A case of palatal adenoid cystic carcinoma with late recurrence.

Abstract

Adenoid cystic carcinoma (ACC) is a slow-growing, indolent cancer which normally develops in the head and neck salivary glands, but occasionally in the uterus.1 It can present with swelling, pain, and paraesthesia, as well as other symptoms such as epistaxis, nasal obstruction, depending on the location of the tumour.2 It accounts for 1% of the malignant tumours of the head and neck region.3 Classical management involves surgery and subsequent radiotherapy.4 The researchers describe a case of ACC of the minor salivary glands of the palate and nasopharynx that recurred 8 years following completion of treatment. A 57-year-old female presented to her GP with a 3-month history of left-sided catarrh and epistaxis from her left nostril. Clinical examination was unremarkable and the patient was initially diagnosed with sinusitis. However, the symptoms did not resolve following treatment for sinusitis. On further examination, her dentist noted left palatal swelling and referred her to the maxillofacial clinic by which time she had been suffering from these symptoms for 18 months. In hindsight, her epistaxis might have been a warning sign, and on reflection, the GP highlighted the need to take new epistaxis seriously. Clinical examination by the maxillofacial team revealed diffuse palatal swelling of the hard palate. Subsequent magnetic resonance imaging (MRI) showed a palatal tumour extending into the floor of the left nasal cavity and projecting into the left maxillary antrum through the medial wall. Biopsy of the palate showed an invasive tumour indicative of an ACC of minor salivary glands in the palate. Staging was T4N0M0. She underwent a …