Diagnosis Of Adenoid Cystic Carcinoma Research Articles

Comparative Analysis of MYB Expression by Immunohistochemistry and RNA Sequencing in Clinical Gene Fusion Detection in Adenoid Cystic Carcinoma.

MYB has been shown to play a central role in oncogenesis in a majority of adenoid cystic carcinomas (ACC). Testing for MYB expression via immunohistochemistry (IHC) or testing for the MYB gene fusion by next-generation sequencing(NGS) have become useful tools for the diagnosis of ACC. In addition, detection of MYB expression may have implications for patient management. A cohort of 35 ACC cases was identified from the archival pathology files of the Massachusetts General Hospital. Cases were tested for MYB expression using a panel of 4 different commercially available MYB antibodies and scored using a modified Allred system. RNA-based NGS for MYB gene fusion detection was also performed. Among 4 different MYB antibodies, the sensitivity for MYB detection ranged from 26 to 97%. When a 30% threshold for determination of MYB immunohistochemical positivity was used, the AB_10900735 IHC clone showed the maximum sensitivity (97%). RNA sequencing revealed 19 (54%) cases positive for MYB fusions, and expression analysis derived from the sequencing data confirmed a significant association between MYB expression and fusion status (p = 0.036). Although less sensitive, the AB_778878 MYB clone showed a significant positive association between IHC staining and MYB RNA expression (R2 = 0.15, p = 0.023). The detection of MYB expression using immunohistochemistry varies significantly depending on the antibody used. Comparison with MYB fusion and transcription levels, as determined by NGS, reveals that MYB has a complex relationship between genetic alterations, transcript levels, and protein abundance.

Uncommon Presentation of Pulmonary Adenoid Cystic Carcinoma: A Case of Brain Metastasis in a Young Smoker

Abstract Introduction/Objective Pulmonary adenoid cystic carcinoma (PACC) is a rare entity, accounting for only 0.04-0.2% lung cancers, and mainly originating from the small salivary glands in the tracheobronchial tree. Due to slow-growing pattern and unspecific symptoms, the diagnosis is often delayed. While metastasis in PACC is uncommon, reports of brain metastasis are exceedingly rare. We present a case of PACC with metastasis to the brain in a young smoker. Methods/Case Report A 29-year-old female with history of smoking presented with headache, hypersomnia, episodes of vomiting and falling. Physical examination revealed multiple palpable nodes on the mid head, left temporal and right parietal area, left shoulder area were found. CT scan demonstrated complex cystic mass with a mural nodule within the left cerebellar hemisphere, with displacement of the cerebellar tonsils, as well as a 7.4 cm left infrahilar mass with heterogenous enhancement. Patient underwent craniotomy with tumor resection and left lower lobe endobronchial biopsy. Touch smear of the brain lesion showed clusters of hyperchromatic cells with myxoid like and hyalinized stroma. H&E stain showed cords of neoplastic cells embedded in a basophilic/myxoid stroma. Lung biopsy showed similar histological patterns. IHC stain showed the tumor cells were positive for epithelial and myoepithelial cells markers(CAM5.2, CK7, p63, Sox 10), retained INI1/BAF47 and BRG1 expression, negative for NUT and BCOR. Salivary Gland NGS Fusion Panel was performed and detected a MYBL1::NFIB [t(8;9)(8q13.1;9p23)] fusion alteration, which confirmed the diagnosis of adenoid cystic carcinoma. Considering no lesion was found in the patient’s head and neck, diagnosis of PACC was made. Results (if a Case Study enter NA) NA Conclusion PACC manifests three histologic subtypes: cribriform (most common), trabecular, and solid. In this case, brain and lung lesions exhibited similar patterns - nests of small, monomorphic cells within a myxoid-like and basophilic stroma background, consistent with trabecular pattern. Cytologically, densely packed cellular clusters were embedded in a myxoid like matrix. Distinguishing PACC from other salivary gland tumors is challenging. Immunostains for epithelial and myoepithelial cells, along with morphology, aid in diagnosis. The MYB::NFIB fusion helps differentiate from other lung salivary gland malignancies, but is found in a lower percentage of PACC cases (~40%) compared to other primary adnoid cystic carcinoma (~85%).

Identification of hepatic metastasis from an unrevealed adenoid cystic carcinoma by PET/CT: A case report.

Adenoid cystic carcinoma is a rare malignant tumor of the salivary glands, with few reports of metastasis to the liver in the literature. We present a case where an isolated hepatic lesion of adenoid cystic carcinoma was identified using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). A 76-year-old male experienced abdominal pain and underwent an enhanced CT scan and magnetic resonance imaging, which revealed a liver mass. Subsequent 18F-FDG PET/CT identified hypermetabolic lesions in both the left and right lobes of the liver, suggesting malignancy, with no other abnormalities detected. A liver biopsy confirmed the diagnosis of adenoid cystic carcinoma. No intervention. Following confirmation of the diagnosis, the patient chose to discontinue treatment and was discharged. Hepatic metastasis from adenoid cystic carcinoma may be detected before the identification of the primary lesion. 18F-FDG PET/CT plays a critical role in differentiating benign from malignant liver tumors, selecting potential biopsy sites, and assessing the extent of metastatic disease.

MYB immunohistochemistry as a predictor of MYB::NFIB fusion in the diagnosis of adenoid cystic carcinoma of the head and neck

Diagnosing adenoid cystic carcinoma (AdCC) is challenging due to histopathological variability and similarities with other tumors. In AdCC pathogenesis, the cellular myeloblastosis gene (c-MYB) often exhibits a MYB::NFIB fusion from a reciprocal translocation. This study aimed to assess the predictive accuracy of MYB immunohistochemistry for detecting this translocation compared to fluorescence in situ hybridization (FISH). This study included 110 AdCC patients (1999-2017) from two Dutch head and neck centers using tissue microarrays and full slides. Median MYB expression levels by immunohistochemistry were compared based on translocation status by FISH, and differences within clinicopathological parameters were examined. An immunohistochemical cut-off was established to estimate the translocation. MYB immunohistochemistry was available in 90/110 patients, with a median expression of 27%. FISH was interpretable in 79/108 tumors, identifying MYB::NFIB fusion in 44 (56%). Among 62 patients with both MYB expression and translocation data, the fusion was present in 38 (61%). These tumors had higher MYB expression (30%) than nontranslocated tumors (6%); P = .02. A 60% MYB expression cut-off yielded 100% specificity for detecting the translocation but had no prognostic value. Although MYB protein expression alone lacks diagnostic precision, protein expression >60% predicted the MYB::NFIB fusion in all tumors.

Case series on the management and outcomes of Bartholin gland carcinoma

ObjectiveTo evaluate the management and outcomes of Bartholin gland cancer at a single tertiary institution. Study DesignA single institution retrospective review of 9 cases of BGC between 2004 and 2022 was conducted. Demographics, pathological characteristics, treatment, follow up and oncologic outcomes were extracted from clinical records. Data are summarised using descriptive statistics and survival probabilities are presented with Kaplan Meier graphs. ResultsTen cases of BGC were identified at our institution over a period of 18 years. Nine out of ten clinical records were available for analysis. Eight patients presented with vulval swelling and four were treated initially for Bartholin cyst or abscess. One patient had a histological diagnosis of adenoid cystic carcinoma while the remaining were squamous cell carcinomas. With the exception of stage I disease chemoradiation was the primary mode of treatment. Adverse events included skin desquamation (4/9), venous thrombo-embolism (2/9), gastro-intestinal (1/9) and neurotoxicity (1/9). Median follow up was 60 months with a 5-year recurrence free and overall survival at 76 % and 64 % respectively. ConclusionBGC may present after a long duration of symptoms and at advanced stages. Primary chemoradiation appears to be a feasible treatment option in advanced disease with the benefit of decreased morbidity.

Usefulness of combined ultrasonography and MRI to distinguish the diagnosis of Adenoid Cystic Carcinoma of the floor of the mouth

Background/Aim: Adenoid cystic carcinoma (ACC) is a rare type of cancer that most often occurs in the salivary glands. The aim of this report was to describe a very rare case of ACC in the floor of the mouth referring to the usefulness of combined imaging methodology for the detection of the exact origin and extension of the tumor. Case Report: A 70-year-old female patient was referred to the private practice of one of the authors (D.A., Thessaloniki, Greece). Before the examination, the patient provided written informed consent in accordance with the Helsinki Declaration for research and patient's ethics. Subsequently, the patient was examined thoroughly. She exhibited a swelling on the floor of the mouth (left side). The swelling was painless, firm-solid upon palpation, non-movable and attached to adjacent tissues with normal covering oral mucosa. The patient was referred for an ultrasonography and MRI examination and afterwards an incisional biopsy was performed. The surgical removal of ACC and the involved sublingual but also the adjacent submandibular (for safety reasons) salivary glands were performed under general nasopharyngeal anesthesia with bilateral, both external and intraoral access. In addition, post-surgical radiotherapy was performed. Conclusions: Due to the aggressiveness of the lesion and the fact that in most cases adjacent tissues are affected, surgeons tend to be rather aggressive in their interventions. The imaging techniques may vary in their interpretation of the lesions. Ultrasonography and MRI examinations may assist the surgeon by depicting borders of the lesion under investigation, much more accurately, supporting the establishment of the diagnosis and avoiding the unnecessary loss of healthy neighboring tissue.

An Uncommon Case of Sinonasal Adenoid Cystic Carcinoma Metastatic to the Kidney Treated with Metastasectomy.

Adenoid cystic carcinoma (ACC) is a rare tumor, accounting for 1% of all head and neck cancers, with an aggressive nature characterized by local recurrence, delayed metastasis, and survival of less than 50% at 10 years. This is a case of biopsy-proven ACC to the kidney, 1 of 29 known occurrences, managed by metastasectomy by robotic-assisted nephrectomy, with plans for resection of lung metastasis. Thirteen years after diagnosis of sinonasal ACC treated with resection, the patient presented with shortness of breath. This prompted a CT scan of the chest, which led to the incidental finding of left renal mass and pulmonary lesion. Literature suggests improved disease-specific survival in locoregional recurrence treated with surgery versus radiation; in patients with metastasis to the lung, metastasectomy offers greater survival benefit than supportive therapy. But, this is not significantly better than chemotherapy or radiation alone. While the optimal therapeutic approach remains to be identified in distant metastatic ACC, metastasectomy remains a viable option for patients who have potentially completely resectable metastatic tumors, appropriate performance status, and adequate affected-organ function. Preoperative counseling should include discussion on partial nephrectomy with prioritization of nephron-sparing but potential for increased perioperative risk versus radical nephrectomy to ensure negative margins and expedite timeline to systemic therapy.

A cytodiagnosis of adenoid cystic carcinoma of the tracheobronchial tree through a systematic clinical case comparison and analysis

BackgroundPrimary adenoid cystic carcinoma (AdCC) of the tracheobronchial tree is very rare with a high risk for recurrence and metastasis. The diagnosis of AdCC by histologic and immunohistochemical means has been well studied clinically. However, the identification of AdCC by cytologic features remains elusive due to the atypical features the cancer presents. This study aimed to describe the cytologic features of AdCC by using bronchial brushing, which could aid in distinguishing AdCC from other pulmonary carcinomas.MethodsThe cytopathological features of bronchial brushing smears collected from seven cases were histologically diagnosed as AdCC. The defined cytologic features, which could potentially be diagnostic, were systemically analyzed.ResultsFour out of the seven cytologic cases were inconcordance with the histologic diagnosis and cytologically classified as positive for malignant cells, small cell carcinoma, or atypical cells. Three cases showed a characteristic adenoid structure and magenta stroma forming globule, which was distinguished from the four cases. Cytologically, the above mentioned three cases were uniform with relatively small bland nuclei and little cytoplasm. In this study, only one case showed atypical polygonal medium-sized cells with conspicuous nucleoli.ConclusionsUnlike fine-needle aspiration cytology, magenta stroma globules might offer an alternate clue for cytodiagnosis of AdCC clinically. Bronchial brushings cytology was more present in bland uniform cells with high nuclear to cytoplasmic ratios and background mucoid substance. More cases should be collected and confirmed using histopathology with careful film reading to reduce the rate of misdiagnosis.

Finding the Way Back Home: Report of 2 Cases of Oral Metastasis

Around 1-1.5 % of all malignant tumors in oral cavity are caused by metastatic dissemination to this region. Lung, kidney, breast, bone and colorectal regions are primary sites which act as source of metastases to oral cavity. Similarly, metastasis from primary oral malignancy to distant sites is not uncommon with metastasis mainly occurring to lung, followed by bone and liver. Here we report 2 cases showing different primary origins but presentation in oral cavity being the first symptom. One case is of an 82 year old male with a complaint of swelling in right mandible and a diagnosis of prostatic adenocarcinoma metastasizing to oral cavity was established. The other case presented here is of a 42 year old male with pain and swelling in right mandible. The diagnosis of adenoid cystic carcinoma was made and a full body scan helped in early identification of metastatic deposits in lung. Despite the infrequent occurrence of metastases in oral region, dental surgeon should be aware of the possibilities for correct diagnostic conduction and subsequently, the initiation of treatment in early stages of disease.

Cystic Adenoid Carcinoma Of The Trachea: A Rare Case Of Asymptomatic Tracheal Tumor

Aim : To present the imaging appearance of tracheal adenoid cystic carcinoma according to the different imaging modalities (ultrasound, computed tomography and magnetic resonance imaging). Method : We present the case of a 60-year-old patient, without symptoms guiding the diagnosis, in whom the diagnosis was suspected on CT scan imaging. Results : The patient was explored by CT angiography of the supra-aortic trunks as part of the etiologic investigation of an ischemic vascular accident. The examination objectified a tissular mass centered on the tracheoesophageal axis lateralized to the left invading the laryngeal cartilages and the left lobe of the thyroid. A cervical ultrasound was performed showing a heterogeneous hypoechoic area of the left lobe of the thyroid with no detected nodule. Fine needle aspiration of the suspicious area was performed, showing a tumoral lesion with basaloid cells evoking the diagnosis of adenoid cystic carcinoma. In order to assess the tumor extension and the patient's operability, a cervical MRI was performed given its better resolution in contrast. A bronchial fibroscopy was indicated showing a tracheal circumferential infiltrative stenosis with biopsies confirming the diagnosis. Conclusion: Adenoid cystic carcinomas of the trachea are rare tumors. Tracheobronchial endoscopy combined with biopsies allow the diagnosis of certainty. Cross-sectional imaging (CT and MRI) plays a key role in locoregional and distant extension assessment, thus guiding therapeutic management.

A case report: An unusual presentation of adenoid cystic carcinoma of the lacrimal gland.

Adenoid cystic carcinoma (ACC) is the most common malignant epithelial tumor of the lacrimal gland with the highest malignant degree. ACC of the lacrimal gland is characterized by symptoms of <1 years duration. We present a 38-year-old male patient who complained of an enlarging mass in the left lacrimal fossa for almost 10 years previous to the diagnosis of ACC. A 38-year-old male patient visited our ophthalmology clinic with a chief complaint of a mass in his left upper lid, which had enlarged significantly over the previous months. Magnetic resonance imaging with intravenous Gadobutrol showed moderate and homogenous mass enhancement. Bone destruction is found. The periosteum is not eroded. The magnetic resonance imaging finding was supportive for malignancy. Histopathological examination of the specimen revealed solid tumor showing a cribriform pattern mixed small amount of basaloid cell proliferation. Therefore, the final diagnose was Adenoid cystic carcinoma of the lacrimal gland. The treatment included en bloc resection of the mass and adjacent bone and radiotherapy. In 1 year follow-up after operation, there is no recurrence. Visual acuity is 30/30. The left eye shows limitation on abduction. The present case demonstrates an unusual progression of ACC of the Lacrimal Gland.

MYB RNA detection by in situ hybridisation has high sensitivity and specificity for the diagnosis of adenoid cystic carcinoma

Adenoid cystic carcinoma (ACC) is one of the most common primary salivary gland cancers. ACC has several benign and malignant mimics amongst salivary gland neoplasms. An accurate diagnosis of ACC is essential for optimal management of the patients and their follow-up. Upregulation of MYB has been described in 85-90% of ACC, but not in other salivary gland neoplasms. In ACC, MYB upregulation can occur as a result of a genetic rearrangement t(6;9) (q22-23;p23-24), MYB copy number variation (CNV), or enhancer hijacking of MYB. All mechanisms of MYB upregulation result in increased RNA transcription that can be detected using RNA in situ hybridisation (ISH) methods. In this study, utilising 138 primary salivary gland neoplasms including 78 ACC, we evaluate the diagnostic utility of MYB RNA ISH for distinguishing ACC from other primary salivary gland neoplasms with a prominent cribriform architecture including pleomorphic adenoma, basal cell adenoma, basal cell adenocarcinoma, epithelial myoepithelial carcinoma, and polymorphous adenocarcinoma. Fluorescent in situ hybridisation and next generation sequencing were also performed to evaluate the sensitivity and specificity of RNA ISH for detecting increased MYB RNA when MYB gene alterations were present. Detection of MYB RNA has 92.3% sensitivity and 98.2% specificity for a diagnosis of ACC amongst salivary gland neoplasms. The sensitivity of MYB RNA detection by ISH (92.3%) is significantly higher than that of the FISH MYB break-apart probe (42%) for ACC. Next generation sequencing did not demonstrate MYB alterations in cases that lacked MYB RNA overexpression indicating high sensitivity of MYB RNA ISH for detecting MYB gene alterations. The possibility that the sensitivity may be higher in clinical practice with contemporary samples as compared with older retrospective tissue samples with RNA degradation is not entirely excluded. In addition to the high sensitivity and specificity, MYB RNA testing can be performed using standard IHC platforms and protocols and evaluated using brightfield microscopy making it a time and cost-efficient diagnostic tool in routine clinical practice.

Value of cytopathology in the diagnosis of adenoid cystic carcinoma and an analysis of misdiagnoses

BackgroundThe diagnosis of adenoid cystic carcinoma (ACC) by cytopathology can be challenging. This study was aimed at testing the effectiveness of this technique and at assessing possible differences in the coincidence rate of fine-needle aspiration cytology(FNAC) and brush exfoliation.MethodsThe pathology database of Southwest Medical University( Luzhou, China) was searched for patients who had undergone surgery or biopsy for ACC between January 2017 and January 2022 and had preoperative cytopathologic results. Their cytologic and histologic data were then analyzed retrospectively and the coincidence rates of cytopathology in the diagnosis of ACC were calculated.ResultsCompared with histopathology, the total coincidence rate of the cytologic diagnosis of ACC was 76.8%, that of FNAC was 78.9%, and that of brush exfoliation was 55.6%.ConclusionIn the diagnosis of ACC, cytopathology is an effective tool; this is especially true of FNAC, which plays an important role in the diagnosis of ACC. The authors further suggest that it is advisable for diagnosticians to master the cytopathological features of ACC to reduce the possibility of preoperative misdiagnoses.

Classification of adenoid cystic carcinoma in whole slide images by using deep learning

Adenoid cystic carcinoma (ACC) is a malignant tumor with poor prognosis, and it is prone to relapse locally and metastasize to distant sites after repeated recurrences. In the clinical diagnosis of ACC, it is often confused with basal cell adenoma (BCA). Meanwhile, the problems of the existing methods are insufficient accuracy and time-consuming, which are not conducive to clinical applications. To tackle these issues, an improved lightweight network termed adaptive feature fusion MobileNet (AFFMNet) is proposed to classify ACC and BCA. AFFMNet applies adaptive feature fusion to preserve discriminative information in both shallow-level and deep-level, attention mechanism is explored to reveal the global information by focusing on the lesion area. AFFMNet preforms patch-level classification, and then heatmaps are generated for representing whole slide images (WSIs). After that, the WSI-level classification for ACC and BCA is achieved by feature aggregation and XGBoost classifier. Experiments are conducted on the Chongqing University Cancer Hospital Adenoid Cystic Carcinoma Dataset, it shows the remarkable performance of the proposed AFFMNet with 97.37% accuracy on patch-level and 92.91% accuracy on WSI-level, which is more accurate than the same magnitude lightweight network MnasNet, and less inference time than EfficientNet. AFFMNet is an effective tool for WSIs, and it is conducive to clinical applications.

Analysis of Cytological Misdiagnosis and Oversight of Adenoid Cystic Carcinoma of Salivary Gland.

In this article on adenoid cystic carcinoma (ACC) of salivary gland, we intend to summarize the causes of misdiagnosis and oversight of ACC hoping to improve cytological diagnostic accuracy, clinical management and patient treatment. The study retrospectively reviewed 32 patients with ACC of salivary gland, registered at the Affiliated Hospital of Southwest Medical University from July 2014 to June 2021. These cases were diagnosed by FNA and surgical excision biopsy. All cytopathological results were retrospectively categorized according to Milan system for reporting salivary gland cytopathology (MSRSGC). The accuracy of FNA was verified by surgical excision biopsy. Of these 32 patients, 16 (50.0%) cases were male, and 16 (50.0%) were female. Their age ranged from 21 to 79 years, with an average age of 50.32 years. The highest incidence (15/32, 46.9%) of ACC was observed in patients between 41 and 50 years of age. 10 cases (31.3%) occurred in the parotid gland, 9 cases (28.1%) in the submandibular gland, 9 cases (28.1%) in the sublingual gland, 3 cases (9.4%) in the palate, and 1 case (3.1%) in the lip. Among the 32 cases of ACC, 23 cases (71.9%) were classified to VI, 4 cases (12.5%) to IVa, and 5 cases (15.6%) to II by MSRSGC. A comparison of the FNA results with biopsy showed that the accuracy of FNA in ACC of salivary gland is 71.9%. Being able to identify the cytomorphological features is the key factor for accurate diagnosis of ACC of the salivary gland. Our results confirm that FNA is an important initial screening in the diagnosis of ACC of salivary gland. Increased study of the cytomorphology of ACC is beneficial for more accurate diagnosis of ACC, to reduce misdiagnosis and oversight.

Cutaneous adenoid cystic carcinoma: clinical conundrum of a lower limb mass

BACKGROUND: Adenoid cystic carcinoma is a rare epithelial tumour of the salivary glands It arises even more rarely in the aerodigestive tract, lacrimal glands and adnexal skin glands. Acral metastasis is a rare presentation of carcinoma of unknown origin. Head and neck malignancies with acral metastasis are extremely rare. CASE REPORT: We present our case of metastatic adenoid cystic carcinoma presenting in the form of a tumour arising from an adnexal skin gland of the foot DISCUSSION: The case is an example of atypical presentation and dilemma in diagnosis of adenoid cystic carcinoma (histopathological confusion). To our knowledge there is no case in the literature with similar clinicopathological highlights CONCLUSION: Corroborative information is crucial for accurate diagnosis and appropriate management of patients by multidisciplinary teams. The need for timeous presentation and treatment for masses, even if clinically asymptomatic, is also highlighted Level of evidence: Level 5

Adenoid Cystic Carcinoma of the Breast: Multimodality Imaging Findings and Review of the Literature

Adenoid cystic carcinoma (ACC) of the breast is a rare type of breast cancer with favorable prognosis. There is limited data on the radiological findings of this rare tumor in literature. The aim of this study is to determine the most common imaging features and review the literature. Pathological databases of seven institutions from 2009 to 2021 were retrospectively reviewed, and patients with a diagnosis of ACC of the breast were determined. Thirteen patients whose imaging studies could be recalled from the picture archiving systems (PACS) were included in the study. Clinical and pathological findings as well as follow-up data were recorded. Radiological findings were analyzed and categorized based on BI-RADS 5th edition. There were 16 mass lesions in 13 patients (two multifocal cases, one case with recurrence). Mammography demonstrated 14 masses, while ultrasound (US) demonstrated all. MRI was available in only seven cases, with eight masses. The most common findings were round or oval shape on all modalities (78.57%-93.75%). Other frequent findings were parallel orientation (81.25%), isoechoic or hyperechoic echogenicity (62.5%), high T2 signal (87.5%), restricted diffusion (71.43%), and homogeneous enhancement (62.5%). Mammography, US and MRI showed circumscribed margins resembling a benign lesion in 35.71%, 37.5% and 50% of the lesions respectively. Three patients had a cyst-like echogenicty on US. Half of the lesions were avascular on Doppler US (6/12) and half were soft (2/4) on strain elastography. Although there were benign features on all imaging modalities seperately, all lesions could be categorized as BI-RADS 4 or 5 when the findings were combined. However 9/16 masses were BI-RADS 4A, emphasizing the subtlety of the malignant features. ACC of the breast can present with findings resembling a benign lesion on different imaging modalities. Although combination of all imaging findings correctly indicated the suspicious nature of the lesions in all cases, final classification was BI-RADS 4A in most of them. Radiologists should be aware of the more frequent findings of ACC of the breast for early diagnosis. US findings of isoechoic or hyperechoic appearance, and cyst-like echogenicity have not been reported previously in literature.

Primary tracheal obstruction caused by adenoid cystic carcinoma during pregnancy: A case report

The incidence of malignant tumors diagnosed during pregnancy is increasing, often ascribed to the recently recognized trend that many women are postponing childbirth. Although early diagnosis is optimal for both mothers and fetuses, the diagnosis of malignant tumors during pregnancy is often delayed until an advanced stage, because generalized symptoms of pregnancy and malignancy may overlap, such as shortness of breath, chest or abdominal discomfort. The study patient was 21years old, and 31weeks-pregnant when she was diagnosed with primary tracheal adenoid cystic carcinoma (ACC). The patient initially presented with dyspnea and decreased blood oxygen saturation and underwent a cesarean section on the first night of hospitalization, resulting from fetal distress. This case report intended to investigate potential barriers to the timely diagnosis of tracheal ACC and consider optimal management strategies when it is diagnosed during pregnancy.

Evaluation of Tru-Cut biopsy in differential diagnosis and challenges in breast adenoid cystic carcinoma on a case basis

Adenoid cystic carcinoma (AdCC) is a very rare low-grade invasive carcinoma primarily in the breast. The fact that similar patterns can be observed in invasive breast carcinomas (IВC) such as AdCC and breast ductal carcinoma in situ (DCIS) in Tru-Cut biopsies creates difficulties in the differential diagnosis. Case presentation. A 70-year-old female patient was admitted to our outpatient clinic with the complaint of a palpable mass in the left breast subareolar region. In the light microscopy examination of 3 tissue samples with a size of 3 measurements, IBC-like tubular structures, some of which were formed by tiny uniform cells with narrow cytoplasm, and some with eosinophilic material, and solid nest structures suggesting DCIS in focal areas were observed. Immunohistochemical examination showed continuity of myoepithelial cells with p63 and calponin, and epithelial cells, staining with Cd117 and CK7. No staining was observed with progesterone, estrogen, and Cerbb2. The staining rate of Ki-67 was determined as 2 percent. A diagnosis of AdCC was made with these findings. Conclusions. It is important to search for different patterns in addition to double cell population and pay attention to the material in the lumens in breast Tru-Cut biopsies that contain AdCC patterns that may cause the diagnosis of IBC and DCIS in error.

A pilot study of 68 Ga-PSMA-617 PET/CT imaging and 177Lu-EB-PSMA-617 radioligand therapy in patients with adenoid cystic carcinoma

BackgroundThis pilot study was designed to evaluate the diagnostic value of 68 Ga-PSMA-617 and 18F-FDG PET/CT in adenoid cystic carcinoma (ACC) and to assess the safety and therapeutic response to PSMA radioligand therapy (RLT) in ACC patients.MethodsThirty patients pathologically diagnosed with ACC were recruited into the cohort. Each patient underwent 68 Ga-PSMA-617 and 18F-FDG PET/CT within 1 week. The number and SUVmax of PET-positive lesions were recorded and compared. Four patients accepted RLT using 177Lu-EB-PSMA-617, in a dosage of approximately 1.85 GBq (50 mCi) per cycle for up to 3 cycles.ResultsCompared with 18F-FDG, 68 Ga-PSMA-617 revealed more PET-positive extrapulmonary tumors (157 vs. 141, P = 0.016) and higher SUVmax (8.8 ± 3.6 vs. 6.4 ± 4.2, P = 0.027). However, 68 Ga-PSMA-617 revealed less PET-positive pulmonary lesions (202 vs. 301, P < 0.001) and lower SUVmax of tumors (3.1 ± 3.0 vs. 4.2 ± 3.9, P < 0.001) than 18F-FDG. The combination of 68 Ga-PSMA-617 and 18F-FDG can detect 469 PET-positive lesions, which was superior to each alone (469 vs. 359 vs. 442, P < 0.001). Two patients achieved remarkable response after PSMA RLT, while the other two patients showed reduced tumor uptake of recurrent foci, lung and liver metastases, whereas increased SUVmax of bone metastases.Conclusions68 Ga-PSMA-617 PET/CT is a valuable imaging modality for the detection of ACC and combining with 18F-FDG PET/CT will achieve a higher detection efficiency. PSMA RLT may be a promising treatment for ACC and is worth of further investigation.Trial registration: Diagnosis of Adenoid Cystic Carcinoma on 68 Ga-PSMA-617 PET-CT and Therapy With 177Lu-EB-PSMA-617 (NCT04801264, Registered 16 March 2021, retrospectively registered).URL of registry: https://clinicaltrials.gov/ct2/show/NCT04801264.