Immunohistochemical detection of carcinoembryonic antigen (CEA) in parotid gland carcinomas. Analysis of 52 cases

Adenoid cystic carcinoma of the Bartholin's gland is easily misdiagnosed: A case report and literature review

RATIONALE

Adenoid cystic carcinoma (ACC) often occurs in the major and minor salivary glands and other sites containing secretory glands, while ACC of the Bartholin's gland (BG-ACC) in the vulva is rare and easily misdiagnosed.

PATIENT CONCERNS

A 58-year-old female was referred to our hospital for further valuation of a mass occurring on the left side of her vulva. In the other hospital, the beginning of the period, local ultrasound showed a vulva mass, which was suspected to be a Bartholin's gland cyst. Mixed neoplasms were considered in some biopsies. When transferred to our hospital, virtuous tumors were considered by ultrasound and magnetic resonance imaging. Pathology initially considered benign hyperplastic active tumor or borderline tumor.

DIAGNOSES

Histological, immunochemical, and molecular tests confirmed a diagnosis of BG-ACC, negative surgical margin, without lymphatic metastasis.

INTERVENTIONS

Extended excision of the mass at left labia majora plus left inguinal lymph node dissection was performed.

OUTCOMES

The patient received surgery therapy, no recurrence was observed during a 18-month follow-up period.

LESSONS

Due to its lack of specific characteristics in clinical, ultrasound and imaging, it is easy to be misdiagnosed, Due to its rarity and nonspecific clinical, radiologic and ultrasonographic manifestations, BG-ACC can be easily misdiagnosed. And its pathomorphological features overlap with other benign and malignant tumors occurring at vulva, BG-ACC can be easily misdiagnosed, and diagnosis by puncture biopsy is extremely difficult. Use of paraffin sections to identify tumor growth characteristics, combined with immunohistochemical findings, is the key to the diagnosis of ACC. In rare sites, MYB gene split are helpful in making a definite diagnosis.

Adenoid cystic carcinoma: An unusual presentation

The adenoid cystic carcinoma is a relatively rare epithelial tumor of the major and minor salivary glands, accounting for about 1% of all malignant tumor of the oral and maxillofacial regions. Peak incidence occurs between the 5^th and 6^th decades of life. The clinical and pathological findings typical of this tumor include slow growth, peri-neural invasion, multiple local recurrences and distant metastasis. Herein, we report a case of adenoid cystic carcinoma of oropharynx with unusual clinical presentation. The diagnosis of this case and importance of cytology in diagnosing such cases is discussed.

Human prominin-1 (CD133) is detected in both neoplastic and non-neoplastic salivary gland diseases and released into saliva in a ubiquitinated form

Prominin-1 (CD133) is physiologically expressed at the apical membranes of secretory (serous and mucous) and duct cells of major salivary glands. We investigated its expression in various human salivary gland lesions using two distinct anti-prominin-1 monoclonal antibodies (80B258 and AC133) applied on paraffin-embedded sections and characterized its occurrence in saliva. The 80B258 epitope was extensively expressed in adenoid cystic carcinoma, in lesser extent in acinic cell carcinoma and pleomorphic adenoma, and rarely in mucoepidermoid carcinoma. The 80B258 immunoreactivity was predominately detected at the apical membrane of tumor cells showing acinar or intercalated duct cell differentiation, which lined duct- or cyst-like structures, and in luminal secretions. It was observed on the whole cell membrane in non-luminal structures present in the vicinity of thin-walled blood vessels and hemorrhagic areas in adenoid cystic carcinoma. Of note, AC133 labeled only a subset of 80B258–positive structures. In peritumoral salivary gland tissues as well as in obstructive sialadenitis, an up-regulation of prominin-1 (both 80B258 and AC133 immunoreactivities) was observed in intercalated duct cells. In most tissues, prominin-1 was partially co-expressed with two cancer markers: carcinoembryonic antigen (CEA) and mucin-1 (MUC1). Differential centrifugation of saliva followed by immunoblotting indicated that all three markers were released in association with small membrane vesicles. Immuno-isolated prominin-1–positive vesicles contained CEA and MUC1, but also exosome-related proteins CD63, flotillin-1, flotillin-2 and the adaptor protein syntenin-1. The latter protein was shown to interact with prominin-1 as demonstrated by its co-immunoisolation. A fraction of saliva-associated prominin-1 appeared to be ubiquitinated. Collectively, our findings bring new insights into the biochemistry and trafficking of prominin-1 as well as its immunohistochemical profile in certain types of salivary gland tumors and inflammatory diseases.

Elevated carcinoembryonic antigen levels correlating with disease recurrence in a patient with adenoid cystic carcinoma

BACKGROUND

Carcinoembryonic antigen (CEA) is an oncofetal glycoprotein involved in cell recognition and adhesion. Serum CEA has been extensively studied as a potential chemical marker for malignancy, most notably in patients with colon carcinoma. Serum CEA measurements have not been reported for patients with salivary gland carcinomas.

METHODS

Serum CEA was measured in a case study using enzyme immunoassay with monoclonal antibody specific for CEA. Tissue was examined with standard histologic and immunohistologic methods.

RESULTS

A patient was initially seen with adenoid cystic carcinoma (ACC) of the trachea and had a markedly elevated serum CEA level which declined after surgical resection. The serum CEA level became elevated again when the patient developed abdominal metastases and then declined after debulking of the tumor. Immunohistochemical study of the tumor was positive for CEA.

CONCLUSIONS

The measurement of serum CEA levels may play a role in the management of patients with ACC. Clinical investigation utilizing monoclonal antibodies against CEA, for imaging and for the delivery of chemotherapy and radiotherapy may be worthwhile.

Immunohistochemical localization of carcinoembryonic antigen (CEA) in salivary gland tumors

Carcinoembryonic antigen (CEA) was first isolated from colonic carcinoma and has been used as a diagnostic marker. CEA has also been observed in a variety of epithelial tumors and normal tissues. In this study, CEA was localized by means of immunohistochemical procedures in benign and malignant salivary gland tumors, as well as in normal parotid gland, indicating that CEA is not a reliable marker for differentiation between benign and malignant salivary gland neoplasms.

Multiple expression of tissue markers in mucoepidermoid carcinomas and acinic cell carcinomas of the salivary glands

The distribution of various tissue antigens was studied in mucoepidermoid carcinomas (n = 74) and acinic cell carcinomas (n = 38) by means of immunocytochemistry. Mucoepidermoid carcinomas were generally positive for cytokeratin and showed double expression for cytokeratin and vimentin in 31.1% and triple expression for cytokeratin, vimentin and GFAP in 24.1%. CEA was studied using new monoclonal antibodies which distinguish between epitopes that are present on CEA alone and those which are present on nonspecific cross reacting antigens as well. The monospecific CEA antibody was completely negative in mucoepidermoid carcinomas, while nonspecific cross reacting antigens (NCAs) were positive in mucoepidermoid carcinomas to a varying degree. Alpha 1-antichymotrypsin, a marker formerly thought to be specific for tissues for histiocytic origin, was positive in 85.1% of mucoepidermoid carcinomas. Twenty three percent of mucoepidermoid carcinomas showed focal infiltration by S-100 positive dendritic stromal cells, tumour cell being negative. Leu-M1 antigen was positive in 58.1% of mucoepidermoid carcinomas. Acinic cell carcinomas were generally positive for cytokeratin and in single cases showed double expression for cytokeratin and vimentin and triple expression for cytokeratin, vimentin and GFAP. Monospecific CEA antibody positivity could be demonstrated in 24.2% of acinic cell carcinoma, while nonspecific cross reacting antigens (NCAs) were positive in acinic cell carcinomas to a varying degree. Alpha 1-antichymotrypsin was positive in 97.4% of acinic cell carcinomas. 2.5% of acinic cell carcinomas showed focal infiltration by S-100 positive dendritic stromal cells, 2.5% of acinic cell carcinomas were positive for S-100 protein with no dendritic stromal cells present. Leu-M1 antigen was positive in 86.8% of acinic cell carcinomas. For S-100 protein and Leu-M1, no correlation with the clinical course, as reported previously for other tumours, could be observed.

Glycoprotein tumour markers in head and neck neoplasms--a consecutive study on CA-50, CA 19-9, and CEA

Serum levels of three glycoprotein tumour antigens (carcino-embryonic antigen, CEA; cancer-associated antigen 50, CA-50; gastrointestinal cancer-associated antigen, CA 19-9) were determined on 125 consecutive patients with tumours of the head and neck region. Elevated CEA values (greater than 5 units/ml) were found in 13/70 squamous cell carcinomas, 3/21 benign and 4/18 malignant salivary gland neoplasms. Elevated CA-50 values (greater than 17 units/ml) were found in 19/70 squamous cell carcinomas, 6/18 malignant and 1/21 benign salivary neoplasms. CA 19-9 displayed higher values (greater than 37 units/ml) in 9/68 squamous cell carcinomas, 4/18 malignant and none of 21 benign salivary gland tumours. Combination of CEA and CA-50 analyses increased the proportion of elevated values to 30/70 in squamous cell carcinomas and 10/18 in salivary gland malignancies. In squamous cell carcinomas no correlation between staging or grading and serum levels was detected for any of the markers. Among malignant salivary gland tumours, CA-50 displayed enhanced serum values in 4/6 mucoepidermoid carcinomas. The mean values for CA-50 and CA 19-9 serum levels were significantly higher for malignant salivary gland neoplasms compared to benign tumours. There was a close correlation between CA-50 and CA 19-9 serum levels. Although, the results suggest that at present none of the tumour markers tested have a place alone in the routine examination of patients with tumours affecting the head and neck region, further studies on salivary gland neoplasms and combinations of the tumour markers are justified.

Comparison of CEA distribution in lesions and tumors of salivary glands as determined with monoclonal and polyclonal antibodies

Immunohistochemical localization of carcinoembryonic antigen (CEA) with conventional antibody to CEA (anti-CEA), nonspecific crossreacting antigen (NCA)-absorbed polyclonal antibody to CEA (NCAa-CEA), and monoclonal antibody to CEA (Mono-CEA) have been compared in obstructive lesions and salivary gland tumors. Normal salivary glands gave strong staining of the luminal borders of acinar cells with anti-CEA, whereas no staining occurred with Mono-CEA. Obstructive lesions showed occasionally marked staining with anti-CEA in some acinar cells, but there was no reaction with Mono-CEA. Of 69 pleomorphic adenomas examined, 34 were positively stained with anti-CEA, 18 with NCAa-CEA and 8 with Mono-CEA along the luminal borders of the tumor cells. The frequency of positive staining of material within tubular lumina was similar with all three immunoreagents. Neoplastic cells were positive with Mono-CEA in only three cases, while eight cases were positive with NCAa-CEA and 11 cases with anti-CEA. In salivary gland tumors true CEA is be found mainly at the border of tumor cells, but the frequency of positive reactions is low.

Small cell undifferentiated carcinoma of the minor salivary gland containing exocrine, neuroendocrine, and squamous cells

The light microscopic, electron microscopic and immunohistochemical features of a small cell undifferentiated carcinoma of the minor salivary gland are presented. The tumor was composed predominantly of undifferentiated small cells with focally admixed neuroendocrine, exocrine and squamous cells, occasionally arranged in an organoid manner. The presence of vasoactive intestinal polypeptide in the tumor was found immunohistochemically. In addition, the tumor cells stained with Grimelius' impregnation. Immunohistochemically the tumor contained cells that reacted positively with the antibodies to carcinoembryonic antigen, 66K keratin polypeptide, or human salivary amylase. These findings indicate that a small cell undifferentiated carcinoma of the minor salivary gland, reported here, exhibits focally multidirectional differentiation as well as neuroendocrine cell derivation.

Carcinoembryonic antigen in mucoceles of oral mucosa

Immunohistochemical detection of carcinoembryonic antigen (CEA) was reported in mucocele and associated minor salivary glands of oral mucosa. Higher levels of staining for CEA occurred in salivary glands with attached mucoceles, in which acinar cells and ductal segments in the gland displayed concentrations of CEA higher than those in normal minor salivary glands. Floating cells also gave positive CEA staining, whereas epithelial fragments and connective tissue in the mucocele wall were lacking in CEA. It was suggested that mucoceles in oral mucosa accumulated CEA in associated minor salivary glands.

Immunohistochemical demonstration of carcinoembryonic antigen (CEA) on tissue sections from squamous cell head and neck cancer and plasma CEA levels of the patients

45 squamous cell head and neck cancers including 36 with carcinoma of the oral cavity and 9 with carcinoma of the maxillary sinus were examined immunohistochemically for the presence of CEA. 12 of 30 carcinomas of the oral cavity and 7 of the 9 carcinomas of the maxillary sinus had tumors containing CEA. This difference in the occurrence of CEA was statistically significant. The mean plasma CEA level of 36 patients with carcinoma of the oral cavity and 7 patients with carcinoma of the maxillary sinus was 1.95 +/- 1.72 ng/ml and 3.70 +/- 3.53 ng/ml, respectively. Significant elevation of plasma CEA levels was found only in the stage-IV group patients with carcinoma of the oral cavity as compared with the stage-I group patients. In the 3 patients having plasma CEA values exceeding 5 ng/ml at the time of pretherapy, plasma CEA levels were decreased to below 2.5 ng/ml with the cancer treatment followed by the complete remission. These findings indicate that plasma CEA as a tumor marker in squamous cell head and neck cancer is meaningful in a small proportion of the cancer patient population.

Histochemical studies of obstructive adenitis in human submandibular salivary glands. I. Immunohistochemical demonstration of lactoferrin, lysozyme and carcinoembryonic antigen

Immunohistochemical detection of lactoferrin (LF), lysozyme (LZ) and carcinoembryonic antigen (CEA) was made in obstructive adenitis of the submandibular glands. Atrophic and altered acinar cells in the early stage of the lesion stained strongly for LF, whereas they were unreactive or stained slightly for LZ. Ductal cells usually stained for LZ. Staining for CEA was strong and irregularly distributed in altered acinar cells. Duct-like structures and dilated ductal segments in the chronic stage were generally negative for LF, LZ and CEA. Secretory components in luminal cavities gave abundant staining for LF, LZ and CEA. Histocytes which infiltrated into the connective tissue in the later stage showed a positive LZ reaction.

Characterization of cells in salivary gland lesions by immunohistochemical identification of carcinoembryonic antigens

Immunohistochemical demonstration of carcinoembryonic antigen (CEA) was reported in normal salivary glands and in pathologic lesions. Staining patterns of CEA and nonspecific cross-reacting antigen-absorbed CEA (NCAa-CEA) were compared. Normal salivary glands disclosed positive staining by CEA on border and luminal sides of acinar cells and occasionally in components secreted into ductal spaces with both antigens used. Chronic obstructive lesions displayed an intense CEA staining in ductlike structures and in material secreted into their lumina in the two antigens used. Pleomorphic adenoma exhibited varying intensities of CEA in neoplastic epithelial cells of ductal structures. In contrast, they showed a slight staining reaction to NCAa-CEA. Squamous-cell carcinomas showed a strong CEA reaction, whereas they showed no reaction or a trace reaction to NCAa-CEA. Positive staining to CEA in squamous neoplastic lesions was related to nonspecific reacting antigens.

Induction of other differentiation stages in neoplastic epithelial duct and myoepithelial cells from the human salivary gland grown in athymic nude mice

The interaction between two cell lines derived from the human salivary gland (HSG), neoplastic epithelial duct HSG cells and myoepithelial human pleomorphic adenoma (HPA) cells, was studied morphologically and immunohistochemically in nude mice tumors produced by inoculation of HSG and HPA cells. Transplantation of HSG cells into nude mice resulted in the production of adenocarcinoma which contained carcinoembryonic antigen (CEA). The nude mice tumors induced by HPA cells were interpreted as myoepithelioma in which the presence of S-100 protein and myosin were identified. On the other hand, the occurrence of squamous cell nests was frequently noted in the nude mice tumors produced by inoculation of a mixture of HSG and HPA cells. The tumor cells present in the squamous cell nests had abundant tonofilaments in the cytoplasm and were attached with tight junction and distinct desmosomes. In addition, the presence of keratin in the tumor cells composing squamous cell nests was demonstrated. When the mixture of HSG and HPA cells treated with polyethylene glycol (PEG) was transplanted into the nude mice, the tumors produced consisted almost entirely of areas showing the histologic features of anaplastic carcinoma, and did not contain all of the specific cell markers observed in the HSG or HPA tumors. The nude mice tumors induced by PEG-treated HSG or HPA cells were interpreted as adenocarcinoma and myoepithelioma, respectively, and giant cells were occasionally observed in the tumor sections. These findings indicate that neoplastic cells showing differentiation stages other than those of the original two cells can be induced in nude mice by utilizing HSG and HPA cells.

The importance of tumor markers in oral pathology. II. Cell membrane and cytoplasmic antigens as tumour markers

Important tumour markers in tumours of the oral mucosa and salivary glands are intermediate filaments of cytoskeleton, oncofetal and proliferative antigens, lectin receptors and blood group substances, enzymes, metalloproteins and viral antigens. The special occurrence of the following tumour markers was demonstrated: keratin, vimentin, carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), lectins (helix pomatia antigen = HPA, peanut agglutinin = PNA), Thomsen-Friedenreich-antigen, blood group substances A and B, amylase, lactoferrin, viral antigens of papilloma virus (group 11 and 16). In oral dysplasia and squamous cell carcinomas, relationships exist between the presence of keratin filaments and cell differentiation. Lectins represent membrane-orientated markers of differentiation. A loss of blood group substances A and B can be observed in oral dysplasias. Papilloma viruses and viral antibodies can be demonstrated in papillomas, leukoplakias and carcinomas. The salivary gland tumours show a distinct pattern of distribution for keratin, vimentin, CEA, TPA, metalloproteins and enzymes. Transplanted human salivary gland tumours in athymic nude mice keep the same tumour marker profile as in the primary tumor.

The pleomorphic adenoma of salivary glands transplanted on athmymic mice. A lightmicroscopical and immunohistochemical investigation

10 pleomorphic adenomas of the human parotid gland were transplanted on several groups of nude mice. For comparative reasons, 10 other pleomorphic adenomas, a neurinoma and a chordoma and transplants of squamous cell carcinomas and of normal salivary gland tissue were also analysed. In the primary tumours and in the transplants, the presence of keratin, carcinoembryonic antigen, tissue polypeptide antigen, lactoferrin, lysozyme, immunoglobulins, secretory component, amylase, fibronectin and of several lectin-receptors (PNA, WGA, HPA, Ulex europaeus) was sought. The immunohistological observations show that many of the features of a pleomorphic adenoma are constant under the conditions of transplantation. In the transplanted tumour, the same heterogeneity as in the primary tumours can be observed. Autoradiographic studies show little labelling with 3-H thymidine, which is in good accordance with the biological behaviour of the tumour. The distribution of fibronectin shows an interesting association with myoepithelial-like cells. Our results support the hypothesis that the histogenetic origin of the pleomorphic adenoma is a cell pool of the terminal ductal segment. A differentiation towards ductal cells (with production of secretory substances) and towards myoepithelial cells (associated with large amounts of basal membrane like substances) is observed.

Search for specific markers of neoplastic epithelial duct and myoepithelial cell lines established from human salivary gland and characterization of their growth in vitro

The neoplastic epithelial duct cells human salivary gland (HSG) and myoepithelial cells human pleomorphic adenoma (HPA) established from human salivary gland were examined by the immunoperoxidase method for the presence of specific antigens such as carcinoembryonic antigen (CEA), S-100 protein, secretory component (SC), lactoferrin (LF), and myosin. Isolation of the cells and their morphologic features were reported previously. Consequently, the presence of CEA, SC, and LF in the HSG cells was demonstrated. The HPA cells were identified to express the specific antigens reactive to anti-S-100 protein, anti-myosin and anti-CEA sera in addition to the presence of oxytocin receptor. When the two cell lines were co-cultured in monolayer culture or within the sponge matrix, a large number of ductlike or tubular structures were formed in an optimal ratio of 1:2 in HSG and HPA cells, whereas the cultures of HSG cells only grew with occasional formation of ductlike structure. In addition, in HSG and HPA cells in an area with their contact in the mixed cultures, CEA staining was intensified as compared with the culture of HSG or HPA cells only and further S-100 protein was detected in HSG cells, whereas S-100 protein was not detected in the culture of HSG cells only. These findings strongly suggest that the intercalated duct and myoepithelial cells from human salivary gland propagate with their interaction together in the expression of specific antigens such as CEA and S-100 protein or in the morphogenesis of salivary gland epithelial cells.

Immunofluorescence study of secretory epithelial markers in pleomorphic adenomas

Amylase (Am), lactoferrin (Lf), lysozyme (Ly), secretory component (SC), epithelial IgA, and epithelial IgM were traced by paired immunofluorescence staining in ethanol-fixed specimens from 15 pleomorphic adenomas of the parotid gland. Epithelial elements positive for some of the markers were detected in a variable number of the specimens (Am, 0; Lf, 11, Ly, 2; CEA, 6; SC, 11; IgA, 9; and IgM, 6); their expression seemed to depend on a certain degree of glandular differentiation. Variable co-expression of secretory epithelial markers probably reflected different degrees of differentiation, indicating that clonal diversification may explain the histological complexity of pleomorphic adenomas. The most consistent expression (in almost 75% of the specimens) shown by Lf and SC might further reflect histogenetic relationship to intercalated ducts in which these antigens are normally found in largest amounts.

The embryonal carcinoma of the parotid gland. A rare example of an embryonal tumor

Embryonal tumors are a neoplastic proliferation of cells of organ rudiments. Morphologically, these tumors are similar to the developmental stages of these organ rudiments. Embryonal tumors of the salivary glands have not been previously described. In the salivary gland register, reviewing the years 1965-1982 (n = 8043), we diagnosed 2,878 tumors of the salivary glands, of these 73 were tumors in children. One case was a malignant epithelial tumor in a 12-year-old boy, which showed the criteria of an embryonal carcinoma in light- and electron microscopy. The tumor revealed solid undifferentiated areas, epidermoid structures with keratinization and acinic structures. Immunhistochemically, the better differentiated epidermoid cells reacted positively with anti-CEA and anti-keratin, the acinic cells were positive with anti-amylase. The ultrastructure was characterized by primitive ductular epithelial cells and acinic cells with their typical morphological features. The embryonal carcinoma has to be distinguished from undifferentiated carcinomas of the salivary glands, which consist of primitive ductular structures only. The failure to detect other tumor markers (lactoferrin, tissue polypeptid antigen) indicates that poorly and well differentiated areas can exist simultaneously in embryonal carcinomas.

Lactoferrin and lysozyme in carcinomas of the parotid gland. A comparative immunocytochemical study with the occurrence in normal and inflamed tissue

Lactoferrin and lysozyme, parts of the non-specific defense system, were studied in normal and diseased parotid glands, using the immunohistochemical PAP-method. 31 normal and inflamed glands were investigated. The presence of lactoferrin and lysozyme was demonstrated in the acinar cells and some duct cells. The amount of these substances was increased in obstructive parotitis. The 52 carcinomas showed a distinct distribution pattern for lactoferrin (positive cases: adenocarcinomas 5 of 8; cystadenocarcinoma: 3 of 5; adenoid cystic carcinomas 2 of 4; salivary duct carcinomas 2 of 3). Some of the carcinomas in pleomorphic adenomas were positive for lactoferrin. Squamous cell carcinomas and anaplastic carcinomas were constantly negative. All carcinomas were negative for lysozyme. These observations are discussed with respect to their physiological and pathological significance.