Laryngeal Adenoid Cystic Carcinoma-Two Case Reports and Literature Review.

Abstract

Laryngeal adenoid cystic carcinoma (LACC) is a rare malignant tumor, representing less than 1% of all laryngeal cancers. This tumor arises from the minor salivary or mucous glands of the upper respiratory tract and is characterized by slow growth, local invasiveness, and a high propensity for distant metastases. The submucosal extension and lack of symptoms often delay diagnosis. Such features present notable challenges in clinical practice.We report two cases of LACC in elderly male patients with clinically advanced laryngeal tumors. The first case involved a 73-year-old patient with bilateral laryngeal paralysis and subglottic stenosis caused by a tumor. Despite a prior history of tracheal adenoid cystic carcinoma treated 9 years earlier, recurrence was considered unlikely based on the available clinical, radiological, and pathological findings. Histopathological analysis confirmed the diagnosis of LACC. The patient underwent total laryngectomy, bilateral selective neck dissection, and right hemithyroidectomy. Postoperative histopathology classified the tumor as pT4aN0, and the patient remains recurrence-free 24 months post-surgery.The second case involved a 79-year-old patient presenting with persistent hoarseness and right-sided laryngeal immobility. Computed tomography scan of the neck revealed a hyperdense paraglottic mass causing laryngeal stenosis and thyroid cartilage erosion. After histopathological confirmation of LACC on an open laryngeal biopsy specimen obtained during laryngofissure, the patient underwent total laryngectomy with selective neck dissection and received postoperative radiotherapy at a total dose of 63 Gy in 30 fractions. Seventeen months after treatment, the patient remains in good health without recurrence.These two cases of LACC, both presenting in elderly male patients without traditional risk factors, showed advanced transglottic extension with cartilage invasion and differing histological patterns-cribriform/tubular in one case and predominantly solid in the other. Despite the challenges in achieving early diagnosis due to submucosal tumor growth, both patients responded favorably to surgery with or without adjuvant radiotherapy. The observed variability in macroscopic and microscopic features underscores the need for individualized treatment strategies and supports the potential value of detailed histopathological classification in guiding therapeutic decision-making for this rare tumor type.