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Seim NB, Philips RHW, Schoenfield L, Teknos TN, Rocco JW, Agrawal A, Ozer E, Carrau RL, Kang SY, Old MO. NUT Midline Carcinoma of the Sublingual Gland: Clinical Presentation and Review. Head Neck Pathol 2017; 11:460-468. [PMID: 28349372 PMCID: PMC5677058 DOI: 10.1007/s12105-017-0809-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
NUT midline carcinoma (NMC) is a rare and aggressive disease encountered in the midline of the head and neck or mediastinum. Due to its sparse incidence and subtle pathologic features, we aim to increase knowledge and awareness for this pathologic entity. We present an exemplary case of a young, healthy male presenting with oral cavity pain and cervical lymphadenopathy. This patient was initially diagnosed with an unspecified, highly aggressive sublingual gland malignancy and underwent locoregional resection with free flap reconstruction however suffered a rapid local recurrence and widely extensive metastasis within just 1 month. After rigorous analysis, final pathologic diagnosis revealed a poorly differentiated carcinoma with evidence of squamous differentiation that eventually, post-mortem tested positive for NMC. Only one prior case of sublingual gland NMC has been previously reported as we discuss the literature regarding all sublingual gland malignancies as well as the pathologic features and treatment options for NMC. We recommend consideration of testing for the NUT proto-oncogene at the time of biopsy in the clinical setting of a poorly differentiated midline carcinoma, especially with squamous differentiation, of the head or neck in order to identify patients for clinical trial enrollment and appropriately counsel on the poor clinical prognosis. Improving clinician awareness is critical to increase diagnostic accuracy and need to study prospective treatment outcomes as the first step toward improving management of this difficult disease.
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Affiliation(s)
- Nolan B. Seim
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Ramez H. W. Philips
- 0000 0001 2285 7943grid.261331.4The Ohio State University College of Medicine, 370 W. 9th Ave, Columbus, OH 43210 USA
| | - Lynn Schoenfield
- 0000 0001 1545 0811grid.412332.5Department of Pathology, The Ohio State University Wexner Medical Center, Doan Hall, N337B, 410 West 10th Ave., Columbus, OH 43210 USA
| | - Theodoros N. Teknos
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - James W. Rocco
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Amit Agrawal
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Enver Ozer
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Ricardo L. Carrau
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Stephen Y. Kang
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Matthew O. Old
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA ,0000 0001 2285 7943grid.261331.4Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center, The Ohio State University, Starling Loving Hall, B217, 320 West 10th Ave, Columbus, OH 43210 USA
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Gemryd P, Lundquist PG, Tytor M, Hellquist HB, Nordenskjöld B. Prognostic significance of DNA ploidy in mucoepidermoid carcinoma. Eur Arch Otorhinolaryngol 1997; 254:180-5. [PMID: 9151016 DOI: 10.1007/bf00879270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thirty-four mucoepidermoid carcinomas were studied retrospectively with regard to histological and clinical parameters. In 28 of the tumors DNA patterns were also assessed using flow cytometry. Twenty-two of the 28 tumors (79%) were DNA diploid and 6 (21%) DNA aneuploid. Two tumors (7%) showed intratumoral DNA as indicated by different stemlines in specimens investigated from different parts of the tumor. DNA ploidy correlated significantly with cervical lymph node status (P < 0.01), but not with tumor size or histological grade. The mean S-phase value was 2.7% and was significantly higher in aneuploid samples than in diploid ones (P < 0.05). The recurrence rate was significantly lower for patients with stage I and II tumor compared with those with stage III and IV disease (P < 0.01). Five aneuploid tumors showed significantly higher recurrence rates (5/6) than the diploid ones (1/22) (P < 0.01). In univariate analysis for survival, only N stage tumor (P < 0.05) and tumor DNA ploidy (P < 0.0003) had significant prognostic influence. Thus, DNA ploidy seems to be a valuable parameter for evaluating the biological behavior of mucoepidermoid carcinomas of the salivary glands.
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Affiliation(s)
- P Gemryd
- Department of Otolaryngology/Head & Neck Surgery, University Hospital, Linköping, Sweden
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6
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Cassidy M, Connolly CE. Clear cell carcinoma arising in a pleomorphic adenoma of the submandibular gland. J Laryngol Otol 1994; 108:529-32. [PMID: 7517988 DOI: 10.1017/s0022215100127331] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Clear cell carcinoma of salivary gland is a rare neoplasm. We report a third case of clear cell carcinoma arising in a pleomorphic adenoma and also in an extraparotid location. We document the immunohistochemical profile of the tumour including reactivity with a marker for the c-erbB-2 oncoprotein and suggest a myoepithelial origin for these lesions. The presence of a tetraploid stemline may account for the rapid tumour progression in this case.
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Affiliation(s)
- M Cassidy
- Department of Pathology, Royal College of Surgeons, Ireland
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Ishii K, Nakajima T. Evaluation of malignant grade of salivary gland tumors: studies by cytofluorometric nuclear DNA analysis, histochemistry for nucleolar organizer regions and immunohistochemistry for p53. Pathol Int 1994; 44:287-96. [PMID: 8044296 DOI: 10.1111/j.1440-1827.1994.tb03366.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Investigations were carried out in 109 surgically resected salivary gland tumors, 46 adenomas and 63 carcinomas for nuclear DNA content by cytofluorometry, nucleolar organizer regions (AgNOR) by histochemistry and nuclear p53 accumulation by immunohistochemistry. The mean nuclear DNA content and the incidence of aneuploidy as well as the mean number of the AgNOR in carcinomas were significantly higher than those in adenomas. In the DNA histogram pattern, the aneuploidy frequently appeared in high grade carcinoma groups (adenocarcinoma, salivary duct carcinoma, carcinoma in pleomorphic adenoma and oncocytic carcinoma). Immunohistochemical nuclear p53 accumulation was observed in 15 tumors, of which ten showed DNA aneuploidy. In high grade carcinomas, DNA aneuploidy was closely related to p53 immunoreactivity. This study revealed that combined cytofluorometric nuclear DNA analysis, histochemical AgNOR count and immunoreactivity for p53 might be quite useful for evaluating the malignant grade of salivary gland tumors.
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Affiliation(s)
- K Ishii
- Second Department of Pathology, Gunma University School of Medicine, Maebashi, Japan
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Tytor M, Gemryd P, Wingren S, Grenko RT, Lundgren J, Lundquist PG, Nordenskjöld B. Heterogeneity of salivary gland tumors studied by flow cytometry. Head Neck 1993; 15:514-21. [PMID: 8253558 DOI: 10.1002/hed.2880150607] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Intratumor DNA heterogeneity was investigated by flow cytometric analysis of multiple samples taken from different sites of 8 benign and 16 malignant primarily resected salivary gland tumors. All benign tumors had diploid DNA content. The overall incidence of DNA diploidy in 16 malignant cases examined was 50%. Intratumor differences in DNA ploidy were observed in four malignant tumors (25%); 2 of these 4 heterogeneous tumors contained both aneuploid and diploid cell clones. The remaining 12 tumors showed a homogeneous DNA content in the different specimens; 8 were diploid, 3 aneuploid, and 1 was polypoid. The DNA nondiploid tumors were clinically more advanced than the DNA diploid ones (p < 0.01). The tumor proliferation rate (fraction of cells in S-phase) was higher in DNA nondiploid samples than in diploid ones (p < 0.01). The DNA nondiploid tumors seemed to recur more often than DNA diploid ones did. The data emphasize the usefulness of DNA measurements for the characterization of malignant salivary gland tumors but also the importance of adequate sampling in assessing their DNA ploidy.
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Affiliation(s)
- M Tytor
- Department of Otolaryngology/Head & Neck Surgery, University Hospital, Linköping, Sweden
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Fonseca I, Soares J. Epithelial-myoepithelial carcinoma of the salivary glands. A study of 22 cases. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1993; 422:389-96. [PMID: 8322454 DOI: 10.1007/bf01605458] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Twenty-two cases of epithelial-myoepithelial carcinoma of major and minor salivary glands were studied retrospectively to define the clinico-pathological profile and to assess the value of DNA ploidy as a prognostic tool. Fifty-nine percent of the cases occurred in the major salivary glands, the patients being mostly females in their 5th to 8th decades. The clinical course was characterized by a high number of recurrences (in 50% of cases). Death due to the neoplastic disease was found in 40% of the patients. The only morphological feature found to be correlated to prognosis was the presence of nuclear atypia in more than 20% of the tumour cells. In 18 cases, cytophotometric DNA analysis was performed; 15 cases had a diploid DNA histogram and 3 an aneuploid one. All the cases that were DNA aneuploid were of the solid, predominantly clear-cell type and were associated with fatal outcome.
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Affiliation(s)
- I Fonseca
- Serviço de Patologia Morfológica, Instituto Português de Oncologia de Francisco Gentil, Lisboa
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Batsakis JG, el-Naggar AK, Luna MA. "Adenocarcinoma, not otherwise specified": a diminishing group of salivary carcinomas. Ann Otol Rhinol Laryngol 1992; 101:102-4. [PMID: 1728879 DOI: 10.1177/000348949210100123] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
As refinements in classification with clinicopathologic correlations proceed, the "adenocarcinomas, not otherwise specified" (NOS) of salivary tissue are reduced in number. Clinicopathologic entities such as salivary duct carcinoma, terminal duct carcinoma, and epimyoepithelial carcinoma, formerly in the NOS category, are examples of this process. There remain, however, adenocarcinomas of salivary tissues that cannot be accommodated in conventional classifications. They are the least common of salivary carcinomas and manifest a cytoarchitecture ranging from a well-differentiated, low-grade appearance to high-grade, invasive lesions. This report addresses this group of carcinomas for which the NOS designation is still applicable.
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Affiliation(s)
- J G Batsakis
- Dept of Pathology, University of Texas M. D. Anderson Cancer Center, Houston 77030
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11
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Chomette G, Auriol M, Vaillant JM, Kasai T, Okada Y, Mori M. Basaloid carcinoma of salivary glands, a variety of undifferentiated adenocarcinoma. Immunohistochemical study of intermediate filament proteins in 24 cases. J Pathol 1991; 163:39-45. [PMID: 1705975 DOI: 10.1002/path.1711630108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Among adenoid cystic carcinomas of salivary glands (ACCs), the solid basaloid type has a poor prognosis similar to that of undifferentiated adenocarcinomas. We studied 24 cases in immunohistochemistry using antibodies reactive with keratins of various molecular weights, vimentin, S-100 protein, and its A and B subunits. Our findings were correlated with the histological pattern and with the variable degree of differentiation of these carcinomas. In comparison with other types of ACC, intermediate filament proteins in this group were weakly expressed. The co-expression of cytokeratin and vimentin was noted in some cases. Additional features noted were the presence of cribriform cavities associated with solid lobules and areas of necrosis giving a comedocarcinomatous pattern. In these two variants, cells characterized by the dual expression of cytokeratin and S-100 protein were seen. In the highly malignant anaplastic variety, only a few cells were weakly positive with antisera to cytokeratin and vimentin. This group shows similarities to undifferentiated adenocarcinomas of salivary glands. Such similarities could be explained by the common origin of these tumours from intercalated ducts.
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Affiliation(s)
- G Chomette
- Department of Pathology, Hopital de la Pitié, Paris, France
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12
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Hamper K, Lazar F, Dietel M, Caselitz J, Berger J, Arps H, Falkmer U, Auer G, Seifert G. Prognostic factors for adenoid cystic carcinoma of the head and neck: a retrospective evaluation of 96 cases. J Oral Pathol Med 1990; 19:101-7. [PMID: 2160530 DOI: 10.1111/j.1600-0714.1990.tb00806.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cases of adenoid cystic carcinomas of the salivary (n = 90) and lacrimal glands (n = 6) from the years 1965-1980 were evaluated retrospectively with regard to clinical, epidemiologic and histomorphologic parameters, and in 52 cases, nuclear DNA content was assessed using a single cell scanning cytophotometry procedure in order to determine prognostic factors. Clinical courses were poor with a high incidence of recurrences, hematogenous metastases and deaths from tumor. Histology was related to prognosis, glandular tumors showing a better prognosis than solid ones. Tumor size greater than 4 cm was correlated with an unfavorable clinical course in all cases. Cytophotometry yielded various types of histograms (7 diploid, 10 proliferative, 14 triploid, 19 atypical, 2 tetraploid). Significant correlations were found as to the time of survival, tumors with diploid histograms showing the longest intervals and those with atypical ones the shortest. Although the prognosis of adenoid cystic carcinoma remains poor, cytophotometry can offer additional prognostic information in the individual case.
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Affiliation(s)
- K Hamper
- Institute of Pathology, University Hospital Hamburg-Eppendorf, W.Germany
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