[Treatment of laryngeal adenoid cystic carcinoma]

Laryngeal localization (nearly always hypoglottic) of adenoid cystic carcinoma is quite rare (0.6% of all malignant laryngeal tumors). In most cases the local development of the neoplasm is slow, of an infiltrating and highly invasive nature (affecting the cartilage, thyroid gland, esophagus). On the other hand in some cases, particularly in the laryngeal-tracheal localization, the tumors take on an exophytic, sessile, polypoid aspect. Although the evolution is quite slow prognosis is poor due to the latent spreading of distant metastasis (average survival is 8 years). Prognosis is further worsened by delay in diagnosis due to the poor, aspecific initial symptoms. C.A.T. and N.M.R. have made a marked contribution to improved diagnostic definition, especially in terms of tumor extension, which is of great importance in therapeutic staging. Given the poor results obtained with radiotherapy and chemotherapy the only possible treatment is surgery which, in most cases, must be quite radical. Only in those forms which are still localized (with endoluminal exophytic development) is it possible to perform conservative surgery. Two paradigmatic cases are reported here indicating two different tumor extensions: in the first case total laryngectomy was performed and extended to the thyroid gland and the upper portion of the trachea; in the second, a partial glottic-subglottic laryngectomy was performed with functional restoration of laryngeal function. Conservative surgery is only possible if the hypoglottic neoformation is limited to the larynx, if it is mainly exophytic in nature and if histological examination reveals a low degree of malignancy (a high degree of cell differentiation). Since this type of carcinoma tends to give rise to latent distant metastases prognosis is, in all cases, poor no matter what surgical technique is employed for the primary tumor. Therefore it is imperative that a conservative laryngectomy be performed in all cases where it proves oncologically possible and particular attention should be paid to the quality of the patient's post-surgery life.