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Carillo AM, De Luca C, Pisapia P, Vigliar E, Ikenberg K, Freiberger SN, Troncone G, Rupp NJ, Bellevicine C. Molecular testing in salivary gland cytopathology: A practical overview in conjunction with the Milan system. Cytopathology 2024; 35:330-343. [PMID: 38308401 DOI: 10.1111/cyt.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
Recently, significant advances in the molecular characterization of salivary gland neoplasms have facilitated the classification and diagnosis of specific diagnostic entities. In the highly challenging diagnostic scenario of salivary malignancies, molecular testing is increasingly being adopted in routine practice to refine the cytological diagnosis of salivary lesions. Here, we reviewed the most recent evidence in the field of salivary glands molecular cytopathology.
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Affiliation(s)
- Anna Maria Carillo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Caterina De Luca
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Kristian Ikenberg
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Sandra N Freiberger
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
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2
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Aliyeva A, Karimov Z, Muderris T. Metastatic salivary gland mammary analogue secretory carcinoma (MASC) of parotid gland – A rare case report in the literature review. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2023. [DOI: 10.1080/23772484.2023.2178439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Aynur Aliyeva
- Department of Otorhinolaryngology, Seoul St.Mary Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkey
| | - Togay Muderris
- Department of Otorhinolaryngology, Cigli Education and Research Hospital, Izmir Bakircay University, Izmir, Turkey
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3
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Sheldon JD, Wakely PE. Cytopathology of benign sebaceous salivary gland neoplasia: Comparison of two analogous yet dissimilar entities. Cytopathology 2023; 34:573-580. [PMID: 37403446 DOI: 10.1111/cyt.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Benign sebaceous salivary gland (SG) neoplasms represent approximately 0.2% of all salivary gland neoplasms. Not only are fine needle aspiration (FNA) biopsy findings of sebaceous adenoma (SA) and sebaceous lymphadenoma (SLA) limited, but their findings are also rarely compared with one another. MATERIALS AND METHODS Our cytopathology files were searched for examples of benign sebaceous SG neoplasms with concomitant histopathological verification. FNA biopsy and cell collection were performed using standard technique. RESULTS One case each of parotid SA and parotid SLA showed markedly dissimilar cytomorphology. The SA case was composed of a repetitive population of profusely multivacuolated polygonal cells with single and multiple nuclei, and was specifically recognised cytologically as a sebaceous neoplasm due to its characteristic cytoplasmic vacuolisation. The SLA case, however, was characterised by smears filled primarily with lymphocytes and only scant widely scattered basaloid cell clusters. A non-specific diagnosis of basaloid neoplasm was rendered. In retrospect, recognition of sebaceous differentiation was limited to rare cell groups. CONCLUSION Though nominally, epidemiologically, and to a degree histopathologically analogous, the cytopathology of SA and SLA are markedly dissimilar, reflecting the dominant cell component in each. With FNA biopsy, a specific interpretation is more likely for SA than SLA due to the overwhelming obscuring lymphoid population in the latter.
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Affiliation(s)
- Jesse D Sheldon
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
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Anthony ML, Kumari N, Jeladharan R, Gowda VN, Joshi PP, Durgapal P, Kumar A, Singh A. MASC Gets UNMASKED: Visiting a Rare Tumor with Emphasis on Cytomorphological Features. J Cytol 2023; 40:192-199. [PMID: 38058671 PMCID: PMC10697318 DOI: 10.4103/joc.joc_155_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 12/08/2023] Open
Abstract
Background Secretory carcinoma (SC) is a newly described entity which has been often misdiagnosed earlier as acinic cell carcinoma on cytology. Diagnosing SC was initially based upon identifying the ETV6:NTRK3 fusion gene with the help of fluorescence in situ hybridization (FISH). Lately, with more knowledge of the reliable histomorphology, cytology, and immunohistochemistry features, definitive diagnosis can be confidently made without the help of FISH in almost every case. Materials and Methods Six histologically confirmed cases of SC were studied. The cytology slides of all the six cases were retrieved and reviewed to identify the characteristic features which could have helped in raising the possibility of SC on fine needle aspiration cytology itself. Cell blocks were also studied, wherever available. Results Patients were all male with average age of 35.2 years. The six cases in the current study demonstrated at least focal cytoplasmic vacuolization of varying sizes, papillae formations, and bland nuclear features on fine needle aspirate smears. It was also seen that S-100 and mammaglobin immunohistochemistry (IHC) are very helpful in confirming the diagnosis. Conclusions The results of the current study highlight the cytomorphological features which may help in clinching the diagnosis SC on cytology itself. They also highlight certain cytological features which help to rule out the other differential diagnoses.
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Affiliation(s)
- Michael L. Anthony
- Department of Pathology, Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India
| | - Neha Kumari
- Department of Pathology, Dr. B R Ambedkar State Institute of Medical Sciences S.A.S Nagar Mohali, Punjab, India
| | - Reshma Jeladharan
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Vinay N. Gowda
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
| | | | | | - Arvind Kumar
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
| | - Ashok Singh
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
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5
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Saraf P, Bharti JN, Malik A. A challenging diagnosis of mammary analogue secretory carcinoma (MASC) on fine needle aspiration cytology and cell block: A cytopathologist's perspective. Cytopathology 2023; 34:377-380. [PMID: 36825352 DOI: 10.1111/cyt.13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/28/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland carcinoma that resembles the secretory carcinoma of the breast and is characterised by t(12;15) (q13;q25) translocation, which results in an ETV6-NTRK3 gene fusion product. On cytomorphology, it is characterised by papillary fragments, clusters, and singly dispersed tumour cells. These tumour cells are large and have abundant vacuolated cytoplasm. Acinic cell carcinoma of the salivary gland is the most common differential diagnosis of MASC. Other differentials include mucoepidermoid carcinoma, salivary duct carcinoma, pleomorphic adenoma, and oncocytic salivary gland neoplasms. Immunohistochemistry and morphology are critical in establishing the correct diagnosis. We present a case of a 46-year-old male patient diagnosed as MASC of the parotid gland on fine needle aspiration cytology and cell block.
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Affiliation(s)
- Pallavi Saraf
- Department of Pathology & Lab Medicine, AIIMS Jodhpur, Jodhpur, India
| | | | - Abhishek Malik
- Department of Pathology & Lab Medicine, AIIMS Jodhpur, Jodhpur, India
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6
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Meng Z, Si W, Xiuli Z, Liu Y. A Parotid Gland Mammary Analogue Secretory Carcinoma in a 4-Year-Old Boy: Case Report and Literature Review. Fetal Pediatr Pathol 2023; 42:342-350. [PMID: 36053082 DOI: 10.1080/15513815.2022.2116621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 02/08/2023]
Abstract
Background: Mammary analogue secretory carcinoma (MASC) is characterized by similar histologic, immunohistochemical, and molecular features with breast secretory carcinoma. MASC usually occurs in adults. Case report: A 4-year-old boy presented with a right infra-auricular mass. Features of the tumor include solid, tubular, and papillary growth patterns, with homogenous eosinophilic secretions inside microcystic structures. Immunohistochemical stains showed strong, diffuse staining for CK7, S100, pan-TRK protein. P63 was positive in a peripheral pattern. Fluorescence in situ hybridization (FISH) analysis showed the characteristic ETV6-NTRK3 gene fusion. Conclusion: Typical histological, immunohistochemical, and molecular features are present in MASC occurring early in childhood.
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Affiliation(s)
- Zhao Meng
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wu Si
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhu Xiuli
- Department of Pediatric, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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7
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AlKaabba F, Alloghbi A, Deajim Y, Sukkari M, Khan MYA, Sukari A. NTRK3
mutation in secretory carcinoma of the parotid gland: A Case report. Clin Case Rep 2022; 10:e6243. [PMID: 36093449 PMCID: PMC9445263 DOI: 10.1002/ccr3.6243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/04/2022] [Accepted: 07/03/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Fahad AlKaabba
- Department of Medicine University of Maryland Medical Center Baltimore MD USA
| | - Abdurahman Alloghbi
- College of Medicine King Khalid University Abha Saudi Arabia
- Department of Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
| | - Yazeed Deajim
- College of Medicine King Khalid University Abha Saudi Arabia
| | | | | | - Ammar Sukari
- Department of Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
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8
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Janik S, Faisal M, Marijić B, Grasl S, Grasl MC, Heiduschka G, Erovic BM. Prognostic factors in mammary analogue secretory carcinomas of the parotid gland: Systematic review and meta-analysis. Head Neck 2021; 44:792-804. [PMID: 34964195 DOI: 10.1002/hed.26971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/04/2021] [Accepted: 12/16/2021] [Indexed: 11/06/2022] Open
Abstract
Mammary analogue secretory carcinomas (MASCs) of the parotid gland are considered as low-grade malignancies with good clinical outcome but lacking data regarding prognostic factors. We performed meta-analysis assessing prognostic factors for disease-free survival (DFS) and overall survival (OS) in 256 patients with MASCs of the parotid gland. A total of 73 studies have met the inclusion criteria and 76.3% of patients were seen with T1 and T2 tumors and negative neck nodes. Lymph node metastasis (57.4%) and distant recurrences (46.2%) were particularly found in T4 tumors (p < 0.001). DFS at 5 and 10 years was 77.9% and 47.2% compared to 88.1% and 77.2% for OS at the same time points. Male sex, T3-T4 tumors, and recurrent disease represented independent worse prognosticators for survival outcome. Altogether, parotid gland MASCs show good long-term outcome, but T4 tumors behave significantly more aggressive and require extended treatment strategies along with close follow-ups.
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Affiliation(s)
- Stefan Janik
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Muhammad Faisal
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Blazen Marijić
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria.,Department of Otorhinolaryngology - Head and Neck Surgery, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Stefan Grasl
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthaeus Ch Grasl
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
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9
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Egusa Y, Nishimura MF, Baba S, Takeuchi K, Makino T, Tachibana T, Nishikori A, Fujita A, Yanai H, Sato Y. Cytopathological Findings of Secretory Carcinoma of the Salivary Gland and the Diagnostic Utility of Giemsa Staining. Diagnostics (Basel) 2021; 11:diagnostics11122284. [PMID: 34943521 PMCID: PMC8700047 DOI: 10.3390/diagnostics11122284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/26/2022] Open
Abstract
Secretory carcinoma is a salivary gland neoplasm first described as a mammary analogue secretory carcinoma by Skalova and redesignated as a secretory carcinoma in the 2017 World Health Organization Classification of Head and Neck Tumors. Secretory carcinoma diagnosis is reliant on specific cytological and histological findings and the detection of an ETV6-NTRK3 fusion gene. Here, we examined the clinical and cytopathological features of four cases of secretory carcinoma occurring in three males and a female, aged between 39 and 74 years. All four tumors involved the parotid gland, and were found to have the ETV6-NTRK3 fusion gene. Fine-needle aspiration-based cytology smears of all tumors displayed papillary and/or dendritic pattern clusters, some of which were associated with blood vessels. The neoplastic cells displayed enlarged nuclei with fine chromatin and small, distinct, single nucleoli. Furthermore, several neoplastic cells with a characteristic vacuolated cytoplasm were identified in each specimen. Giemsa staining revealed cytoplasmic vacuolation, intracytoplasmic metachromatic secretions and/or various sized metachromatic granules, and a background of metachromatic mucin in all four specimens. Given this, we conclude that these cytological findings, especially those of the Giemsa staining, might be helpful in the diagnosis of secretory carcinoma.
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Affiliation(s)
- Yuria Egusa
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (Y.E.); (A.N.); (A.F.)
| | - Midori Filiz Nishimura
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Department of Diagnostic Pathology, Okayama University Hospital, Okayama 700-8558, Japan;
- Correspondence: (M.F.N.); (Y.S.)
| | - Satoko Baba
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (S.B.); (K.T.)
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Kengo Takeuchi
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (S.B.); (K.T.)
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Takuma Makino
- Department of Otolaryngology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Tomoyasu Tachibana
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji 670-8540, Japan;
| | - Asami Nishikori
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (Y.E.); (A.N.); (A.F.)
| | - Azusa Fujita
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (Y.E.); (A.N.); (A.F.)
| | - Hiroyuki Yanai
- Department of Diagnostic Pathology, Okayama University Hospital, Okayama 700-8558, Japan;
| | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (Y.E.); (A.N.); (A.F.)
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Correspondence: (M.F.N.); (Y.S.)
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Sivasubramaniam P, Tiegs-Heiden CA, Geiersbach KB, Hagen CE, Sturgis CD, Thangaiah JJ, Hartley CP. Mammary analogue secretory carcinoma: A challenging case arising in a young man with radiation exposure. Ann Diagn Pathol 2021; 57:151862. [PMID: 34953444 DOI: 10.1016/j.anndiagpath.2021.151862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022]
Abstract
Mammary Analogue Secretory Carcinoma (MASC) is a recently described salivary gland tumor frequently sampled via fine-needle aspiration. The cytologic features of MASC are not entirely distinctive and can simulate acinic cell carcinoma, but the tumor harbors an ETV6 gene rearrangement resulting in an ETV6-NTRK3 fusion gene. We present a case of MASC arising in a 31 year old man with a history of multiple radio-embolization procedures.
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Affiliation(s)
| | | | | | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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11
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Alves LDB, de Melo AC, Farinha TA, de Lima Araujo LH, Thiago LDS, Dias FL, Antunes HS, Amaral Eisenberg AL, Santos Thuler LC, Cohen Goldemberg D. A systematic review of secretory carcinoma of the salivary gland: where are we? Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e143-e152. [PMID: 32493686 DOI: 10.1016/j.oooo.2020.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/22/2020] [Accepted: 04/11/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this systematic review was to describe the epidemiology, diagnostic criteria, differential diagnosis, treatment, prognostic factors, and treatment outcomes of secretory carcinoma. STUDY DESIGN A comprehensive search of Lilacs, PubMed, Science Direct, and Web of Science databases was conducted to identify all case reports, letter to the editor, and histopathologic reclassifications regarding salivary gland secretory carcinoma published in English, Spanish, French, and Portuguese. RESULTS The final analysis included 119 studies, which totaled 642 secretory carcinoma diagnoses, with 239 case reports and 403 diagnostic reclassifications, mostly in the United States. The age range was 5 to 87 years, and cases were predominantly in males (58.7%) and mostly affecting the parotid glands (73.7%). The disease usually presents as a slow-growing, painless mass. The main differential diagnosis is acinic cell carcinoma, and the tumor is usually treated with surgery. The prognosis is considered favorable, although there have been reports of local recurrences, distant metastases, and deaths. CONCLUSIONS It is important that clinicians become aware of this salivary gland neoplasm and report clinical data, clinical course, management and long-term follow-up. There is an urgent need to conduct more clinical trials, especially on tropomyosin receptor kinase (TRK) inhibitors and other potential target therapy modalities.
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Affiliation(s)
| | | | - Thayana Alves Farinha
- Scientific Initiation Student, Clinical Research Division, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA)
| | | | - Leandro de Souza Thiago
- Clinical Research Division, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA)
| | - Fernando Luiz Dias
- Head and Neck Surgery Service, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA)
| | | | | | | | - Daniel Cohen Goldemberg
- Clinical Research Division, National Cancer Institute of Brazil, Rio de Janeiro, Brazil (INCA).
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12
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Silver E, Lazow SK, Peters SM, Solomon M, Yusupov S. Secretory Carcinoma of the Salivary Gland - Systematic Review of the Literature and Report of 2 Cases. J Oral Maxillofac Surg 2021; 80:101-112. [PMID: 34653372 DOI: 10.1016/j.joms.2021.08.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Secretory carcinoma (SC) of the salivary gland, formerly known as mammary analogue secretory carcinoma, is an uncommon and fairly newly described low grade malignant neoplasm of the salivary gland. Given the small number of cases reported in the literature to date, treatment guidelines are scarce. This study aimed to describe the clinical characteristics of SC, discuss prior management strategies, and provide recommendations for future treatment. METHODS We performed a systematic review of all the cases of SC reported in the literature since it was first recognized in 2010. Using Pubmed, Crossref, and Google Scholar, we identified all articles reporting cases of SC. RESULTS We identified 657 cases of SC in 109 articles. In addition, we provided 2 new cases, for a total of 659 cases in 110 articles. To our knowledge, this is the largest review of cases of SC in the literature to date. We summarized the clinical characteristics of SC, as well as the nodal status, clinical management, recurrence rate, and death rate. CONCLUSIONS SC occurs on average in middle age (with a large age range), presents most often initially as localized disease without metastasis, and has a low but not insignificant recurrence rate. Deaths have been reported. The generalized recommendations for treatment of SC are in line with those of other low-grade salivary gland malignancies.
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Affiliation(s)
- Eric Silver
- Resident, Oral and Maxillofacial Surgery, Kings County Hospital Center, Brooklyn, NY.
| | - Stewart K Lazow
- Professor and Vice-Chairman, Oral Maxillofacial Surgery Program Director, Retired, Kings County Hospital Center/SUNY Brooklyn, Brooklyn, NY
| | - Scott M Peters
- Assistant Professor, Oral Pathology, Columbia University, New York, NY
| | - Marshall Solomon
- Professor Emeritus, Oral Maxillofacial Pathology, Kings County Hospital Center, Brooklyn, NY
| | - Steve Yusupov
- Director, Oral and Maxillofacial Oncology, Staten Island University Hospital/Northwell Health, Staten Island, NY
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13
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Kurokawa R, Kurokawa M, Baba A, Ota Y, Moritani T, Srinivasan A. Radiological features of head and neck mammary analogue secretory carcinoma: 11 new cases with a systematic review of 29 cases reported in 28 publications. Neuroradiology 2021; 63:1901-1911. [PMID: 34427706 DOI: 10.1007/s00234-021-02796-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE This retrospective study aimed to investigate the radiological features of head and neck mammary analogue secretory carcinoma (MASC) and systematically review previous publications and 11 new cases. METHODS We included patients with pathologically proven MASCs with preoperative CT or MRI images, including 11 patients from our hospital and 29 patients from 28 publications extracted after screening 645 abstracts. Two board-certified radiologists reviewed and evaluated all radiological images. The frequency of metastasis during the follow-up period in tumors with well- and ill-defined margins was compared using a Fisher's exact test. RESULTS The median age at diagnosis was 52.5 years (range, 7-78 years; 20 males). Of the 40 patients, those in their 50 s were the most common (10/40, 25.0%), and the main tumor site was the parotid gland (27/40, 42.5%). Characteristic radiological features included high intensity on T1WI in the cystic components and tumors frequently showed "papillary and cystic," which showed a projection into the cystic components, or "non-papillary and cystic" morphology, which did not show projection of the solid components. Tumor metastasis was found in 10/35 patients (28.6%) during the follow-up period, with a significant difference in frequency between the tumors with well- and ill-defined margin (well-defined (4/26) vs. ill-defined (6/9); P = 0.0074). CONCLUSION MASCs are newly recognized malignant tumors. Characteristic T1WI high intensity on MRI and predominant cystic morphology may reflect its unique histological profile. Ill-defined tumor margin status was related to frequent metastasis. Awareness of these characteristic radiological features can assist radiologists in better detection of this novel entity.
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Affiliation(s)
- Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA.
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
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14
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Wakely PE, Lott-Limbach AA. Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high-grade transformation. Cancer Cytopathol 2021; 129:973-983. [PMID: 34379894 DOI: 10.1002/cncy.22496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although largely readily recognizable in tissue sections, acinic cell carcinoma (ACC) remains diagnostically problematic in fine-needle aspiration (FNA) cytopathology. The authors undertook an analysis of a large series of ACC aspirates, including acinic cell carcinoma with high-grade transformation (ACC-HGT). METHODS The authors searched their cytopathology files for ACC cases with histopathologic confirmation. FNA biopsy was performed according to standard techniques. RESULTS Fifty FNA biopsy cases of ACC (including 36 of parotid origin [72%]) from 41 patients (female to male ratio, 1.4:1; age range, 23-84 years; average, 54 years) met the study inclusion requirements. Primary neoplasm aspirates were most common (72%), and they were followed by recurrent tumors (16%) and metastases (12%). A precise cytologic diagnosis was made for 64%. Three of 9 ACC-HGT cases (33%) were correctly interpreted as such; 98% of conventional ACC cases were correctly graded as low-grade. With the Milan classification system, 74% fit into the malignant category. Ancillary testing was performed for only 36%. Conventional ACC had moderately to highly cellular smears; monotonous cells in aggregates and single forms; rounded nuclei; and microvacuolated, finely granular, oncocyte-like, or nonspecific cytoplasm. ACC-HGT smears contained larger nuclei, high nuclear to cytoplasmic ratios, coarse nuclear chromatin, and a loss of cytoplasmic granules/vacuoles. CONCLUSIONS A correct diagnosis of ACC via FNA biopsy was made in almost two-thirds of the cases. With the Milan classification, 84% of the cases would have been classified as malignant or suspicious for malignancy. An absence of conventional serous acinar cell morphology in some cases as well as an absence of ancillary immunohistochemistry testing in almost two-thirds of the cases prevented even better diagnostic performance.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, Ohio State University Wexner Medical Center/James Cancer Hospital/Richard Solove Research Institute, Columbus, Ohio
| | - Abberly A Lott-Limbach
- Department of Pathology, Ohio State University Wexner Medical Center/James Cancer Hospital/Richard Solove Research Institute, Columbus, Ohio
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15
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Hua Y, Leng B, Youens KE, Liu L. An Underappreciated Cytomorphological Feature of Secretory Carcinoma of Salivary Gland on Fine Needle Aspiration Biopsy: Case Report with Literature Review. Head Neck Pathol 2021; 16:567-572. [PMID: 34255277 PMCID: PMC9187831 DOI: 10.1007/s12105-021-01361-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022]
Abstract
Secretory carcinoma (SC) of salivary gland, previously known as mammary analogue secretory carcinoma, is a rare low-grade malignancy harboring a diagnostic ETV6-NTRK3 gene fusion. SC of salivary gland shares histopathological, immunohistochemical and genetic characteristics with SC of the breast. There are several previous cytomorphological characterizations of SC of salivary gland reported in the literature. The most commonly reported patterns are of epithelial clusters with papillary architectural features, or of single dispersed epithelial cells on a background of abundant histiocytes. Tumor cells exhibit vacuolated eosinophilic cytoplasm and round to oval nuclei with regular nuclear contours and inconspicuous or small nucleoli. The cytomorphology of SC may closely mimic that of acinic cell carcinoma or low-grade mucoepidermoid carcinoma. Moreover, when cohesive epithelial clusters do not appear on the smears, it may be very difficult to distinguish dispersed tumor cells from histiocytes. In this article, we review the literature pertaining to SC cytomorphology and we report a fine needle aspiration biopsy case of SC in salivary gland showing well-defined intracytoplasmic hyaline globules, a feature that has not been previously reported. This novel cytomorphological feature may be helpful in distinguishing the tumor cells of SC from histiocytes and from other low-grade salivary gland tumors.
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Affiliation(s)
- Yinan Hua
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, TX USA
| | - Bing Leng
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, TX USA
| | - Kenneth E. Youens
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, TX USA
| | - Lina Liu
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, TX USA
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16
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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17
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Ito H, Ishida M, Ebisu Y, Okano K, Sandoh K, Noda Y, Miyasaka C, Fujisawa T, Yagi M, Iwai H, Tsuta K. Utility of an immunocytochemical analysis for pan-Trk in the cytodiagnosis of secretory carcinoma of the salivary gland. Diagn Cytopathol 2021; 49:E329-E335. [PMID: 33885200 DOI: 10.1002/dc.24750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/03/2021] [Indexed: 11/07/2022]
Abstract
Secretory carcinoma (SC) of the salivary gland is a rare distinct clinicopathological entity characterized by the presence of the ETV6-NTRK3 fusion. Although the characteristic cytological features of SC have been recognized, its cytodiagnosis, especially differentiating SC from acinic cell carcinoma, is challenging. Recent studies have revealed that immunohistochemistry for pan-tyrosine receptor kinase (Trk) and nuclear receptor subfamily 4 group member 3 (NR4A3) are specific for SC and acinic cell carcinoma, respectively. However, the usefulness of immunocytochemical detection of these markers in the diagnosis of SC has not been addressed. Hence, the present study aimed to analyze the usefulness of immunocytochemical staining for pan-Trk and NR4A3 in the cytodiagnosis of SC. We enrolled eight patients with a histopathological diagnosis of SC who underwent preoperative fine-needle aspiration cytological examination. The cytological characteristics were reviewed and immunocytochemical staining for pan-Trk and NR4A3 was performed. The characteristic cytological features noted in the patient cohort included neoplastic cell clusters with a sheet-like and papillary cluster arrangement as well as single cells. Additionally, neoplastic cells with mild to moderately enlarged nuclei and small nucleoli, multi-vacuolated cytoplasm, and intracytoplasmic mucin were also observed. The immunocytochemical analyses clearly demonstrated that all eight specimens showed positive nuclear staining for pan-Trk, but were negative for NR4A3 expression. Although all cases of SC do not always show positive immunoreactivity for pan-Trk, immunocytochemical analysis for pan-Trk may be useful for the cytodiagnosis of SC along with assessment of the characteristic cytological features.
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Affiliation(s)
- Hiroko Ito
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Yusuke Ebisu
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Kimiaki Okano
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Kaori Sandoh
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Yuri Noda
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Takuo Fujisawa
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan
| | - Masao Yagi
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan
| | - Hiroshi Iwai
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
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18
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Hrudka J, Drozenová J, Sýba J, Gregová M, Dundr P. Secretory carcinoma of salivary type in a lymph node presenting as a neck cyst diagnosed by cytology: A case report. Diagn Cytopathol 2020; 49:E1-E6. [PMID: 32687687 DOI: 10.1002/dc.24550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/06/2022]
Abstract
Secretory carcinoma (SC) is a relatively recently described salivary gland adenocarcinoma characterized by ETV6-NTRK3 gene fusion and, in most cases, indolent clinical behavior. Morphologically, the tumor shows a glandular architecture and the presence of monophasic tumor cells with vacuolated cytoplasm, low-grade nuclear atypia, and mucin production, with possibly a tubular, papillary, or cystic arrangement. In this article, we describe a case of a 52-year old man with SC involving a neck lymph node clinically manifesting as a slowly growing cystic neck mass without recent proof of the primary tumor, but with a history of a parotid gland "cystadenopapilloma," which had been removed 35 years prior. A fine-needle aspiration biopsy revealed a diagnosis of SC. Subsequent histopathological examination after lymph node dissection confirmed the diagnosis. The tumor showed typical features of SC, including immunohistochemical positivity for NTRK and NTRK3 gene rearrangement, detected using in situ hybridization. We discuss that the tumor may be a late metastasis occurring 35 years after resection of undiagnosed salivary SC or a primary SC arising from heterotopic salivary tissue within a lymph node. Differential diagnostic considerations and review of relevant literature are included.
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Affiliation(s)
- Jan Hrudka
- Department of Pathology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jana Drozenová
- Department of Pathology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jaroslav Sýba
- Department of Otorhinolaryngology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Mária Gregová
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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19
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Abstract
RATIONALE Mammary analogue secretory carcinoma is a low grade salivary gland malignancy, first described by Skalova et al in 2010. The histological, immunohistochemical, and molecular characteristics of this tumor resemble those of secretory carcinoma of the breast. PATIENT CONCERNS A 40-year-old male patient without any specific past history came with complaints of 4 cm-sized hard, fixed, right infra-auricular mass without tenderness. There was no enlarged or enhancing lymph node in both neck. DIAGNOSES Fine needle aspiration biopsy was done for right parotid mass and pathologic report was "lymphocytes only" that suggested benign or low-grade malignant parotid tumor. INTERVENTIONS Partial parotidectomy including mass excision was performed. Operative finding showed hard bluish mass located in deep lobe of right parotid gland. OUTCOMES Final pathologic report revealed secretory carcinoma of parotid gland. Homogenous eosinophilic secretions were identified inside microcystic structure. The immunophenotype was positive for epithelial membrane antigen, vimentin, S-100 protein. After 15 months of the surgery, the patient showed negative evidence of disease state. LESSONS We present here a case of mammary analogue secretory carcinoma of the parotid gland to help further characterize this rare tumor.
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Affiliation(s)
| | - Min Eui Hong
- Department of Pathology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong Jin Lee
- Department of Otolaryngology-Head and Neck surgery
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20
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Helmy D, Chang J, Bishop JW, Vong A, Raslan O, Ozturk A. MR imaging findings of a rare pediatric parotid tumor: Mammary analogue secretory carcinoma. Radiol Case Rep 2020; 15:1460-1463. [PMID: 32642018 PMCID: PMC7334559 DOI: 10.1016/j.radcr.2020.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
We present magnetic resonance imaging findings of an 11-year-old girl with a mammary analogue secretory carcinoma (MASC) of the parotid gland. MASC is a recently described tumor of the salivary glands that is genetically and histologically similar to secretory breast carcinoma. To date, a few cases have been reported in the pediatric population, with limited information of its imaging characteristics. We suggest that decreased T2 signal of the solid component of the MASC representing cellular components with associated complex cystic parts may be a helpful imaging finding and can make a substantial contribution in differentiating this new entity from other rare pediatric parotid masses. Although there are no characteristic imaging findings at this time, MASC should be considered in the differential of salivary gland tumors in the pediatric population as well.
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Affiliation(s)
- Daniel Helmy
- Department of Radiology, University of California Davis Medical Center, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - Jennifer Chang
- Department of Radiology, University of California Davis Medical Center, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - John W Bishop
- Department of Pathology, University of California Davis Medical Center, Sacramento, CA
| | - Angela Vong
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Osama Raslan
- Department of Radiology, University of California Davis Medical Center, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - Arzu Ozturk
- Department of Radiology, University of California Davis Medical Center, 4860 Y St., Suite 3100, Sacramento, CA 95817
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21
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Ramos J, Mahmud W, Ocampo FA, Alex G, Gattuso P. Primary Mammary-Analogue Secretory Carcinoma of the Lung: A Rare Entity With an Unusual Location. Int J Surg Pathol 2020; 28:775-781. [PMID: 32279588 DOI: 10.1177/1066896920914975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a case of a 55-year-old female with past medical history of tobacco smoking, hypertension, and lupus who presented with a left lung nodule, found on computed tomographic scan of the chest during workup for a recently diagnosed squamous cell carcinoma in a cervical lymph node. Resection of the lung nodule showed a 2.3-cm well-defined pale-tan mass, and histologic examination showed a well-circumscribed lesion with papillary, solid, and gland-like architectural patterns, with eosinophilic secretions, areas of comedonecrosis, and increased mitotic activity. Immunohistochemical stains showed the lesion to be positive for cytokeratin 7, S100 protein, and focally positive for mammaglobin. Fluorescence in situ hybridization studies confirmed rearrangement of the ETV6 gene at 12p13.2. To date, our case is the second reported case of a primary mammary-analogue secretory carcinoma arising in the lung, and the first to show evidence of tumor necrosis: an unusual feature in an unusual location.
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Affiliation(s)
- Josean Ramos
- Rush University Medical Center, Chicago, IL, USA
| | - Waqas Mahmud
- Rush University Medical Center, Chicago, IL, USA
| | | | - Gillian Alex
- Rush University Medical Center, Chicago, IL, USA
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22
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Na K, Hernandez-Prera JC, Lim JY, Woo HY, Yoon SO. Characterization of novel genetic alterations in salivary gland secretory carcinoma. Mod Pathol 2020; 33:541-550. [PMID: 31822803 PMCID: PMC7113190 DOI: 10.1038/s41379-019-0427-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
Secretory carcinoma is a salivary gland tumor with a characteristic chromosomal translocation that results in an ETV6-NTRK3 fusion gene. Secretory carcinoma shows relatively frequent rates of lymph-node metastasis and tumor recurrence and has a characteristic histology. Except for the ETV6 translocation, genomic alterations in secretory carcinoma have not been reported. In the present study, we characterized the novel recurrent genetic mutations of secretory carcinoma. On the basis of histology, immunohistochemistry, and ETV6 gene break-apart fluorescence in situ hybridization assays, 22 tumors were classified as secretory carcinomas (19 ETV6 translocation-positive and 3 ETV6 translocation-negative secretory carcinomas) and their clinicopathologic characteristics were reviewed. Targeted deep sequencing analyses were performed on 20 secretory carcinomas (17 ETV6 translocation-positive and 3 ETV6 translocation-negative secretory carcinomas) to investigate their genetic alterations. The A16V (C→T) mutation in PRSS1, which encodes a cationic trypsinogen and has a mutation associated with hereditary pancreatitis and pancreatic adenocarcinoma, was observed in 40% (8/20) (7/17 of ETV6 translocation-positive and 1/3 of ETV6 translocation-negative secretory carcinomas). Pathogenic variants of MLH1, MUTYH, and STK11 were also identified. Variants of uncertain significance included mutations in KMT5A. These novel characteristic genetic alterations may advance current understandings of secretory carcinoma tumorigenesis and progression, leading to improved diagnoses and treatment strategies.
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Affiliation(s)
- Kiyong Na
- Department of Pathology, Yonsei University College of Medicine, Yonsei University Health System, Severance Hospital, Seoul, South Korea
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Juan C Hernandez-Prera
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Ha Young Woo
- Department of Pathology, Yonsei University College of Medicine, Yonsei University Health System, Severance Hospital, Seoul, South Korea
| | - Sun Och Yoon
- Department of Pathology, Yonsei University College of Medicine, Yonsei University Health System, Severance Hospital, Seoul, South Korea.
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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23
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Secretory Carcinoma of Salivary Gland with High-Grade Histology Arising in Hard Palate: A Case Report. REPORTS 2020. [DOI: 10.3390/reports3020006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Secretory carcinoma (SC) is a recently described salivary gland tumor reported in the fourth edition of World Health Organization classification of head and neck tumors. SC is characterized by strong S-100 protein, mammaglobin, and vimentin immunoexpression, and harbors a t(12;15)(p13;q25) translocation which leads to ETV6-NTRK3 fusion product. Histologically, SC displays a lobulated growth pattern and is often composed of microcystic, tubular, and solid structures with abundant eosinophilic homogenous or bubbly secretion. SC is generally recognized as low-grade malignancy with low-grade histopathologic features, and metastasis is relatively uncommon. In this case, we described a SC of hard palate that underwent high grade transformation and metastasis to the cervical lymph node in a 54-year-old patient. In addition, this case showed different histological findings between primary lesion and metastasis lesion. Therefore, the diagnosis was confirmed by the presence of ETV6 translocation. Here, we report a case that occurred SC with high-grade transformation in the palate, and a review of the relevant literature is also presented.
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24
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Kapatia G, Kithan LS, Rohilla M, Gupta N, Srinivasan R, Dey P, Rajwanshi A. Secretory carcinoma: Fine needle aspiration cytology of a rare parotid gland tumour. Cytopathology 2020; 31:243-245. [PMID: 32053255 DOI: 10.1111/cyt.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Gargi Kapatia
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lijanthung S Kithan
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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25
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Balakrishnan M, George SA, Haji BE, Francis IM. Fine-needle Aspiration Cytology of Mammary Analog Secretory Carcinoma of the Parotid Gland: A Diagnostic Conundrum. J Cytol 2019; 36:215-216. [PMID: 31741583 PMCID: PMC6844013 DOI: 10.4103/joc.joc_28_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/08/2019] [Accepted: 08/31/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Meera Balakrishnan
- Department of Cytopathology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Bahiya E Haji
- Department of Cytopathology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Issam M Francis
- Department of Pathology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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26
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Jo VY, Krane JF. Ancillary testing in salivary gland cytology: A practical guide. Cancer Cytopathol 2019; 126 Suppl 8:627-642. [PMID: 30156767 DOI: 10.1002/cncy.22010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 12/19/2022]
Abstract
Salivary gland cytology is challenging, and historically the role of ancillary testing has been limited. However, numerous molecular/genetic advances in the understanding of salivary gland neoplasms during the last decade have facilitated the development of many useful diagnostic markers, such as PLAG1 and HMGA2 immunohistochemistry for pleomorphic adenoma and ETV6 fluorescence in situ hybridization for secretory carcinoma. Numerous salivary gland neoplasms are characterized by specific molecular/genetic alterations, many of which can be identified on cytologic preparations by karyotype analysis, fluorescence in situ hybridization, or immunohistochemical surrogates. Next-generation sequencing also has potential diagnostic applications, although to the authors' knowledge it currently has no routine role in salivary cytology. The primary goal of salivary fine-needle aspiration (FNA) is to facilitate appropriate clinical management. Ancillary testing has greatly enhanced the ability for accurate classification as per The Milan System for Reporting Salivary Gland Cytopathology and allows for the definitive diagnosis of many salivary FNA specimens, and also may resolve diagnostic uncertainty for FNAs that may be classified in The Milan System for Reporting Salivary Gland Cytopathology categories of salivary gland neoplasm of uncertain malignant potential or suspicious for malignancy. This review provides an updated discussion of the molecular/genetic features of the more commonly encountered salivary neoplasms by FNA, and discusses the application of available diagnostic immunohistochemical and molecular tests in salivary gland cytology.
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Affiliation(s)
- Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Peters TM, Phero JA, Golden BA, Curran AE. A biphasic sessile mass of the buccal mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 130:612-615. [PMID: 31954622 DOI: 10.1016/j.oooo.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Tiffany M Peters
- Department of Diagnostic Sciences, University of North Carolina at Chapel Hill, Adams School of Dentistry, Chapel Hill, NC, USA.
| | - James A Phero
- Clinical Instructor, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | | | - Alice E Curran
- Department of Diagnostic Sciences, University of North Carolina at Chapel Hill, Adams School of Dentistry, Chapel Hill, NC, USA
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28
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Miesbauerová M, Tommola S, Šteiner P, Baněčková M, Skálová A, Kholová I. Cytopathological features of secretory carcinoma of salivary glands and ancillary techniques in its diagnostics: impact of new Milan system for reporting salivary gland cytopathology. APMIS 2019; 127:491-502. [PMID: 30942913 DOI: 10.1111/apm.12950] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/22/2019] [Indexed: 12/19/2022]
Abstract
Secretory carcinoma (SC) of salivary glands is a newly described low-grade malignancy characterized by the presence of ETV6 rearrangement. Only a few cases and very small series with cytomorphology were reported so far. Six cases of fine-needle aspirations (FNAs) from afterward histologically, immunohistochemically and genetically confirmed SCs were retrieved from the archives of the authors. Ancillary immunocytochemistry (ICC) and translocation detection were performed on cell blocks (CBs). All aspirates were sufficiently cellular and cells were arranged in more or less cohesive groups with only mild nuclear polymorphism. The cytoplasm was eosinophilic, granulated and vacuolated, especially in CBs. Secretory material within the microcystic spaces was periodic acid-Schiff (PAS) positive. Triple positivity of immunomarkers S-100 protein, mammaglobin and vimentin was present. The proliferation index was low. Ancillary techniques suggested the possibility of SC in a few cytology cases; nevertheless, the final diagnosis was based on histomorphology, immunohistochemistry and genetics. The SC of salivary glands is detectable pre-operatively using ICC and genetics. The presence of the diagnostic ETV6 rearrangement increases the accuracy of FNA to the maximum. According to the Milan system, cases genetically not confirmed should be categorized as Suspicious for Malignancy or Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP), both requiring surgery.
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Affiliation(s)
- Markéta Miesbauerová
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Plzeň, Czech Republic
- Bioptic Laboratory, Ltd, Plzeň 2-Slovany, Czech Republic
| | - Satu Tommola
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
| | - Petr Šteiner
- Molecular Pathology Laboratory, Bioptic Laboratory, Ltd, Plzeň 2-Slovany, Czech Republic
| | - Martina Baněčková
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Plzeň, Czech Republic
- Bioptic Laboratory, Ltd, Plzeň 2-Slovany, Czech Republic
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Plzeň, Czech Republic
- Bioptic Laboratory, Ltd, Plzeň 2-Slovany, Czech Republic
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
- Department of Pathology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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29
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Mammary Analogue Secretory Carcinoma of the Palate: Case Report and Review of the Literature. Case Rep Dent 2019; 2019:7416302. [PMID: 30937197 PMCID: PMC6415289 DOI: 10.1155/2019/7416302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/03/2019] [Accepted: 02/11/2019] [Indexed: 01/29/2023] Open
Abstract
Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland tumor, with a limited number of published reports. Less than three hundred cases have been reported in the literature and only 18 of these cases have been reported in minor palatal salivary glands, though publication bias is likely a factor. We present a case of a 57-year-old male who was diagnosed with MASC tumor presenting in a minor salivary gland and briefly review the current literature. MASC has a variety of histological features and different range of clinical behaviors. The histopathological diagnosis of MASC can be difficult, and the immunohistochemical profile of MASC is still being updated. The gold standard for MASC diagnosis is cytogenetics, with the majority having a translocation t(12;15)(p133;q25). Presently, there is no conclusive evidence that MASC should be treated differently than any other low-grade malignant salivary gland tumors, though high-grade transformation has been described.
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30
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Al‐Husseinawi E, Hamidpour S, Omoscharka E. Mammary analogue secretory carcinoma of salivary gland diagnosed on submandibular gland cytology: A case report and review of the literature. Cytopathology 2019; 30:318-322. [DOI: 10.1111/cyt.12666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ethar Al‐Husseinawi
- Department of Pathology Truman Medical Center University of Missouri at Kansas City Kansas City Missouri USA
| | - Soheila Hamidpour
- Department of Pathology Truman Medical Center University of Missouri at Kansas City Kansas City Missouri USA
| | - Evanthia Omoscharka
- Department of Pathology Truman Medical Center University of Missouri at Kansas City Kansas City Missouri USA
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31
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Kim YA, Joung JW, Lee SJ, Oh HK, Cho CH, Sung WJ. Cytopathologic Features of Secretory Carcinoma of Salivary Gland: Report of Two Cases. J Pathol Transl Med 2018; 53:70-74. [PMID: 30599505 PMCID: PMC6344800 DOI: 10.4132/jptm.2018.11.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 12/04/2022] Open
Abstract
Secretory carcinoma of the salivary gland (SC) is a newly introduced rare salivary gland tumor that shares histological, immunohistochemical, and genetic characteristics with secretory carcinoma of the breast. Here, we report the cytologic features of two cases of SC confirmed by surgical resection. In these two cases, SC was incidentally detected in a 64-year-old female and a 56-yearold male. Fine needle aspiration cytology revealed nests of tumor cells with a papillary or glandular structure floating in mucinous secretions. The tumor cells demonstrated uniform, round, smooth nuclear contours and distinct nucleoli. Multiple characteristic cytoplasmic vacuoles were revealed. Singly scattered tumor cells frequently showed variable sized cytoplasmic vacuoles. The cytopathologic diagnosis of SC should be considered when characteristic cytological findings are revealed. Further immunohistochemistry and gene analyses are helpful to diagnose SC.
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Affiliation(s)
- Young Ah Kim
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jae Won Joung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sun-Jae Lee
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hoon-Kyu Oh
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chang Ho Cho
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Woo Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
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32
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Hang JF, Alruwaii F, Zeng BR, Lai CR, Wu HH. Subtyping salivary gland neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy. Cancer Cytopathol 2018; 126:924-933. [DOI: 10.1002/cncy.22066] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/17/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Jen-Fan Hang
- Department of Pathology and Laboratory Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Fatimah Alruwaii
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Bao-Rung Zeng
- Department of Pathology and Laboratory Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Howard H. Wu
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
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33
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Brastianos PK, Ippen FM, Hafeez U, Gan HK. Emerging Gene Fusion Drivers in Primary and Metastatic Central Nervous System Malignancies: A Review of Available Evidence for Systemic Targeted Therapies. Oncologist 2018; 23:1063-1075. [PMID: 29703764 PMCID: PMC6192601 DOI: 10.1634/theoncologist.2017-0614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/07/2018] [Indexed: 12/11/2022] Open
Abstract
Primary and metastatic tumors of the central nervous system present a difficult clinical challenge, and they are a common cause of disease progression and death. For most patients, treatment consists primarily of surgery and/or radiotherapy. In recent years, systemic therapies have become available or are under investigation for patients whose tumors are driven by specific genetic alterations, and some of these targeted treatments have been associated with dramatic improvements in extracranial and intracranial disease control and survival. However, the success of other systemic therapies has been hindered by inadequate penetration of the drug into the brain parenchyma. Advances in molecular characterization of oncogenic drivers have led to the identification of new gene fusions driving oncogenesis in some of the most common sources of intracranial tumors. Systemic therapies targeting many of these alterations have been approved recently or are in clinical development, and the ability to penetrate the blood-brain barrier is now widely recognized as an important property of such drugs. We review this rapidly advancing field with a focus on recently uncovered gene fusions and brain-penetrant systemic therapies targeting them. IMPLICATIONS FOR PRACTICE Driver gene fusions involving receptor tyrosine kinases have been identified across a wide range of tumor types, including primary central nervous system (CNS) tumors and extracranial solid tumors that are associated with high rates of metastasis to the CNS (e.g., lung, breast, melanoma). This review discusses the systemic therapies that target emerging gene fusions, with a focus on brain-penetrant agents that will target the intracranial disease and, where present, also extracranial disease.
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Affiliation(s)
- Priscilla K Brastianos
- Department of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Franziska Maria Ippen
- Department of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Umbreen Hafeez
- Medical Oncology, Austin Hospital, Heidelberg, Melbourne, Australia
| | - Hui K Gan
- Medical Oncology, Austin Hospital, Heidelberg, Melbourne, Australia
- La Trobe University School of Cancer Medicine, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
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34
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Liu H, Ljungren C, Lin F, Zarka MA, Chen L. Analysis of histologic follow-up and risk of malignancy for salivary gland neoplasm of uncertain malignant potential proposed by the Milan System for Reporting Salivary Gland Cytopathology. Cancer Cytopathol 2018; 126:490-497. [DOI: 10.1002/cncy.22002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Haiyan Liu
- Department of Pathology; Geisinger Health System; Danville Pennsylvania
| | - Clarissa Ljungren
- Department of Laboratory Medicine and Pathology; Mayo Clinic Arizona; Scottsdale Arizona
| | - Fan Lin
- Department of Pathology; Geisinger Health System; Danville Pennsylvania
| | - Matthew A. Zarka
- Department of Laboratory Medicine and Pathology; Mayo Clinic Arizona; Scottsdale Arizona
| | - Longwen Chen
- Department of Laboratory Medicine and Pathology; Mayo Clinic Arizona; Scottsdale Arizona
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35
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Pantanowitz L, Thompson LDR, Rossi ED. Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland. Head Neck Pathol 2018; 12. [PMID: 29524082 PMCID: PMC6232202 DOI: 10.1007/s12105-018-0904-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fine needle aspiration (FNA) has diagnostic and therapeutic value in the management of salivary gland cysts. Rendering an accurate diagnosis from an aspirated salivary gland cyst is challenging because of the broad differential diagnosis, possibility of sampling error, frequent hypocellularity of specimens, morphologic heterogeneity, and overlapping cytomorphology of many cystic entities. To date, there have been no comprehensive review articles providing a practical diagnostic approach to FNA of cystic lesions of salivary glands. This article reviews the cytopathology of salivary gland cysts employing 2017 World Health Organization terminology, addresses the accuracy of FNA, and presents The Milan System approach for reporting in cystic salivary gland cases. The utility of separating FNA specimens from salivary gland cysts, based upon the presence of mucin and admixed lymphocytes in cyst fluid is demonstrated. A reliable approach to interpreting FNA specimens from patients with cystic salivary gland lesions is essential to accurately determine which of these patients may require subsequent surgery.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA.
- Department of Pathology, UPMC Shadyside UPMC Cancer Pavilion, Suite 20, 5150 Centre Ave, Pittsburgh, PA, 15232, USA.
| | - Lester D R Thompson
- Pathology Department, Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of Sacred Heart, Rome, Italy
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36
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Woo HY, Choi EC, Yoon SO. Diagnostic Approaches for Salivary Gland Tumors with Secretory and Microcystic Features. Head Neck Pathol 2017; 12:237-243. [PMID: 29139086 PMCID: PMC5953885 DOI: 10.1007/s12105-017-0864-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
Secretory carcinoma (SC) of the salivary gland is a new entity that shares the unique morphologic features and cytogenetic characteristics of the ETV6-NTRK3 fusion gene with its breast counterpart. Before identification of SC of the salivary gland, it was most frequently diagnosed as acinic cell carcinoma (AciCC). We retrospectively reviewed our own database of salivary gland tumors harboring microcystic and papillary architecture and/or secretory features that were originally diagnosed as AciCC. We selected nine cases of AciCC showing diffuse S-100 expression on immunohistochemistry (IHC). A recently diagnosed case of SC was included in the study as a reference sample. We performed IHC of S-100 and mammaglobin and ETV6 gene fluorescence in situ hybridization (FISH) in all cases. Seven cases were positive for both S-100 and mammaglobin, while five of the seven (71.4%) demonstrated ETV6 gene translocation by FISH. In the cases which did not co-express either S-100 or mammaglobin on IHC, ETV6 gene rearrangement was not shown on FISH. In conclusion, if a salivary gland tumor has morphologic features of SC with co-expression of S-100 and mammaglobin, ETV6 FISH can be performed to confirm the diagnosis of SC of the salivary gland.
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Affiliation(s)
- Ha Young Woo
- Department of Pathology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Sun Och Yoon
- Department of Pathology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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37
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Bissinger O, Götz C, Kolk A, Bier HA, Agaimy A, Frenzel H, Perner S, Ribbat-Idel J, Wolff KD, Weichert W, Mogler C. Mammary analogue secretory carcinoma of salivary glands: diagnostic pitfall with distinct immunohistochemical profile and molecular features. Rare Tumors 2017; 9:7162. [PMID: 29081930 PMCID: PMC5643951 DOI: 10.4081/rt.2017.7162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/27/2017] [Accepted: 08/17/2017] [Indexed: 01/12/2023] Open
Abstract
Mammary analogue secretory carcinoma (MASC) is a newly defined entity among salivary gland malignancies which has just been established in the 4th edition of the WHO classification of head and neck tumors. MASC (synonym: secretory carcinoma) are characterized by a specific rearangement of the ETV6 gene locus. Here, we present a series of 3 MASC cases including clinical data with follow-up for up to 26 months. All tumours immunhistochemically displayed strong positivity for cytokeratin 7, and mammaglobin, focal positivity for S100, cytokeratin 5/6 and muc-4. In contrast, immunhistochemical stainings against cytokeratin 14, hormon receptors, Her2/neu, androgen receptor and prostate-specific antigen were consistently negative. FISH analysis showed translocation of the ETV6 gene locus in the majority of tumour cell nuclei. During clinical follow-up, no local relapse or metastasis was detected. As these carcinomas are clinically and radiologically indistinguishable from other salivary gland tumours and as therapeutic approaches and prognosis might differ, we need to be able to diagnose MASC correctly.
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Affiliation(s)
- Oliver Bissinger
- Department of Oral- and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München
| | - Carolin Götz
- Department of Oral- and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München
| | - Andreas Kolk
- Department of Oral- and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München
| | - Henning A Bier
- Department of Otolaryngology, Klinikum rechts der Isar der Technischen Universität München
| | | | | | - Sven Perner
- Department of Pathology, University Medical Center Schleswig- Holstein, Campus Luebeck and Research Center Borstel.,Leibniz Center for Medicine and Biosciences
| | - Julika Ribbat-Idel
- Department of Pathology, University Medical Center Schleswig- Holstein, Campus Luebeck and Research Center Borstel.,Leibniz Center for Medicine and Biosciences
| | - Klaus Dietrich Wolff
- Department of Oral- and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München
| | - Wilko Weichert
- Institute of Pathology, Technische Universität München, Germany
| | - Caroline Mogler
- Institute of Pathology, Technische Universität München, Germany
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38
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Gavín-Clavero MA, Simón-Sanz MV, López-López AM, Valero-Torres A, Saura-Fillat E. Diagnóstico, tratamiento y seguimiento de un tumor de reciente descripción: el carcinoma análogo secretor de mama (MASC) de glándula salival. A propósito de 2 nuevos casos. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.maxilo.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Gonzalez MF, Akhtar I, Manucha V. Additional diagnostic features of mammary analogue secretory carcinoma on cytology. Cytopathology 2017; 29:100-103. [PMID: 28929545 DOI: 10.1111/cyt.12465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 01/05/2023]
Affiliation(s)
- M F Gonzalez
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - I Akhtar
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - V Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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40
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Ngouajio AL, Drejet SM, Phillips DR, Summerlin DJ, Dahl JP. A systematic review including an additional pediatric case report: Pediatric cases of mammary analogue secretory carcinoma. Int J Pediatr Otorhinolaryngol 2017; 100:187-193. [PMID: 28802370 DOI: 10.1016/j.ijporl.2017.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Mammary Analogue Secretory Carcinoma (MASC) is a newly characterized salivary gland carcinoma resembling secretory carcinoma of the breast. Prior to being described, MASC was most commonly misdiagnosed as Acinic Cell Carcinoma. Though MASC is predominantly an adult neoplasm, cases have been reported in the pediatric population. Reporting and summarizing of known cases is imperative to understand the prognosis and clinical behavior of MASC. OBJECTIVE EVIDENCE REVIEW: Web of Science, Medline, EMBASE, and The Cochrane Library were searched for studies that included pediatric cases of MASC. Data on clinical presentation, diagnosis and management, and pathology were collected from all pediatric cases. FINDINGS CONCLUSIONS AND RELEVANCE: Since the first case of MASC in the pediatric population was described in 2011, only 12 cases, including this one, have been described in the literature. With this paucity of information, much remains unknown regarding this new pathologic diagnosis. The collection of clinical outcomes data of children with MASC is needed to better understand the behavior of this malignancy as well as determine optimal treatment regimens.
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Affiliation(s)
- Amanda L Ngouajio
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarah M Drejet
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - D Ryan Phillips
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Don-John Summerlin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John P Dahl
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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41
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Griffith CC, Schmitt AC, Pantanowitz L, Monaco SE. A pattern-based risk-stratification scheme for salivary gland cytology: A multi-institutional, interobserver variability study to determine applicability. Cancer Cytopathol 2017; 125:776-785. [PMID: 28834233 DOI: 10.1002/cncy.21906] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/20/2017] [Accepted: 07/11/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Salivary gland aspiration cytology is useful in the preoperative management of patients but remains challenging, because of the extensive morphologic overlap of some tumors limits the ability to always determine the presence of malignancy. In response to this challenge, there has been increasing drive to develop a risk-based categorization scheme for salivary gland aspirates. Herein, the authors examine the interobserver variability of 1 such pattern and risk-based system. METHODS Select smears and cell-block sections of 50 salivary gland aspirates from 2 large academic centers were digitally imaged. These scanned slides were independently and blindly reviewed by 4 cytopathologists, and each aspirate was assigned to 1 of the proposed pattern-based categories if it was considered neoplastic by the observer. Interobserver agreement was scored and aggregated risks of malignancy were calculated for cases with available surgical follow-up. RESULTS In total, 42 samples (84%) were considered neoplastic by at least 2 observers and were scored for interobserver agreement: 10 of 42 (23.8%) had uniform agreement, 14 of 42 (33.3%) had majority agreement, and 5 of 42 (11.9%) had divided agreement. Only 9 of 42 samples (21.4%) had minimal agreement, and 4 of 42 (9.5%) had no agreement. Condensation of similar categories was able to improve interobserver agreement and still maintain stratified risk of malignancy. CONCLUSIONS The proposed pattern-based risk-stratification scheme, which could be implemented with the forthcoming Milan System, has good overall interobserver agreement and successfully stratifies the risk of malignancy. Some simplification is possible to make the system easier to use and improve interobserver agreement while maintaining stratification of risk. Cancer Cytopathol 2017;125:776-85. © 2017 American Cancer Society.
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Affiliation(s)
| | | | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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42
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Khalele BA. Systematic review of mammary analog secretory carcinoma of salivary glands at 7 years after description. Head Neck 2017; 39:1243-1248. [PMID: 28370824 DOI: 10.1002/hed.24755] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 01/07/2017] [Accepted: 02/01/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mammary analog secretory carcinoma of the salivary glands (MASCSG ) is a newly introduced malignant tumor of the salivary glands. For decades, it has been confused with acinic cell carcinoma (ACC) of the salivary glands. METHODS All reported cases of MASCSG were surveyed from 2010 until January 2017. The collected data was compiled and computationally processed to describe the clinical parameters of MASCSG . Its epidemiology was also mapped. Moreover, inaccurate data was highlighted. RESULTS Clinically implicating, this article tackles simply the several clinical findings of MASCSG so that our contemporary nosology, at 7 years after description, can be updated. The cytogenetic, histologic, and immunohistochemical details are also defined. CONCLUSION The available data about MASCSG is sufficient enough to diagnose it with no need to investigate the ETV6-NTRK3 translocation. Although high-grade malignancy and distant metastases were rarely reported, a rapt attention should be paid both to the nature of this tumor and to the indicated close follow-up of such cases, especially when necrosis, increased mitotic activity, and other classic caveats are conspicuous. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1243-1248, 2017.
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43
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Evrard SM, Meilleroux J, Daniel G, Basset C, Lacoste-Collin L, Vergez S, Uro-Coste E, Courtade-Saidi M. Use of fluorescent in-situ hybridisation in salivary gland cytology: A powerful diagnostic tool. Cytopathology 2017; 28:312-320. [PMID: 28503786 DOI: 10.1111/cyt.12427] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Salivary gland cytology is challenging because it includes a diversity of lesions and a wide spectra of tumours. Recently, it has been reported that many types of salivary gland tumours have specific molecular diagnostic signatures that could be identified by fluorescent in-situ hybridisation (FISH). The aim of the present study was to demonstrate the feasibility and efficiency of FISH on routine cytological salivary gland smears. METHODS FISH was conducted on 37 cytological salivary gland smears from 34 patients. According to the cytological diagnosis suspected, MECT1/MAML2 gene fusion and rearrangements of PLAG1, MYB, or ETV6 were analysed. The presence and percentages of cells that had gene rearrangements were evaluated. Results were compared with the histological surgical samples, available from 26 patients. RESULTS The PLAG1 rearrangement was observed in 12/20 (60%) cases of pleomorphic adenoma. MECT1/MAML2 gene fusion was observed in 1:2 mucoepidermoid carcinomas but was not observed in five other tumours (two pleomorphic adenomas, one Warthin's tumour, one mammary analogue secretory carcinoma [MASC] and one cystic tumour). MYB rearrangement was observed in 4/4 adenoid cystic carcinomas. ETV6-gene splitting identified one MASC. CONCLUSION Overall, FISH had a specificity of 100% and a sensitivity of 66.7%. When FISH and cytological analyses were combined, the overall sensitivity was increased to 93.3%. It can thus be concluded that when the FISH analysis is positive, the extent of surgery could be determined with confidence pre-operatively without needing a diagnosis from a frozen section.
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Affiliation(s)
- S M Evrard
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - J Meilleroux
- Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - G Daniel
- Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - C Basset
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - L Lacoste-Collin
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - S Vergez
- Otolaryngology Department, Head and Neck Surgery, CHU Toulouse, Larrey Hospital, Toulouse Cedex 9, France.,Otolaryngology Department, Head and Neck Surgery, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France.,Rangueil Medical School, Toulouse III Paul Sabatier University, Toulouse Cedex, France
| | - E Uro-Coste
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Rangueil Medical School, Toulouse III Paul Sabatier University, Toulouse Cedex, France
| | - M Courtade-Saidi
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
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44
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Cipriani NA, Blair EA, Finkle J, Kraninger JL, Straus CM, Villaflor VM, Ginat DT. Salivary Gland Secretory Carcinoma With High-Grade Transformation, CDKN2A/B Loss, Distant Metastasis, and Lack of Sustained Response to Crizotinib. Int J Surg Pathol 2017; 25:613-618. [DOI: 10.1177/1066896917709350] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Salivary gland secretory carcinoma is usually a low-grade neoplasm. However, high-grade transformation can occur and has important implications for clinical outcome. Methods. A patient presented with an enlarging buccal mass. Magnetic resonance imaging (MRI) showed a tumor with a biphasic appearance along the right parotid duct. Local excision and histopathologic examination confirmed the diagnosis of secretory carcinoma with high-grade transformation. ETV6-NTRK3 translocation and loss of CDKN2A/B were identified. Results. The patient subsequently presented with cough and dyspnea and was found to have pleural metastases. Carboplatin and paclitaxel exacerbated the symptoms. Crizotinib resulted in initial symptomatic and radiographic improvement; however, the patient soon succumbed to progressive intrathoracic disease. Conclusions. High-grade salivary gland secretory carcinoma can have a biphasic appearance on MRI. Diagnosis is confirmed by the histologic appearance and associated ETV6-NTRK3 fusion. Additional molecular genetic events leading to transformation are unknown; however, loss of CDKN2A/B may have contributed. Treatment with multimodal chemotherapy was of limited benefit.
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Rooper LM, Onenerk M, Siddiqui MT, Faquin WC, Bishop JA, Ali SZ. Nodular oncocytic hyperplasia: Can cytomorphology allow for the preoperative diagnosis of a nonneoplastic salivary disease? Cancer Cytopathol 2017; 125:627-634. [PMID: 28411376 DOI: 10.1002/cncy.21865] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/22/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nodular oncocytic hyperplasia (oncocytosis) of the salivary glands is a benign process that does not inherently require surgical excision. However, cytologic findings in fine-needle aspiration (FNA) of oncocytosis cases have not been well characterized previously, limiting preoperative identification. METHODS All available cases of oncocytosis with corresponding FNA specimens were identified from the pathology archives of 3 academic institutions. Clinical, cytologic, and histologic findings were tabulated for all cases. RESULTS Twelve cases of oncocytosis were identified from 11 patients, including 11 parotid FNA specimens and 1 submandibular FNA specimen. On the original diagnoses, 6 specimens were classified as benign, 4 as atypical, and 2 as nondiagnostic. Oncocytosis was listed in the differential diagnosis in only 1 case. Among diagnostic aspirates, 8 demonstrated low cellularity and 2 demonstrated moderate cellularity. All 10 cases demonstrated oncocytic cells in small to medium groups, with single cells in just 1 case. Spindled and squamous morphology were each noted in 3 cases. Four cases demonstrated cystic change and 1 showed background mucin without goblet cells. No necrosis or mitoses were observed. CONCLUSIONS Although oncocytosis demonstrates some overlap with Warthin tumor and oncocytoma, it lacks the diagnostic findings specific to oncocytic salivary gland malignancies such as salivary duct carcinoma, acinic cell carcinoma, mammary analog secretory carcinoma, and mucoepidermoid carcinoma. Despite current limitations in the understanding of oncocytic salivary gland lesions, the presence of a paucicellular specimen comprised of small groups of oncocytic cells should raise the possibility of oncocytosis in the differential diagnosis and can favor it in elderly patients with multiple salivary nodules. Cancer Cytopathol 2017;125:627-34. © 2017 American Cancer Society.
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Affiliation(s)
- Lisa M Rooper
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mine Onenerk
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Otolaryngology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
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Utility of Immunohistochemistry and ETV6 (12p13) Gene Rearrangement in Identifying Secretory Carcinoma of Salivary Gland among Previously Diagnosed Cases of Acinic Cell Carcinoma. PATHOLOGY RESEARCH INTERNATIONAL 2017; 2017:1497023. [PMID: 28484662 PMCID: PMC5397614 DOI: 10.1155/2017/1497023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Abstract
Objective. Secretory carcinoma is a recently described entity with characteristic immunoprofile and ETV6 (12p13) rearrangement. Before its initial description, it was generally diagnosed as acinic cell carcinoma (ACCi). We evaluated immunoprofile and ETV6 rearrangement in cytological and surgical cases of previously diagnosed ACCi, in an attempt to identify any misclassified SC. Methods. Fifteen cytology and surgical cases of ACCi diagnosed over a 13-year period were retrieved and subjected to immunohistochemistry for S-100, mammaglobin, GATA-3 and DOG-1 as well as FISH for ETV6 (12p13). Results. Of the 8 cytology cases, only 1 was positive for S100, GATA-3, and mammaglobin, and negative for DOG-1. It also demonstrated ETV6 rearrangement and was reclassified as SC. The same immunoprofile was present in 2 of the 13 surgical cases. ETV6 rearrangement characterized by 3′ interstitial deletion was detected in one of these cases and was reclassified as SC. Immunohistochemistry and ETV6 rearrangement were useful in identifying 2 (13.3%) cases misclassified as ACCi. Conclusions. Characteristic immunoprofile and ETV6 gene rearrangement may prove useful in identifying cases of SC. The presence of ETV6 3′ interstitial deletion in one of our cases suggests that there may be additional ETV6 related genetic alterations contributing to the pathogenesis of SC.
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Abstract
Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland tumor that shares the same histologic appearance and ETV6 gene (12p13) rearrangement as secretory carcinoma of the breast. Prior to its recognition, MASC cases were commonly labeled acinic cell carcinoma and adenocarcinoma, not otherwise specified. Despite distinctive histologic features, MASC may be difficult to distinguish from other salivary gland tumors, in particular zymogen-poor acinic cell carcinoma and low-grade salivary duct carcinoma. Although characteristic morphologic and immunohistochemical features form the basis of a diagnosis of MASC, the presence of an ETV6-NTRK3 gene fusion is confirmatory. Given its recent recognition the true prognostic import of MASC is not yet clearly defined.
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Affiliation(s)
- Vishwas Parekh
- From the Department of Pathology, University of Alabama at Birmingham
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Rodríguez-Urrego PA, Dogan S, Lin O. Cytologic findings of mammary analogue secretory carcinoma arising in the thyroid. Diagn Cytopathol 2017; 45:552-556. [DOI: 10.1002/dc.23692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/29/2017] [Accepted: 02/07/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Paula A. Rodríguez-Urrego
- Department of Pathology; Fundación Santa Fe de Bogotá; Colombia
- Facultad de Medicina, Universidad de los Andes; Bogotá Colombia
| | - Snjezana Dogan
- Department of Pathology; Memorial Sloan-Kettering Cancer Center; New York
| | - Oscar Lin
- Department of Pathology; Memorial Sloan-Kettering Cancer Center; New York
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Suzuki K, Yagi M, Kanda A, Kobayashi Y, Konishi M, Miyasaka C, Tashiro T, Iwai H. Mammary Analogue Secretory Carcinoma Presenting as a Cervical Lymph Node Metastasis of Unknown Primary Site: A Case Report. Case Rep Oncol 2017; 10:192-198. [PMID: 28413396 PMCID: PMC5346937 DOI: 10.1159/000457949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 01/30/2023] Open
Abstract
Background Mammary analogue secretory carcinoma (MASC) is a pathological entity arising in the salivary glands first described by Skalova et al. [Am J Surg Pathol 2010;34: 599–608]. Here, we report the first case of MASC presenting as a cervical lymph node metastasis of unknown primary site together with a brief review of the literature. Case Report We present a 74-year-old male with a painless lump in his left neck. Based on the fine-needle aspiration cytological findings, a possible malignant tumor was suspected. No evidence of a primary lesion was observed using imaging modalities including positron emission tomography/computed tomography. The patient underwent an ipsilateral modified radical neck dissection. Immunohistochemical staining showed that the neoplastic cells were positive for S100 protein and GATA3. A rearrangement of the ETV6 gene was noted during fluorescence in situ hybridization, and the final histopathological diagnosis was MASC. Conclusion We encountered a MASC presenting as a cervical lymph node metastasis of unknown primary site. No adjuvant therapy was administered, and no local recurrence or metastatic disease has been detected during a follow-up period of 9 months. This is the first case report of MASC presenting as a cervical lymph node metastasis of unknown primary site and suggests the new properties of MASC.
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Affiliation(s)
- Kensuke Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Masao Yagi
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Akira Kanda
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Yoshiki Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Masaya Konishi
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory Medicine, Kansai Medical University Hospital, Hirakata, Japan
| | - Takashi Tashiro
- Department of Pathology and Laboratory Medicine, Kansai Medical University Hospital, Hirakata, Japan
| | - Hiroshi Iwai
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Japan
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Skalova A, Michal M, Simpson RH. Newly described salivary gland tumors. Mod Pathol 2017; 30:S27-S43. [PMID: 28060365 DOI: 10.1038/modpathol.2016.167] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022]
Abstract
This review concentrates on three salivary gland tumors that have been accepted in the recent literature as new neoplastic entities: mammary analog secretory carcinoma (MASC), sclerosing polycystic adenoma (SPA) and cribriform adenocarcinoma of tongue and other minor salivary glands (CAMSGs). MASC is a distinctive low-grade malignant salivary cancer that harbors a characteristic chromosomal translocation, t(12;15) (p13;q25) resulting in an ETV6-NTRK3 fusion. SPA is a rare lesion often mistaken histologically for low-grade salivary carcinoma. Previously thought to be a reactive fibroinflammatory process, but recent evidence of clonality, recurrences in up 30%, and dysplastic foci suggest it may be truly neoplastic. CAMSG is a distinct tumor entity that differs from polymorphous low-grade adenocarcinoma (PLGA) by location (ie, most often arising on the tongue), by prominent nuclear clearing, alterations of the PRKD gene family and clinical behavior with frequent metastases at the time of presentation of the primary tumor. Early metastatic disease seen in most cases of CAMSG associated with indolent behavior makes it a unique neoplasm among all low-grade salivary gland tumors. Salivary glands may give rise to a wide spectrum of different tumors. They are often diagnostically challenging as morphological features often overlap between different entities. Although conventional morphology in combination with immunohistochemical findings still provide the most important clues for diagnosis, recent advances in molecular pathology offer new diagnostic tools in investigating the differential diagnosis, as well as providing potentially valuable prognostic indicators. In the last two decades, several new salivary gland tumor entities have been described, namely MASC, SPA and CAMSGs.
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Affiliation(s)
- Alena Skalova
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Roderick Hw Simpson
- Department of Anatomical Pathology, Foothills Medical Centre, Calgary, Alberta, Canada
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