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A rare case of lacrimal adenoid cystic carcinoma with large hepatic and multiple pulmonary metastases with successful surgical treatment

View Article: PubMed Central - PubMed

ABSTRACT

Lacrimal gland adenoid cystic carcinoma present with late metastases.

Surgery of the primary is the only proven mode of treatment with radiotherapy used in selected cases.

Disseminated metastases can be managed successfully with staged procedures depending on the general condition of the patient.

This is the first report describing such staged surgical treatment for widespread hepatic and pulmonary metastases with a good outcome.

This is the first report describing such staged surgical treatment for widespread hepatic and pulmonary metastases with a good outcome.

No MeSH data available.


CT chest showing multiple bilateral pulmonary irregular nodules.
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img0010: CT chest showing multiple bilateral pulmonary irregular nodules.

Mentions: A 42 year old lady presented with complaints of vague right upper abdominal pain. She had undergone a left orbitotomy and excision of lacrimal gland for lacrimal adenoid cystic carcinoma five years ago. She received 5 cycles of chemotherapy with leucovorin, cisplatin and 5-FU along with 27 fractions of radiotherapy (5600 rad). On examination she had mild tenderness in the right hypochondrium with hepatomegaly. She had a normal liver profile and tumour markers. Her orbital imaging studies were normal. The computed tomography (CT) of the chest and abdomen revealed a large 10 × 8 × 5 cm lesion in segment VI and another lesion in segment IVB about 4 × 3 × 3 cm in segment IV superficially with multiple bilateral pulmonary irregular nodules Image 1, Image 2. FNAC of the liver lesion confirmed metastatic adenoid cystic disease of cribriform type. We further evaluated her with a Positron Emission Tomography that confirmed the metastatic disease confined to the liver and lungs only. After discussion with our multidisciplinary team, we decided to do staged resection as patients overall general and physical condition did not allow to undergo upfront extensive surgical resection of both liver and pulmonary metastases in the same sitting. We planned resection of the liver disease first due to a higher standardized uptake value (SUV) followed by the pulmonary lesions as they had a lower SUV. Intra-operatively, we found a lesion in segment VII that was stuck to the anterior abdominal wall and also to the right hemidiaphragm and another separate smaller lesion in segment IVB. The rest of the liver looked normal. Right hemi-hepatectomy with segment IVB resection was done. Another single 1.5 × 1 cm metastatic nodule was excised from the posterior peritoneal surface over the diaphragm (Image 3A). Postoperatively the patient recovered well. Histopathology confirmed metastases of adenoid cystic carcinoma of cribriform type to the liver with clear margins (R0 resection) (Image 4).


A rare case of lacrimal adenoid cystic carcinoma with large hepatic and multiple pulmonary metastases with successful surgical treatment
CT chest showing multiple bilateral pulmonary irregular nodules.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037288&req=5

img0010: CT chest showing multiple bilateral pulmonary irregular nodules.
Mentions: A 42 year old lady presented with complaints of vague right upper abdominal pain. She had undergone a left orbitotomy and excision of lacrimal gland for lacrimal adenoid cystic carcinoma five years ago. She received 5 cycles of chemotherapy with leucovorin, cisplatin and 5-FU along with 27 fractions of radiotherapy (5600 rad). On examination she had mild tenderness in the right hypochondrium with hepatomegaly. She had a normal liver profile and tumour markers. Her orbital imaging studies were normal. The computed tomography (CT) of the chest and abdomen revealed a large 10 × 8 × 5 cm lesion in segment VI and another lesion in segment IVB about 4 × 3 × 3 cm in segment IV superficially with multiple bilateral pulmonary irregular nodules Image 1, Image 2. FNAC of the liver lesion confirmed metastatic adenoid cystic disease of cribriform type. We further evaluated her with a Positron Emission Tomography that confirmed the metastatic disease confined to the liver and lungs only. After discussion with our multidisciplinary team, we decided to do staged resection as patients overall general and physical condition did not allow to undergo upfront extensive surgical resection of both liver and pulmonary metastases in the same sitting. We planned resection of the liver disease first due to a higher standardized uptake value (SUV) followed by the pulmonary lesions as they had a lower SUV. Intra-operatively, we found a lesion in segment VII that was stuck to the anterior abdominal wall and also to the right hemidiaphragm and another separate smaller lesion in segment IVB. The rest of the liver looked normal. Right hemi-hepatectomy with segment IVB resection was done. Another single 1.5 × 1 cm metastatic nodule was excised from the posterior peritoneal surface over the diaphragm (Image 3A). Postoperatively the patient recovered well. Histopathology confirmed metastases of adenoid cystic carcinoma of cribriform type to the liver with clear margins (R0 resection) (Image 4).

View Article: PubMed Central - PubMed

ABSTRACT

Lacrimal gland adenoid cystic carcinoma present with late metastases.

Surgery of the primary is the only proven mode of treatment with radiotherapy used in selected cases.

Disseminated metastases can be managed successfully with staged procedures depending on the general condition of the patient.

This is the first report describing such staged surgical treatment for widespread hepatic and pulmonary metastases with a good outcome.

This is the first report describing such staged surgical treatment for widespread hepatic and pulmonary metastases with a good outcome.

No MeSH data available.