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Cipriani NA, Kakkar A. Top 10 Clear Cell Head and Neck Lesions to Contemplate. Head Neck Pathol 2023; 17:33-52. [PMID: 36928734 PMCID: PMC10063749 DOI: 10.1007/s12105-022-01518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/27/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Optically clear cytoplasm may occur in neoplastic and non-neoplastic conditions, either as a characteristic feature of a disease entity or as a morphologic rarity, potentially creating diagnostic dilemmas in various organ systems. In the head and neck, clear cell change can occur in lesions of salivary, odontogenic, thyroid, parathyroid, or sinonasal/skull base origin, as well as in metastases to these regions. METHODS This review elaborates the top ten clear cell lesions in the head and neck, emphasizing their distinguishing histologic, immunohistochemical, and molecular attributes, and presents a rational approach to arriving at an accurate classification. RESULTS Cytoplasmic pallor or clearing may be caused by accumulations of glycogen, lipid, mucin, mucopolysaccharides, water, foreign material, hydropic organelles, or immature zymogen granules. Overlapping morphologic features may present a diagnostic challenge to the surgical pathologist. Similarity in immunohistochemical profiles, often due to common cell type, as well as rare non-neoplastic mimics, furthers the diagnostic conundrum. CONCLUSIONS The top ten lesions reviewed in this article are as follows: (1) clear cell carcinoma (salivary and odontogenic), (2) mucoepidermoid carcinoma, (3) myoepithelial and epithelial-myoepithelial carcinoma, (4) oncocytic salivary gland lesions, (5) squamous cell carcinoma, (6) parathyroid water clear cell adenoma, (7) metastatic renal cell carcinoma (especially in comparison to clear cell thyroid neoplasms), (8) sinonasal renal cell-like adenocarcinoma, (9) chordoma, and (10) rhinoscleroma.
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Affiliation(s)
- Nicole A Cipriani
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave, MC 6101, Chicago, IL, 60637, USA.
| | - Aanchal Kakkar
- All India Institute of Medical Sciences, Department of Pathology, Ansari Nagar, New Delhi, India
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Lee CS, Poh EHK, Kotamma V, Loy TK, Chow HT. Parotid gland oncocytosis: Multifocal adenomatous oncocytic hyperplasia variant - A case report in Singapore. ACTA ACUST UNITED AC 2020; 39:63-68. [PMID: 32948099 DOI: 10.1142/s2214607519720039] [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: 11/18/2022]
Abstract
Oncocytosis is a rare, benign, non-neoplastic lesion that can be further classified into diffuse oncocytosis or multifocal adenomatous oncocytic hyperplasia. This tumour has been estimated to account for 0.1% of all parotid gland tumours.1 Here, we report a rare case of a patient who presented to the Oral and Maxillofacial Surgery Department with a 3-cm swelling of his left parotid gland. Histopathological results from a superficial parotidectomy revealed the lesion to be a multifocal adenomatous oncocytic hyperplasia of the parotid gland. A description of this rare disease and its management are included in this article.
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Affiliation(s)
- Chee Seng Lee
- Dental Surgery Department, Khoo Teck Puat Hospital, Singapore
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Baněčková M, Uro-Coste E, Ptáková N, Šteiner P, Stanowska O, Benincasa G, Colella G, Vondrák J, Michal M, Leivo I, Skálová A. What is hiding behind S100 protein and SOX10 positive oncocytomas? Oncocytic pleomorphic adenoma and myoepithelioma with novel gene fusions in a subset of cases. Hum Pathol 2020; 103:52-62. [PMID: 32673681 DOI: 10.1016/j.humpath.2020.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
Oncocytomas (OCs) in salivary glands are rare benign tumors composed of mitochondria-rich epithelial cells (oncocytes), mostly localized in the parotid gland. The treatment of choice is simple excision. Extensive oncocytic metaplasia of pleomorphic adenoma (PA) and myoepithelioma (ME) can be diagnostically challenging and may camouflage the correct diagnosis. These tumors should be treated more carefully compared with OC, given the risk of frequent recurrences and the possibility of malignant transformation. We have investigated 89 oncocytic lesions from our files, including OC (n = 74) and metaplastic oncocytic variant of PA/ME (n = 15). All OCs were stained for S100 protein and SOX10. The tumors with immunohistochemical expression of one or both markers were tested by next-generation sequencing (NGS). The NGS results were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and/or fluorescence in situ hybridization (FISH). Ten cases originally diagnosed as OC, and 1 low-grade uncertain oncocytic tumor (11/74) revealed nuclear-cytoplasmic and/or nuclear positivity for S100 protein and/or SOX10, respectively. Fusion transcripts CHCHD7-PLAG1 and GEM-PLAG1 were found in 2 cases (1 fusion in each), and these were confirmed by RT-PCR and PLAG1 break-apart FISH probe, respectively. Another 5 cases were positive for PLAG1 rearrangement by FISH. In the control group of 15 oncocytic PA/ME, 4/15 tested tumors harbored gene fusions including NFT3-PLAG1, CHCHD7-PLAG1, FBXO32-PLAG1, and C1orf116-PLAG1 (1 fusion in each case) as detected by NGS. Two fusions were confirmed by RT-PCR, 1 case by FISH, and 1 case was not analyzable by FISH. We additionally tested 24 OCs negative for S100 protein and SOX10 by immunohistochemistry (IHC) and by FISH for rearrangement of PLAG1 gene, but none of them were positive. SOX10 and/or S100 protein immunopositivity in conjunction with rearrangement of the PLAG1 gene assisted in reclassification of a subset of oncocytomas as oncocytic variants of PA and ME. Therefore, we recommend to include S100 protein and SOX10 IHC when diagnosing tumors with predominantly oncocytoma-like differentiation. In addition, by NGS, 3 new gene fusions were detected in oncocytic ME, including NTF3-PLAG1, FBXO32-PLAG1, and GEM-PLAG1, and a new fusion C1orf116-PLAG1 was detected in oncocytic PA.
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Affiliation(s)
- Martina Baněčková
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic.
| | - Emmanuelle Uro-Coste
- Department of Pathology, Toulouse University Hospital, IUC-Oncopole, Toulouse, 31100, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, 31100, France
| | - Nikola Ptáková
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Petr Šteiner
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Olga Stanowska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 00 001, Poland
| | - Giulio Benincasa
- Department of Pathology, Clinic Pineta Grande, Castel Volturno (CE), 81030, Italy
| | - Giuseppe Colella
- Department of Maxillo-facial Surgery, University Della Campania "Luigi Vanvitelli", Policlinico Piazza Miraglia, Naples, 81100, Italy
| | - Jan Vondrák
- South Bohemian University, Ceske Budejovice, 37005, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, And Turku University Hospital, Turku, 20500, Finland
| | - Alena Skálová
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
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Oncocytoma of the salivary glands: A clinicopathologic and immunohistochemical study. Oral Oncol 2009; 45:e232-8. [DOI: 10.1016/j.oraloncology.2009.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 08/19/2009] [Accepted: 08/19/2009] [Indexed: 11/19/2022]
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Seethala RR, Barnes EL, Hunt JL. Epithelial-myoepithelial carcinoma: a review of the clinicopathologic spectrum and immunophenotypic characteristics in 61 tumors of the salivary glands and upper aerodigestive tract. Am J Surg Pathol 2007; 31:44-57. [PMID: 17197918 DOI: 10.1097/01.pas.0000213314.74423.d8] [Citation(s) in RCA: 231] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To further define the clinicopathologic spectrum of epithelial-myoepithelial carcinoma (EMCa), we report the gross, histologic, and immunophenotypic characteristics of 61 tumors seen within a 30-year-period. The mean age at presentation was 60.9 years, with a female predominance (1.5:1). The most common sites were parotid (62.1%), sinonasal mucoserous glands (10.3%), palate (8.6%), and submandibular (8.6%). Most EMCas showed a characteristic nodular/multinodular growth pattern and classic biphasic tubular histology. However, new morphologies in EMCa such as ancient change (8.2%), "Verocay"-like change (3.3%), and sebaceous differentiation (13.1%) were noted. Specific histologic variants were dedifferentiated EMCa (3.3%), oncocytic EMCa (8.2%), EMCa ex pleomorphic adenoma (1.6%), double-clear EMCa (3.3%), and EMCa with myoepithelial anaplasia (3.3%). All cytokeratin cocktails selectively highlighted the epithelial component well. Of the myoepithelial markers, p63, smooth muscle actin and vimentin performed best. Bcl-2 and c-kit were frequently positive (66.7% and 69.2%, respectively). p53 was highly expressed only in 1 dedifferentiated EMCa. The recurrence rate was 36.3% (median disease-free survival 11.34 y), but death was rare with 5-year and 10-year disease-specific survivals of 93.5% and 81.8%, respectively. The most important univariate predictors of recurrence were margin status (log rank P=0.006), angiolymphatic invasion (P=0.002), tumor necrosis (P=0.004), and myoepithelial anaplasia (P=0.038). Thus, EMCa is generally a low-grade tumor with a broader morphologic spectrum than previously thought, with several key features predictive of recurrence. Immunohistochemistry can aid diagnosis by highlighting the biphasic nature of the tumor.
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Affiliation(s)
- Raja R Seethala
- Head and Neck/Endocrine Division, Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Saqi A, Giorgadze TA, Eleazar J, Remotti F, Vazquez MF. Clear cell and eosinophilic oncocytomas of salivary gland: Cytological variants or parallels? Diagn Cytopathol 2007; 35:158-63. [PMID: 17415919 DOI: 10.1002/dc.20580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Oncocytomas are uncommon tumors of the salivary gland. They have an abundance of mitochondria, which is manifested as granular eosinophilic cytoplasm by light microscopy. On histological sections, presence of cytoplasmic glycogen and/or fixation artifact can impart cytoplasmic clearing, and oncocytomas with a predominance of clear cytoplasm are labeled clear cell oncocytomas. Two forms of oncocytoma, eosinophilic and clear cell, have been described in the surgical pathology literature. The purpose of this manuscript is to conduct a comparative cytological assessment to ascertain parallels and differences between the two variants.
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Affiliation(s)
- Anjali Saqi
- Department of Pathology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY 10021, USA.
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Ozolek JA, Bastacky SI, Myers EN, Hunt JL. Immunophenotypic comparison of salivary gland oncocytoma and metastatic renal cell carcinoma. Laryngoscope 2005; 115:1097-100. [PMID: 15933529 DOI: 10.1097/01.mlg.0000163497.61332.77] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS The differential diagnosis of oncocytic neoplasms of salivary glands includes both primary and metastatic tumors, one of which is renal cell carcinoma. This study compared immunohistochemical staining characteristics of oncocytomas arising from salivary gland to metastatic renal cell carcinoma using a panel of markers. STUDY DESIGN Immunohistochemistry for cytokeratin 7 (CK7), cytokeratin 20 (CK20), epithelial membrane antigen (EMA), vimentin, CD10, and renal cell carcinoma marker (RCC) was performed on 10 oncocytomas and compared with ten metastatic renal cell carcinomas. RESULTS There were overlapping histologic findings in the oncocytomas and metastatic renal cell carcinomas, with oncocytomas displaying clear cell changes in 2 of 10 cases. CK7 was positive in 9 of 10 oncocytomas and CK20 in 8 of 10 (7/10 stained for both), and vimentin was only weakly positive in 4 of 10 oncocytomas. All oncocytomas were EMA positive, with membranous staining, and all were negative for CD10 and RCC. Metastatic renal cell carcinoma was strongly positive for vimentin, EMA, and CD10 in most cases. RCC and CK7 were variably positive in metastatic renal cell carcinomas (4/10), and only 1 of 10 showed weak staining with CK20. CONCLUSIONS Salivary gland oncocytomas and metastatic renal cell carcinomas share some similar histologic and immunohistochemical characteristics. CD10 and CK20 were the most useful markers to distinguish metastatic renal cell carcinoma from oncocytomas in the salivary gland, whereas RCC, EMA, CK7, and vimentin are not as useful.
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Affiliation(s)
- John A Ozolek
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Sakai E, Yoda T, Shimamoto H, Hirano Y, Kusama M, Enomoto S. Pathologic and imaging findings of an oncocytoma in the deep lobe of the left parotid gland. Int J Oral Maxillofac Surg 2003. [DOI: 10.1016/s0901-5027(03)90406-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Oncocytic metaplasia of palatine gland ducts was demonstrated by light and electron microscopy in seven out of 54 dogs. Oncocytes were recognized as distinct swollen epithelial cells with bright eosinophilic cytoplasm, small dark nuclei and scattered microvilli at the luminal surface. Their cytoplasm contained numerous tightly packed mitochondria, which varied in size and shape. Some oncocytes formed nodular hyperplastic foci that were easily recognized by low-power light microscopy. Oncocytic metaplasia appears to be a common incidental finding in palatine ductal epithelium of older dogs.
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Affiliation(s)
- G Wibbelt
- Department of Veterinary Pathology, University of Liverpool, Liverpool, L69 7TJ, UK
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Dardick I, Birek C, Lingen MW, Rowe PE. Differentiation and the cytomorphology of salivary gland tumors with specific reference to oncocytic metaplasia. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:691-701. [PMID: 10625852 DOI: 10.1016/s1079-2104(99)70012-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The different cell types and many growth patterns found in salivary gland tumors provide ample reason for the diagnostic problems caused by these tumors. To improve criteria for differential diagnosis, the potential range of cytologic features possible in salivary gland tumor cells must be better appreciated. STUDY DESIGN From our respective pathology archives, normal salivary tissue and salivary gland tumours--other than Warthin's tumor and oncocytoma--with oncocytic differentiation were identified and studied by means of light and electron microscopy. RESULTS In this article, we cite a number of different salivary gland tumors, including basal cell adenoma, pleomorphic adenoma, myoepithelioma, polymorphous low-grade adenocarcinoma, and mucoepidermoid carcinoma, showing varying degrees of oncocytic differentiation. CONCLUSIONS Variable cellular differentiation is probably the basis for foci of tumor cells unexpected for a particular salivary gland neoplasm, further compounding differential diagnosis. Illustration of oncocytic differentiation serves 2 purposes. First, it can alert pathologists to this potential in otherwise typical salivary gland tumors; an awareness of this and other possible variations in cellular differential patterns can help prevent misdiagnosis. Second, these particular tumors illustrate the role of the cellular differentiation that is responsible for the range of histologic features within any one subtype of salivary gland tumors.
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Affiliation(s)
- I Dardick
- Department of Laboratory Medicine, University of Toronto, Ontario, Canada
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Abstract
Although infrequent, salivary gland tumors with a dominant population of clear staining cells present problems in differential diagnosis. Mucoepidermoid carcinoma, acinic cell adenocarcinoma, "clear cell" oncocytoma, epithelial-myoepithelial carcinoma, clear cell adenocarcinoma, and metastatic renal cell carcinoma are considered in the differential diagnosis. This review focuses on this heterogenous group of clear cell neoplasms and attempts to clarify some of the features that help distinguish one neoplasm from another.
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Affiliation(s)
- G L Ellis
- Department of Oral and Maxillofacial Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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Abstract
BACKGROUND Oncocytomas are benign salivary gland neoplasms that represent approximately 1.5% of all salivary gland tumors. Oncocytomas of the submandibular gland, however, are decidedly uncommon. METHODS Twenty-two cases of submandibular gland oncocytomas from the files of the Oral and Otolaryngic Tumor Registries of the Armed Forces Institute of Pathology were reviewed, and analysis of the histologic criteria, histochemical and immunohistochemical reactions, and ultrastructural and clinical follow-up data was performed. RESULTS The patients included 11 females and 11 males, age 21-88 years, with a mean age at presentation of 58.7 years. Clinically, the tumors were generally asymptomatic masses in the submandibular gland that increased in size over a period ranging from several weeks to 20 years and were occasionally associated with pain (n = 9). The tumors ranged in greatest dimension from 0.7 to 7 cm and were circumscribed to encapsulated. Histologically, the tumors were characterized by large epithelial cells with eosinophilic, granular cytoplasm. The cytoplasm stained positively with stains used to demonstrate mitochondria (phosphotungstic acid-hematoxylin, Novelli, Cresylecht violet V, and Kluver-Barrera Luxol fast blue stains). Immunohistochemical reactions demonstrated an epithelial origin (keratin and epithelial membrane antigen), whereas markers for myoepithelial derivation (S-100 protein, actin, and glial fibrillary acidic protein) were not identified. At the time this study was conducted, all patients with submandibular oncocytomas were either alive without evidence of disease or had died without evidence of recurrent disease, with surgical resection the only treatment. CONCLUSIONS Submandibular gland oncocytomas are rare, benign tumors. The tumor cells are filled with mitochondria, which are easily demonstrated by histochemical reactions. Complete surgical resection is adequate therapy.
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Affiliation(s)
- L D Thompson
- Department of Otolaryngic and Endocrine Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Shrestha P, Huang JW, Takai Y, Mori M. Primary epithelial tumors of salivary glands--histogenesis, histomorphological and immunohistochemical implications--diagnosis and clinical management. Crit Rev Oncol Hematol 1996; 23:239-60. [PMID: 8842592 DOI: 10.1016/1040-8428(96)00203-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- P Shrestha
- Department of Oral and Maxillofacial Surgery, Asahi University School of Dentistry, Gifu, Japan
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Wold L. Critical Commentary. Pathol Res Pract 1996. [DOI: 10.1016/s0344-0338(96)80062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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