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Adenoid cystic carcinoma (ACC) is a rare, slow-growing but locally aggressive malignant tumor that arises from minor salivary glands, including those located in the nasal cavity, paranasal sinuses, and upper aerodigestive tract.

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It is known for its Perineural spread (PNS) , local recurrence, and delayed distant metastasis.

Epidemiology

• Accounts for <5% of sinonasal malignancies
• Peak incidence: 5th–6th decades
• Slight female predominance
• Most commonly arises in:
  • Maxillary sinus
  • Nasal cavity
  • Ethmoid sinus

Etiopathogenesis

• Originates from mucoserous glands of respiratory mucosa
• Subtypes (based on histology):
  • Cribriform (most common)
  • Tubular
  • Solid (worst prognosis)

Key Pathologic Features:

• Perineural invasion
• Bone infiltration
• Late hematogenous metastasis (e.g., to lungs)

Clinical Features

• Slow progression but extensive local invasion
• Unilateral nasal obstruction