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Richards AR, Vijayakumar G, Braun A, Gitelis S, Blank AT. Myoepithelial Carcinoma of Soft Tissue: Report of Two Cases. JBJS Case Connect 2024; 14:01709767-202406000-00010. [PMID: 38608128 DOI: 10.2106/jbjs.cc.23.00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
CASE A 40-year-old man was evaluated for a painful mass on his right calf, and a 36-year-old woman presented with a painless mass on her right foot. Final pathology revealed marked nuclear atypia and positivity for S100/SOX10 and AE1/AE3 confirming diagnoses of myoepithelial carcinoma. Both patients underwent surgical resection and are without evidence of local recurrence or metastatic disease at 1-year follow-up. CONCLUSION Soft-tissue tumors presenting in the extremities warrant careful evaluation and timely histopathologic diagnosis. Myoepithelial carcinomas are rare, aggressive tumors with a propensity for local recurrence and metastasis. Treatment of these tumors should be discussed by a multidisciplinary tumor team.
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Affiliation(s)
- Alexandra R Richards
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
| | - Gayathri Vijayakumar
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
| | - Ankica Braun
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Steven Gitelis
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
| | - Alan T Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
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2
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Argyris PP, Wakely PE. Cytopathology of salivary gland myoepithelial carcinoma: A study of 13 cases and review of the literature. J Am Soc Cytopathol 2023; 12:461-468. [PMID: 37270329 DOI: 10.1016/j.jasc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Myoepithelial carcinoma (MECA) is an infrequently recognized salivary gland (SG) neoplasm that commonly develops within a preexisting pleomorphic adenoma (MECA ex PA). Fine-needle aspiration (FNA) biopsy reports of this neoplasm are largely restricted to small series and single case reports. METHODS Our cytopathology files were searched for examples of SG MECA/MECA ex PA having confirmatory histopathologic verification. Conventional FNA biopsy smears were performed, and exfoliative specimens processed using standard techniques. RESULTS Thirteen cases from 9 patients (M:F = 3.5:1; age range: 36 to 95 years, mean age = 60 years) met inclusion criteria. FNA biopsy sites included parotid gland (4), trunk (2), scalp (2), and neck (2). Exfoliative specimens included pleural fluid (1), bronchial brushing (1), and bronchoalveolar lavage (1). Most cases were metastatic deposits (8; 62%), 4 were primary neoplasms, and 1 a local recurrence. FNA diagnoses were MECA ex PA (6; 46%), myoepithelial neoplasm (2), PA (2), basaloid neoplasm (1), atypical myoepithelial cells (1), and myxoma (1). Ancillary testing in 2 cases showed positive staining for myoepithelial markers. Cytologic features were that of a low-grade neoplasm composed principally of epithelioid/polygonal cells exhibiting minimal if any cytologic atypia. Myxoid and chondromyxoid stroma was often the dominant feature in MECA ex PA aspirates. CONCLUSION In the primary setting, a cytologic diagnosis of MECA/MECA ex PA is extremely challenging if at all possible. Due to overwhelming amounts of stroma, the diagnosis may be challenging in some cases of metastatic MECA ex PA.
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Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
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3
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Val-Bernal JF, Lazuen S, Calapaquí-Terán AK, Martino M. Pure extracellular mucin-producing (colloid) myoepithelioma of the parotid gland. Pathol Res Pract 2022; 239:154162. [DOI: 10.1016/j.prp.2022.154162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 10/31/2022]
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4
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Marginean FE, Lesnik M, Gauthier A, Klijanienko J. The accurate cytological diagnosis of salivary carcinoma ex pleomorphic adenoma may be hampered by myoepithelial differentiation. Cytopathology 2021; 32:527-530. [PMID: 33528074 DOI: 10.1111/cyt.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/21/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Maria Lesnik
- Head and Neck Oncological Surgery, Institut Curie, Paris, France
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5
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Lari EA, Lari AA, Alsaeed T. Malignant adenomyoepithelioma of the breast: A case report. Int J Surg Case Rep 2020; 72:56-58. [PMID: 32506031 PMCID: PMC7283092 DOI: 10.1016/j.ijscr.2020.05.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022] Open
Abstract
Malignant breast adenomyoepithelioma (AME), rare subtype of cancer that usually benign. Mastectomy and sentinel lymph node biopsy with no further recurrence. Inner epithelial cells revealed positivity for CK5/6. Myoepithelial layers were positive for P63, CK5/6, SMA and S100 protein. Metastases chance of 30–40% with malignant adenomyoepithelioma, generally haematogenous route. Whereas metastases to the axillary lymph nodes is rare.
Introduction Malignant breast adenomyoepithelioma (AME) is a rare subtype of breast cancer. AME is mostly a benign disease that uncommonly undergoes malignant transformation. Presentation of case Here we present a case of a young, previously healthy female who initially presented with a painless breast lump. The patient underwent wide local excision for atypical cells with squamous metaplasia by core biopsy, but final histopathology showed AME with carcinoma. Thus, a mastectomy and a sentinel lymph node biopsy was undertaken. The patient had an uneventful recovery and no recurrence after the second surgery. Discussion and conclusion Malignant transformation of adenomyoepithelioma is reported in a small number of cases. Benign AME may be treated with wide local excision as recurrence is rare locally. Whereas malignant AME tends to be treated with simple mastectomy with or without lymph node biopsy.
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Affiliation(s)
- Eisa A Lari
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait.
| | - Ali A Lari
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait.
| | - Talal Alsaeed
- General Surgery Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait.
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Lubin D, Song S, Zafar HM, Baloch Z. The key radiologic and cytomorphologic features of oncocytic and oncocytoid lesions of the salivary gland. Diagn Cytopathol 2019; 47:617-636. [PMID: 30912629 DOI: 10.1002/dc.24175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/18/2022]
Abstract
Oncocytic and oncocytoid lesions represent a distinct subset of salivary gland lesions. True oncocytic lesions of the salivary gland are entirely composed of oncocytes. These are characterized by the presence of abundant eosinophilic granules due to the presence of abundant cytoplasmic mitochondria. Oncocytic lesions of the salivary gland include oncocytosis, oncocytoma, and oncocytic carcinoma. In addition to the true oncocytic lesion, there exists another group of salivary gland lesions, which demonstrate cells with abundant and occasionally granular cytoplasm. These are often termed as "oncocytoid" lesions. The recently proposed Milan System for reporting salivary gland cytology clearly states that fine-needle aspiration specimens representing oncocytic/oncocytoid lesions of salivary gland cannot effectively distinguish between a nonneoplastic lesion, benign and malignant neoplasms. Therefore, most lesions lacking classic cytomorphologic features will be classified under the umbrella diagnostic term of "Salivary Gland Neoplasm of Uncertain Malignant Potential" (SUMP). In this review, we discuss and illustrate key clinicopathologic and radiologic features that can help the practicing cytopathologist narrow down the differential and provide the best management based diagnosis.
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Affiliation(s)
- Daniel Lubin
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sharon Song
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Hanna M Zafar
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Zubair Baloch
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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7
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Virk H, Dey P. Fine needle aspiration cytology of a recurrent parotid tumour. Cytopathology 2018; 30:119-120. [PMID: 30126032 DOI: 10.1111/cyt.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Harpreet Virk
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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8
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Mezei T, Mocan S, Ormenisan A, Baróti B, Iacob A. The value of fine needle aspiration cytology in the clinical management of rare salivary gland tumors. J Appl Oral Sci 2018; 26:e20170267. [PMID: 29489937 PMCID: PMC5829550 DOI: 10.1590/1678-7757-2017-0267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/18/2017] [Indexed: 12/20/2022] Open
Abstract
Salivary gland tumors are relatively rare neoplasms, mostly located in the parotid gland, and few are malignant. Preoperative evaluation of salivary gland tumors includes fine needle aspiration cytology (FNAC).
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Affiliation(s)
- Tibor Mezei
- Mures County Emergency Clinic, Department of Pathology, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania
| | - Simona Mocan
- Mures County Emergency Clinic, Department of Pathology, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania
| | - Alina Ormenisan
- Mures County Emergency Clinic, Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania
| | - Beáta Baróti
- Mures County Emergency Clinic, Department of Radiology, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania
| | - Alina Iacob
- Mures County Emergency Clinic, Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania
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Bhambra AC, Zhang Y, Huang EC, Bishop J, Matin M, Afify A. Pleural fluid metastases of myoepithelial carcinoma: A case report and review of the literature. Cytojournal 2016; 13:13. [PMID: 27382407 PMCID: PMC4916740 DOI: 10.4103/1742-6413.183829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/31/2016] [Indexed: 11/19/2022] Open
Abstract
Myoepithelial carcinoma (MECA) is one of the rarest salivary gland neoplasms, which may either arise de novo or develop within a preexisting pleomorphic adenoma or benign myoepithelioma. The tumor occurs mainly in the parotid gland followed by minor salivary glands and other body sites. As a result of their morphologic heterogeneity, they can be confused easily with many tumors. Awareness of their unique cytoarchitectural patterns and immunohistochemical profile is crucial for accurate identification. Herein, we report a rare case of a 51-year-old female patient with MECA of the maxillary sinus that metastasized to the pleural fluid. To the best of our knowledge, this is the first case of pleural fluid involvement by MECA reported in the literature.
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Affiliation(s)
- Alicia Calderon Bhambra
- Address: Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Yanhong Zhang
- Address: Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Eric C Huang
- Address: Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - John Bishop
- Address: Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Mahan Matin
- Address: Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Alaa Afify
- Address: Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA, USA
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Allison DB, Bishop JA, Ali SZ. Cytopathologic characteristics of SMARCB1 (INI-1) deficient sinonasal carcinoma: A potential diagnostic pitfall. Diagn Cytopathol 2016; 44:700-3. [PMID: 27177850 DOI: 10.1002/dc.23503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/29/2016] [Accepted: 04/28/2016] [Indexed: 11/05/2022]
Abstract
Tumors of the head and neck are extremely diverse and a subset are poorly differentiated and difficult to classify. Recently, a new entity has been described with rhabdoid and/or plasmacytoid cytologic features and a characteristic genetic signature-inactivation of the SMARCB1 (INI-1) tumor suppressor gene. To date, only 16 cases of SMARCB1 (INI-1) deficient sinonasal carcinoma have been described, and there are currently no reports of the cytopathologic features by fine needle aspiration (FNA) cytology. A case of a 77-year-old man who presented with a posterior ethmoid sinus lesion with invasion into the skull base and bone was reported. FNA cytology of a right retropharyngeal lymph node revealed relatively monomorphic, loosely cohesive clusters of plasmacytoid cells with occasional nucleoli, rare intranuclear cytoplasmic inclusions, and mitotic figures in a background of necrosis and absence of overt squamous or glandular differentiation. A diagnosis of metastatic myoepithelial carcinoma was made; however, retrospectively, the surgical excision showed loss of the SMARCB1 (INI-1) tumor suppressor gene by immunohistochemistry. In summary, the cytomorphologic features of SMARCB1 (INI-1) deficient sinonasal carcinoma are relatively nonspecific and overlap with other regional tumors, including myoepithelial neoplasms. As a result, this entity should be considered in the differential diagnosis for a plasmacytoid tumor arising in the sinonasal tract by FNA cytology. Diagn. Cytopathol. 2016;44:700-703. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Rossi ED, Wong LQ, Bizzarro T, Petrone G, Mule A, Fadda G, Baloch ZM. The impact of FNAC in the management of salivary gland lesions: Institutional experiences leading to a risk-based classification scheme. Cancer Cytopathol 2016; 124:388-96. [DOI: 10.1002/cncy.21710] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/03/2016] [Accepted: 02/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Lawrence Q. Wong
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Gianluigi Petrone
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Antonio Mule
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Zubair M. Baloch
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
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12
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Su YX, Roberts DB, Hanna EY, El-Naggar A, Saylam G, Frank SJ, Weber RS, Kupferman ME. Risk Factors and Prognosis for Myoepithelial Carcinoma of the Major Salivary Glands. Ann Surg Oncol 2015; 22:3701-7. [PMID: 25636455 DOI: 10.1245/s10434-015-4389-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The clinical behavior and treatment outcomes of salivary gland myoepithelial carcinoma have yet to be clearly defined. The current study investigated risk factors and prognoses for this tumor. METHODS A retrospective review of the medical records for 32 patients with myoepithelial carcinoma of the major salivary glands was performed. Their clinical parameters were assessed to identify correlations with local-regional recurrence, distant metastasis, and survival. RESULTS The 5-year survival rate was 71 %. Of the reviewed patients, 41 % had local-regional recurrences, and 22 % had distant metastases. Age of 60 years or younger was a predictive factor for distant metastasis. Patients with neck lymph nodes clinically positive for carcinoma had shorter overall survival durations than those with nodes negative for carcinoma. CONCLUSIONS Myoepithelial carcinoma of the major salivary glands is characterized by a high incidence of local-regional recurrence and distant metastasis. Adjuvant therapy is indicated for selected patients with high-risk disease.
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Affiliation(s)
- Yu-Xiong Su
- Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, People's Republic of China.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dianna B Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adel El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Güleser Saylam
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Politi M, Robiony M, Avellini C, Orsaria M. Epithelial-myoepithelial carcinoma of the parotid gland: Clinicopathological aspect, diagnosis and surgical consideration. Ann Maxillofac Surg 2014; 4:99-102. [PMID: 24987609 PMCID: PMC4073474 DOI: 10.4103/2231-0746.133085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The present paper describes the clinical and pathological features of epithelial-myoepithelial carcinoma (EMC) of the parotid gland. This rare tumor represents <1% of all salivary gland tumors and arises most commonly in the parotid gland, but it has also been described in the submandibular gland, minor salivary glands and palate. EMC is considered to be a low-grade malignant tumor that may commonly recur locally after resection in 23-50% of cases. The complex and varied morphological expression of this neoplasm has attracted numerous investigators, who have presented valuable but often contradictory data. After an in-depth analysis of the clinicopathological aspects of EMC, we speculate that adequate resection with negative soft-tissue margins is the minimum recommended and necessary therapy.
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Affiliation(s)
- Massimo Politi
- Department of Maxillo-Facial Surgery, Institute of Pathology, University of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Maxillo-Facial Surgery, Institute of Pathology, University of Udine, Udine, Italy
| | - Claudio Avellini
- Department of Laboratory Medicine, Institute of Pathology, University of Udine, Udine, Italy
| | - Maria Orsaria
- Department of Laboratory Medicine, Institute of Pathology, University of Udine, Udine, Italy
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Sehgal S, Goyal P, Singh S, Kumar A. Fine-needle aspiration cytology of myoepithelial carcinoma of salivary gland: Diagnostic challenge to cytopathologist. J Cytol 2013; 30:207-10. [PMID: 24130417 PMCID: PMC3793362 DOI: 10.4103/0970-9371.117648] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Myoepithelial carcinoma (MC) is rare malignant salivary gland neoplasm and its cytologic features have been rarely described in the literature. Furthermore, MC shows varied cell types and patterns leading to the wide range of differential diagnosis on cytology. Histopathology and immunohistochemistry (IHC) are necessary to make a definite diagnosis. A 37-year-old female presented with painless, progressive swelling in the infra-auricular region since 2 years. Fine-needle aspiration cytology was performed and cytological possibilities of cellular pleomorphic adenoma and myoepithelial cell neoplasm were rendered and patient was advised excision and histopathologic examination for final diagnosis and subtyping. Final diagnosis of MC was made on hematoxylin and eosin sections and IHC. MC is rare malignant salivary gland tumor showing a clinic-pathologic diversity. The cytological features of MC are diverse and may lack overt feature of malignancy. Pathologists should be aware of this entity while evaluating cytological smears of salivary gland mass.
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Affiliation(s)
- Shelly Sehgal
- Department of Pathology, Swami Dayanand Hospital, Shahdara, New Delhi, India
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15
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Abstract
Myoepithelioma of the breast is very rare. Breast myoepithelioma can develop in women from their early 20s right up to their 80s, but it is most common in women over 50. We report a case of 20-year-old female, who presented with a well-defined breast lump of 3 × 3 cm in size. Fine needle aspiration was performed. The cytological findings revealed good cellularity comprising monomorphic loosely cohesive sheets of plasmacytoid, round to polygonal cells with round to ovoid eccentrically placed nuclei, finely dispersed chromatin, and moderate amount of cytoplasm. On the basis of cytological findings, a diagnosis of benign myoepithelioma (plasmacytoid type) was made which was confirmed on histopathologic examination. The breast is a very rare localization for this type of tumor. The benign character of the disease in conjunction with its slow progression could delay its detection and diagnosis. A detailed pathology examination is a prerequisite for avoidance of misleading diagnosis.
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Affiliation(s)
- L Khan
- Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India
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16
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Sethi D, Ahluvalia C, Khatri A, Khetarpal S. Palatal plasmacytoid myoepithelioma. Adv Biomed Res 2013; 1:78. [PMID: 23326808 PMCID: PMC3544089 DOI: 10.4103/2277-9175.102985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/08/2012] [Indexed: 11/18/2022] Open
Abstract
Myoepitheliomas are benign neoplasms of salivary glands derived from myoepithelial cells. These tumors can occur at any age but are most common in young adults. This tumor is usually located in the parotid gland and the minor salivary glands of the soft palate and represents less than 1% of all salivary gland tumors. The myoepithelioma is classified in the follow cells types: spindle, plasmacytoid, reticular, epitheliod, and clear, additionally, mixed histological forms are described. The plasmacytoid myoepithelioma from palate salivary glands is considered as a rare entity. A 45-year-old lady presented with an asymptomatic, well-circumscribed, solid mass located on the hard palate, which was gradually increasing in size. A clinical impression of Pleomorphic Adenoma was made which on histopathological examination revealed cords, clusters, and sheets of homogenous, large cells with plasmacytoid characteristics and a prominent eosinophilic cytoplasm. Ductal and acinar differentiation were absent thus ruling out the pleomorphic adenoma, whereas, features consistent with plasmacytoid myoepithelioma were evident.
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Affiliation(s)
- Divya Sethi
- Department of Pathology, VMMC and Safdarjang Hospital, Delhi, India
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17
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Santos EP, Cavalcante DR, Melo AU, Pereira JC, Gomes MZ, Albuquerque RL. Plasmacytoid myoepithelioma of minor salivary glands: report of case with emphasis in the immunohistochemical findings. Head Face Med 2011; 7:24. [PMID: 22152025 PMCID: PMC3285037 DOI: 10.1186/1746-160x-7-24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 12/12/2011] [Indexed: 11/10/2022] Open
Abstract
Myoepithelioma is a rare benign tumor of the salivary glands and is usually seen in the parotid gland and the minor salivary glands. It was once considered to be a type of pleomorphic adenoma (PA), but myoepitheliomas are today believed to be relatively aggressive tumors. Myoepitheliomas are most common in young adults between the ages of 30 and 50 and there are very few cases reported in individuals less than 18 years of age. We report a case of myoepithelioma located in the hard palate in a 15-year-old Brazilian male. The tumor was composed of plasmacytoid myoepithelial cells. An analysis of the immunohistochemical profile of the tumor cells showed positivity for vimentin, S-100 protein, and glial fibrillary acidic protein (GFAP), but not for smooth muscle actin (α-SMA) and cytokeratin 14 (CK14). We report this case because of the rarity of this tumor, especially in adolescents. We also discuss the histological parameters of the differential diagnosis of this tumor as well as its immunohistochemical profile.
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Affiliation(s)
- Esaú P Santos
- Department of Dentistry, School of Dentistry, University Tiradentes, Aracaju, SE, Brazil.
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18
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Saad RS, Richmond L, Nofech-Mozes S, Ghorab Z. Fine-needle aspiration biopsy of breast adenomyoepithelioma: A potential false positive pitfall and presence of intranuclear cytoplasmic inclusions. Diagn Cytopathol 2011; 40:1005-9. [DOI: 10.1002/dc.21705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 02/25/2011] [Indexed: 12/29/2022]
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Singh A, Haritwal A, Murali B. Correlation between cytology and histopathology of the salivary glam. Australas Med J 2011; 4:66-71. [PMID: 23386881 DOI: 10.4066/amj.2011.518] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Salivary gland swellings can result from tumours, an inflammatory process, or cysts. It can sometimes be difficult to establish whether pathology arises from the salivary gland itself or adjacent structures. Fine needle aspiration cytology (FNAC) is a simple, rapid and safe method to diagnose salivary gland swelling. FNAC has high sensitivity, specificity and accuracy. The aims of this study are to correlate FNAC diagnoses with histopathology and to establish the sensitivity and specificity of FNAC in diagnosis of salivary gland swellings in our institution. METHOD The study was conducted in the department of pathology, Sri Venkateshwara Medical college Hospital and research Centre, Pondicherry, India. Data was collected retrospectively for the time period 2007-2008 and prospectively for that obtained between January 2009 and June 2010. Results of cytologicial assessment were compared with histopathological data where possible to establish sensitivity and specificity of FNAC. RESULTS During the study period, 1309 FNAC were undertaken of which 96 FNAC were of salivary gland swellings. Correlation of cytology from FNAC with histopathology tissue was possible in 56 cases. Of the 96 cases for which FNAC data was available, 38.56% were from male and 61.45% were from female patients. The age of the patients ranged from 8 to 69 years. 48.95% cases were benign swellings, 13.54% were malignant, 6.25% were cysts and 31.25% had an inflammatory aetiology. Comparison of FNAC findings with histopathology specimens was available for 56 (58.33%) cases, following which the sensitivity and specificity of cytology were found to be 76.9% and 97.1% respectively. CONCLUSION FNAC is highly sensitive and specific technique for diagnosis of most of the salivary gland swelling. FNAC can be used preoperatively to avoid unnecessary surgery and discomfort associated with open biopsy.
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Affiliation(s)
- A Singh
- Sri Venkateshwara Medical College Hospital and Research Centre, Pondicherry, India
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Myoepithelial carcinoma of the vulva mimicking bartholin gland abscess in a pregnant woman: case report and review of literature. Int J Gynecol Pathol 2010; 29:501-4. [PMID: 20736781 DOI: 10.1097/pgp.0b013e3181d81cdb] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Myoepithelial tumors of the vulva are extremely rare, with only 8 cases reported in the literature to date. We report the first case of a high-grade myoepithelial vulvar carcinoma diagnosed in a 35-year-old woman during the 27th week of her pregnancy. The patient initially underwent a wide local excision of the lesion but noted rapid regrowth of the vulvar mass during the next 2 months before her delivery. Shortly thereafter, she underwent a classic radical Taussig-Basset total radical vulvectomy, bilateral superficial and deep inguinal groin node dissection, partial vaginectomy, and reconstruction of the vulva. However, the patient rapidly developed both locoregional and distant mestatatic disease, despite aggressive chemoradiotherapy, and she eventually succumbed to disseminated disease almost 20 months after her initial diagnosis.
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Avci A, Günhan O, Cakalağaoğlu F, Günal A, Celasun B. The cell with a thousand faces: detection of myoepithelial cells and their contributions in the cytological diagnosis of salivary gland tumors. Diagn Cytopathol 2010; 40:220-7. [PMID: 20891000 DOI: 10.1002/dc.21544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 08/09/2010] [Indexed: 01/05/2023]
Abstract
Myoepithelial cells are an important component of salivary gland tumors and are partly responsible from the diverse histology of them. In this study, we focus on the myoepithelial cell differentiation by using cytological morphology in a various types of salivary gland tumors especially with regard to their contribution to the diagnosis. The relation of myoepithelial cells with stromal matrix and the associated epithelial cells were evaluated. Cytologic slides of one hundred and forty one benign and twenty malignant salivary gland tumors were examined for identification of morphologically different myoepithelial cells such as; spindle-stellate, polygonal-epitheloid, plasmacytoid, basal and clear types. The best examples of myoepithelial cells were detected in pleomorphic adenomas, in some monomorphic adenomas and in the adenoid cystic carcinoma cases. Most of the pleomorphic adenomas were composed more than one type of myoepithelial cells and epitheloid-spindle cell combination was frequent. Basal and clear cell types of myoepithelial cells closely resembled the epithelial cells and their identification was relatively difficult. Identification of myoepithelial cell types was easier when they were associated with stromal matrix material and stood as a secondary layer around tubule-forming epithelial cells. Myoepithelial cell components of various salivary gland tumors may be quite different and identification of myoepithelial cell types may pose difficulties. A confident cytologic identification of myoepithelial cells may be critical part of diagnosing salivary gland tumors.
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Affiliation(s)
- Arzu Avci
- Department of Pathology, Atatürk Research and Education Hospital, İzmir, Turkey
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Zhang L, Wang D, Ren Y, Feng J, Bu R. Myoepithelial carcinoma of the parotid gland with bilateral thyroid involvement: A case report and review of the literature. Oncol Lett 2010; 1:1079-1082. [PMID: 22870116 DOI: 10.3892/ol.2010.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/10/2010] [Indexed: 01/05/2023] Open
Abstract
A patient was admitted to hospital with enlarged lobes of the thyroid gland with bilateral cervical lymph node involvement, and surgical excision followed. Histological examination of this specimen revealed a lesion that showed myoepithelial cell differentiation. Primary thyroid and skin appendage tumors were excluded based on clinical examination, conventional histology and immunohistochemistry. A tumor of the right parotid surgically treated in June 2008, approximately 2 years previously, was originally classified as a basal cell adenocarcinoma with focal invasion, but was re-examined. Using immunohistochemistry, the parotid tumor was re-classified as a myoepithelial carcinoma. The thyroid tumor proved to be metastasis from a primary parotid tumor, which was not found in the updated review of the literature. The literature is reviewed, including current knowledge on the histological and immunohistochemical features of myoepithelial carcinoma, with limited data on treatment suggestions.
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Affiliation(s)
- Lei Zhang
- Department of Oral and Maxillofacial Surgery, The Chinese PLA General Hospital, The Stomatological Institute of Chinese PLA
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Clark JC, Galloway SJ, Schlicht SM, McKellar RP, Choong PF. Myoepithelioma within the carpal tunnel: a case report and review of the literature. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2009; 6:15. [PMID: 19740441 PMCID: PMC2748076 DOI: 10.1186/1477-7800-6-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/09/2009] [Indexed: 11/10/2022]
Abstract
Myoepitheliomas of the extremity are rare and usually benign, while a minority display malignant features. This case demonstrates the diagnosis and management of myoepithelioma within the carpal tunnel. Clinical and radiological tumour features were evaluated. Hematoxylin and eosin stained tumour sections were examined, and immunohistochemistry was performed. Histology revealed a nodular mass of epithelioid cells in clusters within a myxoid/chondroid stroma. No mitoses were noted. Cytokeratins, neuron-specific enolase, synaptophysin, glial fibrillary acidic protein, and S100 were positive on immunohistochemistry. A literature review revealed very few prior reports of myoepithelioma in the wrist, and limited data concerning any relationship between recurrence and quality of surgical margins. In this case, wide local excision would have significantly compromised dominant hand function, and therefore a marginal excision was deemed appropriate in the context of bland histological features. Surgical margins noted in future case reports will aid clinical decision making.
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Affiliation(s)
- Jonathan Cm Clark
- Department of Orthopaedics and Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Australia.
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Myoepithelioma of the larynx: a case report. CASES JOURNAL 2009; 2:8085. [PMID: 19918450 PMCID: PMC2769400 DOI: 10.4076/1757-1626-2-8085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 06/19/2009] [Indexed: 11/29/2022]
Abstract
Myoepithelioma of the larynx is a very rare tumor with nonspecific local symptoms. We present the second known case, focusing on the peculiarities of the differential diagnosis for this type of tumor that are crucial for the right histologic diagnosis and furthermore for the therapeutic outcome. We report a 37-year-old male presenting with hoarseness and dyspnea. The indirect laryngoscopy revealed a gross glottic tumor from the right vocal cord who occupied the greater part of the glottis. No apparent cartilage invasion was shown in the CT. He came to us with a previous direct laryngoscopy derived biopsy describing a chondroma. A modified vertical partial laryngectomy, under temporary tracheostomy, with muscle reconstruction for the deficit of the right vocal cord was applied for the removal of the tumor. The final histopathologic diagnosis was myoepithelioma (spindle cell type) of the larynx. A long term follow-up in our case showed no recurrence and a good functional result. The larynx is a very rare localization for this type of tumour. The benign character of the disease in conjunction with its slow progression could delay its detection and diagnosis, leading to a more destructive surgery. A detailed pathology examination is prerequisite for avoidance of misleading diagnosis.
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Carrillo JF, Ramírez R, Flores L, Ramirez-Ortega MC, Arrecillas MD, Ibarra M, Sotelo R, Ponce-de-León S, Oñate-Ocaña LF. Diagnostic accuracy of fine needle aspiration biopsy in preoperative diagnosis of patients with parotid gland masses. J Surg Oncol 2009; 100:133-8. [DOI: 10.1002/jso.21317] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jafari A, Royer B, Lefevre M, Corlieu P, Périé S, St Guily JL. Value of the cytological diagnosis in the treatment of parotid tumors. Otolaryngol Head Neck Surg 2009; 140:381-5. [DOI: 10.1016/j.otohns.2008.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/29/2008] [Accepted: 10/21/2008] [Indexed: 10/21/2022]
Abstract
Objective: A cytological diagnosis is frequently used in the management of parotid tumor to distinguish benign from malignant tumors before surgery. The aim of this study was to evaluate the value of the cytological diagnosis in parotid tumors. Study Design: Fine-needle aspiration cytology was performed in 110 patients undergoing a parotidectomy. The results were compared with the definitive histopathological findings, which are considered the standard diagnostic reference for comparative analysis. Setting: University hospital. Results: Correlation with histopathological results was observed in 83 (82.1%) cases. Discordance was observed in eight (8.2%) cases. The sensitivity and the specificity of the cytological diagnosis in the detection of malignant tumors were 67 and 96 percent, respectively. Conclusions: The cytological diagnosis performed in parotid tumors permits differentiation of a benign from a malignant tumor in the majority of cases; however, it underestimates the diagnosis of malignant tumors.
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Affiliation(s)
- Alice Jafari
- Department of Otolaryngology–Head and Neck Surgery, Assistance Publique Hôitaux de Paris, Tenon Hospital, Paris, France
- UPMC University Paris 6, School of Medicine, Paris, France
| | | | - Marine Lefevre
- Department of Pathology, Assistance Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Pascal Corlieu
- Department of Otolaryngology–Head and Neck Surgery, Assistance Publique Hôitaux de Paris, Tenon Hospital, Paris, France
- UPMC University Paris 6, School of Medicine, Paris, France
| | - Sophie Périé
- Department of Otolaryngology–Head and Neck Surgery, Assistance Publique Hôitaux de Paris, Tenon Hospital, Paris, France
| | - Jean Lacau St Guily
- Department of Otolaryngology–Head and Neck Surgery, Assistance Publique Hôitaux de Paris, Tenon Hospital, Paris, France
- UPMC University Paris 6, School of Medicine, Paris, France
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Kim NR, Cho HY, Ha SY. Cytology of Plasmacytoid Type Myoepithelioma - Report of Two Cases -. KOREAN JOURNAL OF PATHOLOGY 2009. [DOI: 10.4132/koreanjpathol.2009.43.5.489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University Gil Hospital, Incheon, Korea
| | - Hyun Yee Cho
- Department of Pathology, Gachon University Gil Hospital, Incheon, Korea
| | - Seung-Yeon Ha
- Department of Pathology, Gachon University Gil Hospital, Incheon, Korea
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Lingamfelter D, Chen Y, Kure K, Lankachandra K. Infiltrating myoepithelial carcinoma of the breast, a case report and cytologic-histologic correlation. Diagn Pathol 2008; 3:7. [PMID: 18261234 PMCID: PMC2257926 DOI: 10.1186/1746-1596-3-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 02/08/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Infiltrating myoepithelial carcinoma remains a rarely encountered lesion of the breast. The few cases that have surfaced firmly document the histopathology of this tumor, but its cytologic characteristics seemingly have been described in only one other report. Case presentation Here we present the cytologic findings from a case of infiltrating myoepithelial carcinoma of the breast in a 52-year-old female and provide a histologic correlation with the subsequent biopsy and mastectomy specimens. While the cytology specimens displayed more myoepithelial cellular heterogeneity than was present on histology, a number of cytologic features including hypercellularity, pleomorphic spindle cells, and mitotic activity correlated well with the histopathology. Conclusion The role of fine needle aspiration in the diagnosis of mammary myoepithelial carcinoma, in this case, was to establish malignancy rather than to arrive at a specific diagnosis, as a number of different entities potentially can mimic this neoplasm on cytologic specimens.
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Affiliation(s)
- Daniel Lingamfelter
- Department of Pathology, University of Missouri-Kansas City School of Medicine and Truman Medical Centers, Kansas City, Missouri, USA.
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30
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Salivary glands epithelial and myoepithelial cells are major vitamin D targets. Eur J Drug Metab Pharmacokinet 2007; 32:123-9. [PMID: 18062404 DOI: 10.1007/bf03190474] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Receptor binding with 3H-1,25(OH)2 vitamin D3 (vitamin D) and its oxygen analog 3H-OCT is demonstrated in rat, hamster, and mice submandibular, sublingual and parotid glands, using receptor microautoradiography high-resolution imaging. Nuclear uptake and retention of radiolabeled compound exist strongest in epithelial cells of striated ducts, granular convoluted tubules and in myoepithelial cells throughout, scattered in epithelial cells of intercalated ducts and relatively low in cells of serous and mucous acini. Deposition and retention of radiolabeled compound is also observed in interstitial spaces. The specific nuclear localization with vitamin D and its analogue OCT, which is absent with 3H-(OH) vitamin D3 and in competition with excess non-radioactive vitamin D, indicates involvement of vitamin D in the multi-hormonal regulation of salivary gland secretion, excretion, and cell proliferation. These data--together with previously recognized similar receptor binding in esophagus, gastric glands, entero-endocrine cells, pyloric muscle, and generative and absorptive epithelium of the small intestine and colon, point to the importance of vitamin D for the digestive system regulation of functions and maintenance with related therapeutic potentials.
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Bean SM, Eltoum I, Horton DK, Whitlow L, Chhieng DC. Immunohistochemical Expression of p16 and Ki-67 Correlates With Degree of Anal Intraepithelial Neoplasia. Am J Surg Pathol 2007; 31:555-61. [PMID: 17414102 DOI: 10.1097/pas.0b013e31802ca3f4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anal intraepithelial neoplasia (AIN) is a human papilloma virus related lesion. It has been shown that infection with high-risk human papilloma virus results in up-regulation of p16 and increased cellular proliferation. The objective of this study is to correlate p16 expression and cellular proliferation measured by Ki-67 staining with the degree of dysplasia in the anal canal and to determine the efficacy of these markers in diagnosing high-grade AIN. Seventy-five anal specimens from 55 patients (37 men; 18 women; mean age: 48 y; median: 44 y; range 25 to 96 y) were studied including 35 normal/reactive lesions, 23 low-grade AIN (AIN I and condyloma), and 17 high-grade AIN (AIN II and III). Immunostaining for p16 and Ki-67 was performed. Expression of p16 in AIN correlated with that of Ki-67 (P<0.001). High-grade AIN often demonstrated p16 staining in more than one-third of the thickness of the epithelium in a diffuse/continuous fashion. p16 expression in low-grade AIN was often restricted to the lower 1/3 of the epithelium and/or was focal and discontinuous. The expression of both p16 and Ki-67 correlated with the degree of dysplasia (P<0.01). When positive p16 staining was defined as the presence of diffuse/continuous staining in more than one-third of the thickness of epithelium, the sensitivity, specificity, and accuracy of p16 as a marker for diagnosing high-grade AIN were 76%, 86%, and 84%, respectively. When positive Ki-67 staining was defined as the presence of nuclear staining in more than 25% of the cells in more than one-third of the thickness of epithelium, the sensitivity, specificity, and accuracy of Ki-67 as a marker for diagnosing high-grade AIN were 71%, 84%, and 83% respectively. Both p16 and Ki-67 are reliable markers for diagnosing high-grade AIN.
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Affiliation(s)
- Sarah M Bean
- Department of Pathology, Duke University, Durham, NC, USA
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Seethala RR, Barnes EL, Hunt JL. Epithelial-myoepithelial carcinoma: a review of the clinicopathologic spectrum and immunophenotypic characteristics in 61 tumors of the salivary glands and upper aerodigestive tract. Am J Surg Pathol 2007; 31:44-57. [PMID: 17197918 DOI: 10.1097/01.pas.0000213314.74423.d8] [Citation(s) in RCA: 231] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To further define the clinicopathologic spectrum of epithelial-myoepithelial carcinoma (EMCa), we report the gross, histologic, and immunophenotypic characteristics of 61 tumors seen within a 30-year-period. The mean age at presentation was 60.9 years, with a female predominance (1.5:1). The most common sites were parotid (62.1%), sinonasal mucoserous glands (10.3%), palate (8.6%), and submandibular (8.6%). Most EMCas showed a characteristic nodular/multinodular growth pattern and classic biphasic tubular histology. However, new morphologies in EMCa such as ancient change (8.2%), "Verocay"-like change (3.3%), and sebaceous differentiation (13.1%) were noted. Specific histologic variants were dedifferentiated EMCa (3.3%), oncocytic EMCa (8.2%), EMCa ex pleomorphic adenoma (1.6%), double-clear EMCa (3.3%), and EMCa with myoepithelial anaplasia (3.3%). All cytokeratin cocktails selectively highlighted the epithelial component well. Of the myoepithelial markers, p63, smooth muscle actin and vimentin performed best. Bcl-2 and c-kit were frequently positive (66.7% and 69.2%, respectively). p53 was highly expressed only in 1 dedifferentiated EMCa. The recurrence rate was 36.3% (median disease-free survival 11.34 y), but death was rare with 5-year and 10-year disease-specific survivals of 93.5% and 81.8%, respectively. The most important univariate predictors of recurrence were margin status (log rank P=0.006), angiolymphatic invasion (P=0.002), tumor necrosis (P=0.004), and myoepithelial anaplasia (P=0.038). Thus, EMCa is generally a low-grade tumor with a broader morphologic spectrum than previously thought, with several key features predictive of recurrence. Immunohistochemistry can aid diagnosis by highlighting the biphasic nature of the tumor.
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Affiliation(s)
- Raja R Seethala
- Head and Neck/Endocrine Division, Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Isitor GN, Thorne R. Comparison between nuclear chromatin patterns of digitalized images of cells of the mammalian testicular and renal tissues: an imaging segmentation study. Comput Med Imaging Graph 2006; 31:63-70. [PMID: 17166699 DOI: 10.1016/j.compmedimag.2006.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 10/30/2006] [Accepted: 10/31/2006] [Indexed: 11/16/2022]
Abstract
Testicular and renal tissue, obtained from adult cattle, pigs, rats, and human was processed by image digital segmentation and pixel texture analytical techniques for comparative evaluation of nuclear chromatin pattern of testicular primary spermatocytes and renal glomerular endothelial cells. The post mortem performed for the animals and the human subject were for reasons not related with either testicular or renal conditions. The objective was to establish a benchmark for identification of rapidly multiplying cells in images of sections of normal, as well as abnormal mammalian tissue. Based on the observed morphological and texture pattern of the nuclear chromatin of the testicular primary spermatocytes, it was determined that the renal glomerular endothelial cells exhibit similar nuclear chromatin morphology consistent with an ongoing rapid multiplication process. The nuclear chromatin of both cell types manifest identical mitotic figures which are strongly indicative of cellular proliferation.
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Affiliation(s)
- Godwin N Isitor
- School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago.
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Dave B, Shet T, Ramadwar M, Kane S. Cytological evaluation of head and neck tumors in children—A pattern analysis. Diagn Cytopathol 2006; 34:434-46. [PMID: 16680771 DOI: 10.1002/dc.20441] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A total of 135 pediatric head and neck tumors diagnosed in our institute were reviewed with a view to elucidate the overall cytological patterns and analyze the important cytological features. Ninety-four tumors (69.6%) were aspirated for a primary diagnosis, and in 41 (30.4%) cases, fine-needle aspiration cytology was performed to document relapse, recurrence or a metastasis. Among the 94 tumors aspirated for a primary diagnosis, 66 cases (70.2%) were accurately diagnosed, in 22 cases (23.4%) a broad working diagnosis was offered, and 6 cases (6.4%) were misdiagnosed. The accuracy rate was higher (79.3%) when relapse-recurrent and metastatic tumors were included. The smears were broadly divided into six patterns, viz. round cell, epithelial, anaplastic, giant cell, mixed inflammatory, and spindle cell patterns. The round cell pattern was the most frequent one encountered in this group. The cytological features that stood the test of variability were lymphoglandular bodies and a noncohesive cell population in hematolymphoid malignancies, pale chromatin and cytoplasmic vacuoles in primitive neuroectodermal tumor/Ewing's sarcoma (PNET/ES), neuropil and rosettes in neuroblastoma, and plasmacytoid rhabdomyoblasts in rhabdomyosarcoma. A fairly good accuracy was seen in the diagnosis of metastatic undifferentiated carcinoma and anaplastic lymphoma, but the giant-cell and spindle-cell tumors continued to pose a problem in diagnosis. Ancillary techniques such as immunocytochemistry and electron microscopy applied in limited cases helped evaluate Langerhans cell histiocytosis, alveolar rhabdomyosarcoma, and the PNET/ES family of tumors.
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Affiliation(s)
- Brijal Dave
- Department of Pathology, Tata Memorial Hospital, Mumbai 400012, Maharashtra, India
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Abstract
BACKGROUND Adenomyoepithelioma (AME) of the breast is a rare neoplasm that is characterized by a biphasic proliferation of epithelial and myoepithelial cells. Incomplete excision of this lesion is associated with a greater risk of recurrence. Although the histology of AME is well characterized, its cytomorphology has not been assessed in a large series. METHODS The authors conducted a retrospective evaluation of cytologic findings in fine-needle aspiration biopsy (FNAB) material from 12 patients with histologically proven benign AMEs of the breast. RESULTS All aspirates were moderately to highly cellular with large clusters composed of epithelium and myoepithelium. The myoepithelium was admixed with the ductal cells or was present as naked bipolar nuclei in 75% of samples. Small clusters or dispersed myoepithelial cells with epithelioid morphology were also present and showed intranuclear and intractyoplasmic vacuoles in one-third of samples. Mild-to-moderate nuclear atypia was noted in some samples, but no necrosis or mitoses were seen. None of the patients were diagnosed originally with AME: Two tumors were classified as benign and consistent with fibroadenoma, 6 tumors were atypical, 2 tumors were suspicious for carcinoma, and 2 tumors were positive for malignant cells. CONCLUSIONS Because of the varied histology of AME, cytologic diagnosis of this neoplasm can be very challenging. Accurate identification of the myoepithelium is crucial to avoid misinterpretation as carcinoma. Conservative diagnosis and further histologic evaluation is recommended for these patients.
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Affiliation(s)
- Pratibha Iyengar
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Noronha V, Cooper DL, Higgins SA, Murren JR, Kluger HM. Metastatic myoepithelial carcinoma of the vulva treated with carboplatin and paclitaxel. Lancet Oncol 2006; 7:270-1. [PMID: 16510337 DOI: 10.1016/s1470-2045(06)70619-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vanita Noronha
- Section of Medical Oncology, Yale Comprehensive Cancer Center, 333 Cedar Street, PO Box 208032, New Haven, CT 06520-8032, USA
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David O, Blaney S, Hearp M. Parotid gland fine-needle aspiration cytology: An approach to differential diagnosis. Diagn Cytopathol 2006; 35:47-56. [PMID: 17173301 DOI: 10.1002/dc.20581] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parotid glands can undergo a wide range of pathologic changes that may be difficult to characterize by clinical features alone. No single diagnostic modality is currently accepted unequivocally as the definitive approach to parotid gland enlargement or tumors. Although it is generally accepted that fine-needle aspiration (FNA) biopsy is useful in the preoperative setting, the accuracy is highly dependent on both operator experience and the interpretative skills of the cytopathologist. Results of FNA biopsy must be considered in a global context, in conjunction with clinical and radiographic findings. The objectives of this paper are threefold: (1) to define the clinical role of parotid FNA, such that pathologists performing and/or interpreting such specimens have a clearer understanding of the expectations of our surgical colleagues; (2) to clearly describe a protocol for the performance of parotid FNA biopsy, including a discussion of complications and pitfalls; and (3) to present the cytologic differential diagnoses of diverse clinicopathologic parotid gland processes that may present as generalized enlargement, cystic lesions, or discrete masses.
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Affiliation(s)
- Odile David
- Department of Pathology, University of Illinois, College of Medicine, Chicago, Illinois 60612, USA.
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