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Weissferdt A, Moran CA. Atypical Thymoma (WHO Type B3) with Prominent Microcystic and Mucoid Changes Mimicking Thymic Mucoepidermoid Carcinoma: A Clinicopathological and Immunohistochemical Study of Five Cases. Int J Surg Pathol 2024:10668969241266935. [PMID: 39150796 DOI: 10.1177/10668969241266935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
Five atypical thymomas (WHO type B3) with prominent microcystic and mucoid changes are presented. The patients were four men and one woman between the ages of 57 and 72 years. The patients presented with non-specific symptoms of cough, chest pain, and dyspnea. None of the patients had a history of myasthenia gravis. Diagnostic imaging revealed the presence of anterior mediastinal masses and surgical resection was accomplished in all patients. Macroscopically, the tumors ranged in size from 3.5 to 5.0 cm in greatest diameter; four of these were well circumscribed but unencapsuled, tan colored tumors without evidence of necrosis, hemorrhage, or gross cystic changes. One tumor had more infiltrative borders and was involving the mediastinal pleura. Microscopically, the low power view was characterized by prominent microcysts that were filled with a mucoid granular material. Higher magnification demonstrated a homogenous epithelial proliferation with mild cytologic atypia but lacking mitotic activity. Focal areas of squamoid differentiation were identified but perivascular spaces were absent. Histochemical staining confirmed mucinous material in the microcysts but no intracytoplasmic mucin. Immunohistochemical stains showed positive staining of the tumor cells with keratin AE1/AE3, keratin 5/6, p63, and p40. No terminal deoxynucleotidyl transferase+/CD3 + immature lymphocytes were identified. Clinical follow-up demonstrated that four patients have remained alive without recurrence while one patient was lost to follow-up. This report highlights histological features in atypical thymoma that may be confused with other tumors, especially thymic mucoepidermoid carcinoma. Separation of these tumors may be important for patient management and prognosis.
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Affiliation(s)
- Annikka Weissferdt
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Cesar A Moran
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
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2
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Malone LC, Twaddell WS, Drachenberg CB, Hatten KM, Papadimitriou JC. Two Head and Neck Carcinomas With Squamous and Mucinous Components and Human Papillomavirus Associations: Maxillary Mucoepidermoid Carcinoma ex Sinonasal Schneiderian Papilloma and Tonsillar Invasive Stratified Mucin Producing Carcinoma (ISMC). Int J Surg Pathol 2024; 32:607-614. [PMID: 37431192 DOI: 10.1177/10668969231185149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Carcinomas of the head-and-neck region with squamous and glandular/mucinous features constitute a heterogeneous group, with a significant minority of tumors showing an human papillomavirus (HPV) association. The differential diagnosis is usually between mucoepidermoid carcinoma (MEC) and adenosquamous carcinoma. We present here two tumors that exemplify both the challenges of diagnostic classification, as well as the complex relationship to HPV: (a) a low risk HPV positive/p16 negative carcinoma that is most consistent with a relatively typical intermediate grade mucoepidermoid type carcinoma with complete MEC phenotype (three cell types), originating from intranasal sinonasal papillomas with exophytic and inverted patterns, and invading surrounding maxillary compartments, and (b) a p16 and keratin 7 (KRT7) positive carcinoma of the right tonsil, characterized by stratified squamous and mucinous cell (mucocyte) features. Whereas the first tumor represents a typical MEC ex-Schneiderian papilloma, the second is morphologically most consistent with the, novel for this anatomic location, diagnosis of "invasive stratified mucin producing carcinoma" (ISMC), pointing to an analogy to similar, high-risk HPV-driven malignancies recently described in the gynecologic (GYN) and genitourinary (GU) areas. Both tumors, despite their mucoepidermoid-like features had no connection to salivary glands and lacked the MAML2 translocation typical of salivary gland MEC, pointing to a mucosal/non-salivary gland origin. Using these two carcinomas as examples, we attempt to address questions related to: (a) the histological distinction between MEC, adenosquamous carcinoma, and ISMC, (b) similarities and differences between these histological entities in mucosal sites versus morphologically similar salivary gland tumors, and (c) the role of HPV in these tumors.
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Affiliation(s)
- Laura C Malone
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
| | - William S Twaddell
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
| | | | - Kyle M Hatten
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
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3
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Prasse G, Glaas A, Meyer HJ, Zebralla V, Dietz A, Hering K, Kuhnt T, Denecke T. A Radiomics-Based Machine Learning Perspective on the Parotid Gland as a Potential Surrogate Marker for HPV in Oropharyngeal Cancer. Cancers (Basel) 2023; 15:5425. [PMID: 38001684 PMCID: PMC10670647 DOI: 10.3390/cancers15225425] [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: 09/07/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In treatment of oropharyngeal squamous cell carcinoma (OPSCC), human papillomavirus status (HPV) plays a crucial role. The HPV-positive subtype tends to affect younger patients and is associated with a more favorable prognosis. HPV-associated lesions have been described in the parotid gland, which is included in routine imaging for OPSCC. This work aims to explore the ability of an ML system to classify HPV status based on imaging of the parotid gland, which is routinely depicted on staging imaging. METHODS Using a radiomics approach, we investigate the ability of five contemporary machine learning (ML) models to distinguish between HPV-positive and HPV-negative OPSCC based on non-contrast computed tomography (CT) data of tumor volume (TM), locoregional lymph node metastasis (LNM), and the parotid gland (Parotid). After exclusion of cases affected by streak artefacts, 53 patients (training set: 39; evaluation set: 14) were retrospectively evaluated. Classification performances were tested for significance against random optimistic results. RESULTS The best results are AUC 0.71 by XGBoost (XGB) for TM, AUC 0.82 by multi-layer perceptron (MLP) for LNM, AUC 0.76 by random forest (RF) for Parotid, and AUC 0.86 by XGB for a combination of all three regions of interest (ROIs). CONCLUSIONS The results suggest involvement of the parotid gland in HPV infections of the oropharyngeal region. While the role of HPV in parotid lesions is under active discussion, the migration of the virus from the oral cavity to the parotid gland seems plausible. The imaging of the parotid gland offers the benefit of fewer streak artifacts due to teeth and dental implants and the potential to screen for HPV in cases of an absent or unlocatable tumor. Future investigation can be directed to validation of the results in independent datasets and to the potential of improvement of current classification models by addition of information based on the parotid gland.
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Affiliation(s)
- Gordian Prasse
- Department of Radiology, University of Leipzig, 04103 Leipzig, Germany; (H.-J.M.); (T.D.)
| | - Agnes Glaas
- Department of Radiation Therapy, University of Leipzig, 04103 Leipzig, Germany (T.K.)
| | - Hans-Jonas Meyer
- Department of Radiology, University of Leipzig, 04103 Leipzig, Germany; (H.-J.M.); (T.D.)
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Kathrin Hering
- Department of Radiation Therapy, University of Leipzig, 04103 Leipzig, Germany (T.K.)
| | - Thomas Kuhnt
- Department of Radiation Therapy, University of Leipzig, 04103 Leipzig, Germany (T.K.)
| | - Timm Denecke
- Department of Radiology, University of Leipzig, 04103 Leipzig, Germany; (H.-J.M.); (T.D.)
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4
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Rooper LM, Agaimy A, Assaad A, Bal M, Eugene H, Gagan J, Nonogaki H, Palsgrove DN, Shah A, Stelow E, Stoehr R, Thompson LDR, Weinreb I, Bishop JA. Recurrent IDH2 Mutations in Salivary Gland Striated Duct Adenoma Define an Expanded Histologic Spectrum Distinct From Canalicular Adenoma. Am J Surg Pathol 2023; 47:333-343. [PMID: 36510691 DOI: 10.1097/pas.0000000000002004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Striated duct adenoma (SDA) is a rare salivary gland neoplasm defined by histologic similarity to normal striated ducts. However, doubt persists about whether SDA represents a genuine entity distinct from canalicular adenoma and if a malignant counterpart exists. This study aims to evaluate the molecular underpinnings of SDA to clarify its pathogenesis and classification. We identified 10 SDA and 2 tumors called low-grade adenocarcinoma not otherwise specified that were retrospectively recognized to resemble SDA. All cases showed recurrent histologic features including (1) discrete monophasic tubules, (2) tall columnar eosinophilic cells, (3) monotonous oval nuclei, and (4) scant fibrous stroma, and most were positive for S100 protein (91%), SOX10 (80%), and CK7 (80%). Although 1 case was previously called adenocarcinoma based on interdigitation with normal acini, this pattern was also seen in some SDA, and likely does not indicate malignancy; the significance of growth surrounding nerve in 1 other case is less clear. Targeted sequencing identified IDH2 R172X mutations in all 8 cases with sufficient tissue, with positivity for IDH1/2 mutation-specific immunohistochemistry in 9 cases stained. In contrast, 5 canalicular adenomas lacked IDH2 mutations or other oncogenic alterations. Overall, IDH2 R172X mutations are a defining feature of SDA that, in combination with its recognizable pathologic profile, confirm it is a unique entity separate from canalicular adenoma. IDH1/2 mutation-specific immunohistochemistry may provide a convenient tool to facilitate diagnosis. Both morphology and IDH2 mutations raise parallels between SDA and breast tall cell carcinoma with reverse polarity.
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Affiliation(s)
- Lisa M Rooper
- Department of Pathology
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Adel Assaad
- Department of Pathology, Virginia Mason Hospital and Seattle Medical Center, Seattle, WA
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Jeffrey Gagan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Doreen N Palsgrove
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Akeesha Shah
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - Edward Stelow
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Robert Stoehr
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | | | - Ilan Weinreb
- Department of Laboratory Medicine and Pathobiology, University of Toronto
- Department of Pathology, University Health Network, Toronto, ON
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
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5
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Analysis of Human Papilloma Virus Content and Integration in Mucoepidermoid Carcinoma. Viruses 2022; 14:v14112353. [PMID: 36366450 PMCID: PMC9698779 DOI: 10.3390/v14112353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 02/01/2023] Open
Abstract
Mucoepidermoid Carcinomas (MEC) represent the most common malignancies of salivary glands. Approximately 50% of all MEC cases are known to harbor CRTC1/3-MAML2 gene fusions, but the additional molecular drivers remain largely uncharacterized. Here, we sought to resolve controversy around the role of human papillomavirus (HPV) as a potential driver of mucoepidermoid carcinoma. Bioinformatics analysis was performed on 48 MEC transcriptomes. Subsequent targeted capture DNA sequencing was used to annotate HPV content and integration status in the host genome. HPV of any type was only identified in 1/48 (2%) of the MEC transcriptomes analyzed. Importantly, the one HPV16+ tumor expressed high levels of p16, had high expression of HPV16 oncogenes E6 and E7, and displayed a complex integration pattern that included breakpoints into 13 host genes including PIK3AP1, HIPI, OLFM4,SIRT1, ARAP2, TMEM161B-AS1, and EPS15L1 as well as 9 non-genic regions. In this cohort, HPV is a rare driver of MEC but may have a substantial etiologic role in cases that harbor the virus. Genetic mechanisms of host genome integration are similar to those observed in other head and neck cancers.
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6
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Palsgrove D, Bishop JA. HPV-related carcinoma of the oropharynx: challenges on small biopsy specimens. J Am Soc Cytopathol 2020; 9:359-368. [PMID: 32651129 DOI: 10.1016/j.jasc.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Human papillomavirus (HPV)-related oropharyngeal carcinoma can morphologically mimic many processes from benign to malignant and lead pathologists to incorrectly diagnose them and/or use inappropriate diagnostic terminology. Recognition of HPV-related oropharyngeal carcinoma and its variants is critical for appropriate prognostic and therapeutic considerations in small biopsy material. Various pitfalls in diagnosing these tumors on limited biopsies are discussed herein.
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Affiliation(s)
- Doreen Palsgrove
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
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7
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Outcome prediction for salivary gland cancer using multivariate adaptative regression splines (MARS) and self-organizing maps (SOM). Neural Comput Appl 2020. [DOI: 10.1007/s00521-018-3473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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8
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The evolving landscape of HPV-related neoplasia in the head and neck. Hum Pathol 2019; 94:29-39. [DOI: 10.1016/j.humpath.2019.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
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9
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Navale P, Rooper LM, Bishop JA, Westra WH. Mucoepidermoid carcinoma of the oropharynx: a tumor type with a propensity for regional metastasis unrelated to histologic grade. Hum Pathol 2019; 93:1-5. [PMID: 31442522 DOI: 10.1016/j.humpath.2019.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 01/22/2023]
Abstract
The designation "mucoepidermoid tumor" is a historic one used in reference to a form of mucoepidermoid carcinoma (MEC) that was believed to be benign. This bygone notion was based on the observation that the vast majority of MECs arising from the intraoral minor salivary glands behave in a benign fashion, particularly when they do not exhibit high grade features. There has been a recent move to partition the oral vault into the oral cavity proper and the oropharynx based on awareness that these compartments are distinct, and that similar tumor types arising from these compartments may behave in dramatically different ways (e.g, oral cavity squamous cell carcinoma vs oropharyngeal squamous cell carcinoma). The pathology databases from 3 large academic medical centers were searched for cases of MECs arising in the oropharynx. Relevant clinical and pathological information was collected from the medical records. Twenty-five cases were identified. They were from 18 females (72%) and 7 males (28%), ranging in age from 31 to 88 years (median, 61). Twenty-two (88%) were classified as low (n = 12) or intermediate (n = 10) grade, and 3 (12%) as high grade. Most arose from the base of tongue (n = 24), but one arose from the lateral pharyngeal wall. The median tumor size was 2.0 cm. Nineteen patients underwent neck node dissections. Of these, 13 (68%) had histologically documented lymph node metastases. MECs that lacked high grade features were almost as likely to metastasize as those with high grade features (50% vs 66%, Fisher exact = 1). Of 3 metastases tested, 2 harbored the MAML2 gene fusion. MECs arising from the base of tongue are associated with an alarmingly high rate of nodal metastases. This behavior cannot be predicted by histologic grading or MAML2 status. The propensity to metastasize may to some degree reflect the unique microenvironment of the oropharynx.
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Affiliation(s)
- Pooja Navale
- Departments of Pathology at the Icahn School of Medicine at Mount Sinai Hospital, 10029 New York, NY
| | - Lisa M Rooper
- The Johns Hopkins Medical Institutions, Baltimore, 21287 MD
| | | | - William H Westra
- Departments of Pathology at the Icahn School of Medicine at Mount Sinai Hospital, 10029 New York, NY.
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10
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Lewis JS, Beadle B, Bishop JA, Chernock RD, Colasacco C, Lacchetti C, Moncur JT, Rocco JW, Schwartz MR, Seethala RR, Thomas NE, Westra WH, Faquin WC. Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists. Arch Pathol Lab Med 2018; 142:559-597. [PMID: 29251996 DOI: 10.5858/arpa.2017-0286-cp] [Citation(s) in RCA: 348] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context Human papillomavirus (HPV) is a major cause of oropharyngeal squamous cell carcinomas, and HPV (and/or surrogate marker p16) status has emerged as a prognostic marker that significantly impacts clinical management. There is no current consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16 or on which tests to choose. Objective To develop evidence-based recommendations for the testing, application, interpretation, and reporting of HPV and surrogate marker tests in head and neck carcinomas. Design The College of American Pathologists convened a panel of experts in head and neck and molecular pathology, as well as surgical, medical, and radiation oncology, to develop recommendations. A systematic review of the literature was conducted to address 6 key questions. Final recommendations were derived from strength of evidence, open comment period feedback, and expert panel consensus. Results The major recommendations include (1) testing newly diagnosed oropharyngeal squamous cell carcinoma patients for high-risk HPV, either from the primary tumor or from cervical nodal metastases, using p16 immunohistochemistry with a 70% nuclear and cytoplasmic staining cutoff, and (2) not routinely testing nonsquamous oropharyngeal carcinomas or nonoropharyngeal carcinomas for HPV. Pathologists are to report tumors as HPV positive or p16 positive. Guidelines are provided for testing cytologic samples and handling of locoregional and distant recurrence specimens. Conclusions Based on the systematic review and on expert panel consensus, high-risk HPV testing is recommended for all new oropharyngeal squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - William C Faquin
- From the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Lewis); the Department of Radiation Oncology, Stanford University Medical Center, Palo Alto, California (Dr Beadle); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Drs Bishop and Westra); the Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri (Dr Chernock); Surveys, the College of American Pathologists, Northfield, Illinois (Mss Colasacco and Thomas); Policy and Advocacy, American Society of Clinical Oncology, Alexandria, Virginia (Ms Lacchetti); the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Moncur); the Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexler Medical Center, Columbus (Dr Rocco); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Schwartz); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Seethala); and the Department of Pathology, Massachusetts General Hospital, Boston (Dr Faquin)
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11
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MAML2 Rearrangements in Variant Forms of Mucoepidermoid Carcinoma: Ancillary Diagnostic Testing for the Ciliated and Warthin-like Variants. Am J Surg Pathol 2017; 42:130-136. [PMID: 28877061 DOI: 10.1097/pas.0000000000000932] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. Recent studies have shown that most MECs harbor gene fusions involving MAML2-an alteration that appears to be specific for MEC, a finding that could be diagnostically useful. While most cases of MEC are histologically straightforward, uncommon variants can cause considerable diagnostic difficulty. We present 2 variants of MEC for which MAML2 studies were crucial in establishing a diagnosis: a previously undescribed ciliated variant, and the recently described Warthin-like variant. All cases of ciliated and Warthin-like MEC were retrieved from the archives of The Johns Hopkins Hospital. Break-apart fluorescence in situ hybridization for MAML2 was performed on all cases. One ciliated MEC and 6 Warthin-like MECs were identified. The ciliated MEC presented as a 4.6 cm cystic lymph node metastasis originating from the tongue base in a 47-year-old woman. The Warthin-like MECs presented as parotid masses ranging in size from 1.2 to 3.3 (mean, 2.7 cm) in 4 women and 2 men. The ciliated MEC consisted of macrocystic spaces punctuated by tubulopapillary proliferations of squamoid cells and ciliated columnar cells. The Warthin-like MECs were comprised of cystic spaces lined by multilayered oncocytic to squamoid cells surrounded by a circumscribed cuff of lymphoid tissue with germinal centers. In these cases, the Warthin-like areas dominated the histologic picture. Conventional MEC, when present, represented a minor tumor component. MAML2 rearrangements were identified in all cases. Warthin-like MEC, and now a ciliated form of MEC, are newly described variants of a common salivary gland carcinoma. Unfamiliarity with these novel forms, unanticipated cellular features (eg, cilia), and morphologic overlap with mundane benign processes (eg, developmental ciliated cysts, Warthin tumor) or other carcinomas (eg, ciliated human papillomavirus-related carcinoma) may render these variants susceptible to misdiagnosis. These unusual variants appear to consistently harbor MAML2 fusions-a finding that establishes a clear link to conventional MEC and provides a valuable adjunct in establishing the diagnosis.
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12
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Chen AA, Gheit T, Stellin M, Lupato V, Spinato G, Fuson R, Menegaldo A, Mckay-Chopin S, Dal Cin E, Tirelli G, Da Mosto MC, Tommasino M, Boscolo-Rizzo P. Oncogenic DNA viruses found in salivary gland tumors. Oral Oncol 2017; 75:106-110. [PMID: 29224806 DOI: 10.1016/j.oraloncology.2017.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/02/2017] [Accepted: 11/04/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous investigations studying the association of DNA viruses with salivary gland tumors (SGTs) have led to conflicting results. The aim of this study was to determine the prevalence of different DNA viruses by using a highly sensitive assay in a multi-center series of over 100 fresh frozen salivary gland samples. METHODS DNA was isolated from 84 SGTs (80 parotid tumors and 4 submandibular gland tumors) and 28 normal salivary tissue samples from 85 patients in Northeast Italy. Using a highly sensitive type-specific multiplex genotyping assay, we analyzed the samples for the presence of DNA from 62 different viruses including 47 papillomaviruses, 10 polyomaviruses, and 5 herpesviruses. RESULTS We observed a high prevalence of beta human papillomavirus DNA in malignant tumors. In contrast, polyomavirus DNA was present in benign, malignant, and non-tumor control samples. Most striking was the significant distribution of herpesvirus DNA in the SGT samples, in particular the high prevalence of Epstein-Barr type 1 and type 2 DNA in Warthin's tumor samples. CONCLUSION Our data provides evidence for the presence of DNA viruses in SGTs. Mechanistic studies are needed to further attribute tumor formation to these viruses.
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Affiliation(s)
- Alyce A Chen
- Section of Infections, International Agency for Research on Cancer, Lyon, France
| | - Tarik Gheit
- Section of Infections, International Agency for Research on Cancer, Lyon, France
| | - Marco Stellin
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Valentina Lupato
- Unit of Otolaryngology, Azienda Ospedaliera "S. Maria degli Angeli", Pordenone, Italy
| | | | - Roberto Fuson
- ENT Department, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Anna Menegaldo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | | | - Elisa Dal Cin
- Head and Neck Department, ENT Clinic, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giancarlo Tirelli
- Head and Neck Department, ENT Clinic, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Massimo Tommasino
- Section of Infections, International Agency for Research on Cancer, Lyon, France
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy.
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13
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Abstract
Human papillomavirus (HPV) is an essential causal factor in a subset of head and neck neoplasms, most notably oropharyngeal squamous cell carcinoma, for which HPV infection has important diagnostic, prognostic, and therapeutic implications. This article summarizes the current understanding of HPV-associated neoplasms of the head and neck, including the recently described carcinoma with adenoid cystic-like features. Salient clinical, gross, and microscopic features are discussed, and the utility of specific ancillary studies is highlighted.
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Affiliation(s)
- Aaron M Udager
- Department of Pathology, University of Michigan Health System, 2G309 UH, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5054, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, 2G332 UH, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5054, USA.
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14
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Lewis AG, Tong T, Maghami E. Diagnosis and Management of Malignant Salivary Gland Tumors of the Parotid Gland. Otolaryngol Clin North Am 2017; 49:343-80. [PMID: 27040585 DOI: 10.1016/j.otc.2015.11.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Malignant parotid tumors are heterogeneous and diverse. Accurate diagnosis requires a pathologist familiar with the various histologic subtypes, immunohistochemistry stains, and common translocations. Clinical course varies according to tumor subtype, ranging from indolent, slow-growing adenoid cystic carcinoma to rapidly progressive, possibly fatal, salivary ductal carcinoma. Histologic grade is important in prognosis and therapy. Surgery remains the mainstay of treatment when negative margins can be achieved. Radiation improves locoregional control of tumors with high-risk features. Chemotherapy for parotid tumors can be disappointing. Studies of new targeted therapies have not offered significant benefits.
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Affiliation(s)
- Aaron G Lewis
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Tommy Tong
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Ellie Maghami
- Division of Head and Neck Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Qian X, Kaufmann AM, Chen C, Tzamalis G, Hofmann VM, Keilholz U, Hummel M, Albers AE. Prevalence and associated survival of high-risk HPV-related adenoid cystic carcinoma of the salivary glands. Int J Oncol 2016; 49:803-11. [PMID: 27279281 DOI: 10.3892/ijo.2016.3563] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/30/2016] [Indexed: 11/06/2022] Open
Abstract
Adenoid cystic carcinoma (SACC) is a rare malignancy, but a frequent subtype in minor and major salivary glands. The molecular alterations or biomarkers that underlie its development and progression as well as therapy outcomes are poorly characterized. The main study goal was to investigate reliable biomarkers and patient-related factors that may have impact on recurrence and long-term survival of SACC. The prevalence of human papilloma virus (HPV) in SACC was determined by HPV-DNA genotyping and p16 immunostaining. Epithelial growth factor receptor (EGFR), p53 and Ki-67 expression were also evaluated. Twenty-eight (42%) of 67 patients were HPV-DNA positive. Kaplan-Meier analysis indicated that SACC patients with metastases (P=0.03) had a poor overall survival (OS) and a shorter recurrence-free survival (P<0.001). Positive resection margins significantly predicted shorter recurrence-free survival (P=0.01). In the multivariate analysis, non-metastatic disease (P=0.033) and p16 positivity (P=0.005) have shown their prediction value for OS while non-metastatic disease (P=0.002), HPV positivity (P=0.041) and negative resection margin predicted a better recurrence-free survival. The present study documents for the first time the positivity for HPV infection and overexpression of certain markers (p16, Ki-67, EGFR and p53) used in diagnostics in SACC as well as characterizes clinical entities. These factors might be exploited in the future as biomarkers for its prognostic value. Using the clinical and pathological basis for predicting different outcomes could significantly facilitate SACC stratification and potentially directing treatment.
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Affiliation(s)
- Xu Qian
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas M Kaufmann
- Clinic for Gynecology, Charité-Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany
| | - Chao Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georgios Tzamalis
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Veit M Hofmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Ulrich Keilholz
- Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Michael Hummel
- Department of Pathology, Campus Benjamin Franklin, Charité, Universitätsmedizin, Berlin, Germany
| | - Andreas E Albers
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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16
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Yin LX, Ha PK. Genetic alterations in salivary gland cancers. Cancer 2016; 122:1822-31. [PMID: 26928905 DOI: 10.1002/cncr.29890] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/15/2015] [Accepted: 12/22/2015] [Indexed: 01/11/2023]
Abstract
Salivary gland cancers are an incredibly heterogeneous group of tumors that include 24 histologically distinct tumor types. The use of new genetic methods has paved the way for promising advancements in our understanding of the molecular biology underlying each type of tumor. The objective of this review was to highlight common oncogenes, tumor suppressor genes, and cytogenetic and epigenetic changes associated with the most common tumor types: mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary duct carcinoma, mammary analogue secretory carcinoma, hyalinizing clear cell carcinoma, carcinoma ex pleomorphic adenoma, and acinic cell carcinoma. Recent insights into the pathogenesis of each cancer subtype have helped better define and classify these tumors. Further research in salivary gland cancers should focus on determining the key genes involved in the tumorigenesis of each distinct malignancy and identifying individualized chemotherapies directed at these targets. Cancer 2016;122:1822-31. © 2016 American Cancer Society.
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Affiliation(s)
- Linda X Yin
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Patrick K Ha
- Department of Otolaryngology, University of California San Francisco, San Francisco, California
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17
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Abstract
Surgical pathology of the sinonasal tract (nasal cavity and paranasal sinuses) is extremely challenging due in part to the tremendous diversity of tumor types that may arise in this region. Compounding the difficulty, a number of new sinonasal tumor entities have been recently described, and pathologists may not yet be familiar with these neoplasms. This manuscript will review the clinicopathologic features of some of the newly described sinonasal tumor types: NUT midline carcinoma, HPV-related carcinoma with adenoid cystic-like features, SMARCB1 (INI-1) deficient sinonasal carcinoma, biphenotypic sinonasal sarcoma, and renal cell-like adenocarcinoma.
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18
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HPV Infection, but Not EBV or HHV-8 Infection, Is Associated with Salivary Gland Tumours. BIOMED RESEARCH INTERNATIONAL 2015; 2015:829349. [PMID: 26618178 PMCID: PMC4651650 DOI: 10.1155/2015/829349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/21/2015] [Indexed: 11/24/2022]
Abstract
Benign and malignant salivary gland tumours are clinically heterogeneous and show different histology. Little is known about the role of human herpes virus 8 (HHV-8), Epstein-Barr virus (EBV), and human papillomavirus (HPV) infection in salivary gland neoplasms. We investigated the presence of the three viruses in formalin-fixed, paraffin-embedded tissue samples in a cohort of 200 different salivary gland tumours. We performed EBV-LMP-1 and HHV-8 and p16 immunohistochemistry, a specific chip based hybridization assay for detection and typing of HPV and a chromogenic in situ hybridization for EBV analysis. Only one case, a polymorphic low-grade carcinoma, showed HHV-8 expression and one lymphoepithelial carcinoma was infected by EBV. In 17 cases (9%) moderate or strong nuclear and cytoplasmic p16 expression was detected. The HPV type was investigated in all of these cases and additionally in 8 Warthin's tumours. In 19 cases HPV type 16 was detected, mostly in Warthin's tumour, adenoid cystic carcinoma, and adenocarcinoma NOS. We concluded that HHV-8 infection and EBV infection are not associated with salivary gland cancer, but HPV infection may play a role in these tumour entities.
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19
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Behring CM, Lazzari MA. Mucoepidermoid Carcinoma in a 33-Year-Old White Man. Lab Med 2015; 46:327-31. [PMID: 26489678 DOI: 10.1309/lmd9ri33qnrsxnmm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PATIENT DEMOGRAPHICS A 33-year-old white man. CHIEF COMPLAINT Longstanding bump on the roof of the mouth. TREATMENT The patient was referred to an oral maxillofacial surgeon for a pathology consultation. The patient had been experiencing pain on both sides of his jaw, but the oral mass was not painful (Image 1). MEDICAL HISTORY The patient has no history of smoking, is slightly overweight with a body mass index of 26.5, and has no systemic or chronic medical conditions. EXAMINATION FINDINGS On initial examination by the oral surgeon, the vital signs of the patient were normal. An indurated lesion was noted on the left hard palate of the patient. Suspecting a benign lesion or possible carcinoma/neoplasm, the oral surgeon scheduled and performed an excisional biopsy (Image 2). The mass was sent for pathological processing. POSTOPERATIVE CARE This included a diet of soft foods, with daily rinsing using 0.12% chlorhexidine gluconate, with a follow-up appointment made for 2 weeks later. PRINCIPAL LABORATORY FINDINGS Figure 1; Image 3; Image 4.
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20
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Radkay-Gonzalez L, Faquin W, McHugh JB, Lewis JS, Tuluc M, Seethala RR. Ciliated Adenosquamous Carcinoma: Expanding the Phenotypic Diversity of Human Papillomavirus-Associated Tumors. Head Neck Pathol 2015; 10:167-75. [PMID: 26411881 PMCID: PMC4838977 DOI: 10.1007/s12105-015-0653-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
This study describes a unique subset of ciliated, human papillomavirus (HPV) related, adenosquamous carcinomas (AsqCA) of the head and neck that in contrast to most AsqCA, often show areas with lower grade cytonuclear features. They are comprised of largely non-keratinizing squamous cell carcinoma components with cystic change, gland formation, mucin production, and cilia in tumor cells. Seven cases of ciliated AsqCA were retrieved. Site distribution was as follows: palatine tonsil--3/7, base of tongue--1/7, and neck (unknown primary site)--3/7. Despite the occasional resemblance to mucoepidermoid carcinoma (MEC), the tumors showed focal keratinizing morphology and atypia, and all tumors were negative for MAML2 rearrangements. Oropharyngeal and neck tumors were uniformly p16 positive and showed punctate staining by in situ hybridization for high risk HPV DNA. There were two distant metastases (lung), and one tumor related death. Thus, ciliated AsqCA are HPV-associated lesions that pose unique pitfalls, closely mimicking MEC and other salivary gland tumors. These tumors add to the list of those which defy the dogma that ciliated epithelium always equates to a benign process.
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Affiliation(s)
- Lisa Radkay-Gonzalez
- Department of Pathology and Laboratory Medicine, Presbyterian-Shadyside Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15232 USA
| | - William Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Jonathan B. McHugh
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - James S. Lewis
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO 63110 USA ,Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN 37232 USA
| | - Madalina Tuluc
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA 19107 USA
| | - Raja R. Seethala
- Department of Pathology and Laboratory Medicine, Presbyterian-Shadyside Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15232 USA ,A614.X Presbyterian University Hospital, 200 Lothrop St, Pittsburgh, PA 15213 USA
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21
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Expression of cyclin-dependent kinase inhibitor 2A 16, tumour protein 53 and epidermal growth factor receptor in salivary gland carcinomas is not associated with oncogenic virus infection. Int J Oral Sci 2015; 7:18-22. [PMID: 25012870 PMCID: PMC4817540 DOI: 10.1038/ijos.2014.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2014] [Indexed: 11/13/2022] Open
Abstract
It is known that human papillomavirus (HPV) infection can cause squamous cell neoplasms at several sites, such as cervix uteri carcinoma and oral squamous carcinoma. There is little information on the expression of HPV and its predictive markers in tumours of the major and minor salivary glands of the head and neck. We therefore assessed oral salivary gland neoplasms to identify associations between HPV and infection-related epidermal growth factor receptor (EGFR), cyclin-dependent kinase inhibitor 2A (CDKN2A/p16) and tumour protein p53 (TP53). Formalin-fixed, paraffin-embedded tissue samples from oral salivary gland carcinomas (n=51) and benign tumours (n=26) were analysed by polymerase chain reaction (PCR) analysis for several HPV species, including high-risk types 16 and 18. Evaluation of EGFR, CDKN2A, TP53 and cytomegalovirus (CMV) was performed by immunohistochemistry. Epstein–Barr virus (EBV) was evaluated by EBV-encoded RNA in situ hybridisation. We demonstrated that salivary gland tumours are not associated with HPV infection. The expression of EGFR, CDKN2A and TP53 may be associated with tumour pathology but is not induced by HPV. CMV and EBV were not detectable. In contrast to oral squamous cell carcinomas, HPV, CMV and EBV infections are not associated with malignant or benign neoplastic lesions of the salivary glands.
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22
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Argyris PP, Wehrs RN, García JJ, Koutlas IG. Fluorescencein-situhybridization identifies Mastermind-like 2 (MAML2)rearrangement in odontogenic cysts with mucous prosoplasia: a pilot study. Histopathology 2015; 66:791-7. [DOI: 10.1111/his.12526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology; School of Dentistry; University of Minnesota; Minneapolis MN USA
| | - Rebecca N Wehrs
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
| | - Joaquín J García
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
| | - Ioannis G Koutlas
- Division of Oral and Maxillofacial Pathology; School of Dentistry; University of Minnesota; Minneapolis MN USA
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23
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Bishop JA. Non-squamous variants of human papillomavirus-related head and neck carcinoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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