PMC7191109_01
Cervical-thoracic CT scans of the patient. Representative axial images of the disease before surgery, post-surgery/before radiotherapy, and 2-years after radiotherapy were shown. The red arrow highlighted the tumor and post-treatment changes in the tumor area.
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F1
The lesions showed slight enhancement with a contrast-enhancement scan and caused compression of the trachea, esophagus and cervical vessels (Figure 1, left panel). Postoperative CT scan showed changes in the area of the thyroid, with thickening of the upper thoracic esophageal wall, but no obvious abnormalities elsewhere in chest (Figure 1, middle panel). Local control was quite satisfactory and the patient was free of local recurrence (Figure 1, right panel).
Pathological features of the tumor. HE staining image indicated a cribriform ACC. Immunohistochemical staining images showed positive expression of Ki-67, SMA, EMA, CK8-18, CK5-6, p63, and CD117, which supported a diagnosis of ACC. ACC, adenoid cystic carcinoma; SMA, smooth muscle actin; EMA, epithelial membrane antigen; CK, cytokeratin; CD, cluster of differentiation.
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F2
Periodic Acid Schiff (PAS) (-), CD56 (-), Syn (-), Calponin (+), smooth muscle actin (SMA) (+), P63 (+), epithelial membrane antigen (EMA) (+), cytokeratin (CK)5/6 (+), CK8/18 (+), CD117 (+), thyroid transcription factor-1 (TTF-1) (-), thyroglobulin (Tg) (-), chromogranin A (CgA) (-) (Figure 2). Perineuronal invasion was also noticed.
Dose distribution of post-surgical radiotherapy. Representative axial, sagittal, and coronal images of dose distribution were shown. Areas with dose coverage of over 54 Gy were presented.
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F3
The patient underwent postoperative intensity-modulated radiation therapy (IMRT) with a prescribed dose of PTV-GTV of 70 Gy, PTV-CTV1 of 60 Gy, PTV-CTV2 of 54 Gy in 31 fractions (1 fraction per day, 5 fractions per week; Figure 3).