A case of sublingual adenoid cystic carcinoma involving the mandible presenting as a “skip lesion”

Mariko Fujita, Yoshinobu Yanagi, Arthur R.G. Cortes, Emiko Saito Arita, Tomoo Onoda, Hitoshi Nagatsuka, Jun-Ichi Asaumi

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Abstract

Adenoid cystic carcinoma (ACC) is a slowly growing malignant neoplasm with a propensity for perineural invasion. Microscopic invasion of ACC often prevents its detection on computed tomography (CT) or magnetic resonance imaging (MRI). We herein report a rare case of sublingual ACC presenting as a “skip lesion” that rapidly infiltrated the mandible after tumor resection. A 64-year-old man presented to Okayama University Hospital with an 18-month history of swelling in the right floor of the mouth. Clinical examination displayed an ulcerated swollen mass in that region. An enhanced mass was detected in the right sublingual space on CT and MRI. Bone surface erosion was observed at the inferior border of the mandible, but continuity with the sublingual mass or mass around that lesion was not detected by imaging. Sublingual tumor resection and selective neck dissection were performed by the pull-through method. Histopathologically, the surgical margins were free of cancer cells, and the tumor was diagnosed as ACC. Continuity with the sublingual mass and mandibular bone was not detected intraoperatively. However, marked bone resorption was detected in the anterior mandible 3 months after the operation. Biopsy was performed, and the findings indicated the same histological type of sublingual ACC. This case suggests that a malignant tumor close to the jaw bone requires the clinician to consider the possibility of bone invasion and to observe a wide region surrounding the tumor using imaging examination.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalOral Radiology
DOIs
Publication statusAccepted/In press - Nov 27 2017

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Keywords

  • Adenoid cystic carcinoma
  • Magnetic resonance imaging
  • Recurrence

ASJC Scopus subject areas

  • Dentistry (miscellaneous)
  • Radiology Nuclear Medicine and imaging

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