Author of

• 12755

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  P3.16 - Poster Session 3 - Other Thoracic Malignancies (ID 188)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Thymoma & Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12756

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    P3.16-001 - Late-developing tongue adenoid cystic carcinoma after pulmonary metastasectomy (ID 1550)

    09:30 - 09:30  |  Author(s): S.W. Moon
    • Abstract

    Background
    Adenoid cystic carcinoma (ACC) is a malignant neoplasm that usually arises in the salivary glands, but can also occur in the breast, skin, uterine cervix, upper digestive tract, and lung. Primary pulmonary ACC accounts for less than 0.2% of all lung cancers, and only 10% of all primary pulmonary ACCs are peripheral in origin. To the best of our knowledge, peripheral pulmonary ACC detected prior to its appearance in the tongue has not been reported previously in the literature.

    Methods
    We report herein a case of peripheral ACC in the right lower lobe, which was followed 27 months later by tongue ACC.

    Results
    A 52-year-old woman was referred to our hospital for evaluation of an incidentally found right lower lobe lung mass. She had a history of hypertension and denied recent weight loss or smoking. Her initial laboratory findings were unremarkable, and the results of a pulmonary function test were normal. A chest computed tomography (CT) scan revealed a relatively well-circumscribed and enhanced mass involving the visceral pleura in the right lower lobe, and no mediastinal lymphadenopathy. The mass was biopsied under video-assisted thoracoscopic surgery, and an intraoperative pathologic diagnosis revealed malignant lung cancer. The patient underwent right lower lobectomy and mediastinal lymph node dissection. A histopathological examination disclosed ACC with a cribriform and tubular pattern; metastasis was not found in the dissected lymph nodes. For confirmation of a primary or metastatic tumor, an otolaryngologic examination and whole-body positron-emission tomography (PET) were performed after lobectomy. The patient was diagnosed with primary peripheral pulmonary ACC because of no evidence of salivary gland tumor or other metastasis; Neither radiotherapy nor chemotherapy was not performed after lobectomy. During follow-up, the patient was diagnosed and treated for transitional cell cancer of bladder. Recurrence of the bladder cancer was suspected at 27 months after the pulmonary operation, and a whole-body PET scan showed that an enlarged and increased uptake pattern of both parotid nodules without recurrence in the lung. The bladder nodule was benign and the parotid nodules disclosed ACC of the tongue with metastasis to the parotid lymph node. The otolaryngologist performed wide excision of the tongue cancer. The pathologic diagnosis was ACC of the tongue; identical to those of the resected right lower lobe lung mass taken 27 months previously. After 5 week-adjuvant chemo-radiation therapy, she remained in good health and with no detectable recurrence at the 7-months follow-up.

    Conclusion
    We have presented herein a case of ACC with unusual clinical behaviors that remain to be fully defined. Although ACC is characteristically slow growing and associated with late distant metastasis, our case showed the reverse presentation pattern: early recognition of a metastasis and late presentation of the primary site. Therefore, peripheral pulmonary ACC should be carefully followed and considered in relation to head and neck ACC, even after successful management.