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Tadi S, Ka-Yan Cheung V, Lee CS, Nguyen K, Luk PP, Low THH, Palme C, Clark J, Gupta R. MYB RNA detection by in situ hybridisation has high sensitivity and specificity for the diagnosis of adenoid cystic carcinoma. Pathology 2023; 55:456-465. [PMID: 37055331 DOI: 10.1016/j.pathol.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/11/2022] [Accepted: 01/20/2023] [Indexed: 04/15/2023]
Abstract
Adenoid cystic carcinoma (ACC) is one of the most common primary salivary gland cancers. ACC has several benign and malignant mimics amongst salivary gland neoplasms. An accurate diagnosis of ACC is essential for optimal management of the patients and their follow-up. Upregulation of MYB has been described in 85-90% of ACC, but not in other salivary gland neoplasms. In ACC, MYB upregulation can occur as a result of a genetic rearrangement t(6;9) (q22-23;p23-24), MYB copy number variation (CNV), or enhancer hijacking of MYB. All mechanisms of MYB upregulation result in increased RNA transcription that can be detected using RNA in situ hybridisation (ISH) methods. In this study, utilising 138 primary salivary gland neoplasms including 78 ACC, we evaluate the diagnostic utility of MYB RNA ISH for distinguishing ACC from other primary salivary gland neoplasms with a prominent cribriform architecture including pleomorphic adenoma, basal cell adenoma, basal cell adenocarcinoma, epithelial myoepithelial carcinoma, and polymorphous adenocarcinoma. Fluorescent in situ hybridisation and next generation sequencing were also performed to evaluate the sensitivity and specificity of RNA ISH for detecting increased MYB RNA when MYB gene alterations were present. Detection of MYB RNA has 92.3% sensitivity and 98.2% specificity for a diagnosis of ACC amongst salivary gland neoplasms. The sensitivity of MYB RNA detection by ISH (92.3%) is significantly higher than that of the FISH MYB break-apart probe (42%) for ACC. Next generation sequencing did not demonstrate MYB alterations in cases that lacked MYB RNA overexpression indicating high sensitivity of MYB RNA ISH for detecting MYB gene alterations. The possibility that the sensitivity may be higher in clinical practice with contemporary samples as compared with older retrospective tissue samples with RNA degradation is not entirely excluded. In addition to the high sensitivity and specificity, MYB RNA testing can be performed using standard IHC platforms and protocols and evaluated using brightfield microscopy making it a time and cost-efficient diagnostic tool in routine clinical practice.
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Affiliation(s)
- Sahithi Tadi
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Veronica Ka-Yan Cheung
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - C Soon Lee
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Discipline of Pathology, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Department of Anatomical Pathology, Liverpool Hospital, Liverpool, NSW, Australia; Cancer Pathology Laboratory, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; CONCERT Biobank, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Kevin Nguyen
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Peter P Luk
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Carsten Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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Chan AX, Chang A, Do JL, Koo SJ, Lin G, Welsbie DS. Polymorphous low-grade adenocarcinoma with cavernous sinus involvement presenting as third nerve palsy. Am J Ophthalmol Case Rep 2022; 26:101460. [PMID: 35313474 PMCID: PMC8933825 DOI: 10.1016/j.ajoc.2022.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Polymorphous low-grade adenocarcinoma is a tumor of the salivary glands that typically localizes within the oral cavity. We present a case of isolated third cranial nerve palsy as the initial presentation of polymorphous low-grade adenocarcinoma involving the left cavernous sinus in a patient status post glaucoma surgery. Observations A 68-year-old woman status post glaucoma drainage device implantation in her left eye presented with an isolated left third nerve palsy ten weeks postoperatively. Differential diagnoses included microvascular ischemic neuropathy, postoperative ptosis, and compressive mass. MRI revealed a left cavernous sinus mass, and subsequent excisional biopsy revealed a diagnosis of polymorphous low-grade adenocarcinoma. Conclusions There are few cases reporting polymorphous low-grade adenocarcinoma originating from and extending beyond the nasopharynx. This report emphasizes an unexpected neuro-ophthalmic manifestation of this salivary gland tumor.
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Nonaka T, Takei H. Immunohistochemical Profile of Polymorphous Adenocarcinoma of Minor Salivary Gland: A Systematic Review and Meta-Analysis. Head Neck Pathol 2022; 16:980-990. [PMID: 35507302 PMCID: PMC9729680 DOI: 10.1007/s12105-022-01453-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 12/16/2022]
Abstract
Polymorphous adenocarcinoma (PAC) is a rare variant of minor salivary gland tumors. Because of its architectural diversity, histological diagnosis of PAC can be difficult especially for small biopsies, and immunohistochemistry is of great help in differentiating it from its histologic mimics. The aim of this study is to conduct a systematic literature review to identify reliable immunohistochemical markers for PAC. We conducted an electronic literature search of the MEDLINE, ScienceDirect, SpringerLink, and Wiley Online Library databases, covering the literature published in the period between 1988 and 2021. The eligibility criteria included case reports and retrospective studies of PAC cases with details of immunohistochemical markers. Following the search and selection process, 32 studies with 409 cases were included in this systematic review. Overall, > 90% positivity was observed for pan-cytokeratin (CK) (97.3%), CK7 (96.8%), CK7/8 (97.4%), E-cadherin (90.0%), Vimentin (92.5%), S100 (97.0%), p63 (91.7%), and SOX10 (100%), while little to no positivity was observed for CK20 (0.0%), p40 (0.0%), and GFAP (5.0%). The average MIB-1 labeling index was 3.78%. The results of this systematic review indicate that CK7+/CK20-, p63+/p40-, S100+, Vimentin+, and GFAP- immunophenotype have diagnostic value for PAC. In addition, the use of S100, MSA, p40, and c-Kit provide additional layers of information helpful to differentiate PAC from adenoid cystic carcinoma, one of challenging differential diagnoses.
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Affiliation(s)
- Taichiro Nonaka
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA.
| | - Hidehiro Takei
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA
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4
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MYB RNA In Situ Hybridization Facilitates Sensitive and Specific Diagnosis of Adenoid Cystic Carcinoma Regardless of Translocation Status. Am J Surg Pathol 2021; 45:488-497. [PMID: 33165092 DOI: 10.1097/pas.0000000000001616] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adenoid cystic carcinoma (AdCC) can demonstrate histologic and immunohistochemical (IHC) overlap with a wide range of salivary and nonsalivary tumors, especially in small biopsy specimens. While MYB fluorescence in situ hybridization (FISH) frequently is used to confirm the diagnosis of AdCC, the pathognomonic MYB-NFIB fusion is only present in 40% to 70% of cases. Likewise, although MYB RNA overexpression is seen in the vast majority of AdCC regardless of translocation status, MYB IHC has shown suboptimal specificity for this diagnosis. In this study, we sought to determine whether a novel chromogenic RNA in situ hybridization (ISH) platform could directly detect MYB RNA overexpression and offer a rapid diagnostic adjunct for AdCC. We performed MYB RNA ISH on 84 cases of AdCC as well as 128 other salivary tumors and 108 basaloid and sinonasal carcinomas that mimic AdCC. MYB RNA ISH was 92% sensitive for AdCC, including 97% of cases with MYB rearrangement and 83% without MYB rearrangement by FISH. It was also 89% specific for AdCC overall, with 95% specificity among other salivary tumors and 81% specificity in basaloid and sinonasal carcinomas. In contrast, MYB IHC was 94% sensitive but just 54% specific for AdCC. Overall, MYB RNA ISH provides superior sensitivity for the diagnosis of AdCC compared with MYB FISH and superior specificity compared with MYB IHC. This assay could provide a useful tool for rapidly confirming the diagnosis of AdCC in formalin-fixed, paraffin-embedded specimens.
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Abstract
Polymorphous adenocarcinoma (PAC) is typically originated from the minor salivary glands and is characterized by cytology uniformity and architectural diversity. PAC commonly harbors PRKD1 E710D mutation. PAC has an excellent prognosis. However, greater than or equal to 10% papillary or greater than or equal to 30% cribriform pattern is an independent adverse prognostic factor. Cribriform adenocarcinoma of salivary gland (CASG) is a controversial entity that is considered within the same histologic spectrum of PAC in current classification schemes; however, it is regarded by some pathologists as a separate entity. CASG shows a propensity to base of tongue location, a lobulated growth pattern, a predominant solid/cribriform architecture, and a high frequency of PRKD1/2/3 fusion.
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Affiliation(s)
- Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Emerging Entities in Salivary Pathology: A Practical Review of Sclerosing Microcystic Adenocarcinoma, Microsecretory Adenocarcinoma, and Secretory Myoepithelial Carcinoma. Surg Pathol Clin 2021; 14:137-150. [PMID: 33526218 DOI: 10.1016/j.path.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, increased molecular testing and improved immunohistochemical panels have facilitated more specific classification of salivary gland carcinomas, leading to recognition of several novel tumor types and unique histologic variants. Sclerosing microcystic adenocarcinoma, microsecretory adenocarcinoma, and secretory myoepithelial carcinoma are three such recently described entities that demonstrate low-grade cytology, production of prominent secretory material, and variable amounts of sclerotic stroma. This review provides a practical overview of these important and overlapping emerging entities in salivary gland pathology with a focus on distinctive histologic features and helpful ancillary studies that differentiate them from a wide range of familiar morphologic mimics.
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7
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Nix JS, Rooper LM. Navigating small biopsies of salivary gland tumors: a pattern-based approach. J Am Soc Cytopathol 2020; 9:369-382. [PMID: 32660844 DOI: 10.1016/j.jasc.2020.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
Diagnosis of salivary gland tumors on small biopsy can be difficult because of overlapping morphology, limited tissue availability, and technical artifact. Although a specific diagnosis is not feasible in all cases, a cautious and thoughtful approach to the differential diagnosis and a keen awareness of clinical consequences can facilitate the most complete and useful classification possible. In this review, we present a general strategy for the evaluation of small salivary biopsies, including consideration of clinical and radiographic information, systematic assessment of histologic patterns, and judicious use of immunohistochemistry and molecular studies. We then focus on the distinctive differential diagnoses raised by 6 specific histologic patterns: tubular and cribriform architecture, squamous differentiation, mucin and other secretions, high-grade cytology, epithelial and lymphoid elements, and oncocytic features. Throughout this systematic and pattern-based approach, we focus on practical and cost-effective strategies to overcome the most common diagnostic challenges in limited material.
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MESH Headings
- Artifacts
- Biomarkers, Tumor/metabolism
- Biopsy/methods
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/metabolism
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Mucoepidermoid/diagnosis
- Carcinoma, Mucoepidermoid/metabolism
- Carcinoma, Mucoepidermoid/pathology
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Diagnosis, Differential
- Humans
- Immunohistochemistry/methods
- Mucins/biosynthesis
- Salivary Gland Neoplasms/diagnosis
- Salivary Gland Neoplasms/metabolism
- Salivary Gland Neoplasms/pathology
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Affiliation(s)
- J Stephen Nix
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Rooper LM. Challenges in Minor Salivary Gland Biopsies: A Practical Approach to Problematic Histologic Patterns. Head Neck Pathol 2019; 13:476-484. [PMID: 30887392 PMCID: PMC6684710 DOI: 10.1007/s12105-019-01010-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
Evaluation of minor salivary gland biopsy can be fraught with a wide range of problems, including technical limitations due to the small size and distorted nature of tissue received and interpretive difficulties navigating the considerable morphologic and immunohistochemical overlap between widely disparate entities. As such, common pathologic findings can evoke a perplexing differential diagnosis that encompasses malignant, benign, and non-neoplastic processes. This review will present the diagnostic considerations that arise from four histologic patterns that are frequently encountered on minor salivary gland biopsies: squamous differentiation, tubular and cribriform growth, mucin production, and myxoid stroma. The discussion herein will emphasize practical strategies and priorities for navigating these differential diagnoses in a clinically-relevant and cost-effective manner.
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Affiliation(s)
- Lisa M. Rooper
- Departments of Pathology and Oncology, The Johns Hopkins Hospital, 401 N. Broadway, Weinberg 2242, Baltimore, MD 21231-2410 USA
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9
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Hernandez-Prera JC. Historical Evolution of the Polymorphous Adenocarcinoma. Head Neck Pathol 2018; 13:415-422. [PMID: 30187348 PMCID: PMC6684715 DOI: 10.1007/s12105-018-0964-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 09/03/2018] [Indexed: 11/26/2022]
Abstract
The 2017 World Health Organization Classification of Head and Neck Tumors introduced for the first time the diagnostic terminology "cribriform variant of polymorphous adenocarcinoma". This nomenclature attempts to reconciliate the ongoing taxonomical controversy related to cribriform adenocarcinoma of tongue. In order to better understand this classification conundrum, it is imperative for pathologist to comprehend the historical evolution of polymorphous adenocarcinoma formerly known as polymorphous "low grade" adenocarcinoma. This review highlights our understanding of these tumors since their origins.
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10
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Omitola OG, Iyogun CA. Immunohistochemical study of salivary gland tumors in a tertiary institution in South-South Region of Nigeria. J Oral Maxillofac Pathol 2018; 22:163-167. [PMID: 30158766 PMCID: PMC6097354 DOI: 10.4103/jomfp.jomfp_108_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of this study was to see the usefulness of immunohistochemistry in diagnosing salivary gland tumors found in a tertiary health institution. Materials and Methods: Twenty-six formalin-fixed paraffin embedded salivary gland tumors were accessioned, and 2 μm were sectioned and processed using Streptavidin-Biotin immunoperoxidase method. Results: Adenoid cystic carcinoma (ADCC) was positive to alpha-smooth muscle actin (α-SMA) while mucoepidermoid carcinoma (MEC), polymorphous low-grade adenocarcinoma (PLGA), squamous cell carcinoma (SCC) and oncocytic carcinoma (OCC) were all negative to it. MEC, PLGA, ADCC and the only pleomorphic adenoma (PA) were positive to Ki-67 while both SCC and OCC were negative to it. All the tumors except PA were positive to p63. Conclusion: It appears that α-SMA may be used to distinguish ADCC from MEC and PLGA, but Ki-67 cannot be used for this purpose. Furthermore, p63 cannot help in the diagnosis of ADCC, MEC or PLGA. It was concluded that immunochemistry can be used as adjunct to routine H and E stain in the diagnosis of the various salivary gland tumors.
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11
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Khurram SA, Speight PM. Characterisation of DOG-1 Expression in Salivary Gland Tumours and Comparison with Myoepithelial Markers. Head Neck Pathol 2018; 13:140-148. [PMID: 29671211 PMCID: PMC6513803 DOI: 10.1007/s12105-018-0917-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/13/2018] [Indexed: 12/14/2022]
Abstract
DOG1 is an established diagnostic marker for gastrointestinal stromal tumours (GIST), but has been reported in salivary gland tumours (SGT) as an acinar and intercalated duct marker. However, its specificity and distribution is not well established. The aim of this study was to evaluate the diagnostic utility of DOG-1 expression in SGT in addition to comparing it with myoepithelial markers. Normal salivary tissue and SGT (n = 184) were examined for expression of DOG1 and a range of myoepithelial markers. SGT included: acinic cell carcinoma (ACC, n = 15), secretory carcinoma (SC, n = 9), pleomorphic adenoma (PA, n = 49), carcinoma ex-PA (Ca ex-PA, n = 11), adenoid cystic carcinoma (AdCC, n = 20), polymorphous adenocarcinoma (PAC, n = 6), myoepithelioma (n = 6), myoepithelial carcinoma (MC, n = 2), basal cell adenoma (BCA, n = 14), canalicular adenoma (CA, n = 19), mucoepidermoid carcinoma (MEC, n = 11), oncocytoma (n = 2), adenocarcinoma NOS (AdNOS, n = 4), basal cell adenocarcinoma (BCAC, n = 2), salivary duct carcinoma (SDC, n = 3) and papillary cystadenocarcinoma (PCAC, n = 1). Normal acini and ACC (14/15) showed strong luminal DOG1 staining; SC were largely negative with only focal expression in 3/9 cases. Luminal staining was seen in PA (14/49), PAC (4/6), Ca ex-PA (4/11) and AdCC (6/20). 8/11 MEC showed luminal and/or mucous cell staining. No staining was seen in myoepithelioma, MC, CA, adNOS and BCAC. BCA showed strong staining of myoepithelial cells in some cases (5/14). Variable myoepithelial DOG1 staining was seen in PA, Ca ex PA, BCA, SDC and PCAC which was not as consistent as myoepithelial markers such as calponin, p63 and αSMA. Absence of DOG1 can differentiate ACC from SC, but staining is variable in PA, PLGA and Ca ex-PA. Myoepithelial staining in some tumours but not in normal gland suggests a wider distribution in SGT than originally envisaged.
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Affiliation(s)
- Syed A Khurram
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, 19 Claremont Crescent, Sheffield, S10 2TA, UK.
| | - Paul M Speight
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, 19 Claremont Crescent, Sheffield, S10 2TA, UK
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12
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Predictors of Outcome in the Phenotypic Spectrum of Polymorphous Low-grade Adenocarcinoma (PLGA) and Cribriform Adenocarcinoma of Salivary Gland (CASG): A Retrospective Study of 69 Patients. Am J Surg Pathol 2017; 40:1526-1537. [PMID: 27454943 DOI: 10.1097/pas.0000000000000705] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Polymorphous low-grade adenocarcinoma (PLGA) shows histologic diversity with fascicular and targetoid features while cribriform adenocarcinoma of salivary gland (CASG) demonstrates predominant cribriform and solid patterns with glomeruloid appearance and optical clear nuclei. The current study is designed to identify pathologic features that may predict clinical outcome in 69 PLGA/CASG. Seven patients had recurrences or distant metastasis, including 3 local recurrences, 2 nodal metastases, and 2 distant metastases. The following histologic factors predicted disease-free survival on univariate analysis: tumor size, bone invasion, lymphovascular invasion, tumor necrosis, ≥10% papillary pattern, and ≥30% cribriform pattern. On multivariate analysis, 10% of papillary pattern and 30% cribriform pattern were independent prognostic factors of disease-free survival. Histologic classification of the 69 tumors (based on the prior reported definition of CASG) showed 21 CASGs (30%), 23 PLGAs (33%), and 22 (32%) with indeterminate features of PLGA and CASG. In addition, 3 (4%) tumors demonstrated a predominant papillary pattern (≥50%). Interestingly, not all CASGs were located in the minor salivary gland and 2 tumors were identified in the parotid. One patient died from her disease and she harbored a CASG with >30% cribriform pattern. In conclusion, tumor size, bone invasion, and lymphovascular invasion are significant parameters that can predict adverse clinical behaviors in PLGA/CASG on univariate analysis. Using the prior reported definition, an overlapping histology between PLGA and CASG was noted in over a third of the cases. Regardless of tumor subclassification, the percentage of cribriform and papillary patterns seems to be prognostically relevant and should be documented.
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Pagano A, Dennis K. Cribriform adenocarcinoma of the minor salivary gland arising in the tonsil with metastasis to a cervical lymph node: A case report with description of fine needle aspiration cytology. Diagn Cytopathol 2017; 45:468-471. [PMID: 28205384 DOI: 10.1002/dc.23687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/23/2016] [Accepted: 01/30/2017] [Indexed: 11/10/2022]
Abstract
Cribriform adenocarcinoma of minor salivary gland (CAMSG) is a rare tumor of the head and neck. We report a case of a 70-year-old female who presented with a 4-5-month history of a left neck mass. CT scan of the neck showed a left neck mass just inferior to the angle of the mandible and left tonsillar prominence. Fine-needle aspiration (FNA) of the neck mass showed epithelial groups with focal cribriform architecture. The cells had round to oval nuclei and fine chromatin. The background contained scattered lymphocytes. A preliminary diagnosis of low grade adenocarcinoma with cribriform features metastatic to a lymph node was made. Subsequent biopsy of the tonsil mass showed a tumor with a combination of tubular, solid, and papillary architecture containing round to ovoid nuclei with very fine chromatin, consistent with cribriform adenocarcinoma of the minor salivary gland. Cribriform adenocarcinoma of minor salivary gland has a documented tendency to metastasize to cervical lymph nodes. Since this neoplasm can cytologically and histologically resemble other neoplasms of the head and neck, including polymorphous low-grade adenocarcinoma (PLGA), papillary thyroid carcinoma (PTC), and occasionally adenoid cystic carcinoma, being aware of and familiar with the cytologic features of CAMSG on FNA smears is important for patient management. Diagn. Cytopathol. 2017;45:468-471. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Alexa Pagano
- University of Kansas School of Medicine, Alexa Pagano, Kansas City, Kansas, 66160
| | - Katie Dennis
- Department of Pathology, University of Kansas School of Medicine, Kansas City, Kansas, 66160
- Department of Laboratory Medicine, University of Kansas School of Medicine, Kansas City, Kansas, 66160
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Sharma P, Wadhwan V, Kumar KVA, Venkatesh A, Thapa T. Indolent palatal swelling: Catch 22. Natl J Maxillofac Surg 2017; 7:221-224. [PMID: 28356700 PMCID: PMC5357931 DOI: 10.4103/0975-5950.201352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We present an interesting but intriguing case of an indolent palatal swelling. The lesion was asymptomatic causing little discomfort to the patient and thus was an incidental clinical finding. Provisional diagnosis was a benign, minor salivary gland tumor. Clinical differential diagnoses included benign lymphoepithelial lesion or mucus extravasation phenomenon. Nevertheless, we also considered malignancies such as mucoepidermoid carcinoma, lymphoma, and neoplasm of the maxillary sinus. However, the histopathology revealed a rare clinicopathologic entity prompting immediate treatment of the lesion.
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Affiliation(s)
- Preeti Sharma
- Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Vijay Wadhwan
- Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - K V Arun Kumar
- Department of Oral Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Arvind Venkatesh
- Department of Oral Pathology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Timsy Thapa
- Department of Oral Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
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15
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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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Mariano FV, Varanda RF, Schultz L, Correa MB, de Almeida OP, Altemani A, Lopes MA. Cribriform adenocarcinoma of the soft palate with multiple lymph node metastasis and long-term follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:e117-e122. [PMID: 28094218 DOI: 10.1016/j.oooo.2016.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/12/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG) is a recently described entity, with most cases previously published as polymorphous low-grade adenocarcinoma (PLGA). Typical cases share some main characteristics, such as oral sites (mainly tongue), regional lymph node metastasis, and morphology resembling solid and follicular variants of papillary thyroid carcinoma. OBJECTIVE To present a CATMSG and emphasize the importance of reclassifying PLGAs with unusual behavior. CASE REPORT A 78-year-old male presented with an ulcerated mass in the soft palate treated as PLGA. The patient developed 5 regional metastases over 11 years of follow-up, all diagnosed as PLGA. He died due to the disease, and because of the very aggressive behavior of PLGA, all histopathologic slides were revised and the tumor was reclassified as CATMSG. CONCLUSION This report emphasizes the importance of reevaluating aggressive PLGA and contributes to a better understanding of CATMSG.
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Affiliation(s)
| | - Renata Freitas Varanda
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas, Brazil
| | | | | | - Oslei Paes de Almeida
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas, Brazil
| | - Albina Altemani
- Pathology Department, Faculty of Medical Sciences, State University of Campinas, Brazil
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas, Brazil
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17
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Dos Santos HT, de Andrade BAB, Egal ESA, Filho ERC, Mariano FV, Altemani A. Plasmacytoid-Type Cellular Differentiation in Polymorphous Low-Grade Adenocarcinoma. Int J Surg Pathol 2016; 24:322-7. [PMID: 26912473 DOI: 10.1177/1066896916633848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Polymorphous low-grade adenocarcinoma (PLGA) occurs more frequently in minor salivary glands. The diagnosis of PLGA, in general, is not difficult but in occasional tumors showing limited invasion or in small biopsy specimens, PLGA may be confused with cellular pleomorphic adenoma (PA). Plasmacytoid cells, a usual component of PAs, have been considered helpful for correct tumor identification. OBJECTIVE The aim of this study was to verify the frequency (if any) of plasmacytoid-type cellular differentiation (PD) in PLGA. MATERIALS AND METHODS Thirty-two cases of PLGA were reviewed. PD was recognized in 2 cases (6.25%), in which immunohistochemical expression of AE1/AE3, CK7, CK14, vimentin, α-SMA, p63, S-100, calponin, GFAP, and Ki-67 was evaluated. RESULTS The 2 cases presented conventional areas of PLGA and variable quantities of cells with PD forming aggregates in the stroma and lining ductal structures. Cells with PD showed positivity for AE1/AE3, CK7, S-100, and vimentin and were negative for CK14, calponin, and GFAP in both cases. In case 1, cells with PD did not present α-SMA and p63 positivity whereas in case 2 they were positive, but for α-SMA such reactivity was restricted to cells forming solid aggregates. CONCLUSION Although PD in PLGA is rare, it is necessary to be aware of this possibility, particularly in small incisional biopsies and in PLGA with limited invasion, to avoid confusion with cellular PA.
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Affiliation(s)
| | | | | | | | | | - Albina Altemani
- Medical Science Faculty, University of Campinas (UNICAMP), Campinas, Brazil
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18
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Piscuoglio S, Fusco N, Ng CKY, Martelotto LG, da Cruz Paula A, Katabi N, Rubin BP, Skálová A, Weinreb I, Weigelt B, Reis-Filho JS. Lack of PRKD2 and PRKD3 kinase domain somatic mutations in PRKD1 wild-type classic polymorphous low-grade adenocarcinomas of the salivary gland. Histopathology 2016; 68:1055-62. [PMID: 26426580 DOI: 10.1111/his.12883] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/25/2015] [Indexed: 02/02/2023]
Abstract
AIMS Polymorphous low-grade adenocarcinoma (PLGA) is the second most common intra-oral salivary gland malignancy. The vast majority of PLGAs harbour a PRKD1 E710D hot-spot somatic mutation or somatic rearrangements of PRKD1, PRKD2 or PRKD3. Given the kinase domain homology among PRKD1, PRKD2 and PRKD3, we sought to define whether PLGAs lacking PRKD1 somatic mutations or PRKD gene family rearrangements would be driven by somatic mutations affecting the kinase domains of PRKD2 or PRKD3. METHODS AND RESULTS DNA was extracted from eight microdissected PLGAs lacking PRKD1 somatic mutations or PRKD gene family rearrangements. Samples were thoroughly centrally reviewed, microdissected and subjected to Sanger sequencing of the kinase domains of the PRKD2 and PRKD3 genes. None of the PLGAs lacking PRKD1 somatic mutations or PRKD gene family rearrangements harboured somatic mutations in the kinase domains of the PRKD2 or PRKD3 genes. CONCLUSION PLGAs lacking PRKD1 somatic mutations or PRKD gene family rearrangements are unlikely to harbour somatic mutations in the kinase domains of PRKD2 or PRKD3. Further studies are warranted to define the driver genetic events in this subgroup of PLGAs.
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Affiliation(s)
- Salvatore Piscuoglio
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicola Fusco
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Division of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Charlotte K Y Ng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luciano G Martelotto
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnaud da Cruz Paula
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Instituto Português de Oncologia, Oporto, Portugal
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian P Rubin
- Department of Pathology, Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alena Skálová
- Department of Pathology, Medical Faculty of Charles University, Plzen, Czech Republic
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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19
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Ohta Y, Hirota Y, Kohno Y, Kishimoto K, Norose T, Ohike N, Takimoto M, Shiokawa A, Ota H. Cytology of low-grade cribriform cystadenocarcinoma in salivary glands: Cytological and immunohistochemical distinctions from other salivary gland neoplasms. Diagn Cytopathol 2015; 44:241-5. [DOI: 10.1002/dc.23411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/14/2015] [Accepted: 11/24/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Yoshiki Ohta
- Department of Clinico-Diagnostic Pathology; Showa University Fujigaoka Hospital; Kanagawa Japan
| | - Yuko Hirota
- Department of Clinico-Diagnostic Pathology; Showa University Koto-Toyosu Hospital; Tokyo Japan
| | - Yohko Kohno
- Division of Pathology; Department of Oral Diagnostic Sciences, Showa University School of Dentistry; Tokyo Japan
| | - Koji Kishimoto
- Department of Clinico-Diagnostic Pathology; Showa University Fujigaoka Hospital; Kanagawa Japan
| | - Tomoko Norose
- Department of Clinico-Diagnostic Pathology; Showa University Fujigaoka Hospital; Kanagawa Japan
| | - Nobuyuki Ohike
- Department of Clinico-Diagnostic Pathology; Showa University Fujigaoka Hospital; Kanagawa Japan
| | - Masafumi Takimoto
- Department of Pathology; Clinico-Diagnostic Pathology, Showa University School of Medicine; Tokyo Japan
| | - Akira Shiokawa
- Department of Pathology; Clinico-Diagnostic Pathology, Showa University School of Medicine; Tokyo Japan
| | - Hidekazu Ota
- Department of Pathology; Clinico-Diagnostic Pathology, Showa University School of Medicine; Tokyo Japan
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20
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Sedassari BT, dos Santos HT, Pigatti FM, Martins Mussi MC, Tobouti PL, Altemani A, Sousa S. Doing more with less: the challenging diagnosis of polymorphous low-grade adenocarcinoma in incisional biopsy samples. Histopathology 2015; 68:1046-54. [DOI: 10.1111/his.12880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Bruno T Sedassari
- Department of Oral and Maxillofacial Pathology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Harim T dos Santos
- Department of Oral Diagnosis; Piracicaba School of Dentistry; State University of Campinas; São Paulo Brazil
| | - Fernanda M Pigatti
- Department of Oral and Maxillofacial Pathology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Maria C Martins Mussi
- Department of Oral and Maxillofacial Pathology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Priscila L Tobouti
- Department of Oral and Maxillofacial Pathology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Albina Altemani
- Department of Anatomic Pathology; School of Medicine; State University of Campinas; São Paulo Brazil
| | - Suzana Sousa
- Department of Oral and Maxillofacial Pathology; School of Dentistry; University of São Paulo; São Paulo Brazil
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21
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Fonseca FP, Brierley D, Wright JM, Santos-Silva AR, Almeida OP, Rocha AC, Van Heerden WF, Hunter KD. Polymorphous low-grade adenocarcinoma of the upper lip: 11 cases of an uncommon diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:566-71. [PMID: 25747177 DOI: 10.1016/j.oooo.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/24/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this case study was to describe an international case series of polymorphous low-grade adenocarcinoma (PLGA) affecting the upper lip. MATERIAL AND METHODS Over a 30-year-period, the files of five pathology services were reviewed for PLGA affecting the upper lip. Hematoxylin and eosin-stained slides were reviewed by three oral and maxillofacial pathologists, and microscopic features were described. Clinical data were retrieved from patients' medical records. RESULTS The review identified 11 cases of upper lip PLGAs, with a complete set of clinical data available for 5 cases. There was a male predominance (1.2:1), and the mean age was 58.7 years. Most cases presented as small asymptomatic swellings that resembled benign tumors. All patients underwent surgery, and no recurrences or metastases were reported in the 8 cases from which follow-up data were available. Microscopically, the typical polymorphic architectural arrangement of PLGA was seen in all cases, with lobular, trabecular, papillary, and cribriform patterns identified. Perineural invasion, normal gland entrapment, Indian filing, and concentric growth were frequently identified. CONCLUSION PLGA must be included in the list of differential diagnoses of tumors affecting the upper lip because of its similar clinical presentation to benign entities. The follow-up data available from 8 of 11 cases suggest that these tumors follow a low-grade clinical course, similar to the majority of palatal cases of PLGA.
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Affiliation(s)
- Felipe Paiva Fonseca
- Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Brazil
| | - Daniel Brierley
- Academic Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, The University of Sheffield, UK
| | - John M Wright
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, Dallas, Texas, USA
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Brazil
| | - Oslei Paes Almeida
- Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Brazil
| | - André Caroli Rocha
- Oral and Maxillofacial Surgery and Traumatology Service, Clinical Hospital, Medical School, University of São Paulo, Brazil
| | - Willie F Van Heerden
- Department of Oral Pathology and Oral Biology, School of Dentistry - Faculty of Health Sciences, University of Pretoria, South Africa
| | - Keith D Hunter
- Academic Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, The University of Sheffield, UK; Department of Oral Pathology and Oral Biology, School of Dentistry - Faculty of Health Sciences, University of Pretoria, South Africa.
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22
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Not just another paediatric neck lump: metastatic cribriform adenocarcinoma of the palate in an adolescent. J Laryngol Otol 2015; 129:194-7. [DOI: 10.1017/s0022215114002643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This paper reports the case of a 13-year-old girl with a 2-year history of left cervical lymph node swelling that was diagnosed as metastatic cribriform adenocarcinoma of the tongue and minor salivary gland.Case report:A 13-year-old girl with a left, level II cervical lymph node underwent excisional biopsy after an ultrasound suggested suspicious features. The histology indicated polymorphous low-grade adenocarcinoma, and a primary lesion in the left palate was identified. The patient underwent left maxillectomy, neck dissection and reconstruction. Histological analysis of resection specimens led to a revised diagnosis of cribriform adenocarcinoma of the tongue and minor salivary gland.Conclusion:Cribriform adenocarcinoma of the tongue and minor salivary gland has recently been described as a separate entity to polymorphous low-grade adenocarcinoma in light of histological and behavioural differences, including higher rates of metastasis at presentation. This is the first report in the world literature of an adolescent with this entity. It is possible that some previous reports of polymorphous low-grade adenocarcinoma in childhood would have been more accurately described as cribriform adenocarcinoma of the tongue and minor salivary gland.
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23
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Zhu S, Schuerch C, Hunt J. Review and Updates of Immunohistochemistry in Selected Salivary Gland and Head and Neck Tumors. Arch Pathol Lab Med 2015; 139:55-66. [DOI: 10.5858/arpa.2014-0167-ra] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Immunohistochemistry is a useful tool for diagnosing salivary gland and head and neck tumors.
Objective
To review immunohistochemical markers, which can aid in the diagnosis of selected salivary gland and head and neck tumors.
Data Sources
Literature review and authors' personal practice experience.
Conclusions
Salivary gland and head and neck tumors include a large diverse group of tumors with complex and overlapping histologic features. Immunohistochemistry plays an important role in resolving the differential diagnosis of some salivary gland and head and neck tumors and can provide information for the prognosis of certain tumors.
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Affiliation(s)
- Shaobo Zhu
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Zhu and Schuerch)
| | - Conrad Schuerch
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Zhu and Schuerch)
| | - Jennifer Hunt
- and the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock (Dr Hunt)
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24
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Weinreb I, Piscuoglio S, Martelotto LG, Waggott D, Ng CKY, Perez-Ordonez B, Harding NJ, Alfaro J, Chu KC, Viale A, Fusco N, da Cruz Paula A, Marchio C, Sakr RA, Lim R, Thompson LDR, Chiosea SI, Seethala RR, Skalova A, Stelow EB, Fonseca I, Assaad A, How C, Wang J, de Borja R, Chan-Seng-Yue M, Howlett CJ, Nichols AC, Wen YH, Katabi N, Buchner N, Mullen L, Kislinger T, Wouters BG, Liu FF, Norton L, McPherson JD, Rubin BP, Clarke BA, Weigelt B, Boutros PC, Reis-Filho JS. Hotspot activating PRKD1 somatic mutations in polymorphous low-grade adenocarcinomas of the salivary glands. Nat Genet 2014; 46:1166-9. [PMID: 25240283 DOI: 10.1038/ng.3096] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/27/2014] [Indexed: 12/15/2022]
Abstract
Polymorphous low-grade adenocarcinoma (PLGA) is the second most frequent type of malignant tumor of the minor salivary glands. We identified PRKD1 hotspot mutations encoding p.Glu710Asp in 72.9% of PLGAs but not in other salivary gland tumors. Functional studies demonstrated that this kinase-activating alteration likely constitutes a driver of PLGA.
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Affiliation(s)
- Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Salvatore Piscuoglio
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Luciano G Martelotto
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daryl Waggott
- 1] Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada. [2] Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Onatrio, Canada. [3] Campbell Family Institute for Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Charlotte K Y Ng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Nicholas J Harding
- Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Javier Alfaro
- 1] Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada. [2] Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Onatrio, Canada. [3] Campbell Family Institute for Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. [4] Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth C Chu
- Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Agnes Viale
- Integrated Genomics Operation, Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicola Fusco
- 1] Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA. [2] School of Pathology, University of Milan, Milan, Italy
| | - Arnaud da Cruz Paula
- 1] Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA. [2] Instituto Português de Oncologia, Oporto, Portugal
| | - Caterina Marchio
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rita A Sakr
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raymond Lim
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lester D R Thompson
- Department of Pathology, Kaiser Permanente, Woodland Hills Medical Center, Woodland Hills, California, USA
| | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alena Skalova
- Department of Pathology and Laboratory Medicine, Charles University in Prague, Plzen, Czech Republic
| | - Edward B Stelow
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Isabel Fonseca
- 1] Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal. [2] Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Adel Assaad
- Department of Pathology, Virginia Mason Hospital and Seattle Medical Center, Seattle, Washington, USA
| | - Christine How
- 1] Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Onatrio, Canada. [2] Campbell Family Institute for Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jianxin Wang
- Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Richard de Borja
- Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Michelle Chan-Seng-Yue
- Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | | | - Y Hannah Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicholas Buchner
- Cancer Genomics Platform, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Laura Mullen
- Cancer Genomics Platform, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Thomas Kislinger
- 1] Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Onatrio, Canada. [2] Campbell Family Institute for Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. [3] Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Bradly G Wouters
- 1] Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Onatrio, Canada. [2] Campbell Family Institute for Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. [3] Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- 1] Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Onatrio, Canada. [2] Campbell Family Institute for Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. [3] Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada. [4] Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John D McPherson
- 1] Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada. [2] Department of Pathology, Virginia Mason Hospital and Seattle Medical Center, Seattle, Washington, USA
| | - Brian P Rubin
- 1] Department of Molecular Genetics, Lerner Research Institute, Cleveland, Ohio, USA. [2] Robert J. Tomsich Pathology and Laboratory Medicine Institute, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Blaise A Clarke
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Paul C Boutros
- 1] Informatics and Bio-Computing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada. [2] Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada. [3] Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Jorge S Reis-Filho
- 1] Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA. [2]
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25
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Weinreb I, Zhang L, Tirunagari LMS, Sung YS, Chen CL, Perez-Ordonez B, Clarke BA, Skalova A, Chiosea SI, Seethala RR, Waggott D, Boutros PC, How C, Liu FF, Irish JC, Goldstein DP, Gilbert R, Ud Din N, Assaad A, Hornick JL, Thompson LDR, Antonescu CR. Novel PRKD gene rearrangements and variant fusions in cribriform adenocarcinoma of salivary gland origin. Genes Chromosomes Cancer 2014; 53:845-56. [PMID: 24942367 DOI: 10.1002/gcc.22195] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/29/2014] [Indexed: 12/11/2022] Open
Abstract
Polymorphous low-grade adenocarcinoma (PLGA) and cribriform adenocarcinoma of minor salivary gland (CAMSG) are low-grade carcinomas arising most often in oral cavity and oropharynx, respectively. Controversy exists as to whether these tumors represent separate entities or variants of one spectrum, as they appear to have significant overlap, but also clinicopathologic differences. As many salivary carcinomas harbor recurrent translocations, paired-end RNA sequencing and FusionSeq data analysis was applied for novel fusion discovery on two CAMSGs and two PLGAs. Validated rearrangements were then screened by fluorescence in situ hybridization (FISH) in 60 cases. Histologic classification was performed without knowledge of fusion status and included: 21 CAMSG, 18 classic PLGA, and 21 with "mixed/indeterminate" features. The RNAseq of 2 CAMSGs showed ARID1A-PRKD1 and DDX3X-PRKD1 fusions, respectively, while no fusion candidates were identified in two PLGAs. FISH for PRKD1 rearrangements identified 11 additional cases (22%), two more showing ARID1A-PRKD1 fusions. As PRKD2 and PRKD3 share similar functions with PRKD1 in the diacylglycerol and protein kinase C signal transduction pathway, we expanded the investigation for these genes by FISH. Six additional cases each showed PRKD2 and PRKD3 rearrangements. Of the 26 (43%) fusion-positive tumors, there were 16 (80%) CAMSGs and 9 (45%) indeterminate cases. A PRKD2 rearrangement was detected in one PLGA (6%). We describe novel and recurrent gene rearrangements in PRKD1-3 primarily in CAMSG, suggesting a possible pathogenetic dichotomy from "classic" PLGA. However, the presence of similar genetic findings in half of the indeterminate cases and a single PLGA suggests a possible shared pathogenesis for these tumor types.
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Affiliation(s)
- Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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26
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Abstract
The next WHO classification should abandon "salivary duct carcinoma"; conventional salivary duct carcinoma should be classified as "high-grade salivary duct carcinoma". Low-grade salivary duct carcinoma should replace the current nosology of "low-grade cribriform cystadenocarcinoma". Cystadenocarcinoma should be classified with the descriptor "Not Otherwise Specified" and should be considered an exclusionary diagnostic category. On the other hand, "Not Otherwise Specified" does not fit for hyalinizing clear cell carcinoma (HCCC). The EWSR1-ATF1 fusion is specific for HCCC within the context of salivary neoplasia. We recommend adding "hyalinizing" even though this feature is not present in all cases; the benefit of which is the mental association with a salivary clear cell malignancy. Sinonasal Renal Cell-like Adenocarcinoma (SNRCLA) is a distinct clear cell neoplasm and should be added to the next WHO classification. Future studies will bear out whether SNRCLA is even a low-grade carcinoma, or may be reclassified as "adenoma". Lastly, the next WHO monograph should include the Risk Model in the general introductory statements on oral squamous cell carcinoma, under a subheading of "Histological Prognosticators". The positive predictive value for developing locoregional recurrence in patients with low-stage oral cavity squamous carcinoma (OSCC) and "worst pattern of invasion type-5" (WPOI-5) is 42 %. Low-stage high-risk OSCC with a combination of features other than WPOI-5 is associated with 32 % likelihood for locoregional progression. WPOI-5 also predicts occult metastatic disease (p = 0.0001, Chi squared, 2 DF). Thus the Risk Model can also be used to make decisions regarding staged elective neck dissections.
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27
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Gailey MP, Bayon R, Robinson RA. Cribriform adenocarcinoma of minor salivary gland: a report of two cases with an emphasis on cytology. Diagn Cytopathol 2014; 42:1085-90. [PMID: 24550144 DOI: 10.1002/dc.23111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/30/2013] [Accepted: 01/09/2014] [Indexed: 11/08/2022]
Abstract
Cribriform adenocarcinoma of minor salivary gland (CAMSG) is a recently characterized low grade salivary gland malignancy that most commonly presents as a mass in the base of the tongue, frequently with regional lymph node metastasis. Given its relative rarity and overlapping cytomorphology, CAMSG may be confused with polymorphous low grade adenocarcinoma (PLGA) in minor salivary gland sites and papillary thyroid carcinoma (PTC) in cervical metastasis, in both fine-needle aspiration and excisional specimens. As there are no cytology reports in the literature, we present two new cases of CAMSG and describe the aspiration cytology of the tumor taken from bench top aspirates, compare it with the histomorphology, and discuss the features that may help one avoid misdiagnosis of PTC in the setting of cervical lymph node metastasis. We found that like PTC, aspirates of CAMSG contain polymorphic fragments of epithelial cells arranged in monolayer sheets, papillary fronds and tips, and occasional cribriform configurations, and metachromatic stromal fragments, which may be misinterpreted as colloid. A background of myxoid/mucoid material also reminiscent of colloid was prominent. Differentiation from PLGA is more difficult based strictly on cytology. A review of the most current literature in relation to the molecular and immunohistochemical profiles, therapeutic options, and prognosis is also presented. It is critical for pathologists and clinicians to be aware of this tumor when presented with patients having a cervical lymph node mass in the absence of a primary tumor.
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Affiliation(s)
- Michael P Gailey
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Michal M, Kacerovska D, Kazakov DV. Cribriform adenocarcinoma of the tongue and minor salivary glands: a review. Head Neck Pathol 2013; 7 Suppl 1:S3-11. [PMID: 23821209 PMCID: PMC3712093 DOI: 10.1007/s12105-013-0457-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 06/08/2013] [Indexed: 12/27/2022]
Abstract
Cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG) is a tumor occurring mostly, but not exclusively, in the base of the tongue. Other locations are minor salivary glands of the oral cavity. Histopathologically, CATMSG resembles papillary carcinoma of the thyroid gland. It usually reveals a solid growth devoid of colloid, and eosinophilic material present in follicular areas is rather pale in contrast to metastatic foci seen in papillary thyroid carcinoma that shows typical deeply eosinophilic colloid with "moth-eaten peripheries" and cystic configuration. In addition, giant multinucleated cells are not observed in CATMSG and psammoma bodies are found only exceptionally. Unlike papillary thyroid carcinoma, CATMSG is composed of hybrid secretory-myoepithelial cells. Most importantly, CATMSG is consistently negative with both thyroglobulin and TTF-1. CATMSG is a distinct tumor entity that also differs from polymorphous low-grade adenocarcinoma by location, cytology, histological architecture, and behavior, with frequent metastases at the time of presentation. Paradoxically, early metastatic disease seen in most cases of CATMSG is associated with an indolent behavior. It makes CATMSG a unique neoplasm among all low-grade salivary gland tumors.
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Affiliation(s)
- Michal Michal
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
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Ettl T, Gosau M, Brockhoff G, Schwarz-Furlan S, Agaimy A, Reichert TE, Rohrmeier C, Zenk J, Iro H. Predictors of cervical lymph node metastasis in salivary gland cancer. Head Neck 2013; 36:517-23. [PMID: 23780687 DOI: 10.1002/hed.23332] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study compares clinicopathological parameters with novel molecular markers for predicting cervical lymph node metastasis in salivary gland cancer. METHODS Three hundred sixteen salivary gland carcinomas were included in this study. Genomic epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), phosphatase and tensin homolog (PTEN), and hepatocyte growth factor receptor (MET) was determined by fluorescence in situ hybridization (FISH). Chi-square tests, multivariate regression, and Kaplan-Meier survival analysis were used for statistics. RESULTS Nodal staging determines long-term survival. Clinicopathological parameters associated with positive neck nodes are advanced age (p = .006), T3/T4 classification, histological high-grade malignancy, and diagnosis of salivary duct carcinoma (p < .001 each). Neck node metastases also correlate with copy number gain of EGFR (p = .004) and HER2, aberration of MET, and deletion of PTEN (p < .001 each). Multivariate analysis showed SDC (p = .002) to be the strongest predictor of lymph node metastasis, followed by MET aberration (p = .009), T3/T4 classification (p = .017), PTEN deletion (p = .042), and adenocarcinoma not otherwise specified (NOS; p = .047). CONCLUSION The histological subtype is crucial for decisions regarding neck dissection. New molecular parameters may also indicate elective treatment of the neck.
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Affiliation(s)
- Tobias Ettl
- Department of Oral and Maxillofacial Surgery, Regensburg University Medical Center, Regensburg, Germany
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Thennavan A, Rao L, Radhakrishnan R. Polymorphous low-grade adenocarcinoma of maxillary alveolus metastasising to the abdomen: the role of immunomarkers in diagnosis. BMJ Case Rep 2013; 2013:bcr2013009633. [PMID: 23661663 PMCID: PMC3669867 DOI: 10.1136/bcr-2013-009633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polymorphous low-grade adenocarcinoma (PLGA) originating mostly in the minor salivary glands of the posterior hard and soft palate is characterised by its indolent growth and a slower rate of metastasis. Seldom does the PLGA present an aggressive behaviour and demonstrate distant metastasis, as in the present case where a 73-year-old female patient with a swelling in the maxillary alveolus was diagnosed as PLGA exhibiting high-grade transformation, subsequently metastasizing to the abdomen and lungs. The importance of immunomarkers, c-kit and ki-67 in deciphering the clinical behaviour of this PLGA is highlighted. Distant metastasis to the abdomen has not yet been reported; hence, this case of PLGA emphasises the importance of immunohistochemistry in assessing its aggressiveness and understanding a novel aspect of its pathogenesis.
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Affiliation(s)
- Aatish Thennavan
- Department of Oral and Maxillofacial Pathology, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Lakshmi Rao
- Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India
| | - Raghu Radhakrishnan
- Department of Oral and Maxillofacial Pathology, Manipal College of Dental Sciences, Manipal, Karnataka, India
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Carcinoma ex pleomorphic adenoma in minor salivary glands of the anterior tongue: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2013. [DOI: 10.1016/j.ajoms.2012.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Differential expression of p16(INK4A) and cyclin D1 in benign and malignant salivary gland tumors: a study of 44 Cases. Head Neck Pathol 2013; 7:224-31. [PMID: 23315417 PMCID: PMC3738749 DOI: 10.1007/s12105-012-0417-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/27/2012] [Indexed: 01/15/2023]
Abstract
Salivary gland tumors (SGT) are a heterogeneous group of lesions. There is conflicting data concerning the molecular events involving the tumour suppressor retinoblastoma protein (pRb) pathway in these tumors. Few studies examined the alterations in components of the Rb pathway by immunohistochemical (IHC) methods in benign and malignant SGTs. Furthermore, recent evidence implicates human papillomavirus (HPV) in mucoepidermoid carcinoma (MEC) carcinogenesis. The purpose of our study is to examine p16(INK4A) and cyclin D1 expression in a variety of benign and malignant salivary gland tumors, and to investigate p16(INK4A) expression as a surrogate marker for HPV infection in MEC. Our series includes 30 malignant tumors [14 MEC, 6 acinic cell carcinomas (ACC), 5 polymorphous low grade adenocarcinomas (PLGA), 5 (AdCC)] and 14 benign tumors (4 benign cysts, 5 Warthin tumors and 5 pleomorphic adenomas (PA). All cases were tested by IHC for p16(INK4A) and cyclin D1. Testing for HPV wide spectrum (HPV-WS) was performed by in situ hybridization in all MEC cases. Staining intensity was recorded semi quantitatively (on a scale from 0 to 4+). Fisher's exact test and Pearson X2 test with a p < 0.05 were used. Cyclin D1 and p16(INK4A) are expressed similarly in malignant and benign tumors (p = 0.146 and p = 0.543, respectively). None of the MEC cases showed nuclear reactivity for HPV-WS. Statistical analysis showed positive correlation between cyclin D1 and p16(INK4A) expression. Our findings suggest that p16(INK4A) overexpression is likely secondary to cyclin D1 gene upregulation or amplification. Further molecular studies are warranted.
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Cribriform adenocarcinoma of minor salivary glands may express galectin-3, cytokeratin 19, and HBME-1 and contains polymorphisms of RET and H-RAS proto-oncogenes. Virchows Arch 2012; 461:531-40. [PMID: 23052371 DOI: 10.1007/s00428-012-1320-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
Abstract
The aim of the study was to further elucidate the immunohistochemical and genetic characteristics of cribriform adenocarcinoma of minor salivary glands (CAMSG). The study comprised five CAMSG from two males and three females, aged 21-72 years. Four tumors were localized at the base of tongue and one in the floor of mouth. At the time of diagnosis, four tumors had metastasised to regional lymph nodes. After tumor resection, two patients were treated by radiotherapy and one by chemoradiotherapy. During the follow-up (median 14 months), two patients developed lymph node metastasis. Microscopically, all tumors showed cribriform, papillary, follicular, and microcystic growth patterns. The tumor cells displayed vesicular nuclei with intranuclear grooves. Immunohistochemically, all tumors showed expression of cytokeratin (CK) 7, CK8, CK18, vimentin, smooth muscle actin, calponin, S-100 protein, and p16 protein. In addition, we observed expression of galectin-3, CK19, and HBME-1, but not of thyroglobulin and TTF-1. No mutations of RET, BRAF, K-RAS, H-RAS, and N-RAS proto-oncogenes were detected. However, in RET proto-oncogene, we found polymorphisms Gly691Ser (exon 11) and Ser904Ser (exon 15) in one case, p.Leu769Leu (exon 13) in one case, and variant p.IVS14-24 G/A of intron 14 in two cases, and in H-RAS proto-oncogene we found polymorphism 81 T-C (exon 1) in three cases. Thyroglobulin and TTF-1 are the only useful markers in the differential diagnosis between CAMSG and papillary thyroid carcinoma as both tumors may express galectin-3, CK19, and HBME-1. The RET, H-RAS, and N-RAS proto-oncoogenes are not mutated in CAMSG.
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Woo SB. Salivary Gland Neoplasms. ORAL PATHOLOGY 2012:286-319. [DOI: 10.1016/b978-1-4377-2226-0.00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
Malignant salivary gland epithelial tumors are histologically diverse with at least 24 recognized distinct entities. In general, malignant tumors account for 15% to 30% of parotid tumors, 40% to 45% of submandibular tumors, 70% to 90% of sublingual tumors, and 50% of minor salivary tumors. Common malignancies include mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma, salivary duct carcinoma, carcinoma ex pleomorphic adenoma, polymorphous lowgrade adenocarcinoma, and myoepithelial carcinoma. Each tumor type has its own unique histologic variants and prognostic pathologic features, and only mucoepidermoid carcinomas have a formalized grading system. The molecular pathogenesis of certain tumors, such as mucoepidermoid carcinoma and adenoid cystic carcinoma, has recently begun to be elucidated.
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Affiliation(s)
- Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, A614.X PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - E Leon Barnes
- Department of Pathology, University of Pittsburgh Medical Center, A608 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Petersson F, Pang B, Loke D, Hao L, Yan B. Biphasic low-grade nasopharyngeal papillary adenocarcinoma with a prominent spindle cell component: report of a case localized to the posterior nasal septum. Head Neck Pathol 2011; 5:306-13. [PMID: 21424532 PMCID: PMC3173538 DOI: 10.1007/s12105-011-0252-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 02/16/2011] [Indexed: 01/08/2023]
Abstract
A case (female, 39 years of) of thyroid-like nasopharyngeal low-grade papillary adenocarcinoma with a significant spindle cell component is presented. The tumor was located on the posterior nasal septum. The spindle cells displayed nuclear features very much similar to the epithelial component and the two cell types merged imperceptibly. Immunohistochemically, the neoplastic cells (including the spindle cell component) were strongly and diffusely positive for TTF-1, cytokeratins (AE1-3), cytokeratin 19 and vimentin. C-kit immunohistochemistry showed diffuse mild to moderate membranous positivity with focal areas displaying moderate to strong immunoreactivity. EMA was strongly positive in the epithelial component with membranous and cytoplasmic reactivity whereas the spindle cell component was weakly although diffusely positive. Carcinoembryonic antigen, calcitonin, chromogranin A, S100-protein, thyroglobulin, cdx2 and p63 were negative. The proliferative activity (Mib-1/Ki-67) was low; 3-4%. In the molecular genetic study we found no mutations at position 1799 (exon 15) in the BRAF-gene, (BRAFV600E) or in exons 9 and 11 of the KIT-gene.
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Affiliation(s)
- Fredrik Petersson
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
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Harmouch A, Maher M, Sefiani S. Adénocarcinome polymorphe de bas grade des glandes salivaires: à propos de neuf cas. ONCOLOGIE 2010. [DOI: 10.1007/s10269-010-1969-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Coček A, Hronková K, Voldánová J, Sach J, Skálová A, Ambruš M, Vránová J, Hahn A. Cribriform adenocarcinoma of the base of the tongue and low-grade, polymorphic adenocarcinomas of the salivary glands. Oncol Lett 2010; 2:135-138. [PMID: 22870142 DOI: 10.3892/ol.2010.213] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 10/22/2010] [Indexed: 11/06/2022] Open
Abstract
Low-grade, polymorphic adenocarcinomas occur mainly in females and are usually associated with the small salivary glands of the palate. The tumors are malignant, but not aggressive. Regional neck as well as distant metastasis is rare and the mortality rate is low. Cribriform adenocarcinoma of the salivary glands is a rare tumor, currently ranked among low-grade, polymorphic adenocarcinomas of the salivary glands. However, it differs from carcinomas in this group as it metastasizes to the cervical lymph nodes and exhibits frequent primary localization in the small salivary glands at the base of the tongue. Despite the tendency to metastasize, patient prognosis remains favorable. A case of a 72-year-old woman with neck metastases of cribriform adenocarcinoma, of unknown primary origin, is reported. The primary tumor origin was ultimately determined using nuclear magnetic resonance, histological verification was difficult due to the presence of an intact mucosal cover over the tumor. Cribriform adenocarcinoma is known to have a number of characteristics in common with a typical low-grade, salivary gland adenocarcinoma. However, in contrast to low-grade adenocarcinomas, the tumor presented with neck lymph node metastasis.
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Affiliation(s)
- Aleš Coček
- Department of Otorhinolaryngology, Third Faculty of Medicine, Charles University in Prague, Faculty Hospital Královské Vinohrady, Prague
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Gupta R, Gupta K, Gupta R. Polymorphous low-grade adenocarcinoma of the tongue: a case report. J Med Case Rep 2009; 3:9313. [PMID: 20062742 PMCID: PMC2803836 DOI: 10.1186/1752-1947-3-9313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 12/02/2009] [Indexed: 11/28/2022] Open
Abstract
Introduction Polymorphous low-grade adenocarcinoma is a distinct neoplasm of the salivary gland composed of luminal and non-luminal tumor cells admixed in varying proportions. Its resemblance to lobular carcinoma of the breast had led to its earlier nomenclature of 'terminal duct carcinoma'. Most patients present with an asymptomatic mass in the hard palate. In rare cases, the mass can also occur in the tongue. We report an unusual case of polymorphous low-grade adenocarcinoma at the base of tongue. Case presentation A 47-year-old Asian Caucasian woman presented with a painless swelling at the right lateral border of the tongue with an intact overlying mucosa. There were no other associated complaints. The lesion was excised and subjected to histopathological examination that revealed an interesting and unusual morphology of polymorphous low-grade adenocarcinoma. Conclusion Polymorphous low-grade adenocarcinoma is a well-defined entity in the minor salivary glands. Its occurrence in the tongue is rare with very few cases reported in the literature. It is a malignant neoplasm with low aggressiveness and it is thus important to identify and treat it accordingly.
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Affiliation(s)
- Ruchi Gupta
- Department of Histopathology and Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Geha H, François A, Boland F, Drikes S, Peron J. Polymorphous low-grade adenocarcinoma: a review regarding an unusual presentation as infected odontogenic cyst. J Plast Reconstr Aesthet Surg 2008; 62:742-6. [PMID: 19109086 DOI: 10.1016/j.bjps.2008.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/03/2008] [Accepted: 11/08/2008] [Indexed: 10/21/2022]
Abstract
The World Health Organisation (WHO) classified polymorphous low-grade adenocarcinoma (PLGA) in 1990 as a low-grade malignancy; ICD-O 8525/3 being the assigned international code. It has been frequently described as occurring in hard- or soft-palate accessory salivary glands: some cases being described in the tongue and in major salivary glands. We present an extensive literature review about PLGA and the most common diagnostic pitfalls. We also report the first case where it was seen surrounding an impacted maxillary tooth and discuss it in regard to our review.
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Affiliation(s)
- H Geha
- Service de Chirurgie Maxillo-faciale et Stomatologie, CHU Rouen, France.
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Hunter JB, Smith RV, Brandwein-Gensler M. Low-grade papillary adenocarcinoma of the palate: the significance of distinguishing it from polymorphous low-grade adenocarcinoma. Head Neck Pathol 2008; 2:316-23. [PMID: 20614302 PMCID: PMC2807587 DOI: 10.1007/s12105-008-0082-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 08/11/2008] [Indexed: 11/28/2022]
Abstract
Low-grade papillary adenocarcinoma (LGPA) represents a relatively rare histological variant of polymorphous low-grade adenocarcinoma (PLGA). There has been a debate as to whether LGPA is associated with greater aggressive potential compared to PLGA; this is further obfuscated by the fact that diagnostic criteria for LGPA have not been well-defined. We believe that this is the first report of a patient with LGPA who developed metastases to the femur and scalp. We review the published evidence for classifying LGPA as distinct from PLGA. The weight of published data does support the idea that LGPA is oncologically distinct from LGPA. However, as uniform diagnostic criteria are lacking, we suggest a cut-off value of 10% or greater papillary formation as being necessary to separate LGPA from PLGA.
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Affiliation(s)
- Jacob B. Hunter
- Departments of Otorhinolaryngology-Head Neck Surgery, Pathology, Albert Einstein College of Medicine (JH), Montefiore Medical Center, Bronx, New York USA
| | - Richard V. Smith
- Departments of Otorhinolaryngology-Head Neck Surgery, Pathology, Albert Einstein College of Medicine (JH), Montefiore Medical Center, Bronx, New York USA
| | - Margaret Brandwein-Gensler
- Departments of Otorhinolaryngology-Head Neck Surgery, Pathology, Albert Einstein College of Medicine (JH), Montefiore Medical Center, Bronx, New York USA
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Prasad ML, Barbacioru CC, Rawal YB, Husein O, Wen P. Hierarchical cluster analysis of myoepithelial/basal cell markers in adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma. Mod Pathol 2008; 21:105-14. [PMID: 18084258 DOI: 10.1038/modpathol.3800983] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Distinguishing adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma of the salivary glands is important for their management. We studied the expression of several myoepithelial and basal/stem cell markers (smooth muscle actin, calponin, smooth muscle myosin heavy chain, metallothionein, maspin, and p63) by immunohistochemistry in 23 adenoid cystic carcinoma and 24 polymorphous low-grade adenocarcinoma, to identify the most useful marker or combination of markers that may help their diagnoses. The results were analyzed using hierarchical cluster analysis and chi(2) test for trend. We noted diffuse expression of smooth muscle actin in 20 adenoid cystic carcinoma vs one polymorphous low-grade adenocarcinoma (P<0.0001), calponin in 15 adenoid cystic carcinoma vs one polymorphous low-grade adenocarcinoma (P<0.0001), smooth muscle myosin heavy chain in 15 adenoid cystic carcinoma vs one polymorphous low-grade adenocarcinoma (P=0.001), metallothionein in 22 adenoid cystic carcinoma vs eight polymorphous low-grade adenocarcinoma (P<0.001), maspin in 22 adenoid cystic carcinoma vs 14 polymorphous low-grade adenocarcinoma, and p63 in 21 adenoid cystic carcinoma vs 14 polymorphous low-grade adenocarcinoma. Hierarchical clustering of smooth muscle actin, calponin, smooth muscle myosin heavy chain, and metallothionein was virtually identical (kappa< or =0.0035), suggesting no significant advantage to their use in combination than individually. Diffuse smooth muscle actin expression showed the highest accuracy (91.5%) and positive predictive value (95.2%) for adenoid cystic carcinoma. Thus, diffuse expression of smooth muscle actin, calponin, smooth muscle myosin heavy chain, and metallothionein was highly predictive of adenoid cystic carcinoma, whereas maspin and p63 were frequently expressed in both tumors. In differentiating adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma, smooth muscle actin as a single ancillary test in support of the histological findings, appears to be as efficient as multiple immunohistochemical tests.
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Affiliation(s)
- Manju L Prasad
- Department of Pathology, Ohio State University, Columbus, OH, USA.
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Epivatianos A, Poulopoulos A, Dimitrakopoulos I, Andreadis D, Nomikos A, Vlahou S, Papazoglou G, Barbatis C. Application of α-smooth muscle actin and c-kit in the differential diagnosis of adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma. Oral Oncol 2007; 43:67-76. [PMID: 16807072 DOI: 10.1016/j.oraloncology.2006.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Accepted: 01/04/2006] [Indexed: 10/24/2022]
Abstract
The expression of vimentin, alpha-smooth muscle actin (alpha-SMA) and c-kit in adenoid cystic carcinomas (AdCCs) and polymorphous low-grade adenocarcinomas (PLGAs) was investigated immunohistochemically to evaluate the application of these markers to distinguish AdCCs from PLGAs when the histological features are equivocal. Tissue specimens of AdCCs and of PLGAs, formalin-fixed and paraffin-embedded were retrospectively studied using vimentin, alpha-SMA and c-kit. Positive staining for alpha-SMA was identified in all AdCCs and 25% of PLGAs. The immunoreactivity of c-kit in all positive cases of AdCCs (83%) and PLGAs (41%) was more than 50% and less than 50% of tumor cells respectively. The expression pattern for both alpha-SMA and c-kit, in tubular structures of AdCCs was different of that seen in the same structures in PLGAs. The results of this study support the potential application of alpha-SMA and c-kit as an adjunctive aid in the differential diagnosis of AdCCs from PLGAs.
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Affiliation(s)
- Apostolos Epivatianos
- Department of Oral Medicine and Oral Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki 51124, Greece
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Parashar P, Baron E, Papadimitriou JC, Ord RA, Nikitakis NG. Basal cell adenocarcinoma of the oral minor salivary glands: review of the literature and presentation of two cases. ACTA ACUST UNITED AC 2007; 103:77-84. [PMID: 17178498 DOI: 10.1016/j.tripleo.2005.12.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 12/09/2005] [Accepted: 12/19/2005] [Indexed: 01/05/2023]
Abstract
Basal cell adenocarcinoma (BCA) is an unusual salivary gland malignancy that very rarely affects the minor glands. Here we present 2 cases of BCA arising in the minor salivary glands of the left cheek and junction of the hard and soft palate, respectively. The patients were both women aged 66 and 42 years. The tumors assumed a tubular-trabecular and a solid-membranous pattern, respectively. Both tumors showed immunopositivity for S-100, Bcl-2, and cytokeratin 7. One tumor was also immunopositive for epithelial membrane antigen and carcinoembryonic antigen, and the other tumor was reactive with p53 and vimentin. Both tumors were surgically removed. A comprehensive literature review revealed only 21 previously reported cases of BCA of oral minor salivary glands. This is an exceptionally rare salivary gland tumor, which, despite its low-grade behavior, demands complete surgical removal with adequate margins. Immunohistochemical studies may complement a thorough histopathologic analysis in discriminating BCA from other salivary gland tumors.
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Affiliation(s)
- Pallavi Parashar
- Department of Diagnostic Sciences and Pathology, University of Maryland, Baltimore, 666 West Baltimore St., Baltimore, MD 21201, USA
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46
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Jäckel MC, Heyny-von Haussen R. [Dysphagia and dysarthria due to the long-term growth of a tongue base tumor]. HNO 2006; 54:382-4. [PMID: 16477463 DOI: 10.1007/s00106-005-1367-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Epivatianos A, Iordanides S, Zaraboukas T, Antoniades D. Adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma of minor salivary glands: a comparative immunohistochemical study using the epithelial membrane and carcinoembryonic antibodies. Oral Dis 2005; 11:175-80. [PMID: 15888109 DOI: 10.1111/j.1601-0825.2005.01110.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate immunohistochemically the expression of epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) in adenoid cystic carcinoma (AdCC) and polymorphous low-grade adenocarcinoma (PLGA) in an attempt to assess the ability of these markers to distinguish AdCC from PLGA when the histological features on routine hematoxylin and eosin are equivocal. MATERIALS AND METHODS Fourteen specimens of AdCC, 10 PLGA, and five normal minor salivary glands fixed in 10% formalin and embedded in paraffin, were retrieved from the files of our department and were retrospectively studied with the streptavidin-biotin complex method using the epithelial membrane and carcinoembryonic antibodies. RESULTS The immunoreactivities and the expression patterns of EMA and CEA in AdCC and PLGA were similar. CONCLUSIONS The results of this study suggest that the immunostaining of AdCC and PLGA with EMA and CEA could not offer an adjunctive aid in differential diagnosis between these two tumors.
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Affiliation(s)
- A Epivatianos
- Department of Oral Medicine and Oral Pathology, Universit of Thessaloniki, Thessaloniki, Greece.
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González-García R, Rodríguez-Campo FJ, Muñoz-Guerra MF, Nam-Cha SH, Sastre-Pérez J, Naval-Gías L. Polymorphous low-grade adenocarcinoma of the palate. Auris Nasus Larynx 2005; 32:275-80. [PMID: 15963668 DOI: 10.1016/j.anl.2005.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 02/14/2005] [Accepted: 03/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Polymorphous low-grade adenocarcinoma (PLGA) is a rare tumor that mostly affects minor salivary glands. The purpose of this study is to report six new cases followed-up during a long period. We also review the literature concerning clinical, histological and immunohistochemical features, as well as the proper management. METHODS Malignant tumors of the salivary glands diagnosed in our department from 1990 to 1999 were reviewed. A total of 66 cases were registered. Six of these cases were diagnosed as PLGA. All cases satisfied the histopathological criteria for this entity, and at least 3 years follow-up was available. RESULTS In the six cases the primary location was the mucosa of the palate. Hard palate was affected in 83.3% of the cases. There were no cases of extraoral PLGA in our series. Tumors were ulcerated in a 16.6% of the cases, and exofitic in the other 86.4%. Histologically, it was observed a tumoral proliferation of round clusters of uniform cells with round-to-oval clear nuclei and small nucleoli. All the cases underwent surgical management with local excision with surgical margins, five of them with bone extirpation associated. No recurrence was observed in four cases, whereas the remaining two cases showed recurrence in the follow-up. In one of the patients, lococervical recurrence appeared 12 months after the surgery, and this patient died after a few months. The remaining patients have been followed-up for 11, 7, 4 and 3 years postoperatively, with no evidence of recurrence. CONCLUSION Our results for a long follow-up period support the idea for a low grade of malignancy and good prognosis of this tumor, but the appearance of recurrences many years after the surgery must induce us to be very careful and systematic with the follow-up.
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Affiliation(s)
- Raúl González-García
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, c/ Diego de León, 62, 28006 Madrid, Spain.
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Lee VKM, McCaughan BC, Scolyer RA. Polymorphous low-grade adenocarcinoma in the lung: a case report. Int J Surg Pathol 2005; 12:287-92. [PMID: 15306944 DOI: 10.1177/106689690401200313] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although uncommon, it is well recognized that salivary gland-type tumors can occur as primary lung tumors, probably arising from minor salivary-type glands lining the bronchial tree. Polymorphous low-grade adenocarcinoma (PLGA) is a rare tumor that usually originates from oral minor salivary glands. There are only 2 reported cases showing metastasis to the lung; however, a primary lung tumor has not been reported so far. In this report we describe the clinical and pathological features of another case of PLGA involving the lung, but in a patient with no evidence of a previous oropharyngeal primary. While our case probably represents another example of metastatic PLGA to the lung, to our knowledge, it is the first description of a PLGA involving the lung in the absence of a history of a previous primary oral salivary gland tumor.
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Affiliation(s)
- Victor K M Lee
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
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Kumar M, Stivaros N, Barrett AW, Thomas GJ, Bounds G, Newman L. Polymorphous low-grade adenocarcinoma—a rare and aggressive entity in adolescence. Br J Oral Maxillofac Surg 2004; 42:195-9. [PMID: 15121262 DOI: 10.1016/j.bjoms.2004.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2004] [Indexed: 11/19/2022]
Abstract
Polymorphous low-grade adenocarcinoma (PLGA) is an uncommon tumour that usually affects the minor salivary glands, particularly in the palate. It is rare in young patients, and here we report a case in a teenage girl. She presented at the age of 16, although the lesion had been noticed 2 years previously. The tumour showed histopathological features of PLGA, but recurred locally, behaved aggressively, and ultimately metastasised to cervical lymph nodes. This was accompanied by an altered histological picture, with a papillary cystic pattern and necrosis becoming progressively more prominent. PLGA is not always a low-grade lesion and some tumours, notably those with a papillary cystic growth pattern, may require more aggressive treatment.
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Affiliation(s)
- M Kumar
- Maxillofacial Unit, University College Hospital, London WC1E 6AU, UK.
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