Longacre T A, O'Hanlan K, Hendrickson M R
Department of Pathology, Stanford University Medical Center, CA 94305, USA.
Int J Gynecol Pathol. 1996 Oct;15(4):349-55. doi: 10.1097/00004347-199610000-00008.
We report the clinical and pathologic features of an adenoid cystic carcinoma of the submandibular gland that metastasized to the ovaries 10 years after initial presentation. A 30-year-old woman underwent excision of a right submandibular adenoid cystic carcinoma followed by regional external beam radiation therapy. Three years later, she underwent extended hepatic resection and localized radiotherapy to the hepatic region for metastatic disease. The patient was without evidence of disease for 7 years when she developed pelvic pain and a pelvic mass was found. A solid and cystic 10-cm left ovarian mass and a single metastatic tumor nodule involving the right ovary were excised via the laparoscope. Histologically, the tumor was identical to the patient's initial salivary gland neoplasm. The neoplastic cells were CAM 5.2 positive, S100 positive, muscle-specific actin positive, and smooth muscle actin positive. Ultrastructurally, characteristic pseudocysts (pseudolumina) with abundant basal lamina and true glandular lumina lined by short microvilli were present. Other than a single anecdotal account of a parotid gland adenoid cystic carcinoma, this case represents the first documented report of an adenoid cystic carcinoma of salivary gland origin that was associated with symptomatic ovarian metastases. This case demonstrates that the ovary is a potential site for metastatic disease many years following the diagnosis and treatment for a primary neoplasm however uncommon or remote the site of origin. Since metastatic adenoid cystic carcinoma can rarely present as an ovarian mass, a clinical history of this neoplasm should be heavily weighed in the differential diagnosis of any unusual ovarian tumor with a predominant cribriform, trabecular, or tubular pattern.
我们报告了一例下颌下腺腺样囊性癌的临床和病理特征，该肿瘤在初次就诊10年后转移至卵巢。一名30岁女性接受了右侧下颌下腺样囊性癌切除术，随后进行了局部外照射放疗。三年后，她因转移性疾病接受了扩大肝切除术及肝区局部放疗。患者在无疾病证据7年后出现盆腔疼痛，发现盆腔肿块。通过腹腔镜切除了一个10厘米大小的左侧卵巢实性和囊性肿块以及一个累及右侧卵巢的单个转移瘤结节。组织学检查显示，肿瘤与患者最初的涎腺肿瘤相同。肿瘤细胞CAM 5.2阳性、S100阳性、肌肉特异性肌动蛋白阳性和平滑肌肌动蛋白阳性。超微结构检查发现，存在具有丰富基底膜的特征性假囊肿（假管腔）以及由短微绒毛衬里的真正腺腔。除了一篇关于腮腺腺样囊性癌的个案报道外，本病例是首例有文献记载的涎腺起源的腺样囊性癌伴症状性卵巢转移的报告。该病例表明，卵巢是原发性肿瘤诊断和治疗多年后转移性疾病的潜在部位，无论原发部位多么罕见或遥远。由于转移性腺样囊性癌很少表现为卵巢肿块，在鉴别诊断任何具有主要筛状、小梁状或管状模式的不寻常卵巢肿瘤时，应高度重视该肿瘤的临床病史。
