M. Shannon Allen

Adenoid cystic carcinoma: biologic behavior in 38 patients.

This study presents the clinical and pathologic data on 38 patients with adenoid cystic carcinoma. Most of the tumors arose from the major salivary glands or the mucus glands of the upper respiratory tract and oral cavity. The typical biological behavior of these tumors was slow but aggressive local growth despite all therapy, followed by eventual death from local disease and/or metastases. Twenty‐eight of the patients have died, 22 from adenoic cystic carcinoma, 3 from postoperative complications, and 3 from intercurrent disease. Of the 10 living patients, 4 have active disease, 2 have no evidence of disease 14 years after diagnosis, and 4 have no evidence of disease but follow‐up is less than 5 years. We compared various microscopic features of the tumors, including histologic grading, with prognosis but did not demonstrate a correlation in this small series.

Hamartomatous inverted polyps of the rectum.

Hamartomatous inverted polyps of the rectum are benign single slightly polypoid intramural masses of the bowel wall formed by an inverted or downward growth of mucosal glands through the muscularis mucosa into the submucosa. The atypical and distorted mucous glands and the ectopic position of both mucous glands and lakes of mucus in these benign lesions may cause an erroneous diagnosis of well‐differentiated carcinoma. Three cases with a differential diagnosis are presented.

Low-grade papillary adenocarcinoma of the palate

Low‐grade papillary adenocarcinoma of the palate is a rare but distinctive neoplasm. This tumor progresses slowly and is often misdiagnosed and inadequately treated initially. Although its slow growth may allow the clinician a second chance at curative surgery even years after the original excision, the axiom of adequate total excision by the initial surgeon is still important, since this carcinoma will recur locally and will metastasize to regional lymph nodes. However, in each of the two cases presented in this report, the metastasis was almost “inclusion‐like:” it involved only a single cervical lymph node.

Lymph node involvement by direct extension in adenoid cystic carcinoma. Absence of classic embolic lymph node metastasis.

Thirty‐four cases of adenoid cystic carcinoma seen at the University of Virginia Hospital from 1946 to 1974 were reviewed, with special emphasis on lymph node involvement by tumor. Lymph node involvement was found in three cases of primary tumors of the submaxillary gland, and all of the affected lymph nodes were in the immediate vicinity of the primary tumor. Two lymph nodes were involved in two of the cases, and one node was involved in the third case. In all of these lymph nodes, adenoid cystic carcinoma was present in the soft tissue surrounding the node, and the tumor extended into the node. No metastatic tumors were observed in 46 lymph nodes removed incidentally at the time of local excision of the primary tumors in 10 additional cases or in 212 lymph nodes examined after unilateral radical neck dissections in six other cases. Five autopsies in this series showed no lymph node metastases. In this series of cases adenoid cystic carcinoma only invades lymph nodes in the immediate vicinity of the primary tumor. When lymph node involvement does occur, it does not result from embolic lymph node metastatsis; rather, a direct invasion of the lymph node from tumor in the perinodal soft tissue occurs. Obviously, this small study does not completely exclude the possibility of embolic metastasis; however, if it does occur, it must be extremely rare.