A case of adenoid cystic carcinoma of the larynx is presented. It was managed by wide field laryngectomy and neck dissection

Bolstad, Donald S.

Muzaffar, Kamil

English

Henry Ford Health System Scholarly Commons

Henry Ford Hospital Medical JournalVolume 22 | Number 2 Article 76-1974Adenoidcystic Carcinoma of the LarynxKamil MuzaffarDonald S. BolstadFollow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournalPart of the Life Sciences Commons, Medical Specialties Commons, and the Public HealthCommonsThis Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in HenryFord Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons.Recommended CitationMuzaffar, Kamil and Bolstad, Donald S. (1974) "Adenoidcystic Carcinoma of the Larynx," Henry Ford Hospital Medical Journal : Vol.22 : No. 2 , 91-96.Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol22/iss2/7H e n r y Ford H o s p . M e d . Journa l V o l . 22, N o . 2, 1974 Ad en Old cystic Carcinoma of the Larynx Kami l M u z a f f a r , M D * a n d D o n a l d S. B o l s t a d , M D * * A case of adenoid cystic carcinoma of the larynx is presented. It was managed by wide field laryngectomy and neck dissection. 'Formerly, Department of Otolaryngology. Now at Monroe Clinic, Monroe, Ml . ••Department of Otolaryngology Address reprint requests to Dr. Bolstad at Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, Ml 48202 /ADENOIDCYSTIC carcinoma is an un-common epithelial tumor of serous and mucous glands. The histopathology of the t umor was f irst descr ibed in 1859 by Bi l l roth' who gave it the original designa-t ion of " cy l i nd roma. " Since then, it has been called by a variety of names. More recently, Foote and FrazelP expressed preference for the name adenoidcystic carcinoma and credited the term to the late James Ewing. Adenoidcystic carcinoma of the larynx is rare. Cady et al,^ in a review of 2,500 laryngeal cancers, reported five cases. Rosenfeld et al" reviewed 184 malignant tumors of salivary gland origin and found only three cases of adenoid cystic car-cinoma involving the larynx. Adams and Duvall^ found one laryngeal cyl indroma in a review of 792 head and neck malignan-cies. Toomey" presented a detailed and c o m p r e h e n s i v e rev iew o f adenocar -cinoma of the larynx. Of 37 reported le-s i ons , he f o u n d 17 c y l i n d r o m a s , 4 epithel iomas, 1 basal cell carcinoma and 1 other neoplasm of minor salivary gland or ig in. He concluded that the latter six cases may also have been of the cyl in-droma type. Recently, two more cases of adenoidcystic carcinoma of the larynx have been reported. Leafsted et a l ' re-v iewed 81 adenoid cystic tumors and found one involving the larynx. Baxley and Farmer' reported another laryngeal primary in their series of 22 carcinomas of the head and neck. 91 Muzaffar and Bolstad Figure 1 Shows the larynx opened posteriorly with a tumor involving the left arytenoid, left epiglottic fold, the left false cord and left true cord. Because of the earlier confusion wi th terminology, it is di f f icul t to enumerate the exact number of reported cases of adenoidcystic carcinoma of the larynx. We estimate this number to be no more than 50 such tumors. We add here one more case of the tumor involv ing the larynx. Case Report A 47-year-old Caucasian woman reported a five-month history of discomfort in the throat. This was initially noticed as easy fatigue of the voice, and, later, a "rawness" in the throat associated with intermittent sharp, stabbing pain. The patient was treated for "laryngitis" by her local physician. However, as the symptoms progressed, the patient was referred to an otolaryngologist who noted a lesion of the left aryepiglottic fold. Tissue taken for biopsy was reported as adenoidcystic carcinoma. The pa-tient was then referred to Henry Ford Hospital for further treatment. Direct laryngoscopy revealed a bulky tumor originating from the left aryepiglottic fold. It involved the left arytenoid, posterior half ofthe left false cord, and extended across the midline to involve the posterior surface of the right arytenoid. The left vocal cord was fixed and the mobility ofthe right vocal cord somewhat im-paired, so that the patient experienced moder-ate dyspnea after the examination. There was a tender, mobile lymph node, 1 cm in size, on the thyrohyoid membrane in the neck on the left side. The remainder of the head and neck and other general examination were unremarka-ble. Laboratory studies including hemoglobin, WBC, FTA-ABS, alkaline phosphatase and urinalysis showed normal results. Findings of a chest x-ray, liver scan, and metastic bone sur-92 Adenoidcystic Carcinoma of the Larynx J • • f .- '''"'-^ ,.^ '»-4 t •'' ' -' ''^^s y •' • • Shows an intact squamous epithelium Figure 2 with tumor present in the deeper layers of the section. vey were also normal. The patient underwent a wide-field laryngectomy and left radical neck dissection 572 months after the onset of her init ial symptoms. Her immediate post-operative course was uneventful and she was discharged home on the 11th postoperative day. A week after discharge, however, there was a breakdown of the wound, with a resulting pharyngocutaneous fistula. This was managed successfully with conservative measures over the subsequent 3 to 4 weeks. The patient has been free of any evidence of disease for 20 months. Pathology G ross exam i nation of the specimen showed a smooth, non-ulcerated 2 x 3 cm mass occupy-ing the region ofthe left arytenoid and the left aryepiglott ic fo ld . When the larynx was opened, we noted that the right vocal cord, the anterior two-thirds of the left vocal cord, the ventricles and subglottic region were free of obvious involvement (Figure 1). Microscopic sections ofthe mass showed an intact stratified squamous epithelium with tumor present in the deeper layers of the larynx (Figure 2). The appearances were of a moderately well-differentiated, unencapsulated adenocar-cinoma. Low power views showed a varying glandularpattern. In someareas,thetumorhad a loose, trabecular cribriform structure; in others, it demonstrated a more compact and dense form. Figure 3 demonstrates the typical cystic spaces and the cordlike pattern. Figure 4 shows a more compact stroma. Individual cells are small with scant cytoplasm. No mitotic fig-ures are seen. In some areas characteristic perineural tumor infiltration can be seen (Fig-ure 5). Comment It is wor thy of note that a painless mass or swell ing is the most common complaint of patients wi th adenoidcystic carcinoma in the head and neck. Other signs or 9.3 Muzaffar and Bolstad Figure 3 Shows the classical "cylindromatous" pattern with cystic spaces and cords of cells. Figure 4 Demonstrates a more compact dense glandular stroma. 44 Adenoidcystic Carcinoma of the Larynx Figure 5 Shows several nerve bundles with perineural tumor infiltration. symptoms of tumor in this region may be present f rom 1 to 5 years before the pa-tient is first seen by a physician." In pa-tients wi th laryngeal involvement, how-ever, the most likely presenting symp-toms are hoarseness and dyspnea. This probably accounts for the relatively short interval in our caseTaelvyeen the onset of symptoms and definit ive treatment. Local pain, a complaint considered to be quite characteristic of this tumor , is reported in as many as 50%° of cases and as few as 11%. ' ' The lymph node metastasis, cl ini-cally evident in our patient, was con-f i rmed by histopathological examinat ion. The course of the disease is charac-terized by a high incidence of local recur-rence and ult imate distant metastases in spite of aggressive surgical management. Distant metastases are found most com-monly in the lungs and bone. The five-year survival of patients w i th laryngeal adenoid cystic carcinoma is reported as 28.6% by Toomey. This is comparable to 26.8% in recent s tud ies of 54 pa t ien ts w i t h adenoidcyst ic carc inoma of the head and neck and no laryngeal i n -vo lvement . ' However , f ive-year survi-vals do not accurately reflect the ult imate prognosis. Because of the relentless and insidious behavior of this tumor, death may occur 10 or 20 years after the initial diagnosis. The treatment of choice is radical surgi-cal excision. Radiation therapy is useful as a palliative measure to produce relief of pain and tumor regression in advanced cases. 95 Muzaffar and Bolstad R e f e r e n c e s 1. Bi l l roth T: Beobachtungen uber Gesch-wulste der Speichisdrusen. Virchow Arch (Path Anat) 17:357-75, 1859 2. Foote FW Jr and Frazell EL: Tumor of the major salivary glands. Cancer 6:1065, 1953 3. Cady B, Rippey JH and Frazell EL: Non -ep idermoid cancer of the larynx. Ann Surg 167:116-20, 1968 4. Rosenfeld L, Sessions DC, McSwain B and ' Graves H Jr: Mal ignant tumors of salivary gland ong in . A n n Surg 163:726-34, 1966 5. Adams GL and Duvall AJ: Adenocarc inoma of the headand neck. Arch Oto 93:261,1971 6. T o o m e y JM: A d e n o c a r c i n o m a o f t he larynx. Laryngoscope 77:931-61, 1967 7. Leafstedt, SW et a l : Adenoidcyst ic car-c inoma of major and mi nor sail vary glands. Amer I Surg 122:756-62, 1971 8. Baxley W W a n d Farmer JC: Cyl indromas of the head and neck. South M e d f 65:685-89, 1972 9. Eby LS et a l : Adenoidcyst ic carcinoma of the head and neck. Cancer29:1160-68,1972 10. Dallachy R: Adenoidcyst ic carcinoma of the larynx, y Laryng 83:1013, 1969 96 

Adenoidcystic Carcinoma of the Larynx

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Adenoidcystic Carcinoma of the Larynx

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