Adenoid Cystic Carcinoma of the Larynx: Prolonged Course and Late Pulmonary Metastases: A Case Report

Introduction: Adenoid cystic carcinoma (ACC) of the larynx is an extremely rare tumor, representing less than 1% of all laryngeal malignancies. Its slow progression, perineural invasion, and tendency for late distant metastases, especially pulmonary, pose significant diagnostic and therapeutic challenges. Case Report: We describe the case of a 24-year-old woman with chronic dysphonia and progressive laryngeal dyspnea. Histopathologic examination revealed a subglottic adenoid cystic carcinoma. She underwent total laryngectomy with bilateral functional neck dissection and total thyroidectomy. Postoperative recovery was uneventful, and no adjuvant therapy was administered. Fourteen years later, she presented with bilateral pulmonary metastases, revealed by persistent dry cough. Histologic subtype: cribriform pattern identified, without solid component. Discussion: Laryngeal ACC typically follows a protracted clinical course with frequent local recurrence and delayed metastases. Surgical resection remains the mainstay of treatment, while adjuvant radiotherapy is indicated for cases with positive margins or aggressive histologic patterns. The solid histologic subtype is the most significant prognostic factor, surpassing the AJCC stage in predicting outcomes. Conclusion: This case highlights the importance of lifelong surveillance for patients with laryngeal ACC, even after apparently curative surgery, due to the high risk of late recurrence and metastasis.