Table of Contents  
Year : 2019  |  Volume : 11  |  Issue : 2  |  Page : 73-78

Genomic Alterations Landscape in Adenoid Cystic Carcinoma of Head and Neck

Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission09-Mar-2019
Date of Decision13-Apr-2019
Date of Acceptance10-Jul-2019
Date of Web Publication29-Jan-2020

Correspondence Address:
Dr. Immanuel Joseph
2/102, East Coast Road, Uthandi, Chennai, Tamil Nadu
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jofs.jofs_40_19

Rights and Permissions

Introduction: Adenoid cystic carcinoma (ACC) accounts for 1% of all head and neck cancers and 10% to 22% of all malignant tumors of the salivary glands. ACC is associated with MYB- nuclear factor I/B-type (NFIB) gene fusion in about 50% of the cases. The genetic alteration (GA) landscape of ACC of head and neck region in this aspect has not been much studied, mainly due to small cohorts. We aim to describe the GA landscape of MYB-NFIB gene fusions, copy number alterations, and mutations of the related gene MYBL1 in human ACC by studying its association with regard to demographics and histopathological parameters. Materials and Methods: Using the GA data of ACC from a peer-reviewed web portal, we studied the presence of MYB-NFIB gene fusion with respect to age and gender distribution, site involved (major/minor salivary gland, lacrimal gland, cancer metastasis, others), histopathological diagnosis, perineural invasion (PNI), and the overall number of mutations. Descriptive statistics and Chi square test were performed. Data were entered and analyzed using SPSS version 23. The mutation counts between the type of gene fusions involved and the gender of patients was studied using analysis of variance tests. Results: Of the 214 reported ACC cases, 65 (30%) cases had MYB-NFIB fusion alone, 15 (7%) other had rare fusions, and 12 (6%) other had GAs. Perineural invasion was found to be associated with MYB gene fusion cases with or without copy number alterations (P = 0.022). The number of mutations were significantly associated with the gender of patient (P = 0.003) and NFIB gene fusions (P = 0.001). The other factors had no statistical significance. Conclusion: MYB-NFIB gene fusion and associated GA correlates with perineural involvement in ACC.

Keywords: Adenoid cystic carcinoma, genetic alterations, myb gene, myb-nfib gene fusion, salivary gland

How to cite this article:
Joseph I, Rooban T, Elizabeth J, Rao UK, Ranganathan K. Genomic Alterations Landscape in Adenoid Cystic Carcinoma of Head and Neck. J Orofac Sci 2019;11:73-8

How to cite this URL:
Joseph I, Rooban T, Elizabeth J, Rao UK, Ranganathan K. Genomic Alterations Landscape in Adenoid Cystic Carcinoma of Head and Neck. J Orofac Sci [serial online] 2019 [cited 2022 Oct 3];11:73-8. Available from:

  Introduction Top

Adenoid cystic carcinoma (ACC) is the most commonly reported malignant tumor of human minor salivary glands.[1],[2] Apart from its occurrence in the major and minor salivary glands, ACC also occurs in the sinonasal tract, tracheobronchial tree, breast, vulva, and skin.[2] It is characterized by perineural invasion (PNI), a high recurrence rate, distant metastases, and an unfavorable response toward therapeutic measures.[1],[2],[3],[4] These factors contribute to the current high mortality rate.[5]

About 50% of salivary ACC is characterized by MYB-nuclear factor I/B-type (NFIB) gene fusion. This MYB activating gene fusion was first discovered in ACCs of breast and head and neck (HN) by Persson et al.[6] The gene fusion involves the exons of MYB gene and the transcription factor NFIB reciprocal t(6;9) translocations.[6],[7] The fusion breakpoint is reported to occur at the target sites of micro-RNAs leading to overexpression of highly active MYB-NFIB fusion protein.[6]

Involvement of MYB-NFIB is reported to influence the histopathological type and perineural events. Although t(6:9)(q22-23;p23-24) is a specific molecular event in ACC, its reliability as an exclusive diagnostic tool is still debatable as this fusion product is seen in only 28% to 49% of ACC patients.[8] Further, the presence of fusion partners of MYB other than NFIB (e.g., MYBL1, also known as AMYB, a closely related member of MYB),[7] other genetic alterations (GAs), and high MYB oncogene expression independent of the fusion mechanism affects tumor behavior.[9] The presence of t(6;9) does not seem to be necessary for higher expression of MYB protein, which could be due to other GAs.[8]

In this article, we aim to present the association of human salivary ACC MYB-NFIB fusion with the histopathological types and PNI characteristics and study the prevalence of non-MYB-NFIB fusion expressions, copy number alterations (CNAs), and number of mutations accumulated.

  Materials and Methods Top

The data of GA of HN-ACC along with the clinicopathological profile of the patients were retrieved from the existing, peer-reviewed cBio Cancer Genomics Web portal.[10],[11] It is an open-access resource for multidimensional cancer genomics data from more than 5000 tumor samples from 20 cancer studies. The cBioPortal has guided the authors to cite the references[10],[11] when publishing the results based on its genomic database. As this is a secondary database analysis, this study was exempted from ethical approval by the Ethical Committee of Ragas Dental College and Hospital, Chennai, Tamil Nadu on January 28, 2019. The database had details of 214 patients diagnosed with HN-ACC from the year 2013 to 2015. The demographic variables of age at diagnosis (in years) and gender (male/female), other variables like the site of tumor (major and minor salivary glands, lacrimal gland, metastatic site, other sites), predominant histopathological types (cribriform/solid/tubular) of HN-ACC, PNI (yes/no), MYB and associated gene alterations, details of CNA, mutation count, and details of mutations were collected. These data retrieved from the Cancer Genomics Web portal were entered and analyzed using statistical software Social Package for Social Service (ver. 23, IBM, IL, USA). Descriptive statistics and Chi square test were performed for all categorical variables. Multiple comparisons were done for significant continuous variables and studied using one-way analysis of variance test. P ≤ 0.05 was taken as significant.

  Results Top

In all, 111 (52%) were males compared to 103 (48%) females forming the study group. The mean age at diagnosis in males were 55.3 ± 12.6 years and in females were 55 ± 14.8 years. The difference was not statistically significant (P = 0.79). Of the 214 cases, there were 65 cases from oral cavity, 64 from salivary gland, and 13 from orbital cavity, and one case each of laryngeal and sinonasal cavity along with 70 unidentified sites. The MYB-NFIB translocation of t(6:9) was noted in 54 cases and t(8:9) in 14 cases, negative in 34 cases, and not available in 112 cases.

The association between the mutational counts in ACC patients along with their gender was also analyzed [Table 1]. The average mutation counts were found to be higher in male patients (16.3 ± 11.3) compared to females (10.5 ± 9.9) (P = 0.003).
Table 1 Association of mutation counts with gender of patients (N = 214)

Click here to view

Association Between Sites of Tumor Involved With MYB-NFIB Gene Alterations

Of the 214 cases, 76 cases had details of site along with MYB-NFIB details. The most common site was the minor salivary glands [Figure 1]. Fifty cases from the minor salivary glands had MYB-NFIB gene fusion and three cases had MYB-NFIB gene fusion with alterations. Tumor site involving the parotid gland had eight cases with MYB-NFIB gene fusion and one case with MYB-NFIB gene fusion with alterations followed by nine cases of submandibular salivary gland, two cases of sublingual salivary gland, and two cases from other nonsalivary gland sites such as the orbital cavity that had MYB-NFIB gene fusions. There was only one reported case from a metastatic site (thyroid) which had CNAs alone. These findings were statistically significant (P = 0.00).
Figure 1 Site of the tumor and MYB gene fusion and alterations.

Click here to view

MYB Gene Fusions and Alterations (N = 214)

Of the 214 cases studied, 71 (33%) cases had MYB-NFIB gene fusions [Figure 2], one (1%) case had other fusion involved with MYB gene [MYB-PDCD1LG2 (programmed cell death 1 ligand 2) fusion], five (2%) cases had other gene alterations which are CNA and home deletions associated with MYB-NFIB fusion, and 137 (64%) cases had no genetic involvement or had details missing.
Figure 2 ACC–MYB gene fusions and alterations (N = 214). ACC, adenoid cystic carcinoma.

Click here to view

Histopathological Variant of ACC and MYB Gene Alterations

Of the 214 cases, the histopathological type of ACC was available for 76 cases [Figure 3]. MYB-NFIB fusion gene product was the most commonly seen GA associated with all the types of ACC (46 cases of cribriform, 20 cases of solid type, and four cases of tubular type). Four cases of cribriform variety had MYB-NFIB fusion with alterations and one case of cribriform type had CNAs. One case of solid pattern had MYB-PDCD1LG2 gene fusion without NFIB involvement (P = 0.526).
Figure 3 ACC histopathological type and associated MYB gene alterations (N = 76). ACC, adenoid cystic carcinoma.

Click here to view

Perineural Involvement and MYB Gene Alterations

PNI was seen in 70 cases of ACC and its associated MYB gene alterations was also studied [Figure 4]. MYB-NFIB gene fusion was most commonly associated with PNI showing statistical significance of P = 0.02. Fifty-eight (83%) cases who had MYB-NFIB fusion had associated PNI; four (6%) cases had MYB-NFIB gene fusion with alterations (CNA, homozygous deletions) and one (1%) case who had other gene fusions apart from MYB had PNI. One case with CNAs and six (9%) cases with MYB-NFIB fusion did not have PNI.
Figure 4 Perineural involvement and MYB gene alterations (N = 70).

Click here to view

Other Gene Fusions Not Involving MYB

Fusion partners involved with NFIB gene were XRCC4, NKAIN2, PTPRD, and AIG2 genes. Fusion partners with MYBL1 gene (AMYB) were NFIB and YTHDF3 and few cases (n = 3) involved truncation of MYBL1.

  Discussion Top

The genetic mutational landscape of ACC has been the subject of study in the recent past. As a result of the oncogenic signature event, the chromosomal translocation occurring in t(6;9)(q22-23; p23-24) specific for ACC, the MYB-NFIB fusion product leads to the altered expression of MYB-associated genes, such as those responsible for apoptosis, cell cycle regulation, and cell growth and angiogenesis.[7] The MYB gene overexpression and associated GAs have been reported to influence ACC prognosis irrespective of its origin and predict the risk of local recurrence and distant metastases.[12],[13]

The main characteristic features of ACC are PNI occurring in 22% to 46% of cases, multiple local recurrences, and distant metastases that are reported in 40% of cases leading to a worse prognosis. Regional lymph-node involvement is reported to be rare, as in present study.[14]

In the present study, data was retrieved from cBioportal genomic database. There were 214 cases of ACC of HN, of which, the major portion of the affected population were males. The mean age at the time of diagnosis for both genders was almost alike, similar to Spiro et al.[15] and Stallmach et al.[16] Moreover, the incidence of ACC in minor salivary glands was found to be common at the 4th and 5th decades of life, the mean age being 54 years which was concurrent with present study.[17],[18]

The most commonly reported site of ACC, in the present study was the minor salivary glands. Most cases arise from the palate and are diagnosed at the advanced stages.[1] The fusion status of the majority of cases in the minor salivary glands were found to be MYB-NFIB positive (P = 0.00) and it has been highlighted that these cases have high chances of recurrence and a decrease in disease-free survival rate.[19]

We identified MYB fusion partners apart from NFIB (7%), other GAs (6%) like mutations, truncations, CNAs, and gene amplifications. These could also play a role in driving ACC tumors by mechanisms which activate MYB other than NFIB, as high MYB overexpression were also seen in fusion-negative tumors.[9] In the present study, the fusion partner with MYB other than NFIB was PDCD1LG2. Other non-MYB gene fusions were NFIB-XRCC4, NFIB-NKAIN2, NFIB-PTPRD, NFIB-AIG1, and MYBL1-NFIB gene fusions. The gene fusion between NFIB and MYBL1, a gene closely related to MYB, has also been recently described in a subset of ACC. Few rare gene fusions associated with the MYBL1 gene (MYBL1-YTHDF3 and MYBL1-RAD51B) have also been reported.[20],[21] Although the oncogenic role of MYB in ACC is a major event, there is a need for detailed analysis of non-MYB-driven ACCs to unravel the underlying molecular pathogenesis.

Among the histopathological variants of ACC (N = 76), the cribriform pattern (67%) was the most common variant found in our study followed by the solid and tubular patterns. The association between the histopathological variants and MYB gene alterations was studied. We found that MYB-NFIB gene fusion was seen in all the types, namely, cribriform (n = 46), solid (n = 20), and tubular (n = 4) growth patterns (P = 0.423). In their study by Xu et al.,[22] 34 cases of ACC were tested for MYB-NFIB Fluorescent in-situ hybridisation (FISH) study and they concluded that the fusion status did not appear to be related to the growth pattern of the tumor. MYB-NFIB gene fusion associated with other GAs was found in four cases of the cribriform variant.

One of the hallmark features of ACC is its propensity for perineural spread. PNI, commonly reported in 29% to 63% of ACC cases,[23],[24],[25],[26],[27] including a recent cohort study, where 80% of cases have been reported.[22] In another study, 83% of cases with balanced translocation had PNI as compared to 54% of patients without any translocation,[11] indicating an increase in the trend for PNI associated with MYB translocation tumors. In the current review, majority of cases (n = 58; 83%) which were fusion positive had associated PNI compared with six cases without PNI.

In conclusion, MYB-NFIB fusion and associated gene alterations help in predicting perineural invasion in ACC tumors of HN. The participation of other genes and gene fusions without the involvement of MYB in ACC can also be a related cause for the other subset of non-MYB ACCs that need to be explored in future. As the prognostic implication of ACC is based on the expression level of MYB and its downstream effectors regardless of MYB-NFIB status of the tumor, future treatment can be directed toward both MYB and non-MYB-driven tumors.

Presentation at a meeting

This concept with its results was presented at the XXVII National IAOMP Conference, Amritsar, Punjab, on November 17, 2018.


The authors would acknowledge the cBioportal cancer genomics for providing their large-scale data sets to analyse and download cancer genome and the Tamil Nadu Dr. MGR Medical University for their constant encouragement toward research work.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Bradley PJ. Adenoid cystic carcinoma of the head and neck: a review. Curr Opin Otolaryngol Head Neck Surg 2004;12:127-32.  Back to cited text no. 1
Coca-Pelaz A, Rodrigo JP, Bradley PJ, Vander Poorten V, Triantafyllou A, Hunt JL et al. Adenoid cystic carcinoma of the head and neck − an update. Oral Oncol 2015;51:652-61.  Back to cited text no. 2
Takebayashi S, Shinohara S, Tamaki H, Tateya I, Kitamura M, Mizuta M et al. Adenoid cystic carcinoma of the head and neck: a retrospective multicenter study. Actaoto-laryngologica 2018;138:73-9.  Back to cited text no. 3
Pinakapani R, Chaitanya NC, Lavanya R, Yarram S, Boringi M, Waghray S. Adenoid cystic carcinoma of the head and neck − literature review. Qual Primary Care 2015;23:309-14.  Back to cited text no. 4
Chahal M, Pleasance E, Grewal J, Zhao E, Ng T, Chapman E et al. Personalized oncogenomic analysis of metastatic adenoid cystic carcinoma: using whole-genome sequencing to inform clinical decision-making. Mol Case Stud 2018;4:a002626.  Back to cited text no. 5
Persson M, Andrén Y, Mark J, Horlings HM, Persson F, Stenman G. Recurrent fusion of MYB and NFIB transcription factor genes in carcinomas of the breast and head and neck. Proc Natl Acad Sci 2009;106:18740-4.  Back to cited text no. 6
Padmavathi G, Thakur KK, Kunnumakkara AB. MYB-NFIB fusion gene − hallmark of adenoid cystic carcinoma (ACC). In Fusion Genes and Cancer, Singapore: World Scientific; 2017. pp. 245-51.  Back to cited text no. 7
de Almeida‐Pinto YD, Costa SF, de Andrade BA, Altemani A, Vargas PA, Abreu LG et al. t(6;9)(MYB‐NFIB) in head and neck adenoid cystic carcinoma: a systematic review with meta‐analysis. Oral Dis 2019;25:1277-82.  Back to cited text no. 8
Brill II LB, Kanner WA, Fehr A, Andrén Y, Moskaluk CA, Löning T et al. Analysis of MYB expression and MYB-NFIB gene fusions in adenoid cystic carcinoma and other salivary neoplasms. Modern Pathol 2011;24:1169-76.  Back to cited text no. 9
Gao J, Aksoy BA, Dogrusoz U, Dresdner G, Gross B, Sumer SO et al. Integrative analysis of complex cancer genomics and clinical profiles using the cBioPortal. Sci Signal 2013;6: pl1.  Back to cited text no. 10
Cerami E, Gao J, Dogrusoz U, Gross BE, Sumer SO, Aksoy BA et al. The cBio cancer genomics portal: an open platform for exploring multidimensional cancer genomics data. Cancer Discov 2012;2:401-4.  Back to cited text no. 11
West RB, Kong C, Clarke N, Gilks T, Lipsick J, Cao H et al. MYB expression and translocation in adenoid cystic carcinomas and other salivary gland tumors with clinicopathologic correlation. Am J Surg Pathol 2011;35:92.  Back to cited text no. 12
Chae YK, Chung SY, Davis AA, Carneiro BA, Chandra S, Kaplan J et al. Adenoid cystic carcinoma: current therapy and potential therapeutic advances based on genomic profiling. Oncotarget 2015;6:37117.  Back to cited text no. 13
De Berardinis R, Viziano A, Micarelli A, Alessandrini M, Bruno E. Adenoid cystic carcinoma of head and neck. Am J Otolaryngol Head Neck Surg 2018;1:1010.  Back to cited text no. 14
Spiro RH, Huvos AG, Strong EW. Adenoid cystic carcinoma of salivary gland origin.A clinicopathologic study of 242 cases. Am J Surg 1974;128:512-20.  Back to cited text no. 15
Stallmach I, Zenklusen P, Komminoth P, Schmid S, Perren A, Roos M et al. Loss of heterozygosity at chromosome 6q23-35 correlates with clinical and histologic parameters in salivary glands adenoid cystic carcinoma. Virchows Arch 2002;440:77-84.  Back to cited text no. 16
Ellis GL, Auclair PL. Atlas of tumor pathology: tumors of the salivary glands. Third series fascicle Washington, DC: Armed Forces Institute of Pathology; 1996. pp. 203-16.  Back to cited text no. 17
Vander Poorten VLM, Balm AJM, Hilgers FJM, Bing T, Ronald BK, Augustinus AM. Stage as major long term outcome predictor in minor salivary gland carcinoma. Cancer 2000;89:1195-204.  Back to cited text no. 18
Rettig EM, Tan M, Ling S, Yonescu R, Bishop JA, Fakhry C et al. MYB rearrangement and clinicopathologic characteristics in head and neck adenoid cystic carcinoma. Laryngoscope 2015;125:E292-9.  Back to cited text no. 19
Brayer KJ, Frerich CA, Kang H, Ness SA. Recurrent fusions in MYB and MYBL1 define a common, transcription factor-driven oncogenic pathway in salivary gland adenoid cystic carcinoma. Cancer Discov 2016;6:176-87.  Back to cited text no. 20
Mitani Y, Liu B, Rao PH, Borra VJ, Zafereo M, Weber RS. Novel MYBL1 gene rearrangements with recurrent MYBL1-NFIB fusions in salivary adenoid cystic carcinomas lacking t(6;9) translocations. Clin Cancer Res 2016;22:725-33.  Back to cited text no. 21
Xu B, Drill E, Ho A, Dunn L, Prieto-Granada CN, Chan T et al. Predictors of outcome in adenoid cystic carcinoma of salivary glands. Am J Surg Pathol 2017;41:1422-32.  Back to cited text no. 22
Morinaga S, Nakajima T, Shimosato Y, Saitoh H, Ebihara S, Ono I. Histologic factors influencing prognosis of adenoid cystic carcinoma of the head and neck. Jpn J ClinOncol 1986;16:29-40.  Back to cited text no. 23
Dantas AN, Morais EF, Macedo RA, Tinôco JM, Morais Mde L. Clinicopathological characteristics and perineural invasion in adenoid cystic carcinoma: a systematic review. Braz J Otorhinolaryngol 2015;81:329-35.  Back to cited text no. 24
Amit M, Binenbaum Y, Trejo-Leider L, Sharma K, Ramer N, Ramer I et al. International collaborative validation of intraneural invasion as a prognostic marker in adenoid cystic carcinoma of the head and neck. Head Neck 2015;37:1038-45.  Back to cited text no. 25
Ganly I, Amit M, Kou L, Palmer FL, Migliacci J, Katabi N et al. Nomograms for predicting survival and recurrence in patients with adenoid cystic carcinoma.An international collaborative study. Eur J Cancer 2015;51:2768-76.  Back to cited text no. 26
Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A et al. Adenoid cystic carcinoma of the nasal cavity and paranasal sinuses: a meta-analysis. J Neurol Surg B Skull Base 2013;74:118-25.  Back to cited text no. 27


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1]

This article has been cited by
1 Perineural Invasion in Adenoid Cystic Carcinoma of the Salivary Glands: Where We Are and Where We Need to Go
Xiaohao Liu,Xiaojun Yang,Chaoning Zhan,Yan Zhang,Jin Hou,Xuemin Yin
Frontiers in Oncology. 2020; 10
[Pubmed] | [DOI]


Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded289    
    Comments [Add]    
    Cited by others 1    

Recommend this journal