Adenoid Cystic Carcinoma of the Maxilla, CT Follow-Up: A Case Report

Background: Intraoral adenoid cystic carcinoma is an uncommon pathology with a variable clinical course, it develops as a slow growing swelling characterized by wide local infi ltration. Most patients are in their fourth and sixth decades of life, and females are slightly more affected than males. Case report: An 46-years-old woman was seen at University Hospital of Cuiabá with strong pain in the upper edge of the right side region. Patient reported being subjected to tooth extraction in the area where the pain was equivalent to 4 years, and in intraoral examination revealed an increase in volume of the region of the right side palate. The patient was submitted to the radical surgery promoting the removal of the lesion in the areas of the right maxilla, maxillary sinus and floor of the right orbit. The diagnosis was adenoid cystic carcinoma and after one year of follow-up the patient showed no presence of recurrences. Case Report Adenoid Cystic Carcinoma of the Maxilla, CT Follow-Up: A Case Report Bruno Vieira Caputo1*, Gilberto Araujo Noro Filho1, Claudio Costa2, Artur Aburad de Carvalhosa3 and Elcio Magdalena Giovani4 1Paulista University (Unip), São Paulo, SP, Brazil 2Stomatology Department, Dental School, University of São Paulo, São Paulo, SP, Brazil 3Department of Oral Pathology, School of Dentistry, University of Cuiabá. And Coordinator, Department of Oral Pathology in Hospital of Cancer, Cuiabá, MT, Brazil 4Chairman, Professor in Integrated Clinic Discipline, Coordinator of Center for Study and Care of Special Patients (CEAPE). Professor in Postgraduate Dentistry Courses, Paulista University (Unip), São Paulo, SP, Brazil Dates: Received: 20 December, 2016; Accepted: 04 January, 2017; Published: 07 January, 2017 *Corresponding author: Bruno Vieira Caputo, Paulista University, UNIP, Center for Study and Care of Special Patients, CEAPE, Rua Doutor Bacelar, 1212, Vila Clementino, CEP 04026-000, São Paulo, SP, Brazil, Tel: 551123672307; E-mail:


Introduction
Intraoral adenoid cystic carcinoma (ACC) is an uncommon pathology with a variable clinical course. Due to lack of highquality evidence, optimal treatment continues to evolve over time [1]. This rare epithelioid head and neck tumor accounting for about 7.5% of all salivary gland malignancies [2] and in the oral cavity this entity comprises only 6.3-10.2% of all minor salivary gland tumors [3]. ACC is originating from ductal cells and myoepithelial cells from intercalated ducts. Most lesions are located in the parotid glands, submandibular and accessory salivary and are rare in the sublingual [4]. Generally, it develops as a slow growing swelling characterized by wide local infi ltration. It can be followed by pain, due to the trend for perineural invasion. Loco-regional lymphatic disease is uncommon; late distant metastases and local recurrences are relatively common. Most ACC patients are in their fourth and sixth decades of life, and females are slightly more affected than males [5][6][7][8].
Surgical resection with clear margins is currently considered as the standard of care for a vast majority of patients with minor salivary gland tumors including ACCs [1,5].
The most important factors infl uencing the prognosis are the clinical staging of the tumor and the surgical margins status, whereas the cervical lymph node involvement is a signifi cant predictive factor for mortality due to tumor disease.
Between these prognostic specifi c survival factors only surgical margin status independently infl uences loco-regional control and disease [6].

Case Report
A 46-years-old woman ( Figure 1A

Discussion
According to the literature [1,6] and in this report adenoid cystic carcinoma occurs in most cases in the fourth and sixth decade of life and is slightly more common in women than in men. Salivary gland tumors rarely develop within maxillary and mandibular bony tissue [9]. The present study confi rms previous reports [6,[10][11][12] the palatal mucosal glands are more frequently involved than any other group of intraoral minor salivary glands. Kim et al. [13], have also reported frequent occurrence of ACC in minor salivary glands of the nose and paranasal sinuses. Surgery was the prime treatment to Adenoid cystic carcinoma like in the others studies [1,5,6,8,12]. However, it is often diffi cult to obtain a complete resection because of vascular invasion and perineural infi ltration [8].
Adjuvant radiotherapy was administered to those patients with positive or close resection margins, advanced-stage disease, deep infi ltration (of bone, cartilage or deep muscle) or lymph node metastases [6,12]. Postoperative radiation therapy enhances local and regional control in ACC [8]. This use though somewhat controversial is increasing over time. PNI, primary site, and T-stage signifi cantly impact upon local control and disease-free survival. Larger prospective studies with mature follow-up are needed to defi ne the optimal treatment of ACC   of the head and neck [1]. In our report we did not administered radiotherapy as adjuvant treatment to the patient, and in the follow-up showed no tumor recurrence.
Regarding to modalities (surgery and radiotherapy) of treatment, combined treatment is more often recommended than surgery alone, especially when negative prognostic factors exist, but some studies demonstrated no difference between combined treatment and surgery only [5,12,14] showed that radiotherapy as well as chemotherapy did not infl uence overall survival signifi cantly and complements that radiation should be therefore used for patients with higher stages or additional bad prognostic factors and as a therapeutic tool for patients with recurrence as used in this study.
In summary, this report presents a recent case of a woman with adenoid cystic carcinoma in the palate region, and using surgical removal as the only treatment, the patient after 1 year of follow-up with CT showed no presence of recurrences. And the making of the acrylic resin plate was of great importance to assist in improving the oral health and quality of life of the patient.