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Patel AM, Haleem A, Choudhry HS, Brody RM, Brant JA, Carey RM. Elective Neck Dissection in cT1-4 N0M0 Head and Neck Basaloid Carcinoma. Otolaryngol Head Neck Surg 2024. [PMID: 38613196 DOI: 10.1002/ohn.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1-4 N0M0 head and neck basaloid carcinoma (HNBC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 hospital-based National Cancer Database. METHODS Patients with surgically resected cT1-4 N0M0 HNBC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were implemented. RESULTS Of 857 patients satisfying inclusion criteria, the majority were male (77.0%) and white (88.1%) with disease of the oral cavity (21.5%) or oropharynx (42.9%) classified as high grade (76.9%) and cT1-2 (72.9%). 389 (45.4%) patients underwent END. END utilization between 2006 and 2017 increased for cT1-2 disease (33.3% vs 56.9%, R2 = .699) but remained relatively constant for cT3-4 disease (66.7% vs 57.9%, R2 = .062). One-hundred and fifteen (29.6%) ENDs detected occult nodal metastases (ONMs). The 5-year overall survival (OS) of patients undergoing neck observation and END was 65.6% and 66.8%, respectively (P = .652). END was not associated with improved OS in survival analyses stratified by patient demographics, clinicopathologic features, and adjuvant therapy. Compared with surgery alone, adjuvant radiotherapy (adjusted hazard ratio: 0.74, 95% confidence interval [CI]: 0.57-0.97, P = .031) was associated with improved OS. END (hazard ratio [HR]: 0.96, 95% CI: 0.71-1.28, P = .770) and ONM (HR: 1.12, 95% CI: 0.78-1.61, P = .551) were not associated with OS. CONCLUSION END is performed in nearly half of patients with HNBC but is not associated with improved OS, even after stratifying survival analyses by patient demographics, clinicopathologic features, and adjuvant therapy. The rate of ONM approaching 30%, however, justifies inclusion of END in the surgical management of HNBC.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Shamir ER, Bean GR, Schwartz CJ, Vohra P, Wang A, Allard GM, Wolsky RJ, Garcia JJ, Chen YY, Krings G. Solid- Basaloid Adenoid Cystic Carcinoma of the Breast: An Aggressive Subtype Enriched for Notch Pathway and Chromatin Modifier Mutations With MYB Overexpression. Mod Pathol 2023; 36:100324. [PMID: 37660928 DOI: 10.1016/j.modpat.2023.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/14/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
Adenoid cystic carcinoma (AdCC) is a rare triple-negative breast cancer analogous to its extramammary counterparts. Diagnosis of the more aggressive solid-basaloid variant of AdCC (SB-AdCC) can be challenging due to poorly defined histopathologic and molecular features. We characterized 22 invasive and in situ basaloid carcinomas by morphology, immunohistochemistry, genetics, and MYB status using multiple platforms and assessed clinical behavior and neoadjuvant chemotherapy responses. After consensus review, 16/22 cases were classified as SB-AdCC. All SB-AdCC had predominantly solid growth and at least focal myxohyaline stroma and were immune-poor. Eosinophilic squamoid cells (69%, 11/16) and basement membrane-like secretions (69%, 11/16) were common, and intercalated ducts (31%, 5/16) were less frequent. SB-AdCC typically expressed SOX10 (100%, 16/16) and luminal markers (100%, 16/16 CK7; 88%, 14/16 CD117; 93%, 13/14 CAM5.2). SMA (40%, 6/15) expression was less common, and SMM (27%, 3/11), GATA3 (20%, 3/15), and p63 (25%, 4/16) were mostly negative. MYB protein and/or MYB RNA overexpression was universal in evaluable cases (13/13), with RNA in situ hybridization (10/10) more reliable than immunohistochemistry (10/11, plus 4 excisions inconclusive). Fluorescence in situ hybridization and/or next-generation sequencing identified MYB rearrangements (20%, 3/15) and amplifications/copy gains (60%, 9/15) but no MYB::NFIB fusions. SB-AdCC often had aberrations in Notch pathway (60%, including 40% NOTCH1 and 20% NOTCH2) and/or chromatin modifier (60%, including 33% CREBBP) genes, with relatively infrequent TP53 mutations (27%). Unclassified invasive basaloid carcinomas lacking described histologic features of SB-AdCC (n = 4) and basaloid ductal carcinoma in situ (n = 2) showed similar immunoprofiles and genetics as SB-AdCC, including Notch aberrations and MYB overexpression with MYB rearrangements/amplifications. Overall, nodal (22%) and distant (33%) metastases were common, and 23% of patients died of disease (mean follow-up, 35 months; n = 22). Responses were poor in all 7 neoadjuvant chemotherapy-treated patients, without any achieving pathologic complete response. The data highlight the histopathologic spectrum of basaloid carcinomas including SB-AdCC and reveal shared genetics and MYB activation, which can be diagnostically useful. Aggressive behavior and poor treatment responses emphasize a need for additional treatment approaches.
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Affiliation(s)
- Eliah R Shamir
- Department of Pathology, University of California San Francisco, San Francisco, California; Department of Pathology, Genentech, Inc, South San Francisco, California
| | - Gregory R Bean
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Christopher J Schwartz
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Poonam Vohra
- Department of Pathology, University of California San Francisco, San Francisco, California; Department of Pathology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Aihui Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Grace M Allard
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Rebecca J Wolsky
- Department of Pathology, Zuckerberg San Francisco General Hospital, San Francisco, California; Department of Pathology, University of Colorado, Aurora, Colorado
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Gregor Krings
- Department of Pathology, University of California San Francisco, San Francisco, California.
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Khoury T, Rosa M, Nayak A, Karabakhtsian R, Fadare O, Li Z, Turner B, Fang Y, Kumarapeli A, Li X, Numbere N, Villatoro T, Wang JG, Sadeghi S, Attwood K, George A, Bhargava R. Clinicopathologic Predictors of Clinical Outcomes in Mammary Adenoid Cystic Carcinoma: A Multi-institutional Study. Mod Pathol 2023; 36:100006. [PMID: 36853781 PMCID: PMC10952059 DOI: 10.1016/j.modpat.2022.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
Adenoid cystic carcinoma (AdCC) is an uncommon type of invasive breast carcinoma with a favorable prognosis. However, some cases are aggressive. The study aims to define the clinicopathologic predictors of outcome. Clinical, radiological, and pathologic variables were recorded for 76 AdCC cases from 11 institutions. The following histologic characteristics were evaluated by the breast pathologist in each respective institution, including Nottingham grade (NG), percentages of various growth patterns (solid, cribriform, trabecular-tubular), percentage of basaloid component, tumor borders (pushing, infiltrative), perineural invasion, lymphovascular invasion, necrosis, and distance from the closest margin. Various grading systems were evaluated, including NG, salivary gland-type grading systems, and a new proposed grading system. The new grading system incorporated the growth pattern (percent solid, percent cribriform), percent basaloid morphology, and mitotic count using the Youden index criterion. All variables were correlated with recurrence-free survival. Nineteen (25%) women developed local and/or distant recurrence. Basaloid morphology (≥25% of the tumor) was identified in 20 (26.3%) cases and a solid growth pattern (using ≥60% cutoff) in 22 (28.9%) cases. In the univariate analysis, the following variables were significantly correlated with worse recurrence-free survival: solid growth pattern, basaloid morphology, lymphovascular invasion, necrosis, perineural invasion, and pN-stage. In the multivariate analysis including basaloid morphology, pN-stage, lymphovascular invasion, and perineural invasion, basaloid morphology was statistically significant, with a hazard ratio of 3.872 (95% CI, 1.077; 13.924; P =.038). The NG and the new grading system both correlated with recurrence-free survival. However, grade 2 had a similar risk as grade 3 in the NG system and a similar risk as grade 1 in the new grading system. For solid growth patterns and basaloid morphology, using a 2-tier system with 1 cutoff was better than a 3-tier system with 2 cutoffs. Basaloid morphology and solid growth pattern have prognostic values for AdCC, with a 2-tier grading system performing better than a 3-tier system.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York.
| | - Marilin Rosa
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Anupma Nayak
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rouzan Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego Health, La Jolla, California
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bradley Turner
- Department of Pathology, University of Rochester, Rochester, New York
| | - Yisheng Fang
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Asangi Kumarapeli
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Xiaoxian Li
- Department of Pathology, Emory University, Atlanta, Georgia
| | - Numbereye Numbere
- Department of Pathology, University of Rochester, Rochester, New York
| | - Tatiana Villatoro
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women Hospital, Pittsburgh, Pennsylvania
| | - Ji-Gang Wang
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Saed Sadeghi
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Anthony George
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women Hospital, Pittsburgh, Pennsylvania
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Santoro A, Travaglino A, Valente M, Arciuolo D, Scaglione G, D’Alessandris N, Sfregola S, Addante F, Fulgione C, Raffone A, Minucci A, Inzani F, Zannoni GF. Pilomatrix-like High-Grade Endometrioid Carcinoma of the Ovary: Case Report, Literature Review, and Differential Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12123146. [PMID: 36553153 PMCID: PMC9777718 DOI: 10.3390/diagnostics12123146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Pilomatrix-like high-grade endometrioid carcinoma (PiMHEC) has recently been described as an aggressive variant of endometrial carcinoma. Herein, we described a case of ovarian PiMHEC, comparing it to endometrial PiMHEC and assessing previously published cases of putative ovarian PiMHEC. A 65-year-old woman underwent hysterectomy for an ovarian tumor characterized by solid nests of basaloid cells with prominent ghost cell keratinization. Immunohistochemistry showed nuclear β-catenin and CDX2 expression and loss of estrogen and progesterone receptors and PAX8. These features were consistently observed in all previously published cases and may represent diagnostic criteria of PiMHEC. Other frequent features were geographic necrosis and a low-grade endometrioid component. CK7, neuroendocrine, and basal/squamous markers were inconsistently expressed. All cases with available follow-up showed poor prognosis. PiMHEC should be distinguished from mimickers, such as high-grade endometrioid carcinoma with geographic necrosis, low-grade endometrioid carcinoma with ghost cell keratinization, and undifferentiated/dedifferentiated carcinoma. In conclusion, PiMHEC can also occur in the ovary and shows several consistent clinical, morphological, and immunophenotypical features. These features support that PiMHEC is a distinct entity requiring an aggressive management.
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Affiliation(s)
- Angela Santoro
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Michele Valente
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Damiano Arciuolo
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Giulia Scaglione
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Nicoletta D’Alessandris
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefania Sfregola
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Addante
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70121 Bari, Italy
| | - Caterina Fulgione
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, 80131 Naples, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Angelo Minucci
- Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Frediano Inzani
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Gian Franco Zannoni
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, 00168 Rome, Italy
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5
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Hang JF, Lee JJL, Nga ME, Higuchi K, Hirata Y, Wu HH, Allison DB, Gilbert JD, Lin O, Saieg M, de Arruda AF, Chen YA, Huang EC, Manucha V. Multi-institutional validation of a modified scheme for subcategorizing salivary gland neoplasm of uncertain malignant potential (SUMP). Cancer Cytopathol 2022; 130:511-522. [PMID: 35637575 DOI: 10.1002/cncy.22593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System is diagnostically challenging. This study aims to validate a modified scheme for subcategorizing SUMP in a large multi-institutional cohort. METHODS Retrospective review of salivary gland fine-needle aspirations (FNAs) from 10 institutions were classified based on the Milan System. Cases diagnosed as SUMP with available cytology slides and surgical follow-up were retrieved for review and subcategorized based on a modified scheme as follows: basaloid SUMP (B1: absent/scant nonfibrillary matrix; B2: presence of nonfibrillary/mixed-type matrix), oncocytic/oncocytoid SUMP (O1: with mucinous background; O2: without mucinous background), and SUMP not otherwise specified (NOS). RESULTS A total of 742 (7.5%) cases from 9938 consecutive salivary gland FNAs were classified as SUMP. Among them, 525 (70.8%) had surgical follow-up and 329 (62.7%) were available for review. The overall risk of malignancy (ROM) of SUMP was 40.4%. There were 156 cases (47.4%) subcategorized as basaloid SUMP with a ROM of 36.5%, 101 (30.7%) as oncocytic/oncocytoid SUMP with a ROM of 52.5%, and 72 (21.9%) as SUMP NOS with a ROM of 31.9%. The ROM of oncocytic/oncocytoid SUMP was significantly higher than basaloid SUMP (P = .0142) and SUMP NOS (P = .0084). No significant differences in ROM were noted between B1 and B2 (36.7% vs 36.4%, P = 1.0000) and O1 and O2 (65.2% vs 48.7%, P = .2349). CONCLUSIONS The ROM of oncocytic/oncocytoid SUMP was 52.5% and significantly higher than that of basaloid SUMP (36.5%, P = .0142) and SUMP NOS (31.9%, P = .0084), whereas no significant differences in ROM were noted for cases with different types of extracellular matrix or background material.
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Affiliation(s)
- Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Min En Nga
- Department of Pathology, National University Hospital, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kayoko Higuchi
- Department of Surgical Pathology, Okinawa Kyodo Hospital, Naha, Japan
| | - Yukiya Hirata
- Department of Pathology, University of the Ryukyus Hospital, Nishihara, Japan
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Derek B Allison
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Jason D Gilbert
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mauro Saieg
- Department of Pathology, A. C. Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Yun-An Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Eric C Huang
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
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Doddanna SJ, Nayak MT, Sanath AK, Abedeen MZ. Basaloid squamous cell carcinoma of gingiva: A rare case report. Dent Res J (Isfahan) 2021; 18:80. [PMID: 34760071 PMCID: PMC8543100 DOI: 10.4103/1735-3327.326653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/17/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
Basaloid squamous cell carcinoma (BSCC) is an exceptional, aggressive variant of squamous cell carcinoma (SCC) because of its unique histological feature and an ominous clinical behavior. Recently, it has been recognized as a high-grade SCC. The most preferential site of occurrence is the upper aerodigestive tract. Because of its aggressive behavior and tendency to metastasize, BSCCs are considered to have poor prognosis. We present a BSCC case in a 60-year-old male, which was clinically diagnosed as an aggressive inflammatory lesion with a differential diagnosis of granulomatous lesion, involving the mandibular anterior gingiva. Till now, only 17 cases of BSCC with gingival involvement have been reported in the literature. Here, we present one additional case of BSCC involving gingiva.
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Affiliation(s)
- Sunitha Jagaluru Doddanna
- Department of Oral Pathology and Microbiology, MNR Dental College and Hospital, Sangareddy, Telangana, India
| | - Meghanand T Nayak
- Department of Oral and Maxilofacial Pathology, Teerthanker Mahaveeer Dental College and Research Centre, TMU, Moradabad, Uttar Pradesh, India
| | - Aparna K Sanath
- Department of Oral and Maxilofacial Pathology, Teerthanker Mahaveeer Dental College and Research Centre, TMU, Moradabad, Uttar Pradesh, India
| | - Mohammad Zanul Abedeen
- Department of Oral and Maxilofacial Pathology, Teerthanker Mahaveeer Dental College and Research Centre, TMU, Moradabad, Uttar Pradesh, India
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Lajara S, Landau M. Metastatic malignant melanoma mimicking a salivary gland basaloid neoplasm after treatment with nivolumab. Diagn Cytopathol 2021; 49:E370-E373. [PMID: 34174024 DOI: 10.1002/dc.24817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 12/18/2022]
Abstract
Malignant melanoma is a well-known diagnostic pitfall, given its propensity to metastasize to different sites and mimic various entities. In this report, we present a fine-needle aspiration biopsy (FNA) of a metastatic melanoma with basaloid features that is occurring in the preauricular/parotid area. The patient is a 17-year-old male with a history of excision of melanoma of the left temple, and was undergoing adjuvant treatment with nivolumab. The prior excision was positive for S100, HMB-45, melan-A, and tyrosinase. On follow-up, he presented with non-FDG avid left preauricular area lesions. FNA was performed, and on-site evaluation demonstrated a cellular basaloid neoplasm with focal fibrillary stroma. Immunohistochemical stains revealed that the tumor cells were positive for SOX-10, S100, MITF, and HMGA2, and were negative for HMB-45, melan-A, tyrosinase, p63, cam 5.2 and PLAG1. The positive S100, SOX-10, and MITF results and negative cam 5.2 result supported the diagnosis of melanoma. Nivolumab was then stopped, Dabrafenib/Trametinib were started, and the patient underwent excision of the nodules. Nine-months later, he developed a rib metastasis that was positive for S100, SOX-10, melan-A, and tyrosinase. This report emphasizes that melanoma involving the parotid gland region has the potential to be misdiagnosed by FNA as a salivary gland neoplasm because of overlapping cytologic features and immunophenotypes. This pitfall is avoided by careful morphologic analysis and judicious use of ancillary studies.
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Affiliation(s)
- Sigfred Lajara
- Department of Pathology, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Michael Landau
- Department of Pathology, University of Pittsburgh Medical Center, Pennsylvania, USA
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8
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Manucha V, Gonzalez MF, Akhtar I. Analysis of the risk of malignancy associated with the basaloid and oncocytic subtypes of the salivary gland neoplasm of unknown malignant potential (SUMP) category in the Milan system. Cancer Cytopathol 2021; 129:603-611. [PMID: 33788998 DOI: 10.1002/cncy.22427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The salivary gland neoplasm of unknown malignant potential (SUMP) category reflects the cytomorphologic overlap and complexity of reporting salivary gland cytology in the Milan system. It includes neoplasms for which a diagnosis of a specific entity cannot be made and, more importantly, for which a carcinoma cannot be entirely excluded. For risk stratification, the subcategorization of SUMP based on the predominant cell type is recommended. This study was aimed at evaluating the risk of neoplasm (RON) and the risk of malignancy (ROM) of the basaloid and oncocytic subtypes of the SUMP category. METHODS A retrospective analysis of 482 salivary gland fine-needle aspirations from 2012 to 2019 resulted in 48 SUMP cases. The cytology of these cases was reviewed and reclassified as the basaloid or oncocytic subtype. Surgical follow-up was available for 36 cases. The RON and ROM for each subtype were calculated. RESULTS The RON and ROM were 100% and 23%, respectively, for monomorphic basaloid tumors and 88% and 58.8%, respectively, for monomorphic oncocytic tumors. The ROM for basaloid tumors was 8.3% without matrix/with minimal matrix and 60% with an nonfibrillary matrix. The ROM for oncocytic tumors was 50% without a cystic background and 60% with a cystic or mucinous background. The difference was not statistically significant for either of the subgroups. CONCLUSIONS Even though statistically not significant in our study, the differential ROMs within the oncocytic and basaloid subgroups help in the risk stratification of SUMP cases. Further subcategorization based on the stroma and background helps in limiting the differential diagnosis but does not necessarily add to the value of the risk stratification.
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Affiliation(s)
- Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Maria F Gonzalez
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Israh Akhtar
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
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9
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Saeed OA, Whaley RD, Segura S, Wu HH, Cramer H. The cytology of salivary gland neoplasms with globules of extracellular matrix: Case-based review of adenoid cystic carcinoma and its potential mimics. Diagn Cytopathol 2021; 49:E195-E202. [PMID: 33417304 DOI: 10.1002/dc.24672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/12/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022]
Abstract
Fine needle aspiration (FNA) cytology is an important tool for diagnosing salivary gland neoplasms and for guiding clinical management. The classic adenoid cystic carcinoma (AdCC) is a basaloid neoplasm with abundant extracellular matrix. The presence globules of extracellular matrix are quite characteristic of AdCC but not diagnostic. We selected from our files six FNA cases that contained at least some globules of amorphous matrix that are similar to the ones seen in AdCC. The aim of this case-based review is to discuss the pitfalls and some of the common differential diagnoses of AdCC in FNA cytology. By the end of this review, we hope to have shared with the readers the lessons we learned from these cases and to highlight the key criteria needed to make a correct diagnosis of AdCC based on cytomorphology. The importance of considering other entities, in addition to AdCC, whenever a salivary gland FNA presents with globules is emphasized.
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Affiliation(s)
- Omer A Saeed
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rumeal D Whaley
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sheila Segura
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Harvey Cramer
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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10
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Lubin DJ, Griffith CC, Buonocore DJ, Wei XJ, Lin O. Putting morphology to the test: An established classification scheme reliably stratifies salivary gland cytology by risk of malignancy with substantial interobserver agreement. Cancer Cytopathol 2020; 129:291-303. [PMID: 33136345 DOI: 10.1002/cncy.22382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology describes several salivary gland fine-needle aspiration cytology (SGFNAC) morphologies developed by Griffith et al. Basaloid neoplasms are pleomorphic (PB) or monomorphic with fibrillary (MBFib), hyaline (MBHy), or other (MBOther) matrix. Oncocytoid neoplasms can be pleomorphic (PO), demonstrate granular and/or vacuolated cytoplasm (OGV), or be monomorphic with mucinous (MOMuc), cystic (MOCyst), or other (MOOther) background. In the current study, the authors explore interobserver agreement (IOA) and risk of malignancy (ROM) for these subcategories. METHODS The study included 169 SGFNAC cases with surgical follow-up. Four reviewers categorized these cases using the criteria of Griffith et al. with consensus determined by majority. For all morphologic categories, IOA (using the Fleiss kappa) and ROM were calculated. RESULTS ROMs for basaloid categories were: PB: 100% (1 of 1 case); MBHy: 71.4% (5 of 7 cases); MBFib: 50.0% (3 of 6 cases); and MBOther: 47.4% (9 of 19 cases). ROMs for oncocytoid neoplasms were: OGV: 100% (10 of 10 cases); MOMuc: 92.3% (12 of 13 cases); PO: 88.9% (8 of 9 cases); MOOther: 33.3% (5 of 15 cases); and MOCyst: 0 (0 of 1 case). The system demonstrated substantial agreement overall (κ = 0.69). For basaloid neoplasms, the IOA results were: MBHy: κ = 0.59; MBFib: κ = 0.41; MBOther: κ = 0.41; and PB: κ = 0.11. For oncocytoid neoplasms, the IOA results were: MOMuc: κ = 0.88; OGV: κ = 0.67; PO: κ = 0.63; MOOther: κ = 0.57; and MOCyst: κ = 0.18. CONCLUSIONS The SGFNAC scheme proposed by Griffith et al. and incorporated into the Milan System for Reporting Salivary Gland Cytopathology demonstrated substantial agreement overall, with particularly high agreement for the MOMuc, OGV, PO, and MBHy categories. The PB and MOCyst categories demonstrated slight agreement and may be improved by revised criteria. The PB, PO, MOMuc, and OGV categories demonstrated high ROM, and the latter 2 categories might best be classified as suspicious for malignancy.
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Affiliation(s)
- Daniel J Lubin
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia
| | | | - Darren J Buonocore
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xiao-Jun Wei
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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11
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Hankinson P, Collins LHC, Nusrath M, Al-Omari A, Khurram SA. An unusual cause of a common presentation: a case of metastatic basal cell carcinoma. Br J Oral Maxillofac Surg 2020; 58:1046-1048. [PMID: 32409129 DOI: 10.1016/j.bjoms.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
Metastasis of basal cell carcinoma is exceedingly rare and usually not considered in the differential diagnosis of neck lumps. We present a case highlighting the importance of a thorough history and consideration of metastatic basal cell carcinoma in patients with a basaloid metastasis and an unknown primary.
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Affiliation(s)
- P Hankinson
- Department of Oral and Maxillofacial Surgery, Sheffield Teaching Hospitals NHS Foundation Trust
| | - L H C Collins
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield
| | - M Nusrath
- Department of Oral and Maxillofacial Surgery, Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Al-Omari
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust
| | - S A Khurram
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield.
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12
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Faquin WC. Diagnosis and grading of basaloid salivary gland tumors using the Milan System for reporting salivary gland cytopathology. Cancer Cytopathol 2019; 128:87-88. [PMID: 31742900 DOI: 10.1002/cncy.22207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 12/18/2022]
Affiliation(s)
- William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Chowsilpa S, An D, Lose H, Huang X, Nayar R, Maleki Z. Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi-institutional study. Cancer Cytopathol 2019; 127:377-389. [PMID: 31116514 DOI: 10.1002/cncy.22150] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Salivary gland neoplasm of uncertain malignant potential (SUMP) is a diagnostic category in the Milan System for Reporting Salivary Gland Cytopathology. The objective of this study was to assess the risk of neoplasm (RON) and the risk of malignancy (ROM) in SUMP cases by evaluating them based on their prominent cytomorphology. METHODS The pathology databases were searched for cases of fine-needle aspiration-diagnosed SUMP at The Johns Hopkins Hospital and Northwestern University from 2013 to 2018. Only cytopathology cases diagnosed as SUMP that had available surgical follow-up were included. RESULTS Sixty-five patients with SUMP were identified, including 31 men and 34 women who ranged in age from 15 to 87 years (mean age, 55.2 years). Sixty-five cases had histologic follow-up, including 13 (20%) with basaloid features, 13 (20%) with oncocytic features, and 39 (60%) with unspecified features. No cases with clear cell features were found. Overall, the RON in the SUMP category was 95.4% (62 of 65 cases), and the ROM was 33.8% (22 of 65 cases). The RON in SUMPs with basaloid, oncocytic, and unspecified subtypes was 92.3%, 100%, and 94.9%, respectively, whereas the ROM was 38.5%, 7.7%, and 41%, respectively. The most common benign neoplasm was pleomorphic adenoma (23.1%), whereas mucoepidermoid carcinoma (9.2%) was the most common malignant neoplasm. CONCLUSIONS This study shows that the ROM differs significantly based on cytomorphology subtypes, whereas the overall ROM is approximately the same as the target rate in the Milan System for Reporting Salivary Gland Cytopathology. Moreover, the RON remains high in the SUMP category among different cytomorphology subtypes. Adequate sampling, immunohistochemical staining, and familiarity with metaplastic and reactive changes may improve the diagnosis.
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Affiliation(s)
- Sayanan Chowsilpa
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Daniel An
- National Institutes of Health, Bethesda, Maryland
| | - Holly Lose
- Division of Cytopathology, Department of Pathology, Northwestern University, Chicago, Illinois
| | - Xiao Huang
- Division of Cytopathology, Department of Pathology, Northwestern University, Chicago, Illinois
| | - Ritu Nayar
- Division of Cytopathology, Department of Pathology, Northwestern University, Chicago, Illinois
| | - Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
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14
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Jumaily M, Faraji F, Zhang D, Walker RJ, Ward GM. Basaloid Squamous Cell Carcinoma of the Larynx: A National Cancer Database Analysis. Otolaryngol Head Neck Surg 2019; 160:847-854. [PMID: 30717636 DOI: 10.1177/0194599818816299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Basaloid squamous cell histology is a rare variant that accounts for about 2% of all head and neck squamous cell laryngeal carcinomas. The purpose of this study was to examine overall survival rates of patients according to treatment, stage, and laryngeal subsite. STUDY DESIGN Retrospective analysis. SETTING National Cancer Database (NCDB). SUBJECTS AND METHODS The NCDB was queried for patients with basaloid squamous cell carcinoma (BSCC) who were treated from 2004 to 2014. Five-year overall survival rates were determined by the Kaplan-Meier method. Univariate and multivariate analysis was used to identify factors correlated with 5-year overall survival. RESULTS The NCDB identified 440 patients meeting inclusion criteria. Median follow-up time was 31.2 months. On univariate analysis, the treatment modalities assessed (surgery alone, surgery with radiotherapy, surgery with chemoradiotherapy, radiotherapy, chemoradiotherapy) did not differ in their survival benefit. On multivariate analysis, only chemoradiotherapy (hazard ratio, 0.587; 95% CI, 0.37-0.93; P = .022) was associated with improved survival. All treatment modalities performed similarly between stage I and II tumors ( P = .340) and stage III and IV tumors ( P = .154). CONCLUSION This study represents the largest laryngeal BSCC series to date. We found that chemoradiotherapy was associated with improved 5-year overall survival of laryngeal BSCC on multivariate analysis.
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Affiliation(s)
- Mejd Jumaily
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Farhoud Faraji
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Donald Zhang
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Ronald J Walker
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Gregory M Ward
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
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15
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Abstract
Eccrine spiradenoma is one of the rare adnexal tumors with eccrine differentiation; however, it is considered to have apocrine differentiation. Around 50 cases of eccrine spiradenoma have been reported in the literature. Due to vascularity and painful symptoms, it is often confused with the painful lesions of skin such as glomus tumor and angioleiomyoma. Surgical excision is considered the gold standard for the treatment of these cases, with low rates of recurrence. Here, we present a 52-year-old male who presented with a nodular lesion in the left side of chest for the past 4 years. Surgical excision was performed and the tissue was sent for histopathological examination. Eccrine Spiradenoma may present congenitally or spontaneously as tumor of the sweat glands with unclear etiology. Early accurate diagnosis is very important in preventing chances of recurrence and more importantly identifying onset of malignant transformation.
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Affiliation(s)
- Singh Kanwaljeet
- Department of Pathology, 166 Military Hospital, Jammu, Jammu and Kashmir, India
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16
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Morey-Matamalas A, de Stefani A, Corbetta D, Grau-Roma L, de Brot S. Pulmonary Basaloid Squamous Cell Carcinoma in a Dog. J Comp Pathol 2018; 159:11-15. [PMID: 29598999 DOI: 10.1016/j.jcpa.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/11/2017] [Accepted: 12/19/2017] [Indexed: 11/15/2022]
Abstract
A 9-year-old neutered male crossbred dog with a 4-week history of progressive vestibulocerebellar signs was presented for necropsy examination. Gross examination revealed neoplastic growth in the lungs, thoracic lymph nodes, left kidney and cerebellum. Microscopically, the tumour consisted of an infiltrative, densely cellular, basaloid epithelial neoplastic growth with extensive areas of abrupt keratinization. Immunohistochemically, neoplastic cells expressed p63 and partially expressed cytokeratins 5/6. Based on these findings, the tumour was diagnosed as a primary pulmonary basaloid squamous cell carcinoma (BSSC) with metastasis to regional lymph nodes, kidney and brain. As far as the authors are aware, this is the first description of BSCC in an animal species.
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Affiliation(s)
- A Morey-Matamalas
- Institute for Research in Biomedicine, Baldiri Reixac 10, Barcelona, Spain
| | - A de Stefani
- Dick White Referrals, Six Mile Bottom, Sutton Bonington, UK
| | - D Corbetta
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - L Grau-Roma
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - S de Brot
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK.
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17
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Valkenburg KC, De Marzo AM, Williams BO. Deletion of tumor suppressors adenomatous polyposis coli and Smad4 in murine luminal epithelial cells causes invasive prostate cancer and loss of androgen receptor expression. Oncotarget 2017; 8:80265-80277. [PMID: 29113300 PMCID: PMC5655195 DOI: 10.18632/oncotarget.17919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/03/2017] [Indexed: 01/02/2023] Open
Abstract
Prostate cancer is the most diagnosed non-skin cancer in the US and kills approximately 27,000 men per year in the US. Additional genetic mouse models are needed that recapitulate the heterogeneous nature of human prostate cancer. The Wnt/beta-catenin signaling pathway is important for human prostate tumorigenesis and metastasis, and also drives tumorigenesis in mouse models. Loss of Smad4 has also been found in human prostate cancer and drives tumorigenesis and metastasis when coupled with other genetic aberrations in mouse models. In this work, we concurrently deleted Smad4 and the tumor suppressor and endogenous Wnt/beta-catenin inhibitor adenomatous polyposis coli (Apc) in luminal prostate cells in mice. This double conditional knockout model produced invasive castration-resistant prostate carcinoma with no evidence of metastasis. We observed mixed differentiation phenotypes, including basaloid and squamous differentiation. Interestingly, tumor cells in this model commonly lose androgen receptor expression. In addition, tumors disappear in these mice during androgen cycling (castration followed by testosterone reintroduction). These mice model non-metastatic castration resistant prostate cancer and should provide novel information for tumors that have genetic aberrations in the Wnt pathway or Smad4.
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Affiliation(s)
- Kenneth C Valkenburg
- Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Angelo M De Marzo
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Bart O Williams
- Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, MI 49503, USA
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18
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Abstract
Basal cell adenoma (BCA) is a rare basaloid tumor, with only 20% of cases occurring in minor salivary glands. Histologically, BCA is characterized by the presence of basaloid cells and may frequently be mistaken with canalicular adenoma, basal cell adenocarcinoma, adenoid cystic carcinoma and basaloid squamous cell carcinoma. Immunohistochemistry may aid in arriving at a final diagnosis as in the present case. Reported here is a case of locally aggressive BCA. Histologically, the lesion mimicked ameloblastoma and other entities which posed a diagnostic challenge. There are no reports of BCA presenting as an aggressive lesion available in English literature so far; moreover, merely a single case of BCA of maxillary sinus has been previously reported to the best of our cognition. This case report highlights the rarity of this tumor with regards to its site of origin, clinical behavior and histopathological mimics.
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Affiliation(s)
- Priya Anil Bhagde
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Suresh Ramchandra Barpande
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Jyoti Dilip Bhavthankar
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Jayanti G Humbe
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
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19
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Jang EJ, Kang SH, Bae YK. Basaloid ductal carcinoma in situ arising in salivary gland metaplasia of the breast: a case report. Int J Clin Exp Pathol 2014; 7:6370-6374. [PMID: 25337293 PMCID: PMC4203264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/23/2014] [Indexed: 06/04/2023]
Abstract
Salivary gland metaplasia is a newly recognized, adenosis-like lesion which could not be classified according to known categories of adenosis of the breast. We report a case of basaloid ductal carcinoma in situ (DCIS) arising in a background of salivary gland metaplasia in a 49-year old woman who visited our hospital for a right breast mass. Breast ultrasonography showed a multi-lobulating mixed hypoechoic and isoechoic mass measuring 2.9 cm in size at the periareolar area. Histologically, the lesion showed a well-defined DCIS with basaloid tumor cells and central comedo-type necrosis surrounded by salivary gland metaplasia composed of glands or ducts not specific to the breast, ducts with cribriform proliferation of luminal epithelial cells, and ducts with varying degrees of proliferation of basaloid cells including solid nests of basaloid cells. Salivary gland metaplasia is a most unusual lesion of the breast characterized by salivary gland-type acini and ducts with various proliferations of luminal and basaloid cells, and accompanied by malignant tumor of basal cell type.
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Affiliation(s)
- Eun Jeong Jang
- Department of Pathology, Yeungnam University College of MedicineDaegu, South Korea
| | - Su Hwan Kang
- Department of Surgery, Yeungnam University College of MedicineDaegu, South Korea
| | - Young Kyung Bae
- Department of Pathology, Yeungnam University College of MedicineDaegu, South Korea
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20
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Friborg J, Hamilton-Therkildsen M, Homoe P, Kristensen C, Hui A, Liu FF, Weinreb I. A spectrum of basaloid morphology in a subset of EBV-associated "lymphoepithelial carcinomas" of major salivary glands. Head Neck Pathol 2012; 6:445-50. [PMID: 22926973 DOI: 10.1007/s12105-012-0394-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/14/2012] [Indexed: 12/27/2022]
Abstract
Nasopharyngeal carcinomas of the undifferentiated or lymphoepithelial type are most commonly seen in South East Asians. Identical tumors have also been described at a variety of other sites including lung, skin and salivary gland and have been referred to by a number of names including lymphoepithelial carcinoma (LEC). LECs of major salivary gland are extremely rare. They are particularly common amongst the Inuit populations of the arctic region including Greenland (Denmark), Canada and Alaska, as well as South East Asians. Within the Inuit group, this tumor represents the majority of all salivary gland carcinomas. Amongst primary LEC of major salivary gland, most cases reported in the literature have represented typical nasopharynx-like tumors. Variants of Epstein-Barr Virus (EBV) associated LEC have not been described previously, to the best of our knowledge. In this report, we describe 4 EBV-associated major salivary gland LECs with prominent basaloid morphology, which represent 22 % of a cohort of 18 salivary LECs from an Inuit population in Greenland. The features described in these cases raise a differential diagnosis of other basaloid tumors, particularly in light of the salivary gland location. A basaloid variant of LEC in major salivary gland should be recognized, especially in highly prone populations, to avoid misdiagnosis of other more common salivary tumors.
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21
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Westra WH. The morphologic profile of HPV-related head and neck squamous carcinoma: implications for diagnosis, prognosis, and clinical management. Head Neck Pathol 2012; 6 Suppl 1:S48-54. [PMID: 22782223 DOI: 10.1007/s12105-012-0371-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Abstract
Much recent attention has highlighted a subset of head and neck squamous cell carcinomas (HNSCCs) related to the human papillomavirus (HPV) that is characterized by an epidemiologic, demographic, and clinical profile that deviates from the profile of conventional non-HPV-related HNSCC. Lost in the dash to develop and implement diagnostic assays to detect the presence of HPV in HNSCCs is the unpretentious observation that these HPV-HNSCCs are also distinctive with respect to their microscopic appearance, and that an awareness of these characteristic morphologic features can facilitate the diagnosis of HPV-related HNSCC (HPV-HNSCC). This review will delineate the microscopic appearance of HPV-HNSCC, spotlight ways in which the misinterpretation of these microscopic features can lead to diagnostic confusion, and provide recommendations for appropriate terminology when diagnosing HPV-HNSCC.
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22
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Abstract
Although squamous cell carcinoma (SCC) variants account for less than 10% of all laryngeal SCCs, they have many unique biological, morphological, and clinical features. They are also easily confused with other tumor types. Recognition of them is critical for surgical pathologists as is the knowledge of what they mean for the patient. Three of the most common and important of these are basaloid, verrucous, and papillary SCC. These tumor types will be briefly reviewed with a focus on specific controversies, biological questions, and/or recent advancements in our understanding of them.
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Affiliation(s)
- James S Lewis
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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