Prognostic significance of biomarkers (c-erbB-2, p53, proliferating cell nuclear antigen, and DNA content) in salivary duct carcinoma

Salivary duct carcinoma--a highly aggressive salivary gland tumor with HER-2/neu oncoprotein overexpression

Salivary duct carcinoma (SDC) is a highly malignant salivary gland tumor with aggressive clinical behavior, and is characterized by its histological resemblance to invasive ductal carcinoma of the breast. Overexpression and/or amplification of proto-oncogene Her2/neu has been shown to influence both prognosis and treatment of breast cancer. Since salivary duct carcinoma and ductal breast carcinoma share many common characteristics, HER2/neu overexpression might also be important in SDC. However, data on the expression of c-erbB2/HER2/neu in salivary gland tumors are still scarce. Therefore, we have evaluated 15 cases of salivary duct carcinomas (SDC) for HER2/neu overexpression using immunohistochemistry with the HercepTest. Overexpression, identified as strong or moderate membrane immunostaining, was observed in all but one case of SDC in most neoplastic cells. Thus, our study suggests that anti-HER2/neu therapy with Herceptin is beneficial for patients with aggressive salivary duct carcinoma.

Intraoral salivary duct carcinoma: case report with immunohistochemical observations

Salivary duct carcinoma is an uncommon malignant salivary gland tumor that occurs predominantly in the parotid gland. Oral involvement is extremely rare, with few cases having been reported in the literature. The tumor is characterized by an aggressive behavior and has a poor prognosis. We describe a case of salivary duct carcinoma arising in the hard palate of a 63-year-old man. Immunohistochemical analysis revealed that tumor cells tested positive for cytokeratin, epithelial membrane antigen, proliferating cell nuclear antigen, Ki67, p53, laminin, and collagen IV. Despite radical surgical resection, bilateral neck dissection, and postoperative radiotherapy, liver metastases developed, and the patient subsequently died of his disease.

Immunoelectron microscopical identification of the c-erbB-2 oncoprotein in patients with laryngeal squamous cell carcinoma

The peroxidase-antiperoxidase (PAP) method was used for localization of the c-erbB-2 oncoprotein at the electron microscopical level in 15 patients with laryngeal squamous cell carcinoma. It was found that c-erbB-2 oncoprotein was present in 7 of 15 samples. Electron microscopical examination revealed expression of the c-erbB-2 oncoprotein both on the membrane of individual cells and in the cytoplasm. In 5 of the 7 cases of positive labeling, it was observed only on the plasma membrane of cells whereas in 2 cases, there was also cytoplasmic staining. Reaction product was associated with endoplasmic reticulum, and the nuclear envelope and was scattered throughout the cytoplasm on ribosomes. Control incubations using normal rabbit serum instead of the primary antibody showed no labeling. A significant correlation between c-erbB-2 oncoprotein and pathological characteristics such as nodal status and histological grade was not found.

Peroxiredoxin I expression in oral cancer: a potential new tumor marker

This study investigates the applicability of the novel antioxidant protein, peroxiredoxin (Prx) I as a marker for tumor status in oral squamous cell carcinoma (SCC). Samples from 53 patients with SCC in the oral cavity were examined by immunohistochemistry. Correlations between the expression level of Prx I and proliferating cell nuclear antigen (PCNA), the clinical features of tumors, and their histopathological classifications were statistically analyzed. Cases exhibiting low Prx I expression level included significantly more with larger tumor mass cases (T-category, P=0.004), positive lymph node metastasis (N-category, P=0.015), advanced stage (P=0.002), and poorly differentiated cells (P=0.020). There was no significant difference between Prx I expression and the other indices.

Adenoid cystic carcinoma: use of cell proliferation, BCL-2 expression, histologic grade, and clinical stage as predictors of clinical outcome

BACKGROUND

Although the three basic histologic growth patterns of adenoid cystic carcinomas (tubular, cribriform, and solid) provide some indication of clinical outcome, additional, perhaps superior, predictors of biologic activity are needed for patient management.

METHODS

This series is composed of 31 adenoid cystic carcinomas that presented in Linköping between 1982 and 1997. The tumors were clinically staged and histologically graded. For each case, after immunohistochemical identification, the proportion of tumor cells expressing the cell cycle markers MIB-1 and bcl-2 (as an indicator of proliferation and apoptosis, respectively) were quantified. Statistical correlation was sought between tumor stage and grade and the two cell cycle markers.

RESULTS

The proportions of cycling tumor cells in adenoid cystic carcinomas ranged from 0.3% to 55%. For patients with no evidence of disease and a follow-up of at least 5 years, the mean percent MIB-1 value was significantly lower than for those patients who were alive with local recurrence and/or metastasis or who had died from their adenoid cystic carcinoma (p =. 024). MIB-1 tumor cell positivity also correlated strongly with tumor grade (p =.053), but not with stage (p =.22). Neither clinical stage nor histologic grade correlated with the degree of bcl-2 tumor cell positivity (p =.97 and p =.49, respectively).

CONCLUSIONS

Staging and grading continue to play a vital role in the management of patients with adenoid cystic carcinoma. Furthermore, in this series of patients with adenoid cystic carcinoma, a cycling tumor cell population as measured by the MIB-1 antibody greater than 10% indicates this group as biologically more aggressive and at an increased risk for a fatal course.

Sarcomatoid salivary duct carcinoma of the parotid gland

Salivary duct carcinoma (SDC) is a high-grade neoplasm known to histologically resemble high-grade ductal carcinoma in situ of the breast. We describe 3 cases of sarcomatoid salivary duct carcinoma, a heretofore unreported variant of SDC. Each case was a composite of SDC and sarcomatoid carcinoma and histologically similar to reported cases arising in the breast. The clinicopathologic features, including immunohistochemistry, of 3 cases were investigated. In the 3 men, ages 56, 68, and 70 years, the resected parotid tumors measured 1.5, 3.5, and 1.5 cm, respectively. Only the 3.5-cm tumor extended beyond the parotid gland into soft tissue. This patient died at 3 years with pulmonary metastases. The other patients were free of disease at 6 and 12 months. Histologically, each case was a composite of usual-type SDC and sarcomatoid carcinoma. SDC showed typical cribriform architecture, whereas anaplastic, spindled cells constituted the sarcomatoid areas. Immunohistochemically, epithelial elements stained as follows: cytokeratin (AE1/AE3 & CAM 5.2) positive in 3 of 3 cases, EMA positive in 3 of 3 cases, vimentin negative in 3 of 3 cases, desmin negative in 3 of 3 cases, c-erbB-2 positive in 1 of 2 cases. Sarcomatoid elements stained as follows: AE1/AE3 negative in 3 of 3 cases, CAM 5.2 rare positive cell in 1 of 3 cases, EMA focally positive in 3 of 3 cases, vimentin positive in 3 of 3 cases, desmin negative in 3 of 3 cases, c-erbB-2 negative in 2 of 2 cases. Electron microscopy, performed in one case, showed scattered junctional complexes congruent with epithelial differentiation. Immunohistochemical results, EMA and CAM 5.2 positivity, and ultrastructural findings supported our belief that these unique biphasic tumors represented SDC with sarcomatoid carcinoma. We conclude an element of sarcomatoid carcinoma rarely may arise in association with SDC, and it is erroneous to diagnose such tumors as "carcinosarcoma."

Proliferating cell nuclear antigen and c-erbB-2 oncoprotein expression in adenoid cystic carcinomas of the salivary glands

BACKGROUND

Adenoid cystic carcinoma (ACC) of the salivary gland shows a variable clinical course. It would be helpful to discover reliable biologic markers in the management of patients with ACC.

METHODS

We examined proliferating cell nuclear antigen (PCNA) and c-erbB-2 oncoprotein expression on 30 cases of ACC of the salivary glands. The immunohistochemical results, and size, location, and histologic grade of the tumors were compared with the clinical outcome of the patients.

RESULTS

Mean PCNA positivity of ACCs was 15%, and was higher in solid than in cribriform/tubular areas. High PCNA value was significantly correlated with shorter disease-free and overall survival of the patients with ACC. c-erbB-2 overexpression was observed in only five cases, focally in cribriform/tubular areas. High histologic grade, which was determined by the presence of solid components, showed a trend toward shorter survival. Size and location of ACC were not associated with patient outcome.

CONCLUSIONS

The present study indicates that PCNA score may be one of the most useful prognostic factor of ACC.

Parotid duct carcinoma arising in bilateral chronic sialadenitis

It is well recognized that, in general, chronic inflammation can predispose to malignant change. There is however, to our knowledge, no previously reported association between chronic obstructive sialadenitis and salivary gland epithelial malignancy. We describe here the first reported example in the English literature of a salivary duct carcinoma arising in a parotid gland with a long history of chronic obstructive sialadenitis. It is possible that a causal relationship exists between the two conditions. If this were the case then non-surgically treated chronic obstructive sialadenitis patients may well warrant careful clinical follow-up.

Salivary duct carcinoma: clinicopathological and immunohistochemical studies

Nine cases of salivary duct carcinoma were reviewed clinically, histologically and immunohistochemically, with special evaluation of biomarkers with prognostic significance (p53, Ki67, c-erbB-2 and DNA content). Eight tumours occurred in the parotid gland and one in the submandibular gland. The average age of the patients (8 males and 1 female) was 62.8 years (range = 47-74 years). Tumour size ranged from 1 to 6 cm (mean = 3.46 cm). Recurrences were found in 33.3% (3 patients), regional metastases in 44.4% (4 patients) and systemic metastases in 33.3% (3 patients). Three patients died of their disease (median survival = 12.3 months), one is alive with the disease (follow-up of 222 months) and 5 are alive without evidence of disease (mean follow-up of 75 months). p53 protein nuclear immunostaining was positive in 66.6% and c-erbB-2 overexpression was observed in 100% of the tumours. Ki 67 positivity ranged from 6.75% to 47.5% of tumour cells (mean = 21.3%). DNA aneuploidy was found in 4 tumours (44.4%) and DNA diploidy in 5 (55.5%). Our results seem to indicate that Ki67 immunostaining can be useful in the evaluation of the biological behaviour of these tumours, as well as the presence of a high proliferative index of aneuploid cells and the presence of distant metastases.

Immunoexpression of c-erbB-2 and p53 in benign and malignant salivary neoplasms with myoepithelial differentiation

AIM

To evaluate whether the immunoexpression of c-erbB-2 and p53 is involved in the pathogenesis and progression of salivary tumours with myoepithelial differentiation.

METHODS

233 tumours from 211 patients were studied. These included 76 primary and 24 recurrent adenocarcinomas (polymorphous low grade adenocarcinoma, 13; epithelial-myoepithelial carcinoma, 19; adenoid cystic carcinoma, 56; and basal cell adenocarcinoma, 12) and 133 pleomorphic adenomas and myoepitheliomas, 96 being primary and the remaining recurrent tumours. All cases were formalin fixed and paraffin wax embedded. A StrepABC peroxidase method and polyclonal c-erbB-2 and p53 specific antisera were used.

RESULTS

Cell membrane staining of c-erbB-2 was not found in any benign or malignant tumour. There was p53 protein accumulation in one primary and one recurrent pleomorphic adenoma and in 10 adenocarcinomas (polymorphous low grade adenocarcinoma, one; epithelial-myoepithelial carcinoma, one; adenoid cystic carcinoma, five; and basal cell adenocarcinoma, three), three of them being recurrences.

CONCLUSIONS

The c-erbB-2 and p53 proteins are not involved in the pathogenesis of pleomorphic adenoma and myoepithelioma and do not constitute biomarkers in assessing the risk of recurrence. c-erbB-2 is not involved in the genesis of low grade salivary neoplasia with myoepithelial differentiation. The percentage of this type of neoplasia with p53 accumulation is low (10%) and does not appear to be related to tumour recurrence.