A retrospective review of 6 patients with adenoid cystic carcinoma (ACC) of the submandibular gland treated between 1978 and 1991 was presented. Two patients who underwent aggressive surgery were disease-free, local control failed in 2 patients, and pulmonary metastasis developed in 2 patients without locoregional disease.
This study supports the following conclusions:
1. The perimeters of ACC are always more extensive than they appear to be clinically, because ACC has a strong tendency to invade the perineural space and extend for long distance.
2. In preoperative diagnosis, aspiration cytology is essential for accurate diagnosis. Diagnostic imagings such as sialography, X-ray CT and MRI are helpful in detecting the size and extent of the tumor. RI study is indispensable in detecting the perineural spread
3. Surgery is the treatment of choice, and it should be as extensive as possible, with a wide margin of healthy tissue. Radiation therapy, although not curative, plays an important role in prolonging survival and pain relief.
4. ACC is characterized by slow growth, frequent recurrence, and systemic spread even after long-term survival without disease, therefore adjuvant chemotherapy should be taken into consideration.