Cylindroma spine metastasis: Long-term follow-up is required

Spinal Metastasis Secondary to Salivary Gland Malignancy: Systematic Review of the Literature with an Illustrative Case Report

BACKGROUND

Spinal metastasis from salivary gland malignancies is a rare clinical entity with only several reports in the literature. There is no clear guidance for its optimal management.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Databases including Medline, Cochrane, and Embase were searched for cases of spinal metastasis from major salivary gland malignancies. A case report of spinal metastasis from salivary duct carcinoma at our institution supplemented the review.

RESULTS

The review included 19 patients with a mean age of 54 years. Patients exhibited varied histopathological subtypes with acinic cell carcinoma and adenoid cystic carcinoma being the most common histopathology. Metastasis appeared from 0 to 35 years after primary diagnosis, with a mean of 11 years. The thoracic spine was most commonly affected (63%), followed by the lumbar spine (33%). Most metastases were osteolytic (79%). Vertebral body involvement was seen in 89% of cases, with significant collapse in 37%. Surgical management was required in 79% of cases, often combined with radiotherapy (63%) and chemotherapy (26%). Surgery generally led to neurological improvement in 80% of cases.

CONCLUSIONS

Spinal metastasis from salivary gland malignancies necessitates a comprehensive and multidisciplinary treatment approach due to the complex nature and variability in presentation. Long-term follow-up is essential for early detection and management of spinal metastases given the extended latency period observed in many cases. The potential for metastasis is not solely dependent on tumor grade, emphasizing the need for ongoing vigilance in all patients with salivary gland malignancies.

Metastatic Ceruminous Adenoid Cystic Carcinoma of the Lumbar Spine Causing Neurological Compromise: A Case Report

Background

Ceruminous glands are modified apocrine glands of the external auditory canal (EAC). Malignant tumours within the ceruminous glands are extremely rare, and the most common histological type is adenoid cystic carcinoma (ADCC), which has high recurrence and metastasis risks. Although a few cases of metastatic ADCC from other head and neck glands have been reported, metastatic ADCC originating from the ceruminous gland are extremely rare.

Case presentation

We present an unusual case of spinal metastases of ADCC from ceruminous glands. A 61-year-old woman complaining of low back pain and both lower limbs pain was referred to our department. The primary ceruminous tumour was resected 26 years ago and recurred 6 years later, which was treated by radiotherapy. Three years ago, she presented with low back pain and was diagnosed as multiple lungs and bone metastases. The patient underwent tumour excision, decompression and fusion. The biopsy revealed metastatic ADCC. The symptoms were alleviated after surgery.

Conclusions

ADCC of EAC is a pernicious malignant tumour that is characterized by slow-growing patterns and a high predisposition to recurrence and metastasis. Differential diagnoses of ADCC and benign tumours in the EAC are challenging, particularly at early stages. We report a rare case of ceruminous ADCC with a prolonged clinical history as well as spinal metastasis and highlight the significance of regular follow-ups for patients undergoing tumour excision in the EAC.

Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Apocrine and Eccrine Differentiation

Adnexal tumors of the skin are a rare group of benign and malignant neoplasms that exhibit morphological differentiation toward one or more of the adnexal epithelium types present in normal skin. Tumors deriving from apocrine or eccrine glands are highly heterogeneous and represent various histological entities. Macroscopic and dermatoscopic features of these tumors are unspecific; therefore, a specialized pathological examination is required to correctly diagnose patients. Limited treatment guidelines of adnexal tumor cases are available; thus, therapy is still challenging. Patients should be referred to high-volume skin cancer centers to receive an appropriate multidisciplinary treatment, affecting their outcome. The purpose of this review is to summarize currently available data on pathogenesis, diagnosis, and treatment approach for apocrine and eccrine tumors.

Intramedullary spinal cord metastasis from an adenoid cystic carcinoma of the external auditory canal: case report

BACKGROUND AND IMPORTANCE

Intramedullary spinal cord metastases (ISCMs) are rare and no cases of ISCM from an adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) have been reported.

CLINICAL PRESENTATION

We report a 54-year old man complaining backpain and worsening myelopathy. He had an ACC of the EAC resected years prior. A spinal MRI demonstrated a contrast-enhancing intramedullary lesion within the conus medullaris. The histopathological diagnosis of the patient was consistent with the patient's primary cancer. At 3 months follow-up, the neurological condition of the patient was unchanged.

CONCLUSIONS

This is the first reported case of ISCM from a primary ACC of the EAC.