Concurrent occurrence of adenoid cystic carcinoma of the salivary glands with small cell carcinoma of the liver: A rare case report
A 28-year-old female was referred from the surgical department of our college with a swelling in the cheek for the duration of 1 month.\nHer medical history revealed that she was diagnosed of SCC of liver confirmed by radiographic, histopathologic, and immunohistochemical investigations; 3 months earlier.\nPatient presented a diffuse swelling of about 2 cm in the left cheek region extraorally below the zygomatic area [].\nExtraoral clinical examination showed that the swelling had indistinct limits and there were no surface alterations of the skin over the growth. Palpation of the left side of the cheek identified a firm, nontender mass that was subcutaneously mobile; but partly attached to the underlying structures. The skin covering the tumor was normal. Intraoral examination showed normal mucosa without any surface changes. The mass was palpable from intraoral aspect and was not attached to the mucosa. Initial clinical diagnosis of metastatic tumor in the oral cavity was made. Subsequently, biopsy was performed in the cheek region.\nOral biopsy specimen showed islands with basaloid, medium cells with oval hyperchromatic nuclei, distinct nucleoli, and scanty eosinophilic cytoplasm. Atypia was mild to moderate. The subsequent deeper section showed evidence of few cribriform islands with eosinophilic coagulum. The lumina of the islands are surrounded by cells with eosinophilic cytoplasm. Moreover, rare small cysts and pseudo glandular structures filled with mucous material were seen. In addition to cribriform pattern [], there were also islands of basaloid, hyperchromatic cells were evident in tissue sections.\nThe histopathology of liver biopsy was in favor of SCC [Figure and ]. Since the oral biopsy showed areas of ACC, to confirm the diagnosis, the tissue sections were subjected to immunohistochemistry. The markers used were cytokeratin (CK)-5-6, high molecular weight CK anitbody (HMWA), vimentin, S-100, smooth muscle actin (SMA), Bcl2, neuron specific enolase (NSE), synaptophysin, and c-KIT (CD 117) and CD 10 to differentiate ACC from SCC and other salivary gland tumors. Immunohistochemically, tissue section from the cheek region reacted strongly with anticytokeratin antibodies such as CK5-6 [], including high molecular weight antibody (HMWA), vimentin, S100 [], Bcl2, c-KIT, CD 10 and Anti SMA whereas neuroendocrine markers such as synaptophysin, and NSE did not show positivity.