Adenoid Cystic Carcinoma (ACC)

• Adenoid cystic carcinoma (ACC) accounts for approximately 10% of all salivary gland neoplasms:

  • This is the most common malignant disorder to arise in the submandibular, the sublingual, and the minor salivary glands.

ACC of the hard palate

ACC of the sublingual gland.

• More than two thirds (65%) of them arise from the minor salivary glands:

  • Most commonly located within the oral cavity (palate), followed by the nasal cavity, and nasopharynx.

  • They were considered the most common malignant salivary gland tumor to involve the palate, but polymorphous low-grade adenocarcinoma is rapidly increasing in incidence.

• ACC arise more often in women than in men and tend to affect adults in their fifth through seventh decades of life, often presenting as an otherwise asymptomatic mass.

• Its natural history demonstrates a paradox:

  • First, tumor growth is slow, but its clinical course is unyielding and progressive.

  • Second, operative intervention is usually possible, but multiple local recurrences are the norm.

  • Third, metastatic spread to regional lymph nodes is rare, but distant spread to the lungs and bones is common (40% to 50% of the cases).

  • And fourth, 5-year survival rates are expectantly high, but 10 to 20-year survival rates are dismally low.

• Tumor stage is considered the most reliable indicator of overall outcome, but some authors have questioned the importance of histologic sub-typing:

  • There is a strong positive correlation between site of origin and prognosis.

    • The more favorable outcome with major (relative to minor) salivary gland ACC is attributed to the earlier discovery of the neoplasm at these more accessible locations.

• ACC is not encapsulated or partially encapsulated and infiltrates the surrounding tissue (the risk of local failure is approximately 50% with surgery alone).

• Histologically they have a basaloid epithelium clustered in nests in a hyaline storm.

• ACC can be categorized into three growth patterns cribriform, tubular, and solid patterns:

  • The most common histologic subtype is the cribriform type (44%), characterized by a “Swiss cheese” pattern of vacuolated areas:

    • The prognosis for the cribriform subtype is intermediate.

• The tubular subtype (35%) carries the best prognosis and is characterized by cords and nests of malignant cells.

• The solid subtype (21%) has the worst prognosis in terms of distant metastasis and long-term survival.:

  • Solid sheets of adenoid malignant cells characterize this subtype.

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon and is amember of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center.

He is first author on some publications on oral cavity cancer:

• Oral Tongue Cancer: Literature Review and Current Management 

  • https://www.oatext.com/pdf/CRR-2-153.pdf

• Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management. 

  • https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

• Current thinking on malignant salivary gland neoplasms

  • https://pdfs.semanticscholar.org/5a38/a8c039c6e049d0c696bb936662de04c16bf1.pdf

• Malignant Salivary Gland Neoplasms Literature Review

  • https://healthdocbox.com/84876772-Brain_Tumor/Malignant-salivary-gland-neoplasms-literature-review.html

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016