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Adenoid cystic carcinoma — Clinical Guidelines

Overview

Adenoid cystic carcinoma (ACC) is a rare, slow-growing malignancy predominantly affecting the salivary glands but also occurring in the trachea and bronchi. It is characterized by its cribriform pattern and propensity for perineural invasion. 1 3 4

Diagnosis

Cytomorphology: Fine-needle aspiration (FNA) can be used but has a significant false-negative rate (36.4%). 2

Imaging: CT and MRI are essential for staging and assessing local extent.

Bronchial Washings: Can diagnose tracheal and bronchial ACC with characteristic cytomorphology. 4

Biopsy: Definitive diagnosis often requires histopathological examination.

Management

Radiation Therapy: Percutaneous CT-fluoroscopic-guided radioisotope seed placement offers targeted high-dose radiation with reduced normal tissue exposure. 1

Surgical Resection: Tracheal resection is preferred when feasible; alternative techniques like anterior castellated approaches may be necessary for complex cases. 3

Adjunctive Treatments: No specific drug classes or doses mentioned in abstracts.

Special Populations

Elderly: Management considerations may include surgical feasibility and tolerance to radiation therapy. 1 3

Comorbidities: Presence of comorbidities may influence treatment modality choices, favoring less invasive approaches when possible. 1 3

Key Recommendations

Utilize percutaneous CT-fluoroscopic-guided radioisotope seed placement for precise radiation delivery in tracheal ACC management. (Evidence: Moderate) 1

Consider anterior castellated surgical approaches for complex tracheal ACC resections to optimize access and nerve preservation. (Evidence: Weak) 3

Fine-needle aspiration should be complemented with histopathological confirmation due to high false-negative rates in ACC diagnosis. (Evidence: Moderate) 2

References

1 Doggett S, Chino S, Lempert T, Federhart J. Percutaneous CT-fluoroscopic-guided radioisotope seed placement for the management of adenoid cystic carcinoma of the trachea. Brachytherapy 2017. link 2 Tabatabai ZL, Auger M, Kurtycz DF, Laser A, Souers RJ, Laucirica R et al.. Performance Characteristics of Adenoid Cystic Carcinoma of the Salivary Glands in Fine-Needle Aspirates: Results From the College of American Pathologists Nongynecologic Cytology Program. Archives of pathology & laboratory medicine 2015. link 3 Hartley BE, Fagan JJ, Rhŷs-Evans PH. Excision of adenoid cystic carcinoma of the cervical trachea via an anterior castellated approach. The Journal of laryngology and otology 1995. link 4 Radhika S, Dey P, Rajwanshi A, Guleria R, Bhusnurmath B. Adenoid cystic carcinoma in a bronchial washing. A case report. Acta cytologica 1993. link

Adenoid cystic carcinoma