Perineural invasion in adenoid cystic carcinoma: Its causation/promotion by brain-derived neurotrophic factor

Adenoid cystic carcinoma (ACC) is a common salivary gland neoplasm with a lengthy clinical course and often late local recurrences after surgical resection. This is accounted for histologically by its infiltrative capacity and distinct propensity for perineural invasion. The expression of biological markers may help explain the clinicopathologic course in ACCs. Brain-derived neurotrophic factor (BDNF) is a growth factor known to be involved in neurogenesis. The aim of this study is to elucidate the expression of BDNF in ACCs, which is currently unknown. Twenty-nine cases of primary ACCs of the head and neck were immunostained to analyze BDNF protein expression. Staining intensity was described as focal or diffuse and graded on a 3-tiered scale. The study group comprised 20 adult females (age 30 to 78) and 9 adult males (age 22 to 70). Sites of involvement included the parotid gland (6 cases), nasopharynx (5), maxilla (4), palate (3), trachea (3), submandibular gland (2), buccal mucosa (2), mandible (1), tongue (1), lacrimal gland (1), and temporal region (1). All tumors exhibited diffuse cytoplasmic staining; 11 cases were classified as 1+ intensity, 12 cases as 2+, and six cases as 3+. Based on the results presented here, BDNF is unformly expressed by ACC and may play a causative role in its predilection for perineural invasion. ACCs may display neurogenesis with high levels of BDNF expression in some tumors. Further studies are warranted to gain better understanding of this possible relationship.