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Uppal SM, Fatima S, Dandekar PR, Jadhav A, Pathan S. Efficacy of Online Adaptive Radiotherapy Using Surface Guidance in Treatment of Tracheal Adenoid Cystic Carcinoma. Cureus 2024; 16:e67691. [PMID: 39318899 PMCID: PMC11420148 DOI: 10.7759/cureus.67691] [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] [Accepted: 08/24/2024] [Indexed: 09/26/2024] Open
Abstract
Primary tracheal tumors are rare, with adenoid cystic carcinoma (ACC) of the trachea being the second most common malignancy of the trachea. Radical surgical resection is found to have better survival outcomes in tracheal ACC. However, with higher submucosal spread rates in tracheal ACC and the inability to achieve clear margins, complete resection is not usually achievable. In these cases, the use of a 60-70 Gy radiation dose is deemed to be sufficient for definitive treatment with or without concurrent chemotherapy. We report a case of an unresectable ACC treated with online daily adaptive cone beam computed tomography (CBCT) radiotherapy on Ethos™ (Varian Medical Systems, Palo Alto, CA). She was planned to receive 59.4 Gy in 33 fractions in two phases. For daily treatment delivery, the patient was set up on the couch using the surface-guided radiotherapy (SGRT) system of AlignRT™ (Vision RT Ltd., London, UK) and translated to the treatment isocenter. A CBCT scan was acquired, followed by rigid registration with the planning scan and PET CT. Organs at risk (OAR) and primary targets were auto-generated by the AI in a two-step process, reviewed, and edited by the radiation oncologist. Adapted and scheduled plans were compared regarding planning target volume (PTV) coverage and dose to OAR. Better PTV coverage was seen in 26 of 33 fractions with the adapted plan. On the days with lesser coverage, adapted plans demonstrated improvement in the hotspot reduction and reduction in hard dose constraints of the esophagus and lungs. Hence, adapted plans were selected for all treatment days. Our results highlight the superior target coverage and improved OAR-sparing plans in daily online adaptive radiotherapy (o-ART) compared to image-guided radiotherapy (IGRT) plans. The system's ability to adapt to daily anatomical changes, improved target coverage, and better sparing of OARs make it an encouraging option for malignancies requiring motion management.
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Affiliation(s)
- Sanjana M Uppal
- Department of Radiation Oncology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Sheereen Fatima
- Department of Radiation Oncology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Prasad R Dandekar
- Department of Radiation Oncology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Anand Jadhav
- Department of Radiation Oncology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Sameer Pathan
- Department of Pathology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
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Ye W, Clark EA, Sheng Q, Colaianni CA, Rohde SL, Gelbard A. Primary tracheal adenoid cystic carcinoma: A case report and analysis of the tumor immune microenvironment using single cell RNA sequencing. Head Neck 2024. [PMID: 39039710 DOI: 10.1002/hed.27879] [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: 11/04/2023] [Revised: 04/01/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Tracheal adenoid cystic carcinoma (ACC) is a slow growing yet aggressive malignancy with high rates of local recurrence as well as distant metastasis. Tracheal ACC exhibit a low mutation burden along with high mutational diversity, and generally do not respond well to chemotherapeutics. METHODS We present a rare case of primary tracheal ACC initially presenting with nonspecific cervicalgia and globus sensation that was ultimately treated with tracheal resection followed by chemoradiation. Immune profiling of intratumoral T-cell receptor (TCR) repertoire was subsequently performed using single cell RNA sequencing (scRNAseq). RESULTS We describe a rare case of primary tracheal adenoid cystic carcinoma highlighting several management principles as well as providing new insights into intratumor T cell populations. CONCLUSIONS Primary tracheal ACC is most commonly treated with surgical resection followed by adjuvant therapy. Further characterization of the tumor immune microenvironment is necessary to better understand ACC disease biology and to identify potential therapeutic targets.
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Affiliation(s)
- Wenda Ye
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Evan A Clark
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Alessandra Colaianni
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Piórek A, Płużański A, Knetki-Wróblewska M, Winiarczyk K, Tabor S, Teterycz P, Kowalski DM, Krzakowski M. Treatment outcomes of patients with primary tracheal tumors - analysis of a large retrospective series. BMC Cancer 2024; 24:686. [PMID: 38840114 PMCID: PMC11155021 DOI: 10.1186/s12885-024-12450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE Primary tracheal tumors are very rare and their management is not definitely established. Due to its rarity, providing patient care in terms of optimal management poses a considerable challenge. The purpose of this study was to investigate treatment outcomes in patients with these rare tumors. METHODS We carried out a retrospective analysis of 89 patients with primary tracheal tumors treated at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland, over sixteen years. The study assessed patient demographics, tumor characteristics and treatment. Different treatment options were compared in terms of overall survival, disease-free survival, and progression-free survival. RESULTS A total of 89 patients were included in the study. In the group presented, 45 patients underwent primary radical treatment and 44 were qualified for palliative treatment. Surgical resection was performed in 13 patients out of radically treated patients. The 5 year OS rates in the group of patients who underwent radical treatment and in the group of patients who underwent palliative treatment were 45.9% and 2.3%, respectively. In the group of patients who underwent radical surgical treatment, the 5 year OS was 76.9% compared to 35.8% in the group of patients who underwent nonsurgical treatment. CONCLUSION A multidisciplinary team should decide treatment options, including in-depth consideration of surgical treatment options.
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Affiliation(s)
- Aleksandra Piórek
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland.
| | - Adam Płużański
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Kinga Winiarczyk
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Sylwia Tabor
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 02-781, Poland
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 02-781, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
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4
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Lu H, Kuo S. Endotracheal enucleation and para-toluenesulfonamide injection for adenoid cystic carcinoma in the upper trachea: A novel therapeutic approach. Thorac Cancer 2024; 15:1320-1324. [PMID: 38634727 PMCID: PMC11147661 DOI: 10.1111/1759-7714.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
We present a case of an adenoid cystic carcinoma (ACC) located in the upper trachea, which resulted in significant airway blockage, that was unsuitable for surgical removal due to concerns about functional impairment. Instead, endotracheal enucleation via rigid bronchoscopy was performed initially, followed by the injection of a novel tumor ablation agent known as para-toluenesulfonamide (PTS). We detail the dosing regimen, effectiveness evaluation, and post-treatment follow-up. The study highlights the potential of PTS injection as a viable alternative treatment option for patients with ACC who cannot undergo surgical resection and feasibility of lipiodol to monitor treatment effect. This research adds to the existing knowledge on ACC treatment and provides new therapeutic possibilities for patients with tracheal ACC.
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Affiliation(s)
- Hsiao‐Hung Lu
- Department of Surgery, Division of Thoracic SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Shuenn‐Wen Kuo
- Department of Surgery, Division of Thoracic SurgeryNational Taiwan University HospitalTaipeiTaiwan
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Rui J, Lian Y. Multislice helical computed tomography imaging diagnosis and surgical treatment of primary tracheal tumor in cardiothoracic surgery. Front Oncol 2024; 14:1376228. [PMID: 38860002 PMCID: PMC11163370 DOI: 10.3389/fonc.2024.1376228] [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: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Objective it aimed to explore the value of multislice helical computed tomography (MSCT) in the diagnosis and surgical treatment of primary tracheal tumors. Methods 64 patients with the primary tracheal tumor who were diagnosed in Wuxi Second People's Hospital from March 2020 to March 2021 were selected as the research objects. MSCT imaging was performed on all patients, and suitable surgical methods. The pathological results were compared with original CT, CT virtual endoscopy (CTVE), and Comparisons were made using CT three-dimensional reconstruction images to evaluate the accuracy of MSCT diagnosis. Parameters such as postoperative complications and survival rates were observed to assess surgical effectiveness and safety. Results Compared with original CT images (70%, 72%, 70%), the diagnostic accuracy of VR images (80%, 80%, 80%), MPVR images (85%, 90%, 92%), and CTVE images (100%, 100%, 100%) was remarkably improved (P<0.05). The three-year survival rate of patients with smooth muscle tumors, malignant tumors, salivary gland adenoma, papillary tumors, and inflammatory polyp was markedly lower than that of the one-year survival rate, with a significant difference (P<0.05). The incidence of postoperative complications was 14.1%, with three cases resulting in complication-related deaths. Conclusion the diagnostic accuracy of MSCT imaging of primary tracheal tumor was high. The diagnostic accuracy of CTVE was higher than that of VR and MPVR. Besides, surgical treatment of primary tracheal tumor had a substantial effect, with no serious postoperative complications.
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Affiliation(s)
| | - Yu Lian
- Department of Cardiothoracic Surgery, Wuxi Second People’s Hospital, Wuxi, Jiangsu, China
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Juan José S, Nicolas GC, José Antonio H. The Fundamental Role of Multidisciplinary Approach in Complex Head and Neck Pathology: A Case Report of Maxillary Adenoid Cystic Carcinoma. EAR, NOSE & THROAT JOURNAL 2024:1455613241240887. [PMID: 38504397 DOI: 10.1177/01455613241240887] [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: 03/21/2024] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare tumor, with a documented annual incidence ranging from 3 to 4.5 cases per million. It constitutes approximately 1% of all head and neck malignancies and around 10% of salivary gland tumors. It is imperative to adopt a multidisciplinary approach to ensure the most appropriate therapeutic outcome. Treatment strategies usually involve a multidisciplinary approach and may include surgery, radiotherapy, chemotherapy, or various combinations of these. In this context, we present a clinical case of ACC originating in the palate of a woman. Throughout this article, we will detail the diagnostic challenges and multidisciplinary treatment strategies implemented, emphasizing the importance of a comprehensive approach in cases of palatal ACC. In addition, we will discuss the rehabilitation process and the outcomes observed during the follow-up of this case.
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Affiliation(s)
- Santivañez Juan José
- Head and Neck Oncological Surgery Section, Department of Surgery, University Hospital Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Granados-Casallas Nicolas
- Department of Internal Medicine, University Hospital Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Hakim José Antonio
- Head and Neck Oncological Surgery Section, Department of Surgery, University Hospital Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
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Gleeson M, Finan M, Redmond K. Pulmonary adenoid cystic carcinoma - a spectrum of disease: two case reports. Respirol Case Rep 2024; 12:e01230. [PMID: 38333199 PMCID: PMC10851025 DOI: 10.1002/rcr2.1230] [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: 07/26/2023] [Accepted: 09/17/2023] [Indexed: 02/10/2024] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare form of adenocarcinoma that usually begins in the oral cavity, with most cases arising from the salivary glands. Owing to its low incidence, the precise clinical and pathological features, including therapeutic strategy and survival data have not been conclusively reported. ACCs are typically characterized by slow growth, perineural invasion with local and often late recurrence after initial diagnosis. However, some cases demonstrate unusual aggressive biologic behaviour. Herein we describe our experience of two patients with a diagnosis of ACC. These cases highlight the spectrum of the disease with individualized treatment strategies.
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Affiliation(s)
| | - Megan Finan
- RespiratoryMater Misericordae University HospitalDublinIreland
| | - Karen Redmond
- RespiratoryMater Misericordae University HospitalDublinIreland
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Jaber MA, Hassan M, Ingafou M, Elameen AM. Adenoid Cystic Carcinoma of the Minor Salivary Glands: A Systematic Review and Meta-Analysis of Clinical Characteristics and Management Strategies. J Clin Med 2024; 13:267. [PMID: 38202273 PMCID: PMC10779762 DOI: 10.3390/jcm13010267] [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: 10/16/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Intraoral adenoid cystic carcinoma (ACC) arising from minor salivary glands (MSG) is a rare malignancy associated with delayed diagnosis and unfavorable outcomes. This study aimed to comprehensively review ACC of MSGs, focusing on clinical characteristics, imaging modalities, treatment approaches, and long-term outcomes. METHODS A systematic search was conducted in PubMed, Web of Science, and MEDLINE databases to identify relevant articles reporting cases of ACC of MSGs between January 1997 and March 2023. The study was registered in PROSPERO (ID: CRD42023449478). A total of 10 studies that met the inclusion criteria were selected for critical review. In total, 902 patients were diagnosed with ACC of MSGs with an age range of 44.3 to 63 years, and an average age of 56.6 years. The female to male ratio ranges from 1:1 to 2.4:1. Regarding the primary site of ACC, the palate was the most common location, accounting for 30.5% to 83.3%, followed by the buccal mucosa, floor of the mouth, and lip and the retromolar area. For histology, the solid mass pattern was the most prevalent, seen in 95.2% of patients, followed by the cribriform pattern. Regarding treatment modalities, surgery was the most common approach, applied in 76.3% of cases, with a combination of surgery and radiotherapy used in 29.0% of cases. A smaller fraction, 3.2%, received a combination of surgery, chemotherapy, and radiotherapy, and 8.3% underwent radiotherapy alone. Local recurrence rates varied between 1% and 28.5%, and distant metastasis occurred in 18.2% to 33.3% of cases, predominantly to lymph nodes (14.5%). An analysis of overall survival across various stages and patient numbers indicated a 5-year survival rate of 68.0%. The findings of this study provide valuable insights for physicians in making treatment decisions and emphasize the need for ongoing research and collaborative clinical efforts to improve the management and outcomes of this challenging disease. CONCLUSION ACC of MSGs is a multifaceted condition typically manifesting as asymptomatic enlargement and ulceration. This disease is marked by distinct histopathological patterns and perineural invasion (PNI). Recognizing these distinctive aspects is key in shaping the treatment plan, which can range from surgical procedures to radiation therapy, chemotherapy, and evolving targeted treatments. Continuous research and collaborative clinical efforts remain critical for ongoing progress in the treatment and management of this challenging condition.
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Affiliation(s)
- Mohamed A. Jaber
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman P.O. Box 346, United Arab Emirates; (M.H.); (M.I.)
- Center of Medical and Bio Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Mawada Hassan
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman P.O. Box 346, United Arab Emirates; (M.H.); (M.I.)
| | - Mohamed Ingafou
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman P.O. Box 346, United Arab Emirates; (M.H.); (M.I.)
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赵 九, 李 珂, 韩 晓, 石 照, 曾 宪, 张 相. [Misdiagnosis of adenoid cystic carcinoma of oropharynx: a case report]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:837-839. [PMID: 37828891 PMCID: PMC10803242 DOI: 10.13201/j.issn.2096-7993.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Indexed: 10/14/2023]
Abstract
Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.
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Affiliation(s)
- 九洲 赵
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
| | - 珂 李
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
| | - 晓东 韩
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院影像科Department of Imaging, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital
| | - 照辉 石
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院鼻颅底外科Department Nasal Skull Base Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital
| | - 宪海 曾
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
| | - 相民 张
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
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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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11
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Chen Z, Jiang J, Fan Y, Lu H. Pulmonary adenoid cystic carcinoma: molecular characteristics and literature review. Diagn Pathol 2023; 18:65. [PMID: 37198615 DOI: 10.1186/s13000-023-01354-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Pulmonary adenoid cystic carcinoma (PACC) is an exceptionally rare salivary gland-type malignant neoplasm. Because of its clinical manifestations, imaging features are not different from other types of non-small cell lung cancer, which is a diagnostic challenge for most doctors. CONCLUSIONS A review of the literature shows that high amounts of immunohistochemical (IHC) markers, such as CK7, CD117, P63, SMA, CK5/6, and S-100 are helpful for PACC diagnosis. Surgical resection is the main treatment of PACC, but treatment options for advanced PACC patients are limited and the research of molecular targeted drugs is ongoing in advanced cases not eligible for surgery. Currently, research on PACC targeted therapy mainly focuses on the exploration of v-myb avian myeloblastosis virus oncogene homolog (MYB) and its downstream target genes. In addition, median tumor mutation burden and PD-1/PD-L1 were lower in PACC, which may indicate poor efficacy of immunotherapy in PACC patients. This review focuses on the pathologic features, molecular characteristics, diagnosis, treatment and prognosis of PACC to establish a comprehensive understanding of PACC.
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Affiliation(s)
- Zhixin Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, P.R. China
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, P.R. China
| | - Jiapeng Jiang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, P.R. China
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, P.R. China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, P.R. China
| | - Ying Fan
- Department of Medical Oncology, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, P.R. China.
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, P.R. China.
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12
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Liu Q, Lai Y, Yang J, Zhang H, Sun X, Gu Y, Li H, Yu H, Wang D. [The outcome of transnasal endoscopic total maxillectomy in the treatment of sinonasal adenoid cystic carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:243-246;251. [PMID: 36987951 PMCID: PMC10406587 DOI: 10.13201/j.issn.2096-7993.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Indexed: 03/30/2023]
Abstract
Objective:To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy. Methods:Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Cox regression was used to investigate the prognosis factors. Masticatory function after maxillectomy has also been assessed using the questionnaire of patients' satisfaction about masticatory function. Results:Margins in 8 patients(30%) were positive. The median time of follow-up was 38 months(6 to 85 months). Twenty-five patients recurred. Four patients died of distant metastasis. The 5-year overall survival rate and relapse-free survival rate was 79.5% and 89.1%, respectively. Independent predictors of outcome on multivariate analysis were positive margin(P=0.018), recurrence(P=0.006) and distant metastasis(P=0.04). Conclusion:Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion. Positive margin, local recurrence and distant metastasis were important predictors for patients' prognosis.
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Affiliation(s)
- Quan Liu
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Yuting Lai
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Jingyi Yang
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Huankang Zhang
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Xicai Sun
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Yurong Gu
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Houyong Li
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Hongmeng Yu
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
| | - Dehui Wang
- Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,Shanghai,200031,China
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13
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Wan Y, Long C, Liu Y, Wang J, Tang X, Wang S. Value of cytopathology in the diagnosis of adenoid cystic carcinoma and an analysis of misdiagnoses. BMC Surg 2023; 23:52. [PMID: 36894958 PMCID: PMC9999663 DOI: 10.1186/s12893-023-01945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The diagnosis of adenoid cystic carcinoma (ACC) by cytopathology can be challenging. This study was aimed at testing the effectiveness of this technique and at assessing possible differences in the coincidence rate of fine-needle aspiration cytology(FNAC) and brush exfoliation. METHODS The pathology database of Southwest Medical University( Luzhou, China) was searched for patients who had undergone surgery or biopsy for ACC between January 2017 and January 2022 and had preoperative cytopathologic results. Their cytologic and histologic data were then analyzed retrospectively and the coincidence rates of cytopathology in the diagnosis of ACC were calculated. RESULTS Compared with histopathology, the total coincidence rate of the cytologic diagnosis of ACC was 76.8%, that of FNAC was 78.9%, and that of brush exfoliation was 55.6%. CONCLUSION In the diagnosis of ACC, cytopathology is an effective tool; this is especially true of FNAC, which plays an important role in the diagnosis of ACC. The authors further suggest that it is advisable for diagnosticians to master the cytopathological features of ACC to reduce the possibility of preoperative misdiagnoses.
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Affiliation(s)
- Yu Wan
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, # No. 25, Taiping Street, 646000, Luzhou, Sichuan, People's Republic of China
| | - Changhai Long
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, # No. 25, Taiping Street, 646000, Luzhou, Sichuan, People's Republic of China
| | - Yun Liu
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, # No. 25, Taiping Street, 646000, Luzhou, Sichuan, People's Republic of China
| | - Jieqiong Wang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, # No. 25, Taiping Street, 646000, Luzhou, Sichuan, People's Republic of China
| | - Xiaoqin Tang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, # No. 25, Taiping Street, 646000, Luzhou, Sichuan, People's Republic of China
| | - Shaohua Wang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, # No. 25, Taiping Street, 646000, Luzhou, Sichuan, People's Republic of China.
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14
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Saleh E, Ukwas A. Adenoid Cystic Carcinoma of Salivary Glands: A Ten-Year Review and an Assessment of the Current Management, Surgery, Radiotherapy, and Chemotherapy. Int J Otolaryngol 2023; 2023:7401458. [PMID: 37159817 PMCID: PMC10163974 DOI: 10.1155/2023/7401458] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 05/11/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare cancer that arises from the salivary glands and other sites in the body, such as the lung and breast. Although the tumor accounts for 10% of all salivary gland malignancies, it only accounts for 1% of head and neck malignancies. It can affect both major and minor salivary glands; here, it is called salivary gland adenoid cystic carcinoma or SACC, with a slight predilection to the latter, and commonly manifests between the 6th and 7th decades of life. The disease also shows a slight female predilection, with a reported female to male ratio of 3 : 2. Lesions of SACC are often insidious and slow-growing, and symptoms such as pain and altered sensation are frequently associated with advanced stages of the disease. Salivary adenoid cystic carcinoma is characterized by perineural invasion (PNI), a distinctive feature that potentially plays a significant role in the tumor's relapse and recurrence, which is approximately 50%. The disease is not prevalent, and its etiopathogenesis is poorly understood, although several genetic patterns and biomarkers have been linked to its initiation and/or progression. The discovery of these mutations and biomarkers has encouraged several clinical studies to use therapeutic agents to target the specific receptors on the cancer cells to potentially prevent further proliferation of the tumor cells and metastasis of the disease. Diagnosis of SACC is often challenging and frequently requires a combination of clinical examination, imaging, and histopathology. Management of SACC is primarily surgical excision, while radiotherapy has shown to be effective in improving local control in cases with microscopic residual disease. However, treatment of recurrent or metastatic tumors by radiotherapy with or without chemotherapy has so far shown limited success. The aim of this thesis is to provide an update of literature on SACC with a particular focus on the latest management approaches and future trends.
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Affiliation(s)
- Eyad Saleh
- Eastman Dental Institute, University College London, London, UK
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15
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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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16
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Caramujo C, da Cruz RM, Marques RV, Jesus E. Primary adenoid cystic carcinoma of the trachea: an elusive diagnosis of chronic dyspnoea. BMJ Case Rep 2022; 15:e250227. [PMID: 35944942 PMCID: PMC9367189 DOI: 10.1136/bcr-2022-250227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/03/2022] Open
Abstract
Primary adenoid cystic carcinoma (ACC) of the trachea is a rare entity, with a 5-year survival between 50% and 80% for resectable cases and 30% in case of unresectable disease. We report a case of a primary ACC on a woman in her 70s that presented with a drawn-out history of dyspnoea. She was diagnosed with an unresectable obstructive tumour of the trachea, which required the placement of a Y-shaped stent. The patient underwent concomitant chemoradiotherapy, with partial response, and is still in follow-up, without evidence of disease progression.
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Affiliation(s)
- Cecília Caramujo
- Department of Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Rafael Moiteiro da Cruz
- Department of Pathology, Hospital de Santa Maria, Lisboa, Portugal
- Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
| | - Rui Vale Marques
- Department of Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Emanuel Jesus
- Department of Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
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17
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Zheng S, Li H, Lin Y, Xie Y, Yin Z, Ge W, Yu T. Treatment response to eribulin and anlotinib in lung metastases from rare perianal adenoid cystic carcinoma: a case report. Anticancer Drugs 2022; 33:e548-e554. [PMID: 34321419 PMCID: PMC8670344 DOI: 10.1097/cad.0000000000001171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/07/2021] [Indexed: 11/25/2022]
Abstract
Adenoid cystic carcinoma (ACC) is a rare salivary glands tumor and often displays aggressive behavior with frequent relapse and metastasis. The terminal ACC lacks standard treatment guidelines and is always accompanied by poor prognosis. Here, we report a case of rare perianal ACC who received resection and palliative adjuvant radiation. Five years later, PET-computed tomography (CT) showed perianal recurrence and multiple pulmonary metastases. Combined chemotherapy with doxorubicin, carboplatin and cyclophosphamide was applied for two cycles but ineffective. Further next-generation sequencing analysis of perianal tissue demonstrated the v-myb avian myelobastosis viral oncogene homolog and nuclear factor I/B fusion gene and two novel BCL-6 corepressor (BCOR) mutations (p.F1106Tfs*5 and p.L1524Hfs*8). The therapy was switched to eribulin and anlotinib and has been performed for eight cycles. At recent follow-ups, MRI and CT examinations revealed the diminishing perianal and pulmonary lesions. This study presented the first case of perianal ACC with multiple pulmonary metastases and particular BCOR mutations, who presented a durable response to eribulin and anlotinib, providing a potential therapeutic option for advanced refractory ACC.
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Affiliation(s)
- Shengnan Zheng
- Department of Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu
- Department of Laboratory Medicine, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu
| | - Huiying Li
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yongjuan Lin
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yu Xie
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhenyu Yin
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Weihong Ge
- Department of Laboratory Medicine, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu
| | - Tingting Yu
- Department of Laboratory Medicine, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu
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