Adenoid cystic carcinoma: A rare presentation as a nasal and hard palate mass

Richa Pandey; PK Singh; Lubna Khan

doi:10.4103/0970-9371.50805

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LETTER TO EDITOR

Year : 2008 | Volume : 25 | Issue : 4 | Page : 159-160

Adenoid cystic carcinoma: A rare presentation as a nasal and hard palate mass

Richa Pandey, PK Singh, Lubna Khan
Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India

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How to cite this article:
Pandey R, Singh P K, Khan L. Adenoid cystic carcinoma: A rare presentation as a nasal and hard palate mass. J Cytol 2008;25:159-60

How to cite this URL:
Pandey R, Singh P K, Khan L. Adenoid cystic carcinoma: A rare presentation as a nasal and hard palate mass. J Cytol [serial online] 2008 [cited 2023 Mar 27];25:159-60. Available from: https://www.jcytol.org/text.asp?2008/25/4/159/50805

Sir,

Adenoid cystic carcinoma (ACC) is a highly malignant but usually slow growing, solid, salivary gland tumor encountered more frequently in the submandibular and minor salivary glands; its occurrence elsewhere is rare. We report here a 35 year-old lady presenting with a hard palate and nasal mass. Fine needle aspiration cytology (FNAC) from both these sites was performed. Smears were prepared; wet fixed, and stained with hematoxylin and eosin (H and E) as well as periodic acid Schiff (PAS) stain. Smears were cellular, showed multilayered aggregates, tridimensional clusters, and a dispersed population of monomorphic, small, round to oval tumor cells with hyperchromatic nuclei, coarsely granular nuclear chromatin, inconspicuous nucleoli, and scanty to moderate amount of cytoplasm. Tumor cells were arranged in dense aggregates forming a cribriform pattern in a few places. Numerous PAS-positive, variably sized, homogenous, hyaline, spherical globules were also seen with clustering of tumor cells around these globules [Figure 1]. Cytological diagnosis of ACC was made based on these findings. A computed tomography scan revealed a mass in the right maxilla along with a nasal and palatal mass. The patient underwent maxillectomy along with excision of the nasal and palatal mass. Histopathological examination revealed nests and columns of cells of bland appearance, arranged concentrically around gland-like spaces (pseudocysts) filled with homogenous, eosinophilic, PAS-positive material [Figure 2]. The diagnosis of ACC was confirmed based on these findings.

ACC of head and neck is rare, accounting for only 1% of all head and neck malignancies and 10% of all salivary neoplasms.^[1] Although it is common in minor salivary glands, it can also arise from submucosal, seromucinous glands of the larynx, trachea, and lung.^[2] The morphological features remain the same regardless of the site. On FNAC, diagnosis of ACC can be made on the following criteria: cellular smear with a monotonous population of small cells with scanty cytoplasm and uniform nuclei with smooth chromatin along with extracellular, homogenous, metachromatic material. This hyaline material which represents reduplicated basement membrane material can be seen as spheres or globules.^[3] All these findings were seen in the present case. ACC has three histological patterns: cribriform, tubular, and solid. As in the present case, the most common pattern is cribriform. This tumor is characterized by slow growth, multiple recurrences, and late, distant metastasis. This case is unique due to its unusual site of presentation. Tumors involving the nose, paranasal sinus, and maxilla, such as in the present case, have a worse prognosis.^[4] Complete surgical removal may cure the disease, which underlines the need for an early diagnosis. The present case highlights the need to be aware of this unusual presentation of ACC to make a correct diagnosis on cytology.

References

1.	Srivastava S, Jaiswal R, Agarwal A, Singh PK, Singh SN. Cytodiagnosis of adenoid cystic carcinoma of the parotid metastatic to kidney and lung. J Cytol 2007;24:201-2.
2.	Florentine BD, Fink T, Avidan S, Braslavasky D, Raza A, Cobb CJ. Extra-salivary gland presentations of adenoid cystic carcinoma: A report of three cases. Diagn Cytopathol 2006;34:491-4.
3.	Nayak SP, Dekate RT, Kotwal MN, Bobhate SK. Cytodiagnosis of adenoid cystic carcinoma of breast: A case report. J Cytol 2006;23:149-50.
4.	Jones AS, Hamilton JW, Rowley H, Husband D, Helliwell TR. Adenoid cystic carcinoma of the head and neck. Clin Otolaryngol Allied Sci 1997;22:434-43. [PUBMED]