Wang Qinying, Yu Xiao Shuang, Liu Yongcai, Chen Haihong
Department of Otolaryngology, First Affiliated Hospital, College of Medicine, Zhe Jiang University, Hangzhou.
Department of Otolaryngology, People's Hospital of Jiang Shan, Quzhou, China.
Medicine (Baltimore). 2018 Dec;97(50):e13622. doi: 10.1097/MD.0000000000013622.
Adenoid cystic carcinomas (ACCs) are malignant tumors and occur in the major and the minor salivary glands. ACCs are rare in the larynx.
A 55-year-old female patient who presented with a 12 months history of paraesthesia pharynges and hoarseness for 4 months. Laryngoscopy showed an endophytic lesion in the right supglottic area with no laryngeal stenosis. And magnetic resonance imaging (MRI) confirmed the presence of a submucosal mass in the supglottic area. Supporting laryngoscope was performed under general anesthesia and a lesion biopsy obtained.
The lesion was sent for frozen-section biopsy, which shows the lesion was the epithelial-derived tumors of salivary gland, but it was impossible to identify the relationship between the tumor and the surrounding normal tissue, and to judge the nature of the tumor further. So, the lesion was sent for the second frozen-section biopsy, an ACC of the larynx was confirmed and margins were negative.
The patient underwent partial laryngectomy.
The patient was doing well except hoarseness during the follow-up period with no evidence of disease recurrence or metastasis for 17 months post-operatively.
Laryngeal ACC is a rare entity. When the nature of lesion cannot be confirmed, multiple biopsies may be required for confirm the diagnosis of pathology. It not only reduces patient's waiting time for surgery, but also define the diagnosis and surgical removal of lesion through a single anesthesia.
腺样囊性癌(ACC)是一种恶性肿瘤,发生于大唾液腺和小唾液腺。喉腺样囊性癌较为罕见。
一名55岁女性患者,有12个月的咽部感觉异常病史,伴声音嘶哑4个月。喉镜检查显示右侧声门上区有一内生性病变,无喉狭窄。磁共振成像(MRI)证实声门上区存在黏膜下肿块。在全身麻醉下进行支撑喉镜检查并获取病变组织活检。
病变组织送去做冰冻切片活检,结果显示该病变为涎腺来源的上皮性肿瘤,但无法明确肿瘤与周围正常组织的关系,也无法进一步判断肿瘤性质。因此,将病变组织送去做第二次冰冻切片活检,确诊为喉腺样囊性癌,切缘阴性。
患者接受了部分喉切除术。
在随访期间,患者恢复良好,除声音嘶哑外,术后17个月无疾病复发或转移迹象。
喉腺样囊性癌是一种罕见疾病。当病变性质无法确定时,可能需要多次活检以确诊病理,这不仅能减少患者等待手术的时间,还能通过一次麻醉明确诊断并切除病变。