Kamigaichi A, Shimizu K, Miki Y, Hakamada K, Otsuki Y, Nakamura T. Solitary pulmonary metastasis from a gingival cancer of 36 years ago: A case report.
Int J Surg Case Rep 2018;
53:436-440. [PMID:
30567063 PMCID:
PMC6262786 DOI:
10.1016/j.ijscr.2018.11.053]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 11/24/2022] Open
Abstract
An adenoid cystic carcinoma is characterized by a long-term behavior and late recurrences.
The recurrences of ACC after more than 30 years have not been reported.
The precise preoperative diagnosis was very difficult due to a history of tongue cancer one year previously in the present case.
We should never overlook a history of any malignancy even if it is over 30 years prior.
Introduction
Unlike a squamous cell carcinoma (SqCC), an adenoid cystic carcinoma (ACC) is an uncommon histology of all head and neck cancers. The clinical significance of a pulmonary metastasectomy differs greatly between these two types of cancers. A solitary pulmonary nodule in a patient with a history of both these different malignancies is a diagnostic and therapeutic challenge.
Presentation of case
An 81-year-old woman presented with a right lung nodule detected by chest computed tomography (CT) one year after a tongue SqCC surgery. She had a remote history of gingival cancer 36 years prior, which was not assessed in detail during the initial work up. We suspected that the nodule was a primary lung cancer and she underwent a right basal segmentectomy. Histology revealed an ACC, which was proven to be a metastasis from the gingival cancer.
Discussion
An ACC is an uncommon type of cancer arises mainly in the salivary glands. It is characterized by a long-term behavior and the histology of ACC is a favorable prognostic factor. With its favorable histology and disease free interval of over 30 years, a better outcome would be expected than that of a primary lung tumor or a metastasis from the tongue SqCC. Furthermore, we could have made a differential diagnosis of a metastatic ACC before the surgery with more careful research for a previous history of a gingival cancer.
Conclusion
Our case emphasized that a precise history taking of any malignancy, even if that of more than 30 years prior, is crucial.
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