Primary adenocarcinoma of the base of tongue a rare case Dil kknn - PDF document

Primary adenocarcinoma of the base of tongue: a rare case Dil kökünün primer adenokarsinomu: Nadir bir olgu1, Erdo¤an Özgür1, Gökçe Tanyeri1, Semin Ayhan21Department of Otorhinolaryngology, Celal Bayar University Medical Faculty, Manisa, Turkey2Department of Pathology, Celal Bayar University Medical Faculty, Manisa, Turkey Oropharyngeal cancers constitute less than %10 of allOropharyngeal cancers constitute less than %10 of allA vast majority (70%) of patients withoropharyngeal cancers are male. The main etiological fac-tors of oropharyngeal cancers are: smoking and alcoholtors of oropharyngeal cancers are: smoking and alcoholUnfortunately, most of the patients with oropharyngealUnfortunately, most of the patients with oropharyngealThe main reason ofdelay in diagnosis is generally related to the asymptomaticdevelopment of the tumoral mass; however, odynophagia,ing due to its anatomical difficulties during surgery andmay cause functional problems such as chronic aspiration,may cause functional problems such as chronic aspiration,On the other hand, adenocarcinoma, a commonhistopathological type for digestive system, is very rarelyreported at this region, even though oropharynx is accept-J Med Updates2014;4(2):81-85lazmlar, adenokarsinom. AbstractHead and neck cancers are the sixth most common type of cancer inworld; and of these, less than 10% are or

opharyngeal cancers. The mostcommon malignant tumor of oropharynx, even though it is accepted asa part of digestive system, is squamous cell carcinoma. On the otherhand, adenocarcinoma, a common histopathological type for digestivesystem, is very rarely reported at base of tongue. Therefore, this articlewas aimed to present a 72-year-old male patient with a primary adeno-carcinoma of the base of tongue and discuss the clinical presentation,radiological evaluation, histopathological examination, treatmentmodalities and prognosis with the literature. Keywords: Head and neck neoplasms, oropharyngeal neoplasms,adenocarcinoma. Görkem Eskiizmir, MD, FTBORLHNS.Department of Otorhinolaryngology, June 3, 2014; July 3, 2014©2014 Sürekli E¤itim ve Bilimsel Ara”t‰rmalar Derne¤i(SEBAD) doi:10. present a case with a primary adenocarcinoma of the baseof tongue and discuss the clinical presentation, histopatho-erature. A 72-year-old malepatient with a history of choking andpieces), (Figs. 4aand b). Both histopathological and EskiizmirG et al. 82 Fig.1. (cisplatin) was recommended; however,only IMRT wasapplication of chemotherapy. Cilt/ Volume4|/ Issue2|/ August2014 Primary adenocarcinoma of the base of tongue 83 Fig.3. Fig.2. a and, all of the lesions in this study were originatedfrom minor salivary glands. On the other hand, primaryadenocarcinoma of the base

of tongue is very unusual. Inthe current article, a case with a locally advanced primaryadenocarcinoma of the base of tongue with a regional cer-vical lymph node metastasis, which is a characteristic featureof malignancies of base of tongue, has been presented.Adenocarcinomas generally contain glycogen before andafter digestion with diastase. On the other hand, most ofother tumors have very little or no glycogen content. Inaddition, intracytoplasmic mucins are not evident withmucicarmine or alcian blue stain.[6]In this case, the diagno-sis of adenocarcinoma was determined depending on themorphologic and immunohistochemical evaluations(mono-CEA and AE1/AE3 positivity). In addition, no evi-dence of minor salivary gland was detected; therefore it wasconsidered as primary adenocarcinoma of the base of tongueŽ. According to NCCN 2012 guidelines, the recom-mended treatments for locally advanced oropharyngealcancer are definitive radiotherapy, surgical resection withneck dissection and adjuvant radiotherapy when at leastone positive lymph node is detected, and definitive radio-therapy with systemic therapy.therapy with systemic therapy.However, these treatmentmodalities are especially suggested for squamous cell car-cinoma; and, unfortunately, optimal treatment of adeno-carcinoma of base of tongue has not been established dueto its rarity. Kessler et al.

offered that combined approachcan be applied for the treatment of malignant salivarycan be applied for the treatment of malignant salivaryTherefore, we alsopreferred to perform wide tumor resection with neck dis-section and adjuvant radiochemotherapy, althoughchemotherapy could not be performed due to perform-ance status of the patient. The follow-up of our patientdemonstrated no local or regional recurrence; however,is high and survival rate is relatively low in malignanttumors of the base of tongue regardless of the histopatho-included 262 cases of squamous cell carcinoma of the baseof tongue, the 5 year-survival rate for all stages wasof tongue, the 5 year-survival rate for all stages wasIn another study that examined the efficacy oftreatment modalities on prognosis in patients with squa-mous cell carcinoma of the base of tongue, 5-year survivalrate for patients treated by irradiation was 41%, forpatients treated by surgery was 58%, and for untreatedpatients treated by surgery was 58%, and for untreatedThey emphasized that a remarkable dif-untreated patients, although no obvious difference in thety (77% died in 10 years) and distant metastasis (57%) in EskiizmirG et al. 84 Fig.4.tions and showing invasions between muscle(H&E, x100) (a). Intracytoplasmic and membranous monoclonal CEA in tumor cells(mCEA x a However, our literature survey demonstra

tedlack of evidence about the short and long term outcomesof the base of the tongue. Therefore, multicenter and mul-1.Auluck A, Hislop G, Bajdik C, Poh C, Zhang L, Rosin M. Trends2.Kjaerheim K, Gaard M, Andersen A. The role of alcohol, tobacco,3.Jones A, Rafferty M, Fenton J, Jones T, Husband DJ. Treatment4.Van Monsjou HS, Lopez-Yurda MI, Hauptmann M, van den5.de Vries EJ, Johnson JT, Myers EN, Barnes EL Jr, Mandell-Brown6.Ellis GL. Clear cell neoplasms in salivary glands: clearly a diagnos-7.National Comprehensive Cancer Network (U.S.). Head andNeck Cancers version 2. 2013.Journal of the national compre-hensive cancer network: JNCCN. http://www.nccn.org8.Kessler DJ, Mickel RA, Calcaterra TC. Malignant salivary gland9.Sessions DG, Lenox J, Spector GJ, Chao C, Chaudry OA. Analysis / Volume4|/ Issue2|/ August2014 Primary adenocarcinoma of the base of tongue 85 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND3.0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc-tion in any medium, provided the original work is properly cited.Please cite this article as:Eskiizmir G, Özgür E, Tanyeri G, Ayhan S. Primary adenocarcinoma of the base of tongue: a rare case. J Med Updates2014;4(2):81