Adenoid cystic carcinoma

oral pathology

1. Adenoid Cystic Carcinoma

2. Adenoid Cystic Carcinoma Cylindroma Adenocystic carcinoma Adenocystic basal cell carcinoma Pseudoadenomatous basal cell carcinoma Basloid mixed tumor • It is a slow growing but aggressive neoplasm with remarkable capacity to reoccur and profound tendency to invade perineural lymphatic spaces.

3. Adenoid cystic carcinoma :- is the most common malignant neoplasm of the submandibular and sublingual glands as well as the minor salivary glands in the palate clinical feature 50-70% starts in minor salivary gland the palate is the most common site If major salivary gland ( parotid is the most affected – painful mass ) Age :- 5 th and 7 th decades Gender :- no gender predilection (slight female predominance) sublingual gland tumor

4. c/p :- - Pain is a common and important finding - slowly growing mass. - Patients often complain of a constant , low-grade, dull ache , which gradually increases in intensity. - Facial nerve paralysis may develop with parotid tumors. - Palatal tumors can be smooth surfaced or ulcerated. - Tumors arising in the palate or maxillary sinus may show radiographic evidence of bone destruction These tumors have a high rate of local recurrence, higher rate of distance metastases

5. Adenoid cystic carcinoma. Painful mass of the hard palate and maxillary alveolar ridge.

6. Gross pathology Adenoid cystic carcinoma of the parotid gland has deceptively well delineated outlines. Microscopically, the tumor extends well beyond the grossly apparent edges of the tumor. White or grayish white color, firm , invasive tumor . Areas of hemorrhage seen.

7. Histopathologic features:  The adenoid cystic carcinoma is composed of a mixture of myoepithelial cells and ductal cells that can have a varied arrangement.  Three major patterns are recognized ; ( 1) cribriform ,( differentiated) ( 2) tubular , ( moderately differentiated) and ( 3) solid .( undifferentiated)  Usually a combination at these is seen, and the tumor is classified based on the predominant pattern.

8. Cribriform pattern :

9. Cribriform pattern: The cribriform pattern is the most classic and best recognized appearance , characterized by islands of basalaid epithelial cells that contain multiple cylindrical, cyst like spaces resembling Swiss cheese or honeycomb pattern . These spaces often contain a mildly basophilic mucoid material a hyalinized eosinophilic product , or a combined mucoid hyalinized appearance . Sometimes the hyalinized material also surrounds these cribriform islands.

10. Tubular pattern : Tubular structure that are lined by stratified cuboidal epithelium. Longitudinal section- ductal structures are viewed as ducts or tubules. The tubular Lumen can be lined by one or more several loayers of cell Adenoid cystic carcinoma. Tubular variant showing morphologically clear abluminal cells .

11. Solid pattern : Solid groups of cuboidal cells with little tendency towards ducts or cyst formation Arranged in nests or sheets of varying size and shape Areas of necrosis seen Cellular pleomorphism, mitosis observed Solid variant higher power showing scattered duct-like structures within the tumor sheet.

12. Adenoid cystic carcinoma. The tumor cells are surrounded by hyalinized material Adenoid cystic carcinoma. Perineural invasion.

13. Tublar pattern in top & bottom . A cribriform in the center Epithelial cells have a clear cytoplasm,poorly defined border & irregular shaped nuclei

14. The tumor appear well circumscribed Mitotic activity Adenoid cystic carcinoma,

15. Adenoid cystic carcinoma . Perineural invasion . Adenoid cystic carcinoma. The tumor cells are surrounded by hyalinized material

16. Treatment and prognosis Surgical excision X-ray radiation, radiation alone is not recommended Cure rate is low Minor gland tumor is more deadly than major gland

17. Thank you