Page 76 - FINAL COMPENDIUM 2020-2021 27.2.2022

CHALLENGES IN DIAGNOSING ADENOID CYSTIC CARCINOMA: A CASE REPORT
NMRR ID: 24373

Ng RE, Apipi M

Introduction: Adenoid cystic carcinoma (ACC) is a slow-growing and relentless salivary
gland malignancy composed of epithelial and myoepithelial neoplastic cells that form
various patterns; including tubular, cribriform and solid form. It occurs most frequently in
the major salivary glands and accounts for <10% of all salivary gland neoplasms. Case
study: A 61-year-old Malay male, without comorbidities, was referred to us by
Otorhinolaryngology Department for second opinion and biopsy in view of a left
submandibular swelling. He presented with pain and swelling over the left submandibular
region for the past 2 years. It was reported to have increase in size gradually without
causing breathing and speech difficulties, dysphagia and fever. On examination, a tender
indurated left submandibular swelling was present, extending to the chin, measuring
6.0cm x 5.5cm. Intraoral examination revealed obliteration of the lower buccal sulcus.
Orthopanthomogram showed a diffuse radiolucency at the left body of the mandible with
cortical destruction. Fine needle aspiration biopsy performed by an Otorhinolaryngologist
revealed suspicion of non-specific malignancy. Computed tomography with contrast was
taken and reported the presence of an irregular heterogeneously enhancing mass at the
floor of the mouth with local infiltration to the adjacent muscles along with cortical
destruction at the left body of the mandible, which is highly suggestive of salivary gland
malignancy. Cervical lymphadenopathy, lung and bone metastasis are also reported.
Incisional biopsy was done underneath the skin at the inferior border of the left mandible,
removing a firm, whitish soft tissue for histopathology examination (HPE), in which
initially suggestive of myopeithelial carcinoma. The specimen was sent for second opinion
and strongly malignant salivary gland neoplasm favouring ACC was determined.

Keywords: Adenoid cystic carcinoma, Metastasis

Virtual oral presentation at the 25 Annual MAOAMS Scientific Meeting on 19-20 March 2021
th
Dr Ng Rou Enn
Dr Muzaffar bin Apipi
Oral and Maxillofacial Surgery Department
Hospital Slim River
Slim River
Perak

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