Original Contributions
Adenosquamous carcinoma of the upper aerodigestive tract: A clinicopathologic study of 12 cases and review of the literature

https://doi.org/10.1053/ajot.2002.123462Get rights and content

Abstract

Purpose: Adenosquamous carcinoma is an uncommon, controversial neoplasm. To further comprehend its natural history, the clinical and pathological features of 12 new cases were reviewed and analyzed collectively with those described in the English literature. Materials and Methods: Twelve cases of adenosquamous carcinoma of the upper aerodigestive tract with adequate follow-up and available microscopic slides and paraffin tissue blocks were identified in the anatomic pathology files of Presbyterian Hospital of the University of Pittsburgh Medical Center over the period 1983-2001. Results: The 8 men and 4 women ranged in age from 34 to 81 years (mean, 62.8 years). The larynx (5 cases) and the floor of the mouth (4 cases) were the most common sites of origin. Nine patients had cervical lymph nodes positive for carcinoma (8 at diagnosis), 7 experienced local recurrences, and 2 developed distant metastases. Four of 10 (40%) patients with follow-up died of disease. Combining our cases with those in the literature (total of 58 cases) revealed similar findings: 64.7% were associated with positive cervical lymph nodes, 46.7% experienced local recurrences, 23.1% developed distant metastases, and 42.9% died of their disease at a mean follow-up period of 24.7 months. Conclusions: Adenosquamous carcinoma is an aggressive neoplasm with a tendency for early lymph node metastasis, frequent local recurrence, occasional distant metastasis, and death from disease, usually within 2-3 years. Surgery with neck dissection is the treatment of choice. (Am J Otolaryngol 2002;23:160-168. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Section snippets

Materials and methods

Twelve cases of adenosquamous carcinoma occurring in the upper aerodigestive tract with adequate clinical information and available microscopic slides and paraffin tissue blocks were identified in the anatomic pathology files of Presbyterian Hospital of the University of Pittsburgh Medical Center. These cases were accessioned during the period 1983-2001.

Clinical data, including age at diagnosis, sex, race, location of the tumor, symptoms and duration, history of smoking and alcohol consumption,

Clinical

Clinical data pertaining to all 12 cases are shown in Table 1.

. Clinical features of 12 cases of adenosquamous carcinoma of the larynx, floor of the mouth, tonsil, and palate

CaseLocationSex/RaceAgeSymptoms and DurationSmokingAlcoholSize (cm)Stage
1Larynx (Supraglottic)F/W64Hoarseness, dysphagia, sore-throat, hemoptysis, 12 mo>100 pkyrN/A4.5T3 N0 M0
2Larynx (Supraglottic)M/W72Neck mass, 3.5 mo12 cigars/d × 52 yrHeavy, quit 7 yr3.0T2 N2c M0
3Larynx (Transglottic)M/W56Hoarseness, 3 mo90-135 pkyrHeavy3.0

Review of the literature

A review of the English literature revealed at least 46 cases of histologically acceptable adenosquamous carcinoma of the upper aerodigestive tract with sufficient clinical information for further analysis.1, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 16, 17, 18, 19, 20, 21, 22, 23 Additional cases have been reported but were excluded for lack of data pertaining to individual patients.6, 24

The clinical features of these 46 cases plus the 12 included in this report (total 58 cases) are summarized in

Discussion

Our study and review of the literature confirms that adenosquamous carcinoma (ASC) of the upper aerodigestive tract, as defined above, is an uncommon, aggressive neoplasm. It occurs over a broad age range (34 to 81 years) and is 2 to 4 times more common in men. The larynx is the most common site of origin, accounting for 44.8% of all cases, followed by the oral cavity (Table 4). In the larynx, the supraglottis is the preferred site, and in the oral cavity the floor of the mouth and tongue are

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