Étude de l’incidence, de la topographie et de la valeur pronostique de l’envahissement péri-nerveux dans les carcinomes adénoïdes kystiques du massif facial

Abstract : Background: adenoid cystic carcinoma (ACC) of the head and neck are uncommon malignant tumors arising from the salivary glands. These tumors have a high propensity for perineural spread, liable for skull base invasion. Objectives: the purpose of this study was to identify imaging and pathological features of perineural invasion (PNI) in ACC of the midface, to define its prognostic value, then to describe the natural history of these tumors. Design: a single-centre retrospective study was managed between 1999 and 2018, at Gustave Roussy Cancer Campus; all the patients with an ACC of the midface were included. PNI was assessed on the first imaging (RMI and CT), and on the histopathological analysis of the resection specimens. The predictive factors of PNI, the overallsurvival (OS) and the disease-free survival (DFS) were analyzed. Results: fifty-five patients were included; 63% had a neural invasion on first imaging. A named nerve involvement was detected by histopathologic examination in 23% of ACC treated surgically. Predictive factors of PNI was an abnormal imaging at diagnosis (p=0,007), and the microscopic infiltration of the nerves sheaths (p=0,03). Mean follow-up was 73 months. The ten-year OS and DFS rates were 69% and 29%, respectively. Our study showed that surgical resection with positive margins on the skull base, particularly on the nerve V2, would not impact significantly patients prognosis, provided that an adjuvant radiotherapy is applied. Conclusions: neurotropism of midface ACC increases the risk of dissemination to the skull base. The treatment recommended for these tumors remains the combination of surgery and adjuvant radiotherapy.
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Master Thesis
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Fabienne Haroun. Étude de l’incidence, de la topographie et de la valeur pronostique de l’envahissement péri-nerveux dans les carcinomes adénoïdes kystiques du massif facial. Médecine humaine et pathologie. 2018. ⟨dumas-02056734⟩

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