Papillary cystadenocarcinoma arising from minor salivary glands in the anterior portion of the tongue: a case report

Cytopathology approach to rare salivary gland lesions with oncocytic features

Salivary glands located in the head and neck area are known to have different lesions with prominent oncocytic features. Fine needle aspiration is usually the initial approach in the management of these lesions, whether they represent neoplastic or non-neoplastic processes. Owing to the limited material present upon cytopathologic examination, knowledge of variants and subtypes of various oncocytic lesions that can occur in this area is of major importance to provide the most accurate interpretation to the patients and clinicians. In this article, we selected rare lesions of the salivary glands that may exhibit oncocytic changes, and provided a brief discussion of each one of them, with emphasis on challenges in navigating the differential diagnosis that these cases may pose, from the cytopathology standpoint.

High-grade Features of Papillary Cystadenocarcinoma of the Parotid Gland

Papillary cystadenocarcinomas (PCAs) are rare low-grade salivary gland tumors first introduced in the World Health Organization classification in 1991. While classically regarded as a low-grade malignancy, PCAs with more clinically and histologically high-grade features have been reported, reflecting the often-underrecognized morphological diversity of this entity. Although no universally advocated grading system exists, high-grade PCAs tend to demonstrate locally aggressive features, cytologic atypia, high mitotic rate, necrosis, and an absence of papillary features. We present a case of a 51-year-old male with slow-onset, progressive right facial fullness over four years. Contrast-enhanced computed tomography of the neck demonstrated a 3.3 cm peripherally enhancing cystic and solid mass in the right superficial lobe of the parotid gland. Following a superficial parotidectomy and a selective right neck dissection, histopathology demonstrated a large cyst with papillary projections lined with cuboidal cells of mild to moderate atypia and surrounding solid tumor nests. The tumor displayed stromal, lymphovascular, and subcutaneous fibroadipose tissue invasion. One of 12 lymph nodes was positive for metastatic carcinoma without extranodal extension. A diagnosis of intermediate-grade PCA was rendered. This case report summarizes the features typical of high-grade PCAs, the few reported cases of intermediate- and high-grade PCAs within the existing literature and provides a brief overview of the radiological and pathological differential diagnosis when considering a parotid gland PCA.

The rare entity of cystadenocarcinoma (CAC) in parotid gland: A single-center experience

PURPOSE

Cystadenocarcinoma (CAC) is an extremely rare disease in parotid gland. This study aimed to identify the clinical characteristics of CAC, and the therapeutic options for its treatment. An attempt was also made to identify postoperative recurrence-related risk factors.

MATERIAL AND METHODS

A retrospective study was conducted of CAC patients treated between 2008 and 2018. Predictive factors for postoperative recurrence (5-year RFS rate) were preliminarily filtered by Kaplan-Meier analysis and then further confirmed by a Cox regression model. Postoperative recurrence was defined as the primary outcome variable and was measured using both univariate and multivariate analysis.

RESULTS

A total of 27 patients were analyzed, and the total incidence of postoperative recurrence was 33.3% (9/27). In the Cox regression analysis, patients who received a superficial parotidectomy were 0.046 times more likely to develop tumor relapse than those who only underwent enucleation (p = 0.032; 95% CI: 0.003-0.070). The chances of tumor recurrence in patients with the cribriform subtype were 9.701 times that for cases with a papillary pattern (p = 0.016; 95% CI: 1.517-62.030). The risk of postoperative recurrence increased abruptly, with an OR of 6.373 (p = 0.042; 95% CI: 1.070-37.965), when LN metastasis was found in patients.

CONCLUSION

Preoperative diagnosis of CAC in parotid gland is extremely important for allowing surgeons to apply appropriate therapeutic strategies (enucleation or superficial parotidectomy). Patients with LN metastasis, cribriform pattern, and Ki-67 positivity should be treated further to avoid tumor relapse.

Papillary cystadenocarcinoma of the sublingual gland

A 68-year-old Caucasian gentleman presented with a 6-month history of a left sided Level I/II neck swelling involving the floor of mouth. MRI revealed a large cystic lesion and histology confirmed a diagnosis of primary papillary cystadenocarcinoma of the sublingual gland. Papillary cystadenocarcinoma was first described in 1991 by the World Health Organisation [WHO], and is a rare malignant neoplasm characterised by cysts and papillary endo-cystic projections. Papillary cystadenocarcinoma arising from the sublingual glands is extremely rare and has the potential to metastasise to cervical lymph nodes. This patient we report was therefore treated with surgical excision and post-operative radiotherapy.

Clinicopathological characteristics, treatment, and survival outcomes of cystadenocarcinoma of the salivary gland: a population-based study

Background

The aim of this study was to investigate the clinicopathological characteristics, treatment, and survival of cystadenocarcinoma of the salivary gland.

Patients and methods

Cases in the Surveillance, Epidemiology, and End Results database from 1991 to 2012 were identified. Factors significantly associated with survival were identified using Kaplan–Meier survival analysis and Cox proportional hazard regression.

Results

A total of 65 patients were identified; of these patients, 64 received surgical treatment, 25 underwent lymphadenectomy, and four (16.0%) patients had nodal metastasis and only one (2.1%) patient had poorly differentiated disease. The most common tumor location was the parotid gland (87.7%). The median follow-up was 55 months. None of the patients died of salivary gland malignant-tumor-related disease. The 5- and 10-year cause-specific survival rates were 97.0% and 81.4%, respectively. The 5- and 10-year overall survival rates were 84.6% and 60.7%, respectively. Surgical procedures, lymphadenectomy, and adjuvant radiotherapy did not affect survival.

Conclusion

Salivary gland cystadenocarcinoma is extremely rare but has an excellent prognosis, and surgery is the mainstay of treatment.

Papillary mucinous cystadenocarcinoma: rare malignant tumor in minor salivary gland

ABSTRACT Clinical case description of a papillary mucinous cystadenocarcinoma, extremely rare malignant tumor in the salivary gland and difficult to diagnose, in geriatric patient. Patient with 86 years old was referred for treatment with nodular lesion on the inner side of left lower lip extending to the bucal mucosa, without any clinical appearances of malignancy. The lesion was asymptomatic, had flabby consistency and slow growth. Despite the favorable clinical features, after surgical removal, was diagnosed as papillary mucinous papillary mucinous cystadenocarcinoma. Nonetheless, the cellular atypia found was considered to be mild and immunohistochemical evaluation the reaction to Ki-67 was low, indicating a low rate of proliferation of the tumor. Medical evaluation confirmed the absence of systemic disorders or distant metastases. Although it is a malignant lesion, due to low degree of proliferation of lesion and the careful follow-up carried out, there was a favorable evolution after conservative treatment in a follow-up period of 11 years and six months.

Papillary Cystadenocarcinoma of the Parotid Gland: A Rare Case Report

Papillary cystadenocarcinoma is a rare malignant neoplasm of the salivary gland, characterized by noticeable cystic and solid areas with papillary endophytic projections. These tumours lack features that characterize cystic variants of several more common salivary gland carcinomas. It was first described in 1991 by World Health Organization as a separate entity and cystadenocarcinoma with or without papillary component in the AFIP classification. Most of these tumours occurred in the major salivary glands followed by minor salivary glands. Cystadenocarcinoma is the malignant counterpart of cystadenoma. We report a case of papillary cystadenocarcinoma of parotid. A 40-year-old lady presented with gradually progressive swelling below the right ear associated with occasional pain. Clinical and radiological features suggested benign neoplasm. Right lobe superficial parotidectomy was performed. The histopathologic diagnosis showed papillary cystadenocarinoma of the parotid gland. Histologic confirmation of stromal invasion is required to differentiate it from the benign lesion. Conservative wide local surgical excision is the treatment of choice.

Cystadenocarcinoma of the salivary glands with potential lymph node metastasis

Cystadenocarcinoma derived from the salivary gland in the head and neck region is an extremely rare malignancy. Therefore, the clinicopathological characteristics is not well understood. The purpose of this study was to clarify the clinicopathological characteristics, and present a total of four patients who were treated at the National Cancer Center Hospital East during the period between 1995 and 2012. The patients were all male, with ages ranging from 47 to 74 years old. The primary sites were the parotid glands, submandibular gland and minor salivary gland of the tongue. Within the follow-up period from 19 to 54 months, lymph node metastases were observed in three of the four patients. However, all the patients were salvaged by additional resection, including neck dissection, and remain alive to date without distant metastases. Cystadenocarcinoma is classified as a low-grade histological subtype of salivary gland tumors. Although the tumor has the potential to produce lymph node metastases, as shown in our patients, it is generally an indolent tumor with a good prognosis as compared with high-grade subtypes. This study suggests that a long-term follow up paying close attention to lymph node metastases is necessary for cystadenocarcinoma.

Central papillary cystadenocarcinoma of the mandible: A case report and review of the literature

INTRODUCTION

Central papillary cystadenocarcinoma of the jaw is an extremely rare tumor with only three previously reported cases in the English literature. This tumor is a histologically low-grade cancer, affecting more commonly in the mandible than in the maxilla.

PRESENTATION OF CASE

A 65-year-old woman presented with a two months history of a rapidly growing, painless mass of the right ascending ramus of the mandible. The pathologic report from incisional biopsy was a papillary cystic tumor with a differential diagnosis of cystadenoma versus cystadenocarcinoma. Segmental mandibulectomy, parotidectomy and submandibular gland resection were performed. The final pathology was intraosseous papillary cystadenocarcinoma.

DISCUSSION

Clinical features of central papillary cystadenocarcinoma of the mandible mimic an odontogenic lesion and metastatic bone disease, careful review of radiograph and pathology should be done. Surgical excision with wide margins is the appropriate treatment. Postoperative radiation therapy should be considered in histologically aggressive or high-stage tumor.

CONCLUSION

This is the fourth case of central papillary cystadenocarcinoma of the mandible in the English literature. Although it is usually a low-grade cancer, en bloc resection with adjuvant postoperative radiotherapy in a high-stage disease, and long-term follow-up allow the patient to have a favorable prognosis.

A case of cystadenocarcinoma of the ectopic salivary gland: comparison of pre-operative ultrasound, CT and MR images with the pathological specimen

Cystadenocarcinoma is a rare salivary gland tumour. Only a few case studies have provided pre-operative images of these tumours. This report demonstrates the case of a 28-year-old male with cystadenocarcinoma arising from an ectopic salivary gland with lymph node metastasis in the right upper neck. Ultrasound including Doppler images showed two masses with scant vascular flow. One was a hyperechoic mass enclosed within a low echoic cystic lesion and the other was a solid hypoechoic mass. Contrast enhancement CT scans demonstrated a ring enhanced mass and weakly homogeneous enhanced masses in the right upper neck. Dynamic studies showed increased enhancement in delayed phase CT that was the same as that in other malignant salivary gland tumours. Moderate to slightly high signal intensity was seen on T(1) weighted MR images and axial T(2) weighted MR images showed one heterogeneous mass in a high signal lesion and a moderate to high signal intensity mass. The authors discuss the pre-operative findings of ultrasound with Doppler imaging of this neoplasm, and CT findings including dynamic study images and MRI, comparing the findings with the post-operative pathological features of the tumour.

Papillary cystadenocarcinoma originating from a minor salivary gland with lymph node metastases

Papillary cystadenocarcinoma is a rare malignant neoplasm of the salivary glands. This tumor most commonly arises in the major salivary glands, mainly in the parotid gland, and rarely metastasizes to regional lymph nodes. We report here a case of papillary cystadenocarcinoma originating from a minor salivary gland, localized in the lateral portion of the tongue and with neck metastases, in a 57-year old woman. We discuss histopathologic and clinical features of this lesion and review the literature.

Cystadenocarcinoma simulating hemangiosarcoma of the salivary gland in dog: case report

Cystadenocarcinoma is regarded as a rare adenocarcinoma variant in animals. This work reports the case of an 8-year-old female Poodle dog with salivary gland cystadenocarcinoma with morphological characteristics similar to a hemangiosarcoma. Histopathological analysis showed a tumor mass with cystic formations containing a large amount of red blood cells. In order to distinguish these two entities, periodic acid Schiff (PAS) staining and immunohistochemical analysis were carried out with the use of cytokeratin AE1/AE3 (CK) and CD31-specific antibodies. Neoplastic cells were PAS-negative, CK-positive and CD31-negative confirming their epithelial origin. Based on the findings, the diagnosis of high grade cystadenocarcinoma was established.

Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature review

Cystadenocarcinoma is a rare malignant tumor, with an estimated incidence of 2% of malignant salivary gland tumors. Cytological diagnosis of cystadenocarcinoma is important for differential diagnosis between benign lesions and malignant tumors with cystic growth. We report a case of cystadenocarcinoma causing difficulty in cytological diagnosis. A 23-year-old man presented with an asymptomatic mass in the left parotid gland that had been present for 2 years. The mass was elastic hard, measuring 30 x 35 mm in diameter. Preoperative fine-needle aspiration cytology (FNAC) showed a small number of tumor cell clusters in the cystic fluid. The cluster was arranged in a ball-like structure and was cohesive with overlapping. Tumor cells had a small vacuolated, soap-bubble appearance in the cytoplasm. The papillary-cystic variant of acinic cell carcinoma (ACC-PCV) was suggested from these findings on FNAC. Histologically, the tumor was not encapsulated, but formed large cystic spaces against a background of fibrous connective tissue. The tumor cells in the cystic dilated duct showed papillary structures, which were continuous with the lining cuboidal cells. There was neither a definite double-layered arrangement in cystic ducts and solid islands nor histological findings characteristic of the papillary-cystic or follicular pattern of ACC-PCV. As tumor cells with a small vacuolated, soap-bubble appearance of the cytoplasm are common findings of both cystadenocarcinoma and ACC-PCV, they are of little use for differentiation; however, they are so characteristic that the majority of benign salivary gland lesions with cystic structures can be excluded, if enough attention is paid.

Expression of PLUNC family members in benign and malignant salivary gland tumours

OBJECTIVES

The aim of this study was to determine the expression of PLUNC proteins in benign and malignant salivary gland tumours and thus their potential use as diagnostic and / or prognostic tools.

MATERIALS AND METHODS

A tissue microarray was assembled from 64 salivary gland tumours including adenoid cystic carcinoma, carcinoma ex-pleomorphic adenoma, mucoepidermoid carcinoma, polymorphous low-grade adenocarcinoma, pleomorphic adenoma, acinic cell carcinoma, myoepithelial carcinoma and papillary cystadenocarcinoma. Clinicopathological data were collected retrospectively and immunohistochemical analysis of three PLUNC proteins (SPLUNC1, SPLUNC2 and LPLUNC1) was performed. Immunoreactivity was assessed as positive or negative.

RESULTS

PLUNC expression was only found in mucoepidermoid carcinomas and papillary cystadenocarcinoma; all other tumours studied were negative. Mucin plugs, mucous and intermediate cells of mucoepidermoid carcinomas were positive for LPLUNC1 and SPLUNC2, but areas composed of epidermoid and clear cells were negative for all PLUNCs. Papillary cystadenocarcinoma was positive for all PLUNCs. No correlation was found with tumour grade or outcome.

CONCLUSIONS

Intense expression of two PLUNC proteins in mucous cells and mucin plugs of mucoepidermoid carcinoma and papillary cystadenocarcinoma indicate that they could be used as additional diagnostic tools in some equivocal cases, but further studies are needed to understand the biological processes involved in PLUNC expression.

Papillary cystadenocarcinoma: Report of a case of high-grade histopathologic malignancy

Papillary cystadenocarcinoma is an extremely rare malignant tumor of the salivary gland which is cytologically considered to be of low-grade malignancy, showing an indolent biological behavior. Histologically, the tumor is characterized by cysts and papillary endocystic projections. This tumor most commonly arises in the major salivary glands, mainly the parotid gland. We report here a case of papillary cystadenocarcinoma originating from the minor salivary gland, which showed marked growth over a short period of time. Histologically, the tumor was characterized by intense cellular and nuclear pleomorphism and numerous mitotic figures. These findings indicate a tumor of high-grade malignancy.

Salivary Gland Cystadenocarcinoma of the Mobile Tongue, Low-Grade Papillary Adenocarcinoma Variant: A Case Report

Cystadenocarcinoma is a rare malignant neoplasm of the salivary gland. Treatment involves local excision; neck dissection and postoperative radiation therapy are used for clinically positive neck metastases. The prognosis varies according to the clinical stage and grade of the tumor.