Adenoid cystic carcinoma with high-grade transformation forming spindle cell component of the submandibular gland

Auris Nasus Larynx. 2019 Dec;46(6):934-939. doi: 10.1016/j.anl.2019.01.014. Epub 2019 Feb 16.

Abstract

Adenoid cystic carcinoma (AdCC) with high-grade transformation (AdCC-HGT) is rare, and AdCC-HGT with spindle cell component is particularly rare. The patient was a 65-year-old man with a 5 cm sized swelling of the right submandibular gland. Submandibular sialoadenectomy was performed. Histopathological findings mainly showed conventional AdCC, and minorly showed two other components: (1) the pleomorphic component, a proliferation of atypical pleomorphic epithelial cells forming solid or small clusters and accompanied by necrosis; (2) the spindle cell component, containing atypical spindle cells invading the stroma. Postoperative chemoradiotherapy was performed. Multiple right lung nodular lesions were found on the contrast-enhanced chest CT one month after the surgery. Thoracoscopic pulmonary resection was performed. The lung tumors exhibited a proliferation of atypical spindle cells, accompanied by necrosis. We considered that the spindle cell component of the AdCC-HGT of the submandibular gland developed lung metastases. The patient died seven months after submandibular sialoadenectomy due to respiratory failure. Although rare, our case highlights the importance of recognising spindle cell components in conventional AdCC; even if the area is small, these high-grade transformation areas can metastasise and become prognostic factors.

Keywords: Adenoid cystic carcinoma; High-grade transformation; Spindle cell; Submandibular gland.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carcinoma, Adenoid Cystic / pathology
  • Carcinoma, Adenoid Cystic / secondary*
  • Carcinoma, Adenoid Cystic / surgery
  • Cell Transformation, Neoplastic*
  • Humans
  • Lung Neoplasms / pathology
  • Lung Neoplasms / secondary*
  • Lung Neoplasms / surgery
  • Male
  • Neoplasm Grading
  • Submandibular Gland Neoplasms / pathology*
  • Submandibular Gland Neoplasms / surgery