A Rare SMARCA4-Deficient Subglottic Adenoid Cystic Carcinoma With Early Pulmonary Metastasis.

This report describes a rare primary subglottic adenoid cystic carcinoma harboring a SMARCA4 loss-of-function mutation, a molecular driver not previously reported in this anatomical site. Despite presenting with locally advanced pT4a disease and early pulmonary metastasis, the patient achieved 5-year local control following total laryngectomy and adjuvant radiotherapy. The findings suggest that molecular profiling can identify non-MYB-driven subtypes and guide individualized management for atypical laryngeal malignancies.