Salivary duct carcinoma in the sinonasal tract

Salivary Duct Carcinoma Originated from the Inferior Turbinate: A Rare Case Report

Salivary duct carcinoma (SDC) is an uncommon but highly aggressive tumor with a poor prognosis. SDC mainly arises from the major salivary glands, typically the parotid gland. Here, we report a rare case of sinonasal SDC in a 54-year-old male patient that might have originated from the inferior turbinate. The patient presented with left nasal congestion and rhinorrhea. Following an endoscopic intervention, the histopathological examination revealed a diagnosis of SDC, characterized by the formation of solid cancer nests and central comedo-type necrosis. Given the highly aggressive nature and unfavorable prognosis of SDC, it is essential to consider it as a differential diagnosis for unilateral nasal tumors.

PAX-8 Expression in Salivary Duct Carcinoma

Salivary duct carcinoma (SDC) is a high-grade adenocarcinoma resembling breast ductal carcinoma. It accounts for ~10% of malignant tumors of the salivary glands. Most cases show expression of CK7 and androgen receptor. PAX-8 is a transcription factor, with expression reported in renal, Müllerian, and thyroid carcinomas. Previous studies have described an absence of PAX-8 immunostaining in most primary salivary gland neoplasms, including SDCs. However, PAX-8 expression is frequently found in neoplasms that can metastasize to salivary glands, suggesting the possibility that this protein can be used to differentiate SDC from secondary neoplastic involvement of the salivary gland. We evaluated the expression of PAX-8 in 14 cases of SDC from our institution. One case showed diffuse moderate to strong PAX-8 positivity, while 2 tumors showed focal weak staining. Therefore, we conclude that although the majority of SDC are negative for PAX-8, rare diffuse positivity can be seen in these primary salivary gland tumors. This could potentially pose difficulty in ruling out metastatic disease from another PAX-8-positive primary neoplasm.

Primary and Secondary/ Metastatic Salivary Duct Carcinoma Presenting within the Sinonasal Tract

Traditionally, sinonasal adenocarcinomas have been subdivided into intestinal (ITAC) and non-intestinal (non-ITAC) categories. The latter encompasses salivary-type adenocarcinomas originating from the seromucinous glands of the sinonasal mucosa and non-salivary adenocarcinomas. The non-salivary adenocarcinoma category is further subdivided into low-and high-grade variants. Among salivary-type sinonasal adenocarcinomas, tumors recapitulating salivary duct carcinoma (SDC) are exceedingly rare, but some might have been lumped into the high-grade non-ITAC category. To date, only three primary SDCs originating in the sinonasal tract have been reported. We herein describe 7 cases of SDC including one previously reported case (4 primary sinonasal, 3 metastatic/ extension from parotid gland SDC). The primary tumors affected 3 males and one female aged 60 - 75. Different sites were involved by the primary tumors while the secondary tumors affected the sphenoidal (2) and the frontal + maxillary (1) sinuses. Three primary tumors were de novo high-grade SDC and one was confined to contours of a pre-existing pleomorphic adenoma. All 3 secondary tumors were SDC ex pleomorphic adenoma of the parotid with a long history of recurrences, ultimately involving the sinonasal tract. Androgen receptor was positive in 7/7 cases. Four of 6 cases were strongly HER2/neu + (either score 3 + or with verified amplification). This small case series adds to the delineation of primary sinonasal SDC highlighting that almost half of invasive SDC presenting within sinonasal tract indeed represents extension or metastasis from a parotid gland primary. There is a tendency towards overrepresentation of HER2/neu-positive cases in both categories (primary and metastatic), but this needs clarification in larger studies.

Salivary duct carcinoma arising from the inferior turbinate

Salivary duct carcinoma (SDC) is an uncommon, aggressive tumour, which carries a poor prognosis. SDC affects the major salivary glands, usually occurring in the parotid gland. A 76-year-old male patient presented with right-sided nasal obstruction and rhinorrhoea. A polypoidal mass was seen in the right inferior turbinate mimicking a benign neoplasm. Histological examination following wide excision led to a diagnosis of SDC. There are no therapeutic guidelines and management is based on experience with SDC of the major salivary glands. Given the aggressive nature and poor prognosis of the disease, it is a rare but important differential to consider in patients with unilateral nasal mass.

Salivary duct carcinoma of the sinonasal cavity: A case report and review of the literature

BACKGROUND

Salivary duct carcinoma is a rare, aggressive tumor entity first described by Kleinsasser et al in 1968, as a group of malignant salivary gland tumors characterized by duct formation and central necrosis. A case with an unusual localization in the nasal cavity and maxillary sinus is being described in our report.

METHODS

A 60-year-old patient presented with difficulty of nasal breathing and recurrent episodes of epistaxis from the left nasal cavity over the previous 3 months. On endoscopy, a vulnerable lesion in the left inferior nasal meatus could be seen. Biopsy showed salivary duct carcinoma. Treatment consisted of tumor resection by means of a combined endoscopic-osteoplastic surgical approach to the maxillary sinus, bilateral neck dissection, partial parotidectomy, and adjuvant radiochemotherapy.

RESULTS

The patient is 6 months after completion of treatment and is free of disease.

CONCLUSION

As salivary duct carcinoma of the sinonasal tract is extremely rare, no therapeutic standards have been developed and treatment essentially is based upon experience with ductal adenocarcinoma of the salivary glands. Surgery therapy should be radical, aiming at eradicating locoregional disease with the role of adjuvant radiotherapy lying in the management of cases with negative prognostic factors. © 2016 Wiley Periodicals, Inc. Head Neck 38:E2464-E2466, 2016.

Intraoral salivary duct carcinoma: A case report and a brief review

Salivary duct carcinoma (SDC) is a rare, extremely aggressive malignancy arising in the ductal epithelium of the salivary glands. SDC occurs almost exclusively in the major salivary glands with parotid gland predominantly affected. Only isolated cases involving minor salivary glands have been reported in the literature. We report an unusual case of extensive SDC occupying the right cheek and the maxillary sinus, possibly arising from the minor glands of the buccal mucosa or from the mixed glands of the maxillary sinus in a 71-year-old man. The case was subjected to a panel of immunohistochemical markers like pan cytokeratin, low molecular weight cytokeratin (LMW CK), high molecular weight cytokeratin (HMW CK), CK 7, CK 20, CD 117, carcinoembryonic antigen (CEA), S-100, p63, Gross cystic disease fluid protein (GCDFP-15) and estrogen receptor (ER) to arrive at a definitive diagnosis.

Primary High-Grade Salivary-Type Duct Carcinoma of the Lung

Primary salivary gland–type lung cancers are a rare group of tumors. When they do occur, the most common type is adenoid cystic carcinoma, followed by mucoepidermoid carcinoma. Primary high-grade salivary-type duct carcinoma (HGSDC) arising in the lung has not been described. We report a case of primary pulmonary HGSDC in a 55-year-old woman who was referred to our hospital for a suspicious lung tumor. The chest computed tomography revealed a solid mass in the left upper lobe. A lobectomy was performed afterward, and the mass was a primary lung HGSDC. To the best of our knowledge, HGSDC arising in the lung has not been reported previously.

[Primary ductal adenocarcinoma near the orbit]

The case of a 59-year-old patient is described who presented with a left-sided pressure sensation in the left orbit and exophthalmus with a proud bulbus. The limited bulbus motility led to double vision. A preoperative MRI showed a space-occupying lesion in the left medial orbit. The morphological and immunohistochemical findings led to the diagnosis of a primary ductal carcinoma resembling salivary duct carcinoma (SDC). The tumor could be removed without compromising the eye. The patient suffers no side-effects or recurrences 12 months later.