A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma
Adam D Fisher, Shawn A McClure, Johnny Franco
Citation Information :
Fisher AD, McClure SA, Franco J. A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma. Int J Head Neck Surg 2015; 6 (4):181-186.
This is a case report of synchronous, noncollision head and neck malignancies, consisting of a large polymorphous low-grade adenocarcinoma (PLGA) and an unknown primary squamous cell carcinoma (SCC) that was diagnosed on final pathology.
Materials and methods
Positron emission tomography– computed tomography (CT) scan with and without contrast was obtained, which showed a large destructive soft tissue mass emanating from the right maxilla into the right maxillary sinus with invasion into the surrounding tissue and bone, compatible with an underlying primary maxillary malignancy. Increased D-18 fluorodeoxyglucose activity was also seen in the neck corresponding to numerous bilateral cervical lymph nodes. Magnetic resonance imaging showed the extent of the soft tissue mass, which expanded to the inferior aspect of the right orbital floor, with no evidence of gross invasion into the orbit.
Results
The patient underwent a subtotal maxillectomy, bilateral modified radial neck dissection, and reconstruction. Pathology revealed metastatic PLGA present in the right cervical lymph nodes. Left cervical lymph nodes, however, revealed metastatic SSC. The patient was taken back to the operating room and a panendoscopy was performed. Physical examination was benign and multiple biopsies were negative for SSC. The patient underwent radiation therapy for PLGA and unknown primary SSC antigen.
Conclusion
Synchronous tumors of the head and neck are seldom reported and they present unique treatment challenges. This case report discusses the diagnosis, management, and unique nature of two malignant synchronous noncollision tumors in the head and neck.
How to cite this article
Fisher AD, McClure SA, Franco J. A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma. Int J Head Neck Surg 2015;6(4):181-186.
Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol 2010 Oct;11(10):1001-1008. doi: 10.1016/S1470-2045(10)70113-3.
The cribriform features of adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma: cytokeratin and integrin expression. Ann Diagn Pathol 2001 Dec;5(6):330-334.
Immunohistochemical expression of cytokeratins 7 and 20 in malignant salivary gland tumors. Mod Pathol 2004 Apr;17(4):407-415.
Value of p63 and cytokeratin 5/6 as immunohistochemical markers for the differential diagnosis of poorly differentiated and undifferentiated carcinomas. Am J Clin Pathol 2001 Dec;116(6):823-830.
Assessment of p63 expression in oral squamous cell carcinomas and dysplasias. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004 Dec;98(6):698-704.
Polymorphous low-grade adenocarcinoma: the University of Pittsburgh experience. Arch Otolaryngol Head Neck Surg 2010 Apr;136(4):385-392.
Polymorphous lowgrade adenocarcinoma: a case report. Dentomaxillofac Radiol 2013 Feb;42(2):1480-4843.
Polymorphous low grade adenocarcinoma: a clinicopathologic study of 164 cases. Cancer 1999 Jul 15;86(2):207-219.
Clinical and therapeutic features of polymorphous low-grade adenocarcinoma. Oral Surg Oral Med Oral Pathol 1994 Jan;77(1):41-47.
Polymorphous low-grade adenocarcinoma: a study of 40 cases with long-term follow up and an evaluation of the importance of papillary areas. Am J Surg Pathol 2000 Oct;24(10):1319-1328.
Polymorphous low grade adenocarcinoma: literature review and report of lower lip lesion with suspected lung metastasis. J Maxillofac Oral Surg 2011 Mar;10(1):60-63.
Orbital and skin metastases in a polymorphous low grade adenocarcinoma of the salivary gland. J Laryngol Otol 1995 Dec;109(12):1222-1225.
Tonsillectomy in diagnosis of the unknown primary tumor of the head and neck. Otolaryngol Head Neck Surg 2000 Jan;122(1):52-55.
Role of tonsillectomy in the search for a squamous cell carcinoma from an unknown primary in the head and neck. Br J Oral Maxillofac Surg 2008 Jun;46(4):283-287. doi: 10.1016/j.bjoms.2007.11.017. Epub 2008 Feb 20.
Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of relapse. Head Neck 2002 Mar;24(3):236-246.
Multiple primary malignant tumors: a survey of the literature and statistical study. Am J Cancer 1932;16:1358-1414.
Multiple primary malignancies in head and neck cancer. Arch Otolaryngol Head Neck Surg 1986 Nov;112(11):1172-1179. PubMed PMID: 3755993.
Multicentric squamous-cell carcinoma of the upper aerodigestive tract. Head Neck Surg 1980 Nov-Dec;3(2):90-96.
Synchronous and metachronous squamous cell carcinomas of the head and neck mucosal sites. J Clin Oncol 2001 Mar 1;19(5):1358-1362.
Multiple primary neoplasms at a single institution: differences between synchronous and metachronous neoplasms. Am J Clin Oncol 2000 Aug;23(4):364-370.
Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin. Cancer 1953 Sep;6(5):963-968.
Multiple synchronous and metachronous cancers of the upper aerodigestive tract: a nine-year study. Laryngoscope 1989 Dec;99(12):1267-1273.
Collision tumor of the thyroid and larynx: a patient with papillary thyroid carcinoma colliding with laryngeal squamous cell carcinoma. Thyroid 2008 Dec;18(12):1325-1328.
Laryngeal collision tumor: pleomorphic adenoma and squamous cell carcinoma. J Otolaryngol Head Neck Surg 2009 Apr;38(2):E31-E34.
A histopathologic comparison between synchronous and single primary oral squamous cell carcinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2010 May;109(5):732-738.
Synchronous squamous cell carcinoma and malignant lymphoma in the head and neck region. Auris Nasus Larynx 2007 Jun;34(2):273-276.
Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.