OS) rate of 81.4%, a 5-year locoregional recurrence-free survival rate of 84.0%, and 5-year disease-free survival rate of 60.1%. The univariate analysis exclusively identified the surgical margin as a predictor of OS, and survival was significantly longer for the patients with negative surgical margins than for those with positive surgical margins (R0 vs. R1: 94.4% vs. 66.0%; p = 0.014). Adjuvant radiotherapy was administered to most of the patients with positive surgical margins, which might have contributed to prolonged OS (R0 vs. R1+RT: 94.4% vs. 66.7%, p = 0.173; R0 vs. R1+no RT: 94.4% vs. 62.5%, p = 0.007). CONCLUSIONS For ACC of lobar bronchial origin, complete resection is the radical treatment, and the OS rate was significantly higher for the R0 patients than for the R1 patients. Adjuvant radiotherapy for patients with R1 may prolong survival.
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Affiliation(s)
- Ying Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guosheng He
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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7
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Montecamozzo G, Cammarata F, Pennacchi L, Yakushkina A, Carsana L, Zerbi P, Danelli P. Thyroid metastasis from adenoid cystic carcinoma of the lung: a case report and literature review. J Surg Case Rep 2021; 2021:rjab178. [PMID: 34040752 PMCID: PMC8136885 DOI: 10.1093/jscr/rjab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 11/14/2022] Open
Abstract
Both adenoid cystic carcinoma (ACC) and thyroid metastasis are quite peculiar clinical presentations. ACC is a malignant salivary gland-type tumour mostly found in the head and neck district, but that can arise from different organs. Due to its rarity, it can pose problems in the diagnostic and therapeutic management. A 72-year-old woman presented for a persistent non-productive cough. A computed tomography showed a lung mass. She underwent lung surgery, and the lesion was an ACC primitive of the lung. She developed hoarseness and ultrasound and cytology confirmed metastatic involvement of left thyroid lobe from ACC. A total thyroidectomy was performed, followed by radiotherapy. The present case highlights the need to be aware of possible metastatic thyroid localization of ACC originating in lower airways. This is a very rare event, and clinical and cytological findings must be carefully examined. It represents an opportunity to consider the current knowledge about ACC metastasis to thyroid.
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Affiliation(s)
- Giulio Montecamozzo
- Department of General Surgery, Luigi Sacco University Hospital, 20157 Milan, Italy
| | - Francesco Cammarata
- Department of General Surgery, Luigi Sacco University Hospital, 20157 Milan, Italy
| | - Luca Pennacchi
- Department of General Surgery, Luigi Sacco University Hospital, 20157 Milan, Italy
| | - Al'ona Yakushkina
- Department of General Surgery, Ospedale di Saronno, 21047 Saronno VA, Italy
| | - Luca Carsana
- Department of Pathology, Luigi Sacco University Hospital, 20157 Milan, Italy
| | - Pietro Zerbi
- Department of Pathology, Luigi Sacco University Hospital, 20157 Milan, Italy
| | - Piergiorgio Danelli
- Department of General Surgery, Luigi Sacco University Hospital, 20157 Milan, Italy
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8
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Behbahani S, Barinsky GL, Wassef D, Paskhover B, Kaye R. Patterns of Care and Outcomes of Primary Adenoid Cystic Carcinoma of the Trachea. Ann Otol Rhinol Laryngol 2021; 131:78-85. [PMID: 33870720 DOI: 10.1177/00034894211008101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Primary tracheal malignancies are relatively rare cancers, representing 0.1% to 0.4% of all malignancies. Adenoid cystic carcinoma (ACC) is the second most common histology of primary tracheal malignancy, after squamous cell carcinoma. This study aims to analyze demographic characteristics and potential influencing factors on survival of tracheal ACC (TACC). METHODS This was a retrospective cohort study utilizing the National Cancer Database (NCDB). The NCDB was queried for all cases of TACC diagnosed from 2004 to 2016 (n = 394). Kaplan-Meier (KM) and Cox proportional-hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes. RESULTS Median age of diagnosis was 56 (IQR: 44.75-66.00). Females were affected slightly more than males (53.8% vs 46.2%). The most prevalent tumor diameter range was 20 to 39 mm (34.8%) followed by greater than 40 mm in diameter (17.8%). Median overall survival (OS) was 9.72 years with a 5- and 10-year OS of 70% and 47.5%, respectively. Localized disease was not associated with a survival benefit over invasive disease (P = .388). The most common intervention was surgery combined with radiation therapy (RT) at 46.2%, followed by surgery alone (16.8%), and standalone RT (8.9%). When adjusting for confounders, surgical resection was independently associated with improved OS (HR 0.461, 95% CI 0.225-0.946). Tumor size greater than 40 mm was independently associated with worse OS (HR 2.808; 95% CI 1.096-7.194). CONCLUSION Our data suggests that surgical resection, possibly in conjunction with radiation therapy, is associated with improved survival, and tumor larger than 40 mm are associated with worse survival.
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Affiliation(s)
- Sara Behbahani
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David Wassef
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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9
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Ran J, Qu G, Chen X, Zhao D. Clinical features, treatment and outcomes in patients with tracheal adenoid cystic carcinoma: a systematic literature review. Radiat Oncol 2021; 16:38. [PMID: 33608038 PMCID: PMC7893857 DOI: 10.1186/s13014-021-01770-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Primary tracheal adenoid cystic carcinoma (TACC) is rare and originates from the minor salivary gland. Biologically, TACC results in delayed presentation, and the therapeutic effects of multimodal treatment differ across individuals. This study aimed to review cases of TACC to identify clinical features, imaging modalities, treatment, and patient outcomes across follow-ups. Methods The PubMed, Web of Science and MEDLINE databases were searched to identify articles reporting cases of TACC. The study variables included in the analysis were patient demographics, biological characteristics, presenting symptoms, imaging modalities, treatments, follow-up times and survival outcomes. Results A total of 76 articles and 1252 cases were included in this review. The most common presenting symptom was dyspnoea (86.0%), followed by cough (58.0%). Surgery alone (40.9%), surgery with postoperative radiotherapy (36.4%) and radiotherapy alone (19.2%) were used most frequently treatments modalities. Of the 1129 cases with disease control and survival data, there was no evidence of disease in 78.7%, local recurrence was reported in 3.8%. Distant metastasis rate was 24.9% of 418 reported cases, lung (44.2%) was the most commonly involved organ. The 5, 10 years survival rate of patients treated with surgery alone and surgery with postoperative radiotherapy were 86.4%, 55.6% and 97.3%, 44.4%, respectively. Conclusion TACC most common presenting symptoms were dyspnoea, cough and shortness of breath. Surgery alone and surgery with postoperative radiotherapy are predominant treatment modalities. Both seems to provide a good result in term of disease control and long-term survival rate in patients with TACC.
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Affiliation(s)
- Juntao Ran
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - Guofeng Qu
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - Xiaohua Chen
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Da Zhao
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
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Hiyama T, Kuno H, Sekiya K, Oda S, Kobayashi T. Imaging of Malignant Minor Salivary Gland Tumors of the Head and Neck. Radiographics 2020; 41:175-191. [PMID: 33245669 DOI: 10.1148/rg.2021200062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Minor salivary gland carcinomas (MSGCs) are nonminor tumors in the head and neck region and account for about half of all salivary gland carcinomas. Imaging evaluation based on the anatomy of minor salivary and mucous glands in the head and neck region as well as invasion patterns in each site helps in identifying optimal treatment modalities and planning suitable treatment strategies. MSGCs can be divided radiologically into localized and invasive subtypes on the basis of the clinical utility of such categorization. Characteristic invasion patterns of the invasive type include deep submucosal extension, bone marrow infiltration, and perineural spread, which are difficult to assess clinically. MSGCs easily invade adjacent structures because of their submucosal location and may spread along the muscles, nerves, periosteum, and dura mater. Moreover, the tumor may spread into the bone marrow without obvious bone destruction. In addition to imaging classification, examining the anatomy and distribution of the minor salivary glands, including the palatal, lingual, buccal, labial, and retromolar glands, as well as other mucous glands, including the glands of the sinonasal cavity and nasopharynx, lacrimal glands, ceruminous glands, laryngeal glands, and tracheal glands, facilitates MSGC diagnosis and tumor extension assessment. The authors review the precise anatomy of the minor salivary and mucous glands in the head and neck region, discuss the MSGC imaging classifications, and describe how to evaluate the extent of MSGCs in each site on the basis of the imaging classification and invasion patterns. ©RSNA, 2020.
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Affiliation(s)
- Takashi Hiyama
- From the Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Hirofumi Kuno
- From the Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Kotaro Sekiya
- From the Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Shioto Oda
- From the Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Tatsushi Kobayashi
- From the Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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11
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Kapatia G, Rajasekaran S, Rohilla M, Gupta P, Gupta N, Srinivasan R, Rajwanshi A, Saikia UN, Dey P. Fine-needle aspiration cytology of extra-salivary adenoid cystic carcinoma. Cytopathology 2019; 31:215-222. [PMID: 31743547 DOI: 10.1111/cyt.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/11/2019] [Accepted: 10/31/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Adenoid cystic carcinoma (ACC) is a ubiquitous tumour which can occur in several sites of the human body. Commonly, it affects the salivary glands but also can rarely occur in various extra-salivary locations. AIM To study the clinical and cytological features of extra-salivary ACC on fine needle aspiration cytology. METHODS In this paper, we included 27 patients with extra-salivary ACC on fine needle aspiration cytology over a period of 5.5 years. The complete cytomorphological spectrum of extra-salivary ACC was studied. RESULTS The mean age of the patients was 50.2 years, with age ranging between 14 and 80 years. Male to female ratio was 1:1.7 with 17 females and 10 males. The most frequent primary site was the orbit, and the most frequent sites of metastasis were liver and lung. CONCLUSION Cytopathologists should be alert about the full range of location as well as the cytological spectrum of extra-salivary ACC for greater precision in diagnosis and prompt treatment.
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Affiliation(s)
- Gargi Kapatia
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
| | - Sangamitra Rajasekaran
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
| | - Manish Rohilla
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
| | - Parikshaa Gupta
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
| | - Nalini Gupta
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
| | - Radhika Srinivasan
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
| | - Arvind Rajwanshi
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
| | - Uma Nahar Saikia
- Departments of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pranab Dey
- Departments of Cytology, Post Graduate Institute of Medical Education& Research, Chandigarh, India
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12
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Saad AB, Kadoussi R, Njima M, Mhamed SC, Fahem N, Abdeljelil NB, Joobeur S, Rouatbi N. Primary adenoid cystic carcinoma of the tracheobronchial tree: report of two cases. Pan Afr Med J 2019; 34:137. [PMID: 33708306 PMCID: PMC7906545 DOI: 10.11604/pamj.2019.34.137.14902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/25/2019] [Indexed: 11/19/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor that predominantly originates in the salivary glands. Primary ACC of the tracheobronchial tree is extremely rare. We report two new cases of central airways primary ACC: a 58 year-old male with an ACC of the left main bronchus who underwent a pneumonectomy with node dissection, and a 52 year-old female with proximal tracheal ACC presenting as asthma treated by surgical resection and a postoperative radiotherapy. Primary ACC of the tracheobronchial tree is often misdiagnosed given the non-specific clinical presentation. An early diagnosis is essential to ensure good outcomes. An interdisciplinary treatment is required based especially on surgery and radiotherapy.
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Affiliation(s)
- Ahmed Ben Saad
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Rania Kadoussi
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Manel Njima
- Department of Pathology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Nesrine Fahem
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Samah Joobeur
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Naceur Rouatbi
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
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Adenoid Cystic Carcinoma of the Bartholin's Gland: A Diagnostic Dilemma. Case Rep Obstet Gynecol 2019; 2019:1784949. [PMID: 31531253 PMCID: PMC6720055 DOI: 10.1155/2019/1784949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022] Open
Abstract
Adenoid cystic carcinomas of the Bartholin's gland are extremely rare and are often misdiagnosed. There are currently no definite treatment guidelines. This article describes the case of a 33-year-old female who was managed at our centre for adenoid cystic carcinoma of the Bartholin's gland. She presented with a prolonged history of a vulvar lesion which was eventually diagnosed as adenoid cystic carcinoma of the Bartholin's gland. She was subsequently treated with wide local excision of the primary and inguinal lymph node dissection followed by adjuvant radiotherapy and chemotherapy. She had gross perineural invasion on MRI imaging. The present case highlights the diagnostic dilemma in this extremely rare cancer and the literature further explores the natural history and treatment options.
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14
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Ning Y, He W, Bian D, Xie D, Jiang G. Tracheo-bronchial adenoid cystic carcinoma: A retrospective study. Asia Pac J Clin Oncol 2019; 15:244-249. [PMID: 31111681 DOI: 10.1111/ajco.13162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Adenoid cystic carcinoma (ACC) of the trachea and bronchus is rare, representing 1% of all respiratory tract cancers. We presented our experiences in treating tracheal-bronchial ACC and the results of long-term surveillance. METHODS We conducted a retrospective study of treating tracheo-bronchial ACC. From 2009 to 2014, 42 patients presented to our department. All of them received surgical resection and adjunctive therapy. RESULTS R0 resections were achieved in 33 patients, whereas 15 patients whose lesions spread outside the tracheo-bronchial lumens. Nine patients had R1 resections followed by radiation and chemotherapy. The 5 year survival rate of R1 resection group showed no difference compared to the R0 resection group, but the 5 year disease-free survival rate showed difference in extra-lumenal invasion (ELI) and non-ELI group (P = 0.0357 < 0.05), although no difference was seen in the overall survival rate in these two groups. CONCLUSIONS ACC of the trachea and bronchus is a rare and low-to-moderate grade malignant tumor. When the R0 resection is over risky or may cause mortal complication, the R1 resection with adjunctive therapy is acceptable for patients to obtain a promising prognosis, whereas pathological ELI is an adverse prognostic indicator.
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Affiliation(s)
- Ye Ning
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongliang Bian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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15
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Verma V, Lin L, Simone CB. Proton Beam Therapy for Bronchogenic Adenoid Cystic Carcinoma: Dosimetry, Toxicities, and Outcomes. Int J Part Ther 2018; 4:1-9. [PMID: 31773012 DOI: 10.14338/ijpt-17-00014.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 04/23/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose Bronchogenicadenoid cystic carcinoma (ACC) is a rare malignancy particularly challenging to irradiate, largely owing to anatomic location and associated toxicities. Proton beam therapy (PBT) can reduce doses to nearby organs at risk, but only one case report has been published detailing PBT for this neoplasm. Patients and Methods This study was an institutional review board-approved retrospective chart review of all patients at one institution with bronchogenic ACC treated with PBT. Toxicities were assessed per Common Toxicity Criteria for Adverse Events, version 4.0. Results Five patients, median age 67 years (range = 40-97 years), were all symptomatic before PBT. Two patients were debulked before PBT, which was delivered at a median 66.6 Gy (RBE) (range, 57.5-80 Gy (RBE)). Two patients received concurrent platinum-based chemotherapy. Symptoms improved in all patients. Acute toxicities included the following: grade 1 fatigue (n = 3), grade 1 dermatitis (n = 2), grade 1 esophagitis (n = 1), grade 2 fatigue (n = 1), grade 2 dermatitis (n = 1), grade 2 esophagitis (n = 2). There was one case of late radiation fibrosis causing bronchial stenosis and requiring a stent, and another of late grade 1 dysphagia. All grade 2 toxicities occurred in patients receiving concurrent chemoradiotherapy. At median follow-up of 10 months (range = 5-47 months), no patient experienced tumor recurrence and none had symptoms impairing daily functioning or quality of life. Although statistically nonsignificant owing to low sample sizes, dosimetric data revealed that PBT numerically reduced doses, most notably to the heart and to low-dose volumes of the lung. Conclusions This is the largest series to date evaluating PBT for bronchogenic ACC. PBT is associated with low rates of acute and late toxicities and excellent early local control.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Liyong Lin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
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Kapatia G, Gupta K, Shrestha O, Kumar A, Bhalla A. An Autopsy Report of an Adenoid Cystic Carcinoma Arising in the Trachea. Head Neck Pathol 2018; 13:243-246. [PMID: 29687352 PMCID: PMC6514026 DOI: 10.1007/s12105-018-0921-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
While adenoid cystic carcinoma is a common malignancy to arise within the salivary glands (21.9%) (Kokemueller et al. in Int J Oral Maxillofac Surg 33:25-31, 2004), it is seldom encountered as a tracheal mass and represents < 1% of all lung cancers. Tracheal tumors are an uncommon cause of dyspnoea due to their relatively rare occurrence (Baydur and Gottlieb in JAMA 234:829-831, 1975). They pose considerable diagnostic challenge clinically as their symptoms mimics more commoner ailments like asthma and chronic bronchitis. As they carry good prognosis, a timely diagnosis is highly warranted for appropriate therapeutic intervention. We describe a rare autopsy case of an adenoid cystic carcinoma in a middle-aged gentleman who presented with severe breathlessness and dyspnoea and succumbed to his illness after a brief hospital stay. Because the symptoms were non-specific, he was treated on lines of asthma and bronchitis.
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Affiliation(s)
- Gargi Kapatia
- 0000 0004 1767 2903grid.415131.3Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kirti Gupta
- 0000 0004 1767 2903grid.415131.3Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Oshan Shrestha
- 0000 0004 1767 2903grid.415131.3Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anil Kumar
- 0000 0004 1767 2903grid.415131.3Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- 0000 0004 1767 2903grid.415131.3Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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