Adenoid Cystic

Carcinoma
Maxilla

Adenoid Cystic
Carcinoma
Most common malignant tumor of the

submandibular and minor salivary glands

Parotid: 3%
Submandibular: 15%
Minor salivary gland: 30%

Comprises 6% of all salivary gland tumors

it is sometimes referred to as cylindroma
Commonly present as a slowly growing tumor

Adenoid Cystic
Carcinoma
5th most common malignant epithelial tumor of

the salivary gland

7.5% of all epithelial malignancies
Presentation in childhood is unusual and the

mean age at the time of clinical diagnosis is in

midforties.
Lymphogenous spread

Adenoid Cystic
Carcinoma
These tumors have a relentless recurrence and

becoming progressively more aggressive

Severe pain and spontaneous paralysis of the facial

nerve occur in nearly 1/3 of the patients.

Hallmark of the tumor is peripheral nerve invasion
Both sexes are affected with about equal frequency

Causes
Occupational exposure
Nickel
Wood dust
Isopropyl oil
Volatile hydrocarbons
Organic fibers found on wood, shoes

Symptoms
Dental pain
Loose teeth
Oropalatal fistula/palatal mass
Ocular symptoms
Epiphora
Proptosis
Diplopia
Visual loss

Symptoms
Facial manifestation
Cheek swelling
Pain
Nasal complaints: epistaxis, anosmia, and
discharge

Staging TNM (AJCC) 2002

TX: Indicates the primary tumor cannot be evaluated.
T0: No evidence of a tumor is found.
T1: Describes a small noninvasive tumor that is 2 centimeters (cm)

at its greatest dimension.

T2: Describes a larger noninvasive tumor, between 2 cm to 4 cm.
T3: Describes a tumor that is larger than 4 cm, but not larger than
6 cm, that has spread beyond the salivary gland. However, the
tumor does not affect the seventh nerve, which is the facial nerve
that controls such expressions as smiles or frowns.
T4a: The tumor invades the skin, jawbone, ear canal, and/or facial
nerve.
T4b: The tumor invades the skull base and/or the nearby bones
and/or encases the arteries.

Staging TNM (AJCC) 2002

NX: Indicates the regional lymph nodes cannot be evaluated.
N0: There is no evidence of cancer in the regional nodes.
N1: Indicates that cancer has spread to a single node on the same

side as the primary tumor and the cancer found in the node is 3 cm
or smaller.
N2: Describes any of these conditions:
N2a: Cancer has spread to a single lymph node on the same side as
the primary tumor, and is larger than 3 cm, but not larger than 6 cm.
N2b: Cancer has spread to more than one lymph node on the same
side as the primary tumor, and no tumor measures larger than 6 cm.
N2c: Cancer has spread to more than one lymph node on either side
of the body, and no tumor measures larger than 6 cm.
N3: Cancer found in lymph nodes is larger than 6 cm.

Staging TNM (AJCC) 2002

MX: Indicates distant metastasis cannot be

evaluated.
M0: Indicates the cancer has not spread to
other parts of the body.
M1: Describes cancer that has spread to
other parts of the body.

Adenoid Cystic
Carcinoma
Prognosis:

(after first histological verification)

5 year survival rate 75%

10 year survival rate 30%
20 year survival rate 13%

Local recurrence: 42%

Distant metastasis: Lungs
Prognostic significance of metastases is difficult

to ascertain since this is usually a late finding.

Horizontal
lines of
Sebileau
Oldest classification
Horizontal line
TOP: floors of the orbits
BOTTOM: floors of the antra
Suprastructure: ethmoid,
sphenoid, frontal sinuses
Mesostructure: maxillary sinus,
respiratory portion of the nose
Infrastructure: alveolar process

1
2
3

Line of
Lederman
Utilized the horizontal
line of Sebileu and added
a vertical line on each
side of the nose
Vertical lines separates
the ethmoid sinuses and
nasal fossa from the
maxillary sinus

1
2
3

Triple S Lines
of Baclese
Formed by:
Lesser wing of the sphenoid
Posterolateral wall of the
maxillary antrum
Posterior wall orbit
For assessment of
superoposterior extent of
maxillary Carcinoma

Triple S-lines of
Baclese

Ohngrens
Line
Extends from the medial
canthus to the angle of
the mandible.
Divides the maxillary
sinus into
superoposterior
(suprastructure) and
Inferoanterior
(infrastructure)

Plane of Malignancy

Adenoid Cystic
Carcinoma
Fairly high recurrence rate may well be due

to:
Unsatisfactory primary surgical treatment and

failure to recognize the neural extension.

Insidious infiltration of adenoid cystic

carcinomas

Relation of site of primary to

Survival rates of ACC
Follow-up
time
(Years)

PERCENTAGE OF DETERMINATE SURVIVAL

Parotid Gland

Submandibular
Gland

Palate

73

50

80

10

39

25

44

15

21

38

20

13

36

Determination survival are from the data presented by Eneroth et al.

Adenoid Cystic
Carcinoma
Treatment:
Complete local excision
Tendency for perineural invasion: facial nerve

sacrifice
Postoperative XRT

Thank you...