the adenoid cystic carcinoma ( acc ) is a relatively rare epithelial tumor of the salivary glands .
it accounts for about 5 - 10% of all salivary gland neoplasms , representing 2 - 4% of malignant occurrences of the head and neck area .
approximately , 31% of lesions affect minor salivary glands , particularly the palate , although they can also be observed in the sub - mandibular and parotid glands .
the frequency reported in the tongue is 19.8% , with 85% observed at the base of the tongue .
we report one such rare case of tongue neoplasm which turned out to be acc in a middle aged lady .
a 45-year - old - female patient presented with an asymptomatic growth of the tongue , which was perceived just 2 weeks before consultation .
the intra - oral examination at that time revealed a mass in the dorsum of the tongue with light pain to pressure , without any evidence of cervical lymphadenopathy .
the mass was firm , same color as that of the surrounding mucosa and asymptomatic otherwise [ figure 1 ] .
as a pre - operative assessment of the lesion , a fine needle aspiration was done and the smear revealed a salivary neoplasm consisting of well delineated , tightly cohesive clusters of basaloid cells surrounding mucoid , hyaline globules , or clear spaces also forming honeycomb ( cribriform ) pattern [ figure 2 ] . at places
dense aggregates of monomorphic small cells with uniform round to oval hyperchromatic nuclei and scanty cytoplasm were seen .
smears also showed individual tumor cells with high n : c ratio and nuclear moulding .
macroscopically , the mass had firm consistency with an irregular form and surface , brown color and measured 2.5  1.5  1.0 cm .
the histopathologic study revealed multiple pseudocystic spaces of variable sizes surrounded by cuboidal cells with scarce cytoplasm and oval nuclei , filled with eosinophilic material and hence was consistent with the diagnosis of acc [ figure 3 ] .
however , there was no evidence of perineural infiltration on serial sections . clinical photograph showing a swelling on the dorsum of the tongue cytological smears show well - delineated clusters of basaloid cells surrounding hyaline globules with uniform round to oval hyperchromatic nuclei and scanty cytoplasm ( papanicolaou stain , 400 ) histopathological section showing multiple pseudocystic cavities of variable size composed of cuboidal cells with scarce cytoplasm and oval nuclei ( h and e , 400 )
minor salivary gland neoplasms occur less commonly than the major salivary gland tumors and tongue is a relatively uncommon site for salivary gland neoplasms
acc is a malignant neoplasm that originates in both the minor and major salivary glands , characterized by slow growth , diffuse invasion , and potential to produce distant metastases , mainly to the lungs and bones .
it is an infrequent lesion , as it represents approximately 1 - 2% of all malignant neoplasms of the head and neck , and up to 10 - 15% of all malignant salivary gland neoplasms .
the most common intra - oral site for minor salivary gland tumors is the hard palate , followed by the base of the tongue where up to 96% of all tumors are malignant , and acc represents 30% of them . on the other hand ,
one of the least frequent sites of presentation for acc is the mobile tongue , as several authors have reported an incidence of only approximately 3% of the cases .
, analyzed 178 cases of salivary gland tumors , out of which only six cases were located on the tongue .
cytologically , cribriform variety of acc can be diagnosed by hypercellular smears composed of clusters of small , relatively monomorphic epithelial cells with hyperchromatic nuclei .
these appear bright magenta in may - grunwald giemsa mgg stains and pale blue with papanicolaou stain .
finger - like process of similar material can also be found in between the groups of cells in tubular variety .
the solid variant of acc also exhibits the same material and the cells resemble that of small cells of anaplastic carcinoma .
the globules of amorphous material surrounded by the monomorphic hyperchromatic cells was a clue to the diagnosis of acc in our case , but since the hyaline globules are also found in other tumors like basal cell adenoma , pleomorphic adenoma , polymorphous low grade adenocarcinoma , epithelial myoepithelial carcinoma etc .
it is important to distinguish the adenomas from acc because of the conservative mode of management in case of adenomas .
we ruled out the adenomas because of the nature of the globules and the cytological morphology . unlike the adenomas , the hyaline globules were dense and stained intensely with mgg and the cells were relatively monomorphic , hyperchromatic with coarse chromatin and irregular nuclear membrane like that of acc .
of three histologic variants - tubular , cribriform and solid ; in our case cribriform pattern was the dominant one without any evidence of perineural infiltration .
the main factors associated with patient survival were tumor location , clinical stage , and the observed histologic variable .
conversely , spiro et al . , have not found histologic classification to be of any benefit , and deny a correlation between microscopic appearance and prognosis . due to the slow growth pattern of the tumor
however , due to local recurrence and late metastasis , surgery remains the mainstay of management with or without radiotherapy .
 adenoid cystic carcinoma is a relatively rare epithelial tumor of the salivary glands accounting for about 5 - 10% of all salivary gland neoplasms . 
 approximately , 31% of salivary gland neoplasms affect minor salivary glands particularly the palate . 
 it involves tongue in only 19.8% of cases and even rarely the dorsum of the tongue . 
 we report such a rare case that affected dorsum of the tongue in a 45-year - old - female patient . 