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Year : 2019  |  Volume : 46  |  Issue : 2  |  Page : 60-62

Adenoid cystic carcinoma of the maxillary sinus, predominant tubular pattern

1 Department of Pathology, KAHER’s J.N. Medical College, Belgaum, Karnataka, India
2 Department of ENT, KAHER’s J.N. Medical College, Belgaum, Karnataka, India

Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Hema Basappa Bannur
Department of Pathology, KAHER’s J.N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jss.JSS_62_18

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Adenoid cystic carcinoma (ACC) of the maxillary sinus is the second most common epithelial tumor, next to squamous cell carcinoma. Surgery and radiotherapy are advocated as treatment of choice for these tumors. Here, we present a case of a 48-year-old male with ACC of the maxillary sinus which showed predominant tubular pattern on microscopy.

Keywords: Adenoid cystic carcinoma, maxillary sinus, tubular pattern

How to cite this article:
Bannur HB, Harugop AS, Davanageri RS, Suranagi VV, Pathak K. Adenoid cystic carcinoma of the maxillary sinus, predominant tubular pattern. J Sci Soc 2019;46:60-2

How to cite this URL:
Bannur HB, Harugop AS, Davanageri RS, Suranagi VV, Pathak K. Adenoid cystic carcinoma of the maxillary sinus, predominant tubular pattern. J Sci Soc [serial online] 2019 [cited 2021 Jul 29];46:60-2. Available from: https://www.jscisociety.com/text.asp?2019/46/2/60/276984

  Introduction Top

Adenoid cystic carcinoma (ACC) accounts for 3%–5% of all head-and-neck malignancies and ACC of the Maxillary sinus accounts for 5%–15% of the paranasal sinus malignant tumors.[1] It behaves aggressively with high incidence of local recurrence and distant metastases.[2] It has an unfavorable prognosis compared to those arising from major and minor salivary glands due to its extension into surrounding structure and the difficulty in complete surgical resection. Survival depends on the location, staging, pathological grading, and mode of therapy

  Case Report Top

A 48-year-old male presented with a history of left-sided nose block of 6-month duration. It was progressively increasing and was not relieved by any medications. He also had three episodes of bleeding through the nose. It was associated with nasal discharge and dull-aching headache. There was also a history of decreased perception of smell. Externally, the nose appeared normal. Cold spatula test showed absent misting. On anterior rhinoscopy, there was a right-sided deviated nasal septum, and on the left side, a pale polypoidal mass, which was extending into the vestibule, medially touching the septum, and inferiorly extending into the inferior meatus. Superior aspect of the mass was not seen. On posterior rhinoscopy, the mass was seen in the left choanae filling it completely. Paranasal sinus examination showed tenderness over the left maxillary, frontal, and ethmoid sinuses. Ear and throat examination was normal. Neck examination did not reveal any lymph node enlargement. Computed tomography showed a soft-tissue mass filling the left maxillary sinus and extending to the nasal cavity and filling it completely, extending into the choanae. There was an erosion of posteromedial wall and medial wall of the left maxillary sinus. Furthermore, the left-sided ethmoid and sphenoid sinus were filled with soft-tissue mass. Minimal thickening was seen on the right side maxillary sinus [Figure 1].
Figure 1: Computed tomography scan showing a soft-tissue mass in the left maxillary sinus, extending into the nasal cavity

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Functional endoscopic sinus surgery using microdebrider was done, and the polypoidal mass from the left nasal cavity was removed. Mass is seen in the middle meatus extending behind middle turbinate toward choanae. Inferior turbinectomy was done. Debulking of mass was done from the left maxillary antrum. The maxillary sinus ostium was widened after which, posterior wall erosion was seen. Intraoperatively, the mass was seen extending to the left maxillary, ethmoid, and sphenoid sinus, extensively. Anterior ethmoid cells were removed. Sphenoid sinus was opened and the thick white mucopurulent secretions were suctioned out.

Histopathological examination of the maxillary sinus mass revealed ciliated columnar epithelium with subepithelial tissue showing small round cells with scanty cytoplasm, and hyperchromatic nuclei arranged in tubular pattern enclosing secretions and surrounded by hyaline stroma, with few areas showing cribriform pattern. Sparse lymphocytic infiltration was seen in the surrounding tissue. Sections from the nasal cavity and inferior turbinate mass showed only tubular pattern of ACC. There were no solid areas [Figure 2] and [Figure 3]. Nerve invasion was not seen. A diagnosis of low-grade ACC, predominant tubular pattern of the maxillary sinus extending into the nasal cavity, and inferior turbinate – Stage T2N0M0 was given.
Figure 2: Section from the left maxillary sinus mass showing the cribriform type of adenoid cystic carcinoma (H and E, ×100)

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Figure 3: Section from the left nasal cavity mass showed the predominant tubular pattern of adenoid cystic carcinoma (H and E, ×200)

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Postoperatively, chemotherapy with six cycles of injection carboplatin 150 mg was followed by radiation. Monthly follow-up did not reveal recurrence.

  Discussion Top

ACC is the second common malignant tumor of the paranasal sinuses. Other sites of ACC include major and minor salivary glands of the palate, oral cavity, and breast. They are invasive tumors, extending into other sinuses, orbit, nasal cavity, oral cavity, pterygoid process, and infratemporal fossa.[1] The growth pattern is classified as an expansile type with minimal bony defects and destructive type with extensive bony defects.[3] Histologically, they have cribriform, tubular, solid, or mixed pattern. They are classified as high grade if solid component is >30% of tumor and low grade if <30%. Our case showed maxillary growth extending into the nasal cavity, microscopically predominant tubular pattern with focal cribriform areas. Cribriform histologic subtype is the most common pattern encountered, accounting for 50% of ACC, whereas tubular subtype represents 20%–30%. Nasal cavity invasion was observed in 7 of 9 patients by Kato et al.[3] Prognostic factors influencing survival are staging, grading, and modes of treatment. Patients treated with combined surgery and radiation have better prognosis than those treated with surgery or radiation alone.[4] These tumors are diagnosed late and surgical resection is usually inadequate because of the close proximity to vital structures. Maxillary sinus ACC is less likely to metastasize to regional lymph nodes, whereas distant metastasis to lungs, liver, bones, kidney, and brain are more frequent. Leafstedt et al. have reported an average survival of 4.6 years with 31% 5-year survival rate and 6% patients surviving for 10 years.[5] Liu et al. have reported 5-, 10-, and 15-year cumulative survival rates to be 65.2%, 37.1%, and 26.3%, respectively.[4] About 50% of paranasal ACC show perineural spread, though survival and disease-free survival rates are independent of perineural invasion.[6]

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There are no conflicts of interest.

  References Top

Kim GE, Park HC, Keum KC, Lee CG, Suh CO, Hur WJ, et al. Adenoid cystic carcinoma of the maxillary antrum. Am J Otolaryngol 1999;20:77-84.  Back to cited text no. 1
Eby LS, Johnson DS, Baker HW. Adenoid cystic carcinoma of the head and neck. Cancer 1972;29:1160-8.  Back to cited text no. 2
Kato H, Kanematsu M, Sakurai K, Mizuta K, Aoki M, Hirose Y, et al. Adenoid cystic carcinoma of the maxillary sinus: CT and MR imaging findings. Jpn J Radiol 2013;31:744-9.  Back to cited text no. 3
Liu WS, Xu ZG, Gao L, Tang PZ, Xu GZ, Zhang GF. Adenoid cystic carcinoma of maxillary sinus: Diagnosis, treatment and prognostic factors. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011;46:402-7.  Back to cited text no. 4
Leafstedt SW, Gaeta JF, Sako K, Marchetta FC, Shedd DP. Adenoid cystic carcinoma of major and minor salivary glands. Am J Surg 1971;122:756-62.  Back to cited text no. 5
Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A, et al. Adenoid cystic carcinoma of the nasal cavity and paranasal sinuses: A meta-analysis. J Neurol Surg B Skull Base 2013;74:118-25.  Back to cited text no. 6


  [Figure 1], [Figure 2], [Figure 3]


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