Department of Oral and Maxillofacial Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Pathol Res Pract. 2012 Jun 15;208(6):360-2. doi: 10.1016/j.prp.2012.04.002. Epub 2012 May 7.
Laryngeal adenosquamous carcinoma (ASC) is a rare malignancy, and the problems in true diagnosis of this entity are well known. In this paper, we describe a case of ASC and discuss its distinct histopathology in metastatic lymph nodes. A heavy smoker man presented with a progressive neck mass. Based on incisional biopsy, diagnosis of squamous cell carcinoma (SCC) was made and total laryngectomy with bilateral radical neck dissection was performed. Sections of primary tumor showed a well-differentiated SCC. However, lymph node metastases had a distinct feature of glandular structures. Further investigation with Mayer's mucicarmine stain confirmed the presence of rare scattered glands in primary tumor and the final diagnosis was changed to ASC. Adenosquamous carcinoma is a distinct entity and must be distinguished from the common SCC of larynx. As a result, when a lesion with diagnosis of squamous cell carcinoma shows evidence of glandular differentiation in a subsequent biopsy or in nodal metastases, more investigation is necessary. Moreover, the glandular structures in primary tumor, as in this case, may be rare and inconspicuous. Therefore, we suggest the precise evaluation of metastatic lymph nodes for any laryngeal tumor with diagnosis of SCC. This helps to make appropriate therapeutic decisions with respect to the aggressive behavior of ASC and its high propensity for lymph node metastasis.
喉咽涎腺癌（ASC）是一种罕见的恶性肿瘤，其准确诊断一直是个难题。本文报道了一例 ASC，并讨论了其在转移性淋巴结中的独特组织病理学特征。一名重度吸烟者因进行性颈部肿块就诊。根据切开活检，诊断为鳞状细胞癌（SCC），行全喉切除术和双侧根治性颈淋巴结清扫术。原发性肿瘤的切片显示为分化良好的 SCC。然而，淋巴结转移具有明显的腺结构特征。进一步用迈尔黏液卡红染色证实了原发性肿瘤中罕见的散在腺体的存在，最终诊断更改为 ASC。涎腺癌是一种独特的实体肿瘤，必须与常见的喉 SCC 相区别。因此，当诊断为 SCC 的病变在后续活检或淋巴结转移中显示出腺分化的证据时，需要进一步调查。此外，如本例所示，原发性肿瘤中的腺结构可能很少且不明显。因此，我们建议对诊断为 SCC 的任何喉肿瘤的转移性淋巴结进行精确评估。这有助于根据 ASC 的侵袭性行为及其高淋巴结转移倾向做出适当的治疗决策。
