The Teaching Point

Adenoid cystic carcinoma is usually slow growing and distant metastases preferentially go to lungs. Some clinical and pathological factors, such as involvement of accessory salivary glands, size, histological grade, solid or cribriform adenoid cystic subtypes and perineural invasion, may indicate aggressive subtypes that require more thorough work-up. The curtain sign is a pathognomonic sign of epidural involvement and should be recognized early on MRI.






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From the manuscript

Aggressive Adenoid Cystic Carcinoma With Asymptomatic Spinal Cord Compression Revealed By A "Curtain Sign"

Free full text article: Aggressive Adenoid Cystic Carcinoma With Asymptomatic Spinal Cord Compression Revealed By A

Abstract
The authors present a case of unusually aggressive adenoid cystic carcinoma of the head and neck. The patient presented with sciatica one year after initial diagnosis. She was otherwise asymptomatic. Complete work-up for bone involvement, included bone scan and MRI. The patient had painful osteolytic sacral metastasis and asymptomatic thoracic (T5) vertebral metastasis revealed by a typical curtain sign on MRI. The curtain sign, originally described by Trolard, is due to the displacement of the Trolard's membrane with the median ligament attaching the dura to the bone while there is a dorsal displacement and loosening of the posterior longitudinal ligament. The patient benefited from radiotherapy and did not develop respiratory distress, paraplegia or pain but died of liver metastases.






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