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Adenoid cystic carcinoma (AdCC) is a rare and aggressive salivary gland cancer. The tumour grows slowly but can spread unpredictably, making diagnosis and treatment complex. Diagnosing AdCC on biopsy specimens is challenging due to similarities with other salivary gland tumours. Although survival has improved, about half of patients experience recurrence or distant metastases within ten years.

This thesis focuses on three areas: biomarkers, targeted imaging, and therapy. A fusion of the cellular myeloblastosis gene (MYB) with the nuclear factor I B-type (NFIB) gene is a hallmark of AdCC. Immunohistochemistry offers a faster and more cost-effective alternative to fluorescence in situ hybridisation (FISH) for detecting this translocation. Chemokine receptor type 4 (CXCR4) is associated with an increased risk of recurrence and can help tailor follow-up strategies. Prostate-specific membrane antigen (PSMA) is expressed in nearly all tumour sites and can be accurately visualised using PSMA PET/CT. This scan proved more effective than existing methods in detecting metastases. In addition, the physiological uptake of PSMA in healthy salivary glands was mapped, supporting improved image interpretation and radiotherapy planning.

Finally, a new treatment was explored in which PSMA is used to deliver targeted radiation therapy directly to tumour cells. Although long-term effects were limited, some patients experienced temporary disease stabilisation and symptom relief.

In conclusion, this research provides concrete improvements for personalised care in AdCC, with a focus on precision diagnostics, treatment, and quality of life.