Adenoid cystic carcinoma

To reevaluate breast aspirates showing extracellular hyaline material (EHM) and globules to assess if clinicoradiologic and cytologic features could help in differentiating between benign and malignant lesions, especially collagenous spherulosis (CS) and adenoid cystic carcinoma (ACC). Fine needle aspiration was performed on 884 patients with breast lumps. The cytomorphologic features of 6 cases showing EHM, including classic hyaline globules (HGs), were analyzed in detail. Three cases also had hemorrhagic nipple discharge. Tissue diagnosis (4) and mammography (6) were available. Aspirate smears revealed high cellularity composed of monolayers: clusters of uniform, small cells; EHM; and HGs surrounded by similar cells. Benign naked nuclei and stromal fragments (4), nuclear pleomorphism (3), apocrine cells (2), foam cells (2), naked HGs (2) and spindle cells in proximity to HGs were also seen (4). Nipple discharge smears showed foam cells, erythrocytes (3) and epithelial cell cluster...

Opinion statement Malignancies of the nasal cavity and paranasal sinuses represent a wide spectrum of histologies, tissues of origin, and anatomic primary sites. The inherent difficulty in generalizing treatment approaches is obvious, given the numerous variables associated with the broadly-based term, paranasal sinus malignancy (PNSCa). Nevertheless, the majority of epithelial and salivary malignancies of this region (ie, squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, sinonasal undifferentiated carcinoma, and esthesioneuroblastoma) require surgical intervention as part of any treatment regimen. Recent trends have broadened the indications for chemotherapeutic and radiotherapeutic options in the management of advanced PNSCa. Nonepithelial malignancies, including the wide variety of sarcomas arising in this region, most commonly require multimodality treatment including chemotherapy, radiation, and/or surgery for definitive treatment. Moreover, the proximity of the nasal cavity and paranasal sinuses to structures including the orbit, dura, brain, cranial nerves, and carotid arteries mandates careful radiologic and neurologic evaluations throughout the course of the disease. Surgical advances now permit complex tumor removal and reconstruction surrounding these structures resulting in functional and cosmetic improvements when compared to earlier techniques. However, additional clinical trials are necessary to systematically evaluate the locoregional control, organ-preservation strategies, and survival related to the variety of treatments currently available.

Primary adenoid cystic carcinoma of lung is a rare tumour. It is a slowly growing, indolent tumour. Average time that elapses before diagnosis is reported to be two years. We report the case of a patient who remained well inspite of harbouring primary adenoid cystic carcinoma of lung for 15 years.

Adenoid cystic carcinoma (ACC) constitutes about 4% of salivary epithelial tumors and is the second common malignant epithelial salivary gland tumor involving both the major and minor salivary glands. High grade transformation in ACC is a recently recognized entity with only a few cases reported in literature. We report the first case of ACC with high grade transformation involving the parotid. A 54-year-old man with a history of right parotid painful swelling from 1.5 years presented with recent increase in size of the swelling and facial paresis of 2 months duration. The locally invasive salivary neoplasm was composed predominantly of an undifferentiated carcinoma with foci of conventional ACC occupying less than 10% of tumor area. Immunohistochemical study of the undifferentiated component as compared to conventional ACC showed greater over-expression of p53 and Ki-67. Her-2/Neu was negative in both components. Recognition of occasional clusters of basaloid cells and hyaline globules in association with larger poorly differentiated malignant cell population in aspiration smears can help in cytological diagnosis. The acquisition of high proliferation index and over-expression of p53 may be the probable factors involved in the pathogenesis of high grade transformation in a conventional ACC.

Collagenous spherulosis of the breast is distinctive breast histological finding characterised by the accumulation of basement membrane material in form of eosinophilic or rarely basophilic spherules that exhibit concentric and radiating fibrillar patterns. It is usually an incidental microscopic uni- or multifocal finding that occurs adjacent to benign proliferative lesions, but it can be also coexistent with malignant breast processes. Its occurrence within a malignant process is exceptional. We present a case of collagenous spherulosis of the breast associated with poorly differentiated carcinoma in situ in a 54-year-old woman. This rare change can be misinterpreted as adenoid cystic carcinoma.

ABSTRACT Adenoid cystic carcinoma (ACC) was first described in 1853 and 1854 by three french scientists, Robin, Lorain and Laboulbène. ACC is a rare cancer of the head and neck (about 1%) and it comprises from 6% to 10% of all malignant tumors of the salivary glands. 15%–30% of these tumors are located in submandibular gland, 30% occur in small salivary glands (in the palate, tongue, mouth, nose, sinuses, mucous membrane of the cheeks) and about 6% in parotid gland. Because of its specificity ACC is a challenge for the doctor – it is usually recognized at an advanced stage, spreads along the nerves, it has a high propensity for recurrence, often gives distant metastases, 10-year survival are very small.

Aims and objectives: The aim of this paper was to study the impact of neoadjuvant chemoradiation on downstaging of locally advanced rectal carcinoma, sphincter saving procedures and toxicity profile of chemoradiation.
Method: 31 patients were studied who had locally advanced adenocarcinoma of rectum. They were treated preoperatively with 20 frations of 225 cGy (5 days/wk) radiation (total of 45Gy over 28 days). Chemotherapy consisted of 5-FU (500mg/m.sq) only for day 1, 2, & 3. After an interval of of 4-6 wks, all patients were submitted to surgery.The principles of TME was
Results: The median follow up in our study was 1year. At 1 year the overall survival in operated cases was 100% with no disease relapse. 67% of patients underwent low anterior resection,6.5% had proctosigmoidectomy with end colostomy,16.5% had a palliative surgical procedure, 6.5% became non compliant after neoadjuvant and 3.2% expired preoperatively during chemoradiation. At the time of surgery 82.6% of patients had pathological downstaging of tomour and 45.4% had lymphnode downstaging.Consequently 67.7% of patients underwent a sphincter preserving surgical procedure.
The incidence of complication was 29% with grade 2 mucositis and 9.7% with grade 1 mucositis. Myelosuppression was seen in non.
Conclusion: Significant downstaging of disease was seen with this regime of treatment and with improved subsequent sphincterv preserving procedures with acceptable toxicity profile.

Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm. We report two observations occurring in female patients, 54 and 65 years old, who consulted for a mastodynia. Clinical examination showed limited painful breast nodules. On ultrasound and mammography they are well-limited bulky mass without microcalcifications. Diagnosis was based on final histopathological exam completed by immunohistochemistry or after slides review. The two patients were treated by mammectomy plus adjuvant radiotherapy and remain alive in remission with a follow-up of 29 and 36 months.