A 50-year-old man presents with a hard palate mass. Biopsy shows adenoid cystic carcinoma. MRI reveals tumor tracking along the greater palatine nerve toward the pterygopalatine fossa. Which pattern of spread is most characteristic of this tumor and directly influences the extent of surgical resection?
- A Perineural spread along named nerves ✓
- B Lymphatic spread to level II nodes
- C Hematogenous spread to lungs
- D Transcapsular spread into the neck
Correct answer: A. Perineural spread along named nerves
Explanation
Adenoid cystic carcinoma has a well-documented propensity for perineural spread, which occurs in up to 50-70% of cases. This tracking along nerves (commonly the facial nerve in parotid tumors, or greater/lesser palatine nerves in palate tumors) mandates wide surgical margins with nerve tracing to the skull base and often adjuvant radiotherapy. Lymphatic spread is uncommon in adenoid cystic carcinoma compared to other salivary malignancies. Hematogenous spread to lungs is a late feature but does not guide the extent of primary resection.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.