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Ma TY, Wu J, He SZ, Wang XL, Yang GL, Zhang SJ, Zhou J, Ding YM, Li LF, Liu HF, Xuan LL, Chen XH. High-grade transformation of head and neck adenoid cystic carcinoma demonstrates distinctive clinicopathological features and an unfavorable prognosis: a matched case-control study of the largest series in China. Clin Transl Oncol 2024; 26:1338-1347. [PMID: 38097822 DOI: 10.1007/s12094-023-03357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 05/22/2024]
Abstract
PURPOSE Amidst the rarity of High-grade transformation (HGT) in adenoid cystic carcinoma (ACC), this study offers unprecedented insights into its aggressive nature and clinical implications. METHODS A 1:1 match comparison between 23 HGT patients and non-HGT counterparts was extracted from 412 ACC cases, focusing on dissecting distinctive clinicopathological features and prognostic outcomes. RESULTS The predominant sites of HGT were the sinonasal and lacrimal glands (30.4% each). Notably, the solid subtype was the most prevalent pattern within HGT, accounting for 69.6% of cases. Compared to non-HGT, the HGT cohort exhibited significantly higher rates of lymph node metastasis (39.1% vs. 8.7%; P < 0.05), perineural invasion (60.9% vs. 26.1%; P < 0.05), and increased Ki-67 proliferation index (35.0% vs. 10.0%; P < 0.05). Moreover, HGT regions typically showed reduced or absent p63 expression, along with high-grade pathomorphology. HGT was associated with increased recurrence (55.0%) and distant metastasis (78.3%), leading to an average survival of 35.9 months and a 3-years mortality rate of 35.0%. Overall and progression-free survival rates were significantly decreased in the HGT group. CONCLUSION This study represents the largest single-center cohort of HGT cases to our knowledge, highlighting its frequent occurrence in the sinonasal and lacrimal glands and association with poorer outcomes. The findings support classifying HGT in ACC as Grade 4, reflecting its severity.
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Affiliation(s)
- Ting-Yao Ma
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Jun Wu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Shi-Zhi He
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Xue-Lian Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Guo-Liang Yang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Shu-Jing Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Jin Zhou
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Yi-Ming Ding
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Li-Feng Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Hong-Fei Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Lan-Lan Xuan
- Department of Pathology, Anqing Medical Center, Anhui Medical University, Anqing Municipal Hospital, Anqing, 246003, People's Republic of China.
| | - Xiao-Hong Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China.
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Agha‐Hosseini F, Esmaili P, Yousefian M. A torus-like sublingual adenoid cystic carcinoma in a 35-year-old male: Review of literature and case report. Clin Case Rep 2023; 11:e7591. [PMID: 37476597 PMCID: PMC10354358 DOI: 10.1002/ccr3.7591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023] Open
Abstract
Key Clinical Message The case report describes an adenoid cystic carcinoma occurring at a rare location and the diagnostic pathway. Swellings of the floor of the mouth, whether painful or without subjective symptoms and regardless of consistency, should be taken seriously. Abstract Adenoid cystic carcinoma (ADCC) of the sublingual salivary gland only accounts for 2% of all ADCCs. In this study, we report a rare case of ADCC with sublingual salivary gland origin in a 35-year-old man and a comprehensive review of articles published over the past 62 years.
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Affiliation(s)
- Farzaneh Agha‐Hosseini
- Department of Oral and Maxillofacial Medicine, School of DentistryTehran University of Medical SciencesTehranIran
| | - Parnian Esmaili
- School of DentistryAlborz University of Medical SciencesKarajIran
| | - Marzieh Yousefian
- Department of Oral and Maxillofacial Medicine, School of DentistryAlborz University of Medical SciencesKarajIran
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3
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Xu F, Jiang M, Tang Q, Lin J, Liu X, Zhang C, Zhao J, He Y, Dong L, Zhu L, Lin T. MiR-29a-3p inhibits high-grade transformation and epithelial-mesenchymal transition of lacrimal gland adenoid cystic carcinoma by targeting Quaking. Mol Biol Rep 2023; 50:2305-2316. [PMID: 36575320 DOI: 10.1007/s11033-022-08150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Lacrimal adenoid cystic carcinoma (LACC) is the most common orbital malignant epithelial neoplasm. LACC with high-grade transformation (LACC-HGT) has higher rates of recurrence, metastasis, and mortality than LACC without HGT. This study investigated the effects of microRNA-29a-3p (miR-29a-3p) in the pathogenesis of LACC-HGT. METHODS An Agilent human miRNA microarray was used to screen the differentially expressed miRNAs (DEMs) in LACC and LACC-HGT tumor tissues. Then, the primary cells obtained in previous studies were used to determine the effect of miR-29a-3p. RESULTS The expression of miR-29a-3p was abnormally lower in LACC-HGT than in LACC. miR-29a-3p can specifically target the 3' UTR of Quaking mRNA and down-regulate Quaking expression, thereby inhibiting the proliferation, migration, and epithelial-mesenchymal transition of LACC cells. CONCLUSIONS This study illustrated that miR-29a-3p functions as a tumor suppressor by down-regulating the expression of Quaking to inhibit the tumorigenesis of LACC cells. This study may also reveal the pathogenesis of HGT in LACC cells and provide a reference for LACC-HGT targeted diagnosis.
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Affiliation(s)
- Fei Xu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China
| | - Meixia Jiang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology &Visual Sciences, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Qin Tang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China
| | - Jiaqi Lin
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China
| | - Xun Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China
| | - Chuanli Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China
| | - Jinzhi Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China
| | - Yanjin He
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China
| | - Lijie Dong
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China.
| | - Limin Zhu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China.
| | - Tingting Lin
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, People's Republic of China.
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Shah SA, Parikh L, Solanki R, Bhojani J, Gohil R. Lacrimal Gland Adenoid Cystic Carcinoma with High Grade Transformation: A Case Report and Current Concepts in Multi Modality Management. Indian J Otolaryngol Head Neck Surg 2022; 74:2599-2606. [PMID: 36452811 PMCID: PMC9702296 DOI: 10.1007/s12070-020-02277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022] Open
Abstract
Lacrimal gland adenoid cystic carcinoma (AdCC) is associated with an aggressive clinical course and grave prognosis. A high grade transformation within adenoid cystic carcinoma of lacrimal gland is a rare condition which is even more locally aggressive with frequent neck and distant metastasis. We present a case of left lacrimal gland adenoid cystic carcinoma with high grade transformation to adenocarcinoma NOS type presenting with orbital pain and proptosis. After thorough evaluation for locoregional and distant spread of the disease, the patient underwent left orbital exenteration with orbitectomy and neck dissection with free flap reconstruction. Patient received adjuvant radiation therapy and is presently disease free for last 6 months. A multi-modality management protocol involving surgery, radiotherapy and chemotherapy has been proposed for management of lacrimal gland AdCC with high grade transformation. We report the 4th case in the literature of lacrimal gland adenoid cystic carcinoma with high grade transformation.
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Affiliation(s)
- Siddharth A. Shah
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Loma Parikh
- Department of Histo-Pathology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat India
| | - Raghuvir Solanki
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Jatin Bhojani
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Raviraj Gohil
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
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5
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Wang Y, Sun B, Zhang C, Xia R, Sun J, Gu T, Tian Z, Li J. Genetic heterogeneity and therapeutic target detection through microdissection in solid-type adenoid cystic carcinoma. Pathology 2022; 54:580-590. [PMID: 35337667 DOI: 10.1016/j.pathol.2021.12.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022]
Abstract
Solid-type adenoid cystic carcinomas (ACCs) are highly aggressive and heterogeneous tumours. Because of their rarity, therapeutic strategies guided by genetic profiles based on next generation sequencing (NGS) have not been published for these tumours. Forty-nine solid-type ACCs including 43 tumours with a predominantly solid pattern, and six tumours comprising a roughly equal mixture of cribriform/tubular and solid histological forms were included in our study. The solid components from the 49 solid ACCs were enriched for mutations of genes in the NOTCH pathway (NOTCH1 61%, SPEN 24%) and chromatin remodelling pathway and the absence of myoepithelial cell differentiation. Cases with NOTCH1 mutations exhibited strong NICD expression, which was associated with poor overall and distant metastasis free survival. BRCA2 mutation and BCOR/BCORL1 mutations were observed in 20% and 18.4% of solid ACCs, respectively. In six of the solid ACCs, intratumour heterogeneity was delineated between the cribriform/tubular and solid components. NOTCH1 and FGFR2 mutations as well as NOTCH2 amplification were restricted to the solid component, indicating clonal selection within the same tumour. In two recurrent/metastatic solid ACCs, the subclones evolved in progression for local relapse and distant metastasis, although they manifested close genomic resemblance to primary tumours. Guided by the genetic profiles, the preclinical efficiency of the gamma-secretase inhibitor BMS-906024 was evaluated in patient derived xenograft models (PDXs) with activating NOTCH1 mutations and demonstrated robust antitumour effects. Our report revealed intratumour heterogeneity among solid-types within an ACC as well as the inter-tumour evolution of dominant clones among two primary and recurrent/metastatic tumours. In contrast to cribriform/tubular ACCs, solid-type ACCs should be approached with a distinct therapeutic strategy, particularly targeting NOTCH1. Microdissecting the highest grade component guided by histology is a highly recommended tumour sampling strategy and facilitates the detection of key molecular targets.
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Affiliation(s)
- Yu Wang
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Bao Sun
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Chunye Zhang
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Ronghui Xia
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jingjing Sun
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Ting Gu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zhen Tian
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Jiang Li
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Centre for Stomatology, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China.
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6
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Lv JJ, Ren M, Cai X, Hu J, Kong JC, Kong YY. Primary cutaneous adenoid cystic carcinoma: a clinicopathologic, immunohistochemical, and fluorescence in-situ hybridisation study of 13 cases. Histopathology 2021; 80:407-419. [PMID: 34519081 DOI: 10.1111/his.14565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023]
Abstract
AIMS This study aimed to investigate the clinical, histological, immunohistochemical and chromosomal features of primary cutaneous adenoid cystic carcinoma (PCACC). METHODS AND RESULTS We retrospectively analysed 13 cases identified on their clinicopathological features and performed fluorescence in-situ hybridisation (FISH) on six available cases. Head and neck (46.2%) were most commonly involved. The median age was 53 years, with a male predilection. Histologically, tumours were classified as grades 1 (eight), 2 (four) and 3 with high-grade transformation (HGT) (one). The HGT component was demonstrated as poorly differentiated carcinoma with multifocal necrosis and myoepithelial differentiation. Patients with one of the following factors: longest diameter of the lesion (≥ 1 cm), involvement of subcutaneous fat tissue and widely infiltrative border had a relatively higher rate of local recurrence, distant metastasis and death. Five of six cases were confirmed to have MYB translocation, while nuclear staining for MYB proto-oncogene, transcription factor (MYB) protein was found in four cases. During the follow-up (median = 64 months), two patients experienced local recurrences. One patient, who was classified as grade III PCACC with HGT, developed multiple metastases and died of disease. Another patient was alive with multiple metastases. CONCLUSIONS This is the largest single-institution study, to our knowledge, of PCACC in an Asian population. We describe the first case of scalp PCACC with HGT, which is the only death case in our series. PCACC tends to recur locally and has metastatic potential. PCACC with HGT has a poor prognosis.
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Affiliation(s)
- Jiao-Jie Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jue Hu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Cheng Kong
- Department of Pathology, First People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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High-grade Transformation/Dedifferentiation in Salivary Gland Carcinomas: Occurrence Across Subtypes and Clinical Significance. Adv Anat Pathol 2021; 28:107-118. [PMID: 33825717 DOI: 10.1097/pap.0000000000000298] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
High-grade transformation (HGT) or dedifferentiation has been described in a variety of salivary gland carcinomas, including acinic cell carcinoma, secretory carcinoma, adenoid cystic carcinoma, epithelial-myoepithelial carcinoma, polymorphous adenocarcinoma, low-grade mucoepidermoid carcinoma, and hyalinizing clear cell carcinoma. High-grade (HG) transformed tumors are composed of a conventional low-grade component characterized by specific microscopic and immunohistochemical features for the given entity, intermingled with or juxtaposed to areas of HG morphology. This is usually either poorly differentiated adenocarcinoma, carcinoma not otherwise specified, or undifferentiated carcinoma, in which the original line of differentiation is lost. The HG component is composed of solid nests of anaplastic cells with large vesicular pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. Frequent mitoses and extensive necrosis may be present. The Ki-67 labeling index is consistently higher in the HG component. The molecular genetic mechanisms responsible for HGT of salivary gland carcinomas are largely unknown, though p53 inactivation and human epidermal growth factor receptor 2 overexpression and/or gene amplification have been demonstrated in the HG component in a few examples, the frequency varies for each histologic type. Salivary gland carcinomas with HGT are more aggressive than conventional carcinomas, with a higher local recurrence rate and a poorer prognosis. They have a high propensity for cervical lymph node metastasis suggesting a need for a wider resection and neck dissection. HGT of salivary gland carcinoma can occur either at initial presentation or less commonly at the time of recurrence, sometimes following postoperative radiotherapy. The potential for HGT in almost any type of salivary gland carcinoma warrants a thorough sampling of all salivary gland malignancies to prevent oversight of a HG component.
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8
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Chia N, Petersson F. Adenoid cystic carcinoma with dedifferentiation/expansion of the luminal cell component and preserved biphasic morphology - Early high-grade transformation. Ann Diagn Pathol 2020; 50:151650. [PMID: 33254086 DOI: 10.1016/j.anndiagpath.2020.151650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022]
Abstract
We present two patients (29 and 67 years) with histomorphologic and immunohistochemical evidence of early high-grade transformation of adenoid cystic carcinoma in the nasal cavity and floor of mouth, respectively. The component of early high-grade transformation was characterized by 1) selective expansion of the luminal (CK7+, c-kit+, p63-) cell component with severe cytologic atypia and significantly increased Ki-67 proliferation index, and 2) retained albeit attenuated abluminal (CK7-, c-kit-, p63+) cells, surrounding nests of high-grade luminal cells.
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Affiliation(s)
- Noel Chia
- Department of Pathology, National University Hospital, Singapore, 5 Lower Kent Ridge Road, Main Building Level 3, S(119074)
| | - Fredrik Petersson
- Department of Pathology, National University Hospital, Singapore, 5 Lower Kent Ridge Road, Main Building Level 3, S(119074).
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Adenoid Cystic Carcinoma with Transformation to High Grade Carcinomatous and Sarcomatoid Components: A Rare Case Report with Review of Literature. Head Neck Pathol 2020; 14:1094-1104. [PMID: 31898057 PMCID: PMC7669942 DOI: 10.1007/s12105-019-01120-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022]
Abstract
Adenoid cystic carcinoma (AdCC) comprises of less than 1% of all head and neck cancers and less than 10% of all salivary gland neoplasms. Dedifferentiation/high-grade transformation (HGT) in AdCC is a rare but well known phenomenon which is associated with aggressive clinical behaviour and poor prognosis. We herein report the clinical, cytologic, histologic and immunohistochemical findings of a left submandibular gland AdCC with transformation to high grade carcinomatous and probable dedifferentiation to sarcomatoid component, occurring in a 64 year old male patient. To the author's best knowledge, this is the first case report of such dual transformation occurring in adenoid cystic carcinoma.
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Miyazaki M, Aoki M, Koga K, Hamasaki M, Sugiyama Y, Midorikawa K, Hamatake D, Masaki M, Takamatsu Y, Iwasaki A, Sakata T, Nagao T, Nabeshima K. Adenoid cystic carcinoma with high-grade transformation forming spindle cell component of the submandibular gland. Auris Nasus Larynx 2019; 46:934-939. [PMID: 30777403 DOI: 10.1016/j.anl.2019.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 01/22/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
Adenoid cystic carcinoma (AdCC) with high-grade transformation (AdCC-HGT) is rare, and AdCC-HGT with spindle cell component is particularly rare. The patient was a 65-year-old man with a 5 cm sized swelling of the right submandibular gland. Submandibular sialoadenectomy was performed. Histopathological findings mainly showed conventional AdCC, and minorly showed two other components: (1) the pleomorphic component, a proliferation of atypical pleomorphic epithelial cells forming solid or small clusters and accompanied by necrosis; (2) the spindle cell component, containing atypical spindle cells invading the stroma. Postoperative chemoradiotherapy was performed. Multiple right lung nodular lesions were found on the contrast-enhanced chest CT one month after the surgery. Thoracoscopic pulmonary resection was performed. The lung tumors exhibited a proliferation of atypical spindle cells, accompanied by necrosis. We considered that the spindle cell component of the AdCC-HGT of the submandibular gland developed lung metastases. The patient died seven months after submandibular sialoadenectomy due to respiratory failure. Although rare, our case highlights the importance of recognising spindle cell components in conventional AdCC; even if the area is small, these high-grade transformation areas can metastasise and become prognostic factors.
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Affiliation(s)
- Masaru Miyazaki
- Department of Pathology, Fukuoka University, School of Medicine, Japan; Department of Otorhinolaryngology and Head & Neck Surgery, Fukuoka University, School of Medicine, Japan
| | - Mikiko Aoki
- Department of Pathology, Fukuoka University, School of Medicine, Japan.
| | - Kaori Koga
- Department of Pathology, Fukuoka University, School of Medicine, Japan
| | - Makoto Hamasaki
- Department of Pathology, Fukuoka University, School of Medicine, Japan
| | - Yoshikazu Sugiyama
- Department of Otorhinolaryngology and Head & Neck Surgery, Fukuoka University, School of Medicine, Japan
| | - Kensuke Midorikawa
- Department of Thoracic, Breast, Endocrine, and Pediatric Surgery, Fukuoka University, School of Medicine, Japan
| | - Daisuke Hamatake
- Department of Thoracic, Breast, Endocrine, and Pediatric Surgery, Fukuoka University, School of Medicine, Japan
| | - Michio Masaki
- Department of Medical Oncology, Hematology and Infectious Diseases, Fukuoka University, School of Medicine, Japan
| | - Yasushi Takamatsu
- Department of Medical Oncology, Hematology and Infectious Diseases, Fukuoka University, School of Medicine, Japan
| | - Akinori Iwasaki
- Department of Thoracic, Breast, Endocrine, and Pediatric Surgery, Fukuoka University, School of Medicine, Japan
| | - Toshifumi Sakata
- Department of Otorhinolaryngology and Head & Neck Surgery, Fukuoka University, School of Medicine, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, School of Medicine, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University, School of Medicine, Japan
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11
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Song JY. Adenoid cystic carcinoma of the sublingual gland: A case report. Imaging Sci Dent 2016; 46:291-296. [PMID: 28035309 PMCID: PMC5192029 DOI: 10.5624/isd.2016.46.4.291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/13/2016] [Accepted: 07/27/2016] [Indexed: 11/18/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the sublingual gland is an extremely rare neoplasm. The clinicopathological characteristics of ACC are slow-growing swelling with or without ulceration, perineural spread, local recurrence, and distant metastasis. This report describes a 58-year-old male who had a slowly growing swelling without ulceration on the right side of the mouth floor that had been present for 1 month. In a radiological examination, the mass showed multilocular cystic features and no bony or tongue muscle invasion. No enlarged cervical lymph nodes were detected. Excisional biopsy and histological analysis showed that the lesion was ACC. In addition to reporting a rare case of ACC, this report also discusses the differential diagnosis and treatment of ACC with a review of the relevant literature.
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Affiliation(s)
- Ji-Young Song
- Department of Oral and Maxillofacial Surgery, School of Medicine, Jeju National University, Jeju, Korea
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12
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Hellquist H, Skalova A, Azadeh B. Salivary gland hybrid tumour revisited: could they represent high-grade transformation in a low-grade neoplasm? Virchows Arch 2016; 469:643-650. [PMID: 27605055 DOI: 10.1007/s00428-016-2018-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/27/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022]
Abstract
Salivary gland hybrid tumour, first described in 1996, is a very rare neoplasm for which exact morphological criteria have not been universally agreed upon. In contrast, the concept of high-grade transformation (HGT) in salivary neoplasms has been widely accepted during the last decade, and the number of reported cases is rapidly increasing. A review of the literature revealed 38 cases of hybrid tumour reported in 22 publications. During approximately the same time period, well over 100 cases of HGT in salivary neoplasms have been reported. There are important histological similarities between hybrid tumours and salivary tumours with HGT. In the latter, containing one tumour component of low-grade malignancy and the other of high grade, the two tumour components are not entirely separated and appear to originate in the same area. Virtually, all cases reported as hybrid tumour had no clear lines of demarcation between the two tumour types. We are inclined to suggest that most of the 38 cases of hybrid tumours described in the literature would today better be called tumour with HGT rather than hybrid tumour. The relative proportion of the two components may vary, and the high-grade component is sometimes very small, which emphasises the importance of very generous sampling of the surgical specimen. The molecular genetic mechanisms responsible for HGT, including what used to be called hybrid tumour, remain largely unknown. Abnormalities of a few genes (including p53, C-MYC, cyclin D1, HER-2/neu) have been documented. As insufficient data exist on gene abnormalities in these lesions, conclusions as to whether or not they have a common origin and which mechanisms are involved in transformation cannot be drawn. Due to the small number of cases reported, many of which lack follow-up details; indicators of prognosis of hybrid tumours are not available, but their behaviour seems to be similar to that of tumours with HGT, i.e. an accelerated aggressive course. HGT of salivary gland neoplasms greatly influences macroscopic and microscopic evaluation of the specimen but also, given the high incidence of metastases and morbidity, carries significant treatment implications.
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Affiliation(s)
- Henrik Hellquist
- Department of Biomedical Sciences and Medicine, University of Algarve, Campus de Gambelas, 8005-139, Faro, Portugal.
| | - Alena Skalova
- Department of Pathology, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic
| | - Bahram Azadeh
- Department of Pathology, Glan Clwyd Hospital, Rhyl, UK
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13
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Hellquist H, Skálová A, Barnes L, Cardesa A, Thompson LDR, Triantafyllou A, Williams MD, Devaney KO, Gnepp DR, Bishop JA, Wenig BM, Suárez C, Rodrigo JP, Coca-Pelaz A, Strojan P, Shah JP, Hamoir M, Bradley PJ, Silver CE, Slootweg PJ, Vander Poorten V, Teymoortash A, Medina JE, Robbins KT, Pitman KT, Kowalski LP, de Bree R, Mendenhall WM, Eloy JA, Takes RP, Rinaldo A, Ferlito A. Cervical Lymph Node Metastasis in High-Grade Transformation of Head and Neck Adenoid Cystic Carcinoma: A Collective International Review. Adv Ther 2016; 33:357-68. [PMID: 26895332 PMCID: PMC4833802 DOI: 10.1007/s12325-016-0298-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 12/11/2022]
Abstract
Adenoid cystic carcinoma (AdCC) is among the most common malignant tumors of the salivary glands. It is characterized by a prolonged clinical course, with frequent local recurrences, late onset of metastases and fatal outcome. High-grade transformation (HGT) is an uncommon phenomenon among salivary carcinomas and is associated with increased tumor aggressiveness. In AdCC with high-grade transformation (AdCC–HGT), the clinical course deviates from the natural history of AdCC. It tends to be accelerated, with a high propensity for lymph node metastasis. In order to shed light on this rare event and, in particular, on treatment implications, we undertook this review: searching for all published cases of AdCC-HGT. We conclude that it is mandatory to perform elective neck dissection in patients with AdCC-HGT, due to the high risk of lymph node metastases associated with transformation.
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Affiliation(s)
- Henrik Hellquist
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic
| | - Leon Barnes
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Antonio Cardesa
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Asterios Triantafyllou
- Oral and Maxillofacial Pathology, School of Dentistry, University of Liverpool and Cellular Pathology, Liverpool Clinical Laboratories, Liverpool, UK
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Douglas R Gnepp
- University Pathologists, Providence, RI, USA
- University Pathologists, Fall River, MA, USA
| | - Justin A Bishop
- Departments of Pathology and Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bruce M Wenig
- Department of Pathology, Beth Israel Medical Center, New York, NY, USA
| | - Carlos Suárez
- Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Jatin P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Patrick J Bradley
- Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
- European Salivary Gland Society, Geneva, Switzerland
| | - Carl E Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Pieter J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Afshin Teymoortash
- Department of Otolaryngology-Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Jesus E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Karen T Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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An oncogenic MYB feedback loop drives alternate cell fates in adenoid cystic carcinoma. Nat Genet 2016; 48:265-72. [PMID: 26829750 PMCID: PMC4767593 DOI: 10.1038/ng.3502] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 01/06/2016] [Indexed: 12/11/2022]
Abstract
Translocation events are frequent in cancer and may create chimeric fusions or ‘regulatory rearrangements’ that drive oncogene overexpression. Here we identify super-enhancer translocations that drive overexpression of the oncogenic transcription factor MYB as a recurrent theme in adenoid cystic carcinoma (ACC). Whole-genome sequencing data and chromatin maps reveal distinct chromosomal rearrangements that juxtapose super-enhancers to the MYB locus. Chromosome conformation capture confirms that the translocated enhancers interact with the MYB promoter. Remarkably, MYB protein binds to the translocated enhancers, creating a positive feedback loop that sustains its expression. MYB also binds enhancers that drive different regulatory programs in alternate cell lineages in ACC, cooperating with TP63 in myoepithelial cells and a Notch program in luminal epithelial cells. Bromodomain inhibitors slow tumor growth in ACC primagraft models in vivo. Thus, our study identifies super-enhancer translocations that drive MYB expression and provides insight into downstream MYB functions in the alternate ACC lineages.
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15
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Sepúlveda I, Platin E, Delgado C, Rojas P. Sinonasal Adenoid Cystic Carcinoma with Intracranial Invasion and Perineural Spread: A Case Report and Review of the Literature. J Clin Imaging Sci 2015; 5:57. [PMID: 26664774 PMCID: PMC4647119 DOI: 10.4103/2156-7514.168710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/13/2015] [Indexed: 11/24/2022] Open
Abstract
We present the case of a 51-year-old patient with sinonasal adenoid cystic carcinoma (SACC). Computed tomography (CT) and magnetic resonance imaging (MRI) exams revealed an expansive process in the right nostril accompanied with perineural spread and invasion to the floor of the middle cranial fossa. Due to the size of the tumor and brain involvement, the Head and Neck Tumor Board (HNTB) recommended radiochemotherapy treatment to decrease the size of the lesion. Presently, the patient is undergoing treatment without major complications.
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Affiliation(s)
- Ilson Sepúlveda
- Department of ENT-Head and Neck Surgery Service, General Hospital of Concepcion, Santiago, Chile ; Department of Oral and Maxillofacial Radiology, Finis Terrae University School of Dentistry, Santiago, Chile
| | - Enrique Platin
- Department of Oral and Maxillofacial Radiology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Carolina Delgado
- Department of Pathology, General Hospital of Concepción, University of Concepcion School of Medicine, Concepcion, Chile
| | - Pablo Rojas
- Department of ENT-Head and Neck Surgery Service, General Hospital of Concepcion, Santiago, Chile
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High-Grade Transformation (“Dedifferentiation”)—Malignant Progression of Salivary Gland Neoplasms, Including Carcinoma ex Pleomorphic Adenoma. AJSP-REVIEWS AND REPORTS 2015. [DOI: 10.1097/pcr.0000000000000076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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High grade transformation in a case of adenoid cystic carcinoma associated with Epstein-Barr virus expression. Pathology 2014; 45:693-5. [PMID: 24247629 DOI: 10.1097/pat.0000000000000012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Analysis of MYB oncogene in transformed adenoid cystic carcinomas reveals distinct pathways of tumor progression. J Transl Med 2014; 94:692-702. [PMID: 24732452 DOI: 10.1038/labinvest.2014.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/20/2014] [Accepted: 03/06/2014] [Indexed: 11/09/2022] Open
Abstract
Adenoid cystic carcinomas can occasionally undergo dedifferentiation, a phenomenon also referred to as high-grade transformation. However, cases of adenoid cystic carcinomas have been described showing transformation to adenocarcinomas that are not poorly differentiated, indicating that high-grade transformation may not necessarily reflect a more advanced stage of tumor progression, but rather a transformation to another histological form, which may encompass a wide spectrum of carcinomas in terms of aggressiveness. The aim of this study was to gain more insight in the biology of this pathological phenomenon by means of genetic profiling of both histological components. Using microarray comparative genomic hybridization, we compared the genome-wide DNA copy-number changes of the conventional and transformed area of eight adenoid cystic carcinomas with high-grade transformation, comprising four with transformation into moderately differentiated adenocarcinomas and four into poorly differentiated carcinomas. In general, the poorly differentiated carcinoma cases showed a higher total number of copy-number changes than the moderately differentiated adenocarcinoma cases, and this correlated with a worse clinical course. Special attention was given to chromosomal translocation and protein expression of MYB, recently being considered to be an early and major oncogenic event in adenoid cystic carcinomas. Our data showed that the process of high-grade transformation is not always accompanied by an accumulation of genetic alterations; both conventional and transformed components harbored unique genetic alterations, which indicate a parallel progression. Our data further demonstrated that the MYB/NFIB translocation is not necessarily an early event or fundamental for the progression to adenoid cystic carcinoma with high-grade transformation.
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19
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Thompson LDR, Penner C, Ho NJ, Foss RD, Miettinen M, Wieneke JA, Moskaluk CA, Stelow EB. Sinonasal tract and nasopharyngeal adenoid cystic carcinoma: a clinicopathologic and immunophenotypic study of 86 cases. Head Neck Pathol 2013; 8:88-109. [PMID: 24037641 PMCID: PMC3950387 DOI: 10.1007/s12105-013-0487-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
Primary sinonasal tract and nasopharyngeal adenoid cystic carcinomas (STACC) are uncommon tumors that are frequently misclassified, resulting in inappropriate clinical management. Eighty-six cases of STACC included 45 females and 41 males, aged 12-91 years (mean 54.4 years). Patients presented most frequently with obstructive symptoms (n = 54), followed by epistaxis (n = 23), auditory symptoms (n = 12), nerve symptoms (n = 11), nasal discharge (n = 11), and/or visual symptoms (n = 10), present for a mean of 18.2 months. The tumors involved the nasal cavity alone (n = 25), nasopharynx alone (n = 13), maxillary sinus alone (n = 4), or a combination of the nasal cavity and paranasal sinuses (n = 44), with a mean size of 3.7 cm. Patients presented equally between low and high stage disease: stage I and II (n = 42) or stage III and IV (n = 44) disease. Histologically, the tumors were invasive (bone: n = 66; neural: n = 47; lymphovascular: n = 33), composed of a variety of growth patterns, including cribriform (n = 33), tubular (n = 16), and solid (n = 9), although frequently a combination of these patterns was seen within a single tumor. Pleomorphism was mild with an intermediate N:C ratio in cells containing hyperchromatic nuclei. Reduplicated basement membrane and glycosaminoglycan material was commonly seen. Necrosis (n = 16) and atypical mitotic figures (n = 11) were infrequently present. Pleomorphic adenoma was present in 9 cases; de-differentiation was seen in two patients. Immunohistochemical studies showed positive reactions for pan-cytokeratin, CK7, CK5/6, CAM5.2, and EMA, with myoepithelial reactivity with SMA, p63, calponin, S100 protein and SMMHC. CD117, CEA, GFAP and p16 were variably present. CK20 and HR HPV were negative. STACC needs to be considered in the differential diagnosis of most sinonasal malignancies, particularly poorly differentiated carcinoma, olfactory neuroblastoma and pleomorphic adenoma. Surgery (n = 82), often accompanied by radiation therapy (n = 36), was generally employed. A majority of patients developed a recurrence (n = 52) 2-144 months after initial presentation. Overall mean follow-up was 19.4 years (range 0.4-37.5 years): 46 patients died with disease (mean 6.4 years); 5 were alive with disease (mean 5.4 years), and 35 patients were either alive or had died of unrelated causes (mean 16.3 years). ACC of the SNT is uncommon. Recurrences are common. The following parameters, when present, suggest an increased incidence of either recurrence or dying with disease: mixed site of involvement, high stage disease (stage IV), skull base involvement, tumor recurrence, a solid histology, perineural invasion, bone invasion, and lymphovascular invasion.
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Affiliation(s)
- Lester D. R. Thompson
- grid.417224.6Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
| | - Carla Penner
- grid.21613.370000000419369609Department of Pathology, Health Sciences Centre and Faculty of Dentistry, University of Manitoba, Winnipeg, MB Canada
| | - Ngoc J. Ho
- grid.280062.e0000000099577758Southern California Permanente Medical Group, Pasadena, CA USA
| | - Robert D. Foss
- grid.414467.40000000105606544Naval Postgraduate Dental School, Bethesda, MD USA
| | - Markku Miettinen
- grid.94365.3d0000000122975165National Institutes of Health, Bethesda, MD USA
| | | | | | - Edward B. Stelow
- grid.27755.32000000009136933XUniversity of Virginia, Charlottesville, VA USA
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Sayar H, Sarıoğlu S, Bakariş S, Yıldırım I, Oztarakçı H. High-grade transformation of adenoid cystic carcinoma delineated with a fibrous rim: a case report. Balkan Med J 2013; 30:333-6. [PMID: 25207133 DOI: 10.5152/balkanmedj.2013.7220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 04/10/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND High-grade transformation or dedifferentiation in carcinoma is progression of a low-grade malignant neoplasm to a high-grade carcinoma or poorly differentiated adenocarcinoma. This is rarely observed in adenoid cystic carcinoma of the salivary glands. CASE REPORT A 39 year-old woman presented with a painless mass at the left submandibulary region that had been growing slowly for 5 years. Submandibulary mass resection revealed a mass with peripheral adenoid cystic carcinoma and a central high-grade tumor delineated with a fibrous rim, raising the possibility of a hybrid or composite carcinoma, requiring differential diagnosis depending upon morphology and immunohistochemistry findings. The final histopathological diagnosis was high-grade transformation of adenoid cystic carcinoma. After surgical therapy, the patient was irradiated to the neck and submandibulary region. No sign of tumor recurrence has been evident for 36 months. CONCLUSION This present case seems to be another rare case with high-grade transformation of adenoid cystic carcinoma and the fibrous rim may be a histopathological feature of such cases, which should be kept in mind.
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Affiliation(s)
- Hamide Sayar
- Department of Pathology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Sülen Sarıoğlu
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sevgi Bakariş
- Department of Pathology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Ilhami Yıldırım
- Department of Otolaryngology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Hüseyin Oztarakçı
- Department of Otolaryngology, Necip Fazıl Şehir State Hospital, Kahramanmaraş, Turkey
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Ishida M, Okabe H. Dedifferentiated adenoid cystic carcinoma of the trachea: a case report with respect to the immunohistochemical analyses of mammalian target of rapamycin pathway proteins. Hum Pathol 2013; 44:1700-3. [DOI: 10.1016/j.humpath.2012.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/16/2012] [Accepted: 12/19/2012] [Indexed: 12/01/2022]
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Nagao T. "Dedifferentiation" and high-grade transformation in salivary gland carcinomas. Head Neck Pathol 2013; 7 Suppl 1:S37-47. [PMID: 23821210 PMCID: PMC3712099 DOI: 10.1007/s12105-013-0458-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/08/2013] [Indexed: 12/21/2022]
Abstract
"Dedifferentiation" and/or high-grade transformation (HGT) has been described in a variety of salivary gland carcinomas, including acinic cell carcinoma, adenoid cystic carcinoma, epithelial-myoepithelial carcinoma, polymorphous low-grade adenocarcinoma, myoepithelial carcinoma, low-grade mucoepidermoid carcinoma and hyalinizing clear cell carcinoma, although the phenomenon is a rare event. Recent authors tend to preferably use the term HGT instead of "dedifferentiation" in these cases. HGT-tumors are composed of conventional carcinomas juxtaposed with areas of HG morphology, usually either poorly differentiated adenocarcinoma or "undifferentiated" carcinoma, in which the original line of differentiation is no longer evident. The HG component is generally composed of solid nests, sometimes occurring in cribriform pattern of anaplastic cells with large vesicular pleomorphic nuclei, prominent nucleoli and abundant cytoplasm. Frequent mitoses and extensive necrosis is evident. The Ki-67 labeling index is consistently higher in the HG component. p53 abnormalities have been demonstrated in the transformed component in a few examples, but the frequency varies by the histologic type. HER-2/neu overexpression and/or gene amplification is considerably exceptional. The molecular-genetic mechanisms responsible for the pathway of HGT in salivary gland carcinomas largely still remain to be elucidated. Salivary gland carcinomas with HGT have been shown to be more aggressive than conventional carcinomas with a poorer prognosis, accompanied by higher local recurrence rate and propensity for cervical lymph node metastasis, suggesting the need for wider resection and neck dissection.
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Affiliation(s)
- Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
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23
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Kusafuka K, Miki T, Nakajima T. Salivary adenoid cystic carcinoma with an early phase of high-grade transformation: case report with an immunohistochemical analysis. Diagn Pathol 2013; 8:113. [PMID: 23819679 PMCID: PMC3737055 DOI: 10.1186/1746-1596-8-113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The early phase of salivary gland carcinomas with high-grade transformation (HGT) is extremely rare. We reported one case of adenoid cystic carcinoma (AdCC) with early HGT, herein. CASE PRESENTATION The patient was a 27-year-old Japanese woman who suffered from swelling of the left parotid region. Most of this tumor consisted of typical AdCC histology, whereas the central area of this tumor was composed of solid growth component by atypical cells with clear cytoplasm and marked nuclear atypia. Immunohistochemically, this area was strongly and diffusely positive for epithelial membrane antigen, p53, p16, Her-2, cyclin A and cyclin B1. The Ki-67 labeling index of this area was high, entirely different from that of AdCC area. CONCLUSION Overall, this area was an early phase of AdCC-HGT. This case is the second case of early AdCC-HGT. We discuss the development of salivary gland carcinoma with HGT. VIRTUAL SLIDES http://www.diagnosticpatology.diagnomx.eu/vx/1598278104895730.
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Affiliation(s)
- Kimihide Kusafuka
- Pathology Division, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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Yanagi Y, Matsuzaki H, Katase N, Onoda T, Hara M, Unetsubo T, Nagatsuka H, Asaumi JI. Imaging features of adenoid cystic carcinoma of the tongue with dedifferentiated components: a case report. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0097-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Argyris PP, Pambuccian SE, Cayci Z, Singh C, Tosios KI, Koutlas IG. Lacrimal gland adenoid cystic carcinoma with high-grade transformation to myoepithelial carcinoma: report of a case and review of literature. Head Neck Pathol 2012; 7:85-92. [PMID: 22829347 PMCID: PMC3597153 DOI: 10.1007/s12105-012-0383-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/29/2012] [Indexed: 11/28/2022]
Abstract
Adenoid cystic carcinoma (AdCC) is the most frequent malignant neoplasm of the lacrimal glands. Like its salivary gland counterpart, lacrimal AdCC can rarely undergo high-grade transformation ("dedifferentiation"). We herein report the clinical, radiographic and microscopic findings of a lacrimal gland AdCC with high grade transformation, occurring in a 39-year-old female patient. In contrast to salivary gland AdCC with high-grade transformation, which usually shows a high grade component with "ductal" differentiation, in the case presented, the "dedifferentiated" component showed morphologic and immunohistochemical features of myoepithelial differentiation.
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Affiliation(s)
- Prokopios P. Argyris
- />Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefan E. Pambuccian
- />Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN USA
| | - Zuzan Cayci
- />Department of Diagnostic Radiology, University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN USA
| | - Charanjeet Singh
- />Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN USA
| | - Konstantinos I. Tosios
- />Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis G. Koutlas
- />Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, 515 Delaware Street, SE 16-206B, Minneapolis, MN USA
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26
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Hussaini HM, Angel CM, Speight PM, Firth NA, Rich AM. A double-clear variant of epithelial-myoepithelial carcinoma of the parotid gland. Head Neck Pathol 2012; 6:471-5. [PMID: 22427262 PMCID: PMC3500893 DOI: 10.1007/s12105-012-0350-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
The hallmark of the histology of epithelial-myoepithelial carcinoma (EMC) is the presence of a regular repetitive mixture of bilayered duct-like structures with an outer layer of myoepithelial cells and inner ductal epithelial cells. Clear cell change in the myoepithelial component is common, but clearing of both cell types, giving an impression of a monocellular neoplasm, is rare. A parotid biopsy was received from an 83-year-old male and subject to routine histologic processing for conventional staining and immunohistochemistry. The encapsulated tumour was composed of sheets of PAS/diastase negative clear cells, separated by fibrous septae. The clear myoepithelial cells were positive for S-100 protein, SMA, and p63 and negative for CK19 and surrounded CK19-positive luminal cells. It is important to utilise immunohistochemistry to differentiate this tumour from others with a similar histologic pattern. Information about the behaviour of the double-clear EMC is limited since there are few cases reported.
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Affiliation(s)
| | - Christopher M. Angel
- School of Dental Science, University of Melbourne and St John of God Pathology, Melbourne, VIC Australia
| | - Paul M. Speight
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Norman A. Firth
- MedLab Dental Oral Pathology Diagnostic Service and the Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 647, Dunedin, 9054 New Zealand
| | - Alison M. Rich
- MedLab Dental Oral Pathology Diagnostic Service and the Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 647, Dunedin, 9054 New Zealand
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Costa AF, Altemani A, Hermsen M. Current concepts on dedifferentiation/high-grade transformation in salivary gland tumors. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:325965. [PMID: 21876843 PMCID: PMC3160012 DOI: 10.4061/2011/325965] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 05/09/2011] [Indexed: 12/16/2022]
Abstract
The concept of dedifferentiation had previously been used in salivary gland carcinomas. Recently, the term “high-grade transformation” was introduced for adenoid cystic carcinoma, acinic cell carcinoma, epithelial-myoepithelial carcinoma, and polymorphous low-grade adenocarcinoma and may better reflect this phenomenon, although transformation into moderately differentiated adenocarcinoma (i.e., not “high grade”) has also been described. Among the immunohistochemical markers, Ki-67 seems to be the only one that can help distinguish between the conventional and transformed components; however, the combination of morphological criteria is still sovereign. The overexpression of p53 was observed in the transformed component in all tumor types studied, despite few cases having been demonstrated to carry mutations or deletions in TP53 gene. Genetic studies in salivary gland tumors with dedifferentiation/high-grade transformation are rare and deserve further investigation. This paper aims at providing an overview on the recent concepts in histopathological classification of salivary gland tumors, complemented by immunohistochemical and genetic findings.
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Affiliation(s)
- Ana Flávia Costa
- Department of Pathology, University of Campinas, (UNICAMP), 13083-887 Campinas, SP, Brazil
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Genetic profile of adenoid cystic carcinomas (ACC) with high-grade transformation versus solid type. Cell Oncol (Dordr) 2011; 34:369-79. [PMID: 21541734 DOI: 10.1007/s13402-011-0037-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND ACC can occasionally undergo dedifferentiation also referred to as high-grade transformation (ACC-HGT). However, ACC-HGT can also undergo transformation to adenocarcinomas which are not poorly differentiated. ACC-HGT is generally considered to be an aggressive variant of ACC, even more than solid ACC. This study was aimed to describe the genetic changes of ACC-HGT in relation to clinico-pathological features, and to compare results to solid ACC. METHODS Genome wide DNA copy number changes were analyzed by microarray CGH in ACC-HGT, four with transformation into moderately differentiated adenocarcinoma (MDA) and two into poorly differentiated carcinoma (PDC), and five solid ACC. In addition, Ki67 index and p53 immunopositivity was assessed. RESULTS ACC-HGT carried fewer copy number changes compared to solid ACC. Two ACC-HGT cases harboured a breakpoint at 6q23, near the cMYB oncogene. The complexity of the genomic profile concurred with the clinical course of the patient. Among the ACC-HGT, p53 positivity significantly increased from the conventional to the transformed (both MDA and PDC) component. CONCLUSION ACC-HGT may not necessarily reflect a more advanced stage of tumor progression, but rather a transformation to another histological form in which the poorly differentiated forms (PDC) presents a genetic complexity similar to the solid ACC.
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Sasahira T, Kurihara M, Yamamoto K, Bhawal UK, Kirita T, Kuniyasu H. Downregulation of runt-related transcription factor 3 associated with poor prognosis of adenoid cystic and mucoepidermoid carcinomas of the salivary gland. Cancer Sci 2011; 102:492-7. [PMID: 21105967 PMCID: PMC11158044 DOI: 10.1111/j.1349-7006.2010.01787.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Runt-related transcription factor 3 (RUNX3) is a transcription factor of the transforming growth factor (TGF)-β superfamily and acts as a tumor suppressor gene, which is silenced by hypermethylation of the promoter region in various cancers. In this study, we examined the expression and methylation status of RUNX3 in the salivary gland cancers pleomorphic adenoma (PA), adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC). The cytoplasmic expression rates of RUNX3 in PA, ACC and MEC were 65% (13/20), 22.2% (8/36) and 20.6% (7/34), respectively. Low expression or deletion of RUNX3 in ACC and MEC was significantly associated with tumor progression and poor prognosis. Using microdissected cDNA, we found that RUNX3 mRNA expression was lower in ACC and MEC than in PA and noncancerous salivary glands; furthermore, hypermethylation of RUNX3 was detected more frequently in PA (2/8, 25%), ACC (6/8, 75%) and MEC (7/8, 87.5%) than in noncancerous salivary glands (0/8, 0%). Our results suggest that low expression or deletion of RUNX3 in salivary gland tumors might play a pivotal role in tumorigenesis and tumor progression and poor prognosis in the case of salivary gland ACC and MEC. Recovery of the tumor suppressive function of RUNX3 might inhibit tumorigenesis and cancer progression in the human salivary gland.
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MESH Headings
- Adenoma, Pleomorphic/genetics
- Adenoma, Pleomorphic/metabolism
- Adenoma, Pleomorphic/pathology
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Adenoid Cystic/genetics
- Carcinoma, Adenoid Cystic/metabolism
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Mucoepidermoid/genetics
- Carcinoma, Mucoepidermoid/metabolism
- Carcinoma, Mucoepidermoid/pathology
- Core Binding Factor Alpha 3 Subunit/biosynthesis
- Core Binding Factor Alpha 3 Subunit/genetics
- DNA Methylation
- Down-Regulation
- Gene Expression Profiling
- Humans
- Immunohistochemistry
- Kaplan-Meier Estimate
- Lasers
- Microdissection
- Neoplasm Staging
- Reverse Transcriptase Polymerase Chain Reaction
- Salivary Gland Neoplasms/genetics
- Salivary Gland Neoplasms/metabolism
- Salivary Gland Neoplasms/pathology
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Affiliation(s)
- Tomonori Sasahira
- Department of Molecular Pathology, Nara Medical University, Kashihara, Japan
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Seethala RR, Cieply K, Barnes EL, Dacic S. Progressive genetic alterations of adenoid cystic carcinoma with high-grade transformation. Arch Pathol Lab Med 2011; 135:123-30. [PMID: 21204718 DOI: 10.5858/2010-0048-oar.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Although genome-wide imbalances have been characterized in conventional adenoid cystic carcinoma, other than p53 mutational status, the molecular profile of adenoid cystic carcinoma with high-grade transformation has not been explored. OBJECTIVE To evaluate progressive genetic alterations in adenoid cystic carcinoma with high-grade transformation using array comparative genomic hybridization. DESIGN Five adenoid cystic carcinomas with high-grade transformation (4 primary tumors and 1 paired metastasis) were selected and characterized at the DNA level by array comparative genomic hybridization on formalin-fixed paraffin-embedded tissue. Select alterations were validated by fluorescence in situ hybridization. RESULTS Chromosomal gains were mostly confined to the areas of high-grade transformation while losses were seen only in the conventional areas. Chromosomal regions with significant gains included 8q24, 17q11.2-q12, 17q23, and 15q11-13. Regions that showed the significant losses included 9q34, 4p16, 1p36.1, and 11q22. Fluorescence in situ hybridization analysis demonstrated increases in C-MYC (8q24.12-q24.13) and a low level increases in ERBB2 ( formerly HER2/neu ) (17q11.2-q12) in cases showing gains by array comparative genomic hybridization in these regions. However, no tumor showed HER2/ neu immunopositivity. CONCLUSIONS High-grade transformation in adenoid cystic carcinoma is a complex process that is reflected by several chromosomal alterations. Our findings implicate C-MYC amplification in this progression, although the role of HER2/neu is still unclear. Other candidate oncogenes, particularly on chromosome 17q23, warrant investigation in this rare tumor.
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Affiliation(s)
- Raja R Seethala
- Department of Pathology and Laboratory Medicine, University of Pittsburgh, 200 Lothrop St., Pittsburgh, PA 15213, USA.
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Petersson F, Chao SS, Ng SB. Anaplastic myoepithelial carcinoma of the sinonasal tract: an underrecognized salivary-type tumor among the sinonasal small round blue cell malignancies? Report of one case and a review of the literature. Head Neck Pathol 2010; 5:144-53. [PMID: 21104210 PMCID: PMC3098327 DOI: 10.1007/s12105-010-0226-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 11/08/2010] [Indexed: 12/23/2022]
Abstract
We present a 45 year old female patient with a nasal carcinoma showing high-grade/anaplastic histomorphological features and with a distinct myoepithelial immunohistochemical phenotype including positivity for smooth muscle actin, p63, S100 protein with no sustentacular pattern, calponin, cytokeratin 14, vimentin and cytokeratins (AE1-3 and CK5/6). A minority (<5%) of the cells showed focal and variable immunoreactivity for EMA with no cuticular/canalicular pattern. Bcl-2, CD99, CD117 and CD56 were variously positive, but chromogranin and synaptophysin were negative. Weak to moderate nuclear p53 immunoreactivity was seen in 50% of tumor cells. Mib-1/Ki-67 showed an average proliferation of 60-70%. Fluorescent in situ hybridization revealed no EWS-gene translocation. In situ hybridization for EBER was negative.
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Affiliation(s)
- Fredrik Petersson
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Siew Shuen Chao
- Department of Otolaryngology, Head & Neck Surgery, National University Health System, Singapore, Singapore
| | - Siok Bian Ng
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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High grade transformation in adenoid cystic carcinoma of the parotid: report of a case with cytologic, histologic and immunohistochemical study. Head Neck Pathol 2009; 3:310-4. [PMID: 20016788 PMCID: PMC2791488 DOI: 10.1007/s12105-009-0122-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 05/29/2009] [Indexed: 11/20/2022]
Abstract
Adenoid cystic carcinoma (ACC) constitutes about 4% of salivary epithelial tumors and is the second common malignant epithelial salivary gland tumor involving both the major and minor salivary glands. High grade transformation in ACC is a recently recognized entity with only a few cases reported in literature. We report the first case of ACC with high grade transformation involving the parotid. A 54-year-old man with a history of right parotid painful swelling from 1.5 years presented with recent increase in size of the swelling and facial paresis of 2 months duration. The locally invasive salivary neoplasm was composed predominantly of an undifferentiated carcinoma with foci of conventional ACC occupying less than 10% of tumor area. Immunohistochemical study of the undifferentiated component as compared to conventional ACC showed greater over-expression of p53 and Ki-67. Her-2/Neu was negative in both components. Recognition of occasional clusters of basaloid cells and hyaline globules in association with larger poorly differentiated malignant cell population in aspiration smears can help in cytological diagnosis. The acquisition of high proliferation index and over-expression of p53 may be the probable factors involved in the pathogenesis of high grade transformation in a conventional ACC.
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Sasahira T, Oue N, Kirita T, Luo Y, Bhawal UK, Fujii K, Yasui W, Kuniyasu H. Reg IV expression is associated with cell growth and prognosis of adenoid cystic carcinoma in the salivary gland. Histopathology 2009; 53:667-75. [PMID: 19076683 DOI: 10.1111/j.1365-2559.2008.03188.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Regenerating islet-derived family, member 4 (Reg IV) is associated with the progression of various cancers. The aim was to examine Reg IV expression in adenoid cystic carcinomas (ACCs) in salivary glands. METHODS AND RESULTS Reg IV expression was detected by immunohistochemistry and compared with clinicopathological parameters. Expression of phosphorylated epidermal growth factor receptor (pEGFR), phosphorylated AKT (pAKT) and MUC2 was examined by immunohistochemistry. Reg IV function was assessed with Reg IV antisense S-oligodeoxynucleotides (AS) in ACC3 human ACC cells. Reg IV was expressed by salivary duct epithelia and acinus myoepithelia, but not in squamous epithelia. Reg IV expression was found in 41% (17/41) of ACCs, but in none of 40 oral squamous cell carcinomas (OSCCs) and was associated with nodal metastasis (P = 0.047) and poor prognosis (P = 0.012) in ACCs. Reg IV expression was associated with pEGFR (14/17, 82%) in Reg IV+ ACCs, but had no relationship with pAKT or MUC2 expression in ACCs. Cell growth was inhibited by AS treatment in Reg IV+ ACC3 cells, but not in HSC-4 OSCC cells, whereas in vitro invasion of neither cell types was affected by AS treatment. CONCLUSIONS These results suggest that Reg IV might accelerate cell growth and disease progression of ACCs.
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Affiliation(s)
- T Sasahira
- Department of Molecular Pathology, Nara Medical University, Kashihara, Nara, Japan
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Dedifferentiated epithelial-myoepithelial carcinoma of the parotid gland: a rare case report of immunohistochemical analysis and review of the literature. ACTA ACUST UNITED AC 2008; 106:85-91. [PMID: 18417380 DOI: 10.1016/j.tripleo.2008.01.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 01/09/2008] [Accepted: 01/14/2008] [Indexed: 01/01/2023]
Abstract
Dedifferentiation of salivary gland neoplasms is a rare event, unlike bone and soft part sarcomas, which was first described by Stanley et al. in 1988. An additional case of dedifferentiated epithelial-myoepithelial carcinoma (EMC) is reported here. The patient was a 70-year-old Japanese man who requested examination of the rapid growth of a mass in the right parotid region, which he had first noticed 25 years previously. Clinical examination showed an ill-circumscribed, 6.8 x 4.7 x 7.0-cm lesion. Histologically, most parts of the lesion were high-grade carcinoma (HGC) with sheetlike and nestlike growth of markedly atypical cells and comedonecrosis, whereas the minor part consisted of typical EMC. The outer clear cells of EMC were positive for alpha-smooth muscle actin (ASMA), p63, cytokeratin (CK) 14, and vimentin, and the inner ductal cells of EMC were positive for CKs and epithelial membrane antigen. HGC was negative for ASMA, CK14, and vimentin, but diffusely positive for p53 protein and cyclin D1. The Ki-67 labeling index of EMC was 11.5%, whereas that of HGC was 67.1%. These findings and a review of literature indicate that HGC arose from preexisting EMC, and this phenomenon is the dedifferentiation of EMC. Dedifferentiated EMC is extremely rare.
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