Primary adenoid cystic carcinoma of the lung: A clinicopathologic study

Background: Primary adenoid cystic carcinoma (ACC) of lung is a rare but distinctive salivary gland-type malignant epithelial neoplasm. Methods: The clinical and pathological features in seven cases of primary ACC of the lung were reviewed. The age of patients ranged from 48 years to 65 years. All were males and smokers. The tumours arose from submucosal bronchial glands as endobronchial growth measuring 2.6 cm to 3.8 cm in greatest dimension. The presenting symptoms were cough, wheezing, dyspnoea and hemoptysis all related to obstruction to airway passage. The tumours were diagnosed by computed tomography (CT) scan and bronchial biopsy. Histologically three main growth patterns were identified admixed in various proportions: cribriform, tubular and solid. Lobectomy or pneumopnectomy was carried out in all the patients. In one patient chemotherapy was given apart from surgery due to detection of tumour infiltration in adjoining lung at the time of surgery. Follow up studies showed all the patients were well except two died of wide spread metastases. Results: Of the two patients who had died one had a predominantly solid pattern of growth limited to bronchus while the other had a predominant cribriform pattern with local infiltration in the adjoining lung parenchyma. Conclusion: Prognosis of ACC of lung depends on the histological type (predominantly tubular has best prognosis while predominantly solid pattern has worst prognosis) and clinical stage at the time of diagnosis (size of tumour, extent of spread and metastases). Despite their generally slow and indolent growth in other locations, ACC arising in lung may in certain cases be more aggressive. © 2008 Indian Association of Cardiovascular-Thoracic Surgeons.