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Fukumura M, Ishibashi K, Nakaguro M, Nagao T, Saida K, Urano M, Tanigawa M, Hirai H, Yagyuu T, Kikuchi K, Yada N, Sugita Y, Miyabe M, Hasegawa S, Goto M, Yamamoto H, Ohuchi T, Kusafuka K, Ogawa I, Suzuki H, Notohara K, Shimoda M, Tada Y, Kirita T, Takata T, Morinaga S, Maeda H, Warnakulasuriya S, Miyabe S, Nagao T. Salivary Gland Polymorphous Adenocarcinoma: Clinicopathological Features and Gene Alterations in 36 Japanese Patients. J Oral Pathol Med 2022; 51:710-720. [PMID: 35880805 DOI: 10.1111/jop.13336] [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: 04/13/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Polymorphous adenocarcinoma (PAC) is a common intraoral minor salivary gland carcinoma in Western countries but is extremely rare in Japan. The current study aimed to characterize the clinicopathological features and status of molecular alterations of PAC-associated genes, such as (e.g., PRKD1/2/3, ARID1A, and DDX3X) in a large cohort of Japanese patients with PAC. MATERIALS AND METHODS We examined the cases of 36 Japanese patients with salivary gland PAC and 26 cases involving histopathological mimics. To detect gene splits, fluorescence in situ hybridization was carried out for PAC-associated genes. Additionally, we applied a SNaPshot multiplex assay to identify PRKD1 hotspot mutations. RESULTS This study revealed the indolent clinical course of PAC with a high 10-year overall survival rate (92.9%), accompanied by occasional local recurrences and cervical lymph node metastasis (both 23.3%). Twenty cases (55.6%) of PAC (but none of the mimics) exhibited alterations in at least one PAC-associated gene. Rearrangement of PAC-associated genes and PRKD1 E710D were identified in 17 (47.2%) and 4 (11.1%) cases, respectively; one case showed coexisting PRKD3 split and PRKD1 E710D. In the multivariate analysis, high clinical stage (P=0.0005), the presence of prominent nucleoli (P=0.0003), and ARID1A split positivity (P=0.004) were independent risk factors for disease-free survival. CONCLUSION Japanese patients with PAC showed clinicopathological features similar to those reported in Western countries. This study disclosed that PAC-associated genetic alterations were common and specific findings in PACs. The diagnostic role and possible prognostic significance of PAC-associated genetic alterations in PACs were suggested.
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Affiliation(s)
- Masahiro Fukumura
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Kenichiro Ishibashi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Kosuke Saida
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan.,Department of Oral and Maxillofacial Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Makoto Urano
- Department of Diagnostic Pathology, Bantane Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Hirai
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Takahiro Yagyuu
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Kentaro Kikuchi
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University, School of Dentistry, Saitama, Japan
| | - Naomi Yada
- Division of Oral Pathology, Kyushu Dental University, Fukuoka, Japan
| | - Yoshihiko Sugita
- Department of Oral Pathology/Forensic Odontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Megumi Miyabe
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Shogo Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Mitsuo Goto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Ohuchi
- Department of Diagnostic Pathology, Keiyukai Sapporo Hospital, Sapporo, Japan
| | | | - Ikuko Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroaki Suzuki
- Division of Diagnostic Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Okayama, Japan
| | - Masayuki Shimoda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | | | - Shojiroh Morinaga
- Department of Diagnostic Pathology, Hino Municipal Hospital, Hino, Japan
| | - Hatsuhiko Maeda
- Department of Oral Pathology/Forensic Odontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London and The WHO Collaborating Centre for Oral Cancer, London, UK
| | - Satoru Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Toru Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Histologic Classification and Molecular Signature of Polymorphous Adenocarcinoma (PAC) and Cribriform Adenocarcinoma of Salivary Gland (CASG): An International Interobserver Study. Am J Surg Pathol 2020; 44:545-552. [PMID: 31917707 DOI: 10.1097/pas.0000000000001431] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Polymorphous adenocarcinoma (PAC) shows histologic diversity with streaming and targetoid features whereas cribriform adenocarcinoma of salivary gland (CASG) demonstrates predominantly cribriform and solid patterns with glomeruloid structures and optically clear nuclei. Opinions diverge on whether CASG represents a separate entity or a variant of PAC. We aimed to assess the level of agreement among 25 expert Head and Neck pathologists in classifying these tumors. Digital slides of 48 cases were reviewed and classified as: PAC, CASG, tumors with ≥50% of papillary architecture (PAP), and tumors with indeterminate features (IND). The consensus diagnoses were correlated with a previously reported molecular alteration. The consensus diagnoses were PAC in 18/48, CASG in16/48, PAP in 3/48, and IND in 11/48. There was a fair interobserver agreement in classifying the tumors (κ=0.370). The full consensus was achieved in 3 (6%) cases, all of which were classified as PAC. A moderate agreement was reached for PAC (κ=0.504) and PAP (κ=0.561), and a fair agreement was reached for CASG (κ=0.390). IND had only slight diagnostic concordance (κ=0.091). PAC predominantly harbored PRKD1 hotspot mutation, whereas CASG was associated with fusion involving PRKD1, PRKD2, or PRKD3. However, such molecular events were not exclusive as 7% of PAC had fusion and 13% of CASG had mutation. In conclusion, a fair to moderate interobserver agreement can be achieved in classifying PAC and CASG. However, a subset (23%) showed indeterminate features and was difficult to place along the morphologic spectrum of PAC/CASG among expert pathologists. This may explain the controversy in classifying these tumors.
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Mimica X, Katabi N, McGill MR, Hay A, Zanoni DK, Shah JP, Wong RJ, Cohen MA, Patel SG, Ganly I. Polymorphous adenocarcinoma of salivary glands. Oral Oncol 2019; 95:52-58. [PMID: 31345394 DOI: 10.1016/j.oraloncology.2019.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Polymorphous adenocarcinoma of salivary gland (PAC) is rare. Despite being described as a low risk histology, some patients develop regional and distant metastasis. More aggressive behavior has been attributed to a PAC subcategory called cribriform adenocarcinoma of minor salivary glands (CAMSG). We examined oncological outcomes of PAC. PATIENTS AND METHODS Fifty-seven patients with PAC were identified from an institutional database of 884 patients surgically treated for salivary gland malignancies from 1985 to 2015. Detailed histopathological analysis was performed. Survival outcomes were calculated using the Kaplan-Meier method. Factors predictive of recurrence were identified using the Cox proportional hazard method. RESULTS Fifty-four (95%) had tumors of minor salivary gland origin; the most frequent location was the oral cavity in 41 (76%), specifically the hard palate in 32 (55%). Forty-six patients (81%) were clinical T1-T2; 3 (5%) had a clinically positive neck. Thirty-two patients (56%) were classified as PAC and 14 (25%) as CAMSG. Forty-four patients (77%) had surgery alone; 13 (23%) had surgery and postoperative radiotherapy. The 5- and 10-year overall survival and disease-specific survival were 88% and 79% and 98% and 94%, respectively (median follow up 84 [1-159] months); 5- and 10-year recurrence-free survival were 93% and 88%, respectively. Univariate analysis showed male sex, III/IV stage, and CASMG variant had increased incidence of recurrence but were not statistically significant. CONCLUSION PAC of the salivary glands is an indolent disease with good survival outcomes. Recurrence is uncommon and tends to occur late. Long-term follow-up is indicated in patients with this disease.
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Affiliation(s)
- Ximena Mimica
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Marlena R McGill
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Ashley Hay
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Daniella Karassawa Zanoni
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Predictors of Outcome in the Phenotypic Spectrum of Polymorphous Low-grade Adenocarcinoma (PLGA) and Cribriform Adenocarcinoma of Salivary Gland (CASG): A Retrospective Study of 69 Patients. Am J Surg Pathol 2017; 40:1526-1537. [PMID: 27454943 DOI: 10.1097/pas.0000000000000705] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Polymorphous low-grade adenocarcinoma (PLGA) shows histologic diversity with fascicular and targetoid features while cribriform adenocarcinoma of salivary gland (CASG) demonstrates predominant cribriform and solid patterns with glomeruloid appearance and optical clear nuclei. The current study is designed to identify pathologic features that may predict clinical outcome in 69 PLGA/CASG. Seven patients had recurrences or distant metastasis, including 3 local recurrences, 2 nodal metastases, and 2 distant metastases. The following histologic factors predicted disease-free survival on univariate analysis: tumor size, bone invasion, lymphovascular invasion, tumor necrosis, ≥10% papillary pattern, and ≥30% cribriform pattern. On multivariate analysis, 10% of papillary pattern and 30% cribriform pattern were independent prognostic factors of disease-free survival. Histologic classification of the 69 tumors (based on the prior reported definition of CASG) showed 21 CASGs (30%), 23 PLGAs (33%), and 22 (32%) with indeterminate features of PLGA and CASG. In addition, 3 (4%) tumors demonstrated a predominant papillary pattern (≥50%). Interestingly, not all CASGs were located in the minor salivary gland and 2 tumors were identified in the parotid. One patient died from her disease and she harbored a CASG with >30% cribriform pattern. In conclusion, tumor size, bone invasion, and lymphovascular invasion are significant parameters that can predict adverse clinical behaviors in PLGA/CASG on univariate analysis. Using the prior reported definition, an overlapping histology between PLGA and CASG was noted in over a third of the cases. Regardless of tumor subclassification, the percentage of cribriform and papillary patterns seems to be prognostically relevant and should be documented.
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Sathyanarayanan R, Suresh V, Therese Thomas BA. Polymorphous Low-Grade Adenocarcinoma of the Palate: A Rare Case Report. IRANIAN JOURNAL OF CANCER PREVENTION 2015; 9:e3447. [PMID: 27366306 PMCID: PMC4926308 DOI: 10.17795/ijcp-3447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/20/2015] [Accepted: 11/05/2015] [Indexed: 11/25/2022]
Abstract
Introduction Polymorphous low-grade adenocarcinoma (PLGA) has been known as a comparatively less aggressive malignant tumor that predominantly occurs in the minor salivary glands. It has presented as a painless, slow growing tumor in the oral cavity. It has been reported to occur rarely in the palate and the prognosis of this lesion is far better than adenocarcinoma as the regional metastasis would be very minimal. A clear difference between the biologic behaviors of adenocarcinoma and PLGA has been reported in literature. Case Presentation A 63-year-old female reported at our institute with a swelling in relation to her upper left back region of her jaw for three months, gradual in onset and associated with pain. After clinical and radiological examination, the differential diagnosis were consolidated abscess or minor salivary gland tumor. An incisional biopsy was done and the lesion was diagnosed as PLGA. The lesion was treated by wide excision and reconstruction with immediate obturator. The post-operative follow up showed no evidence of recurrence and the healing was satisfactory. Conclusions The site of predilection of PLGA is more in favor of palate (49 - 77.8%) followed by either upper lip or buccal mucosa (7.4 - 13.4%). There are sporadic reports of metastasis sometimes even transformation to a high grade adenocarcinoma, sometimes ending in mortality. Cervical lymph node metastasis is rare with reported incidence of 5 - 15% and is more commonly seen in recurrent tumor than the initial diseases. Extra palatal PLGAs present with significant papillary growth or arising from ventral surface of tongue frequently metastasize to cervical lymph nodes. Distant metastasis is very rare with an incidence of 7.5% and the site involved is the lung which is attributed to the inadequate control of the disease.
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Affiliation(s)
- Ramanujam Sathyanarayanan
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - Venkatachalam Suresh
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - Beena Agnes Therese Thomas
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
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Wanjari SP, Wanjari PV, Patidar KA, Parwani RN. Papillary cystadenocarcinoma of the hard palate. BMJ Case Rep 2014; 2014:bcr-2013-009215. [PMID: 24408937 DOI: 10.1136/bcr-2013-009215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Papillary cystadenocarcinoma (PCC) is an uncommon malignant tumour of the salivary gland, sometimes involving the minor salivary gland. Previously this entity was classified as an atypical type of adenocarcinoma, malignant papillary cystadenoma, low-grade papillary adenocarcinoma or mucus producing adenopapillary carcinoma. PCC is a glandular tumour with an indolent biological behaviour characterised by cysts and papillary endophytic projections. We report two cases of PCC involving the minor salivary gland of the hard palate. Both the patients presented with a swelling in the palate with difficulty in chewing. MRI revealed an extensively destructive lesion involving hard palate, alveolar ridge and maxillary antrum. Clinical and radiological features suggested the malignant nature of the lesion. Histopathology of incisional biopsy revealed tumour proliferation in a multicystic pattern, with extensive papillary proliferation. Diverse and cellular cytomorphology, and cellular and nuclear pleomorphism with few mitotic figures were the prominent features. Both the lesions were confirmed as PCC.
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Affiliation(s)
- Sangeeta Panjab Wanjari
- Department of Oral & Maxillofacial Pathology, Modern Dental College & Research Centre, Indore, Madhya Pradesh, India
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