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Hutchens T, Thorstad W, Wang X, Li Y, Duncavage EJ, Sun L, Chernock RD. Head and neck squamous cell carcinomas of unknown primary: Can ancillary studies help identify more primary tumor sites? Exp Mol Pathol 2024; 138:104915. [PMID: 38964052 DOI: 10.1016/j.yexmp.2024.104915] [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] [Received: 10/23/2023] [Revised: 05/31/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
A subset of head and neck squamous cell carcinomas present solely as metastatic disease in the neck and are of unknown primary origin (SCCUP). Most primary tumors will ultimately be identified, usually in the oropharynx. In a minority of cases, the primary site remains elusive. Here, we examine the role of ancillary testing, including mutational signature analysis (MSA), to help identify likely primary sites in such cases. Twenty-two cases of SCCUP in the neck, collected over a 10-year period, were classified by morphology and viral status; including human papillomavirus (HPV) testing by p16 immunohistochemistry (IHC) and RT-qPCR, as well as Epstein-Barr virus (EBV) testing by EBER-ISH. CD5 and c-KIT (CD117) IHC was done to evaluate for possible thymic origin in all virus-negative cases. Whole exome sequencing, followed by MSA, was used to identify UV signature mutations indicative of cutaneous origin. HPV was identified in 12 of 22 tumors (54.5%), favoring an oropharyngeal origin, and closely associated with nonkeratinizing tumor morphology (Fisher's exact test; p = 0.0002). One tumor with indeterminant morphology had discordant HPV and p16 status (p16+/HPV-). All tumors were EBV-negative. Diffuse expression of CD5 and c-KIT was identified in 1 of 10 virus-negative SCCUPs (10%), suggesting a possible ectopic thymic origin rather than a metastasis. A UV mutational signature, indicating cutaneous origin, was identified in 1 of 10 (10%) virus-negative SCCUPs. A cutaneous auricular primary emerged 3 months after treatment in this patient. Primary tumors became clinically apparent in 2 others (1 hypopharynx, 1 hypopharynx/larynx). Thus, after follow-up, 6 tumors remained unclassifiable as to the possible site of origin (27%). Most SCCUPs of the neck in our series were HPV-associated and thus likely of oropharyngeal origin. UV signature mutation analysis and additional IHC for CD5 and c-KIT for possible thymic origin may aid in further classifying virus-negative unknown primaries. Close clinical inspection of hypopharyngeal mucosa may also be helpful, as a subset of primary tumors later emerged at this site.
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MESH Headings
- Humans
- Neoplasms, Unknown Primary/virology
- Neoplasms, Unknown Primary/pathology
- Neoplasms, Unknown Primary/genetics
- Male
- Female
- Middle Aged
- Aged
- Squamous Cell Carcinoma of Head and Neck/virology
- Squamous Cell Carcinoma of Head and Neck/genetics
- Squamous Cell Carcinoma of Head and Neck/pathology
- Head and Neck Neoplasms/virology
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/genetics
- Papillomavirus Infections/virology
- Papillomavirus Infections/pathology
- Papillomavirus Infections/genetics
- Proto-Oncogene Proteins c-kit/genetics
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 4, Human/pathogenicity
- Immunohistochemistry
- Biomarkers, Tumor/genetics
- Mutation
- Aged, 80 and over
- Adult
- Papillomaviridae/genetics
- Papillomaviridae/pathogenicity
- Papillomaviridae/isolation & purification
- Exome Sequencing
- Carcinoma, Squamous Cell/virology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/genetics
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Affiliation(s)
- Troy Hutchens
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, United States of America.
| | - Wade Thorstad
- Department of Radiation-Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Xiaowei Wang
- Department of Pharmacology and Regenerative Medicine, The University of Illinois at Chicago, Chicago, IL, United States of America
| | - Yuanxiang Li
- Department of Pharmacology and Regenerative Medicine, The University of Illinois at Chicago, Chicago, IL, United States of America
| | - Eric J Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Lulu Sun
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Rebecca D Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States of America; Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
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Uchiyama T, Terada C, Tachibana Y, Nishiura H, Takeda M, Fujii T, Kimura T, Tsutsumi M, Ohbayashi C. Carcinoma showing thymus-like differentiation of the parotid gland: The brief report of cytomorphology and review of the literature. Diagn Cytopathol 2023; 51:E98-E104. [PMID: 36484759 DOI: 10.1002/dc.25088] [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: 09/14/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Here, we report an extremely rare case of carcinoma with thymus-like differentiation (CASTLE) of the parotid gland. CASTLE is a rare malignant epithelial tumor with thymic epithelial differentiation that arises in the thyroid gland or perithyroidal soft tissue. CASTLE of salivary gland origin is rare, with only nine published case reports to date (reported as "CASTLE" or "thymic carcinoma"). It is critical to diagnose salivary gland tumors using fine needle aspiration cytology. However, this tumor is rare, and there have been few studies on its cytomorphological features. Therefore, it is important to understand the cytological diagnostic characteristics of CASTLE. Herein, we review the cytological features and diagnostic characteristics of salivary gland CASTLE. We also report the genotype results obtained using targeted exome sequencing, which we analyzed with DNA extracted from formalin-fixed paraffin-embedded tissue.
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Affiliation(s)
- Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Chiyoko Terada
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Yuma Tachibana
- Department of Clinical Technology, Yamatotakada Municipal Hospital, Yamatotakada, Japan
| | - Hirokazu Nishiura
- Department of Clinical Technology, Yamatotakada Municipal Hospital, Yamatotakada, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Takahiro Kimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Masahiro Tsutsumi
- Department of Clinical Technology, Yamatotakada Municipal Hospital, Yamatotakada, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
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Wang W, Xu JY, Zhang BT, Jiang J. Ectopic Thymic Carcinoma Located on The Dorsal Side of The Thyroid Gland. EAR, NOSE & THROAT JOURNAL 2022; 102:263-267. [PMID: 36494893 DOI: 10.1177/01455613221145287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Migration of the embryonic thymus is thought to be the basis for the formation of ectopic thymic tumors. Thymic ectopy may be a result of the abnormal migration of the third or fourth branchial cleft to the anterior mediastinum during weeks 5–6 of embryonic development. However, ectopic thymic carcinoma has highly nonspecific histologic features and occurs in variable and unpredictable locations making it difficult to diagnose. However, the clinical diagnosis and treatment should not overlook the possibility of ectopic thymic tumors. Here, we report a case of ectopic thymic carcinoma diagnosed as thyroid cancer before surgery occurring in a location consistent with current assumptions. Furthermore, we briefly review the literature on ectopic thymic carcinoma and discuss current diagnostic and treatment approaches.
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Affiliation(s)
- Wei Wang
- The Department of General Surgery (Department of Thyroid Surgery), the Affiliated Hospital of Southwest Medical University, Luzhou,Sichuan Province,China
| | - Jia-Ying Xu
- The Department of General Surgery (Department of Thyroid Surgery), the Affiliated Hospital of Southwest Medical University, Luzhou,Sichuan Province,China
| | - Bo-Tao Zhang
- The Department of General Surgery (Department of Thyroid Surgery), the Affiliated Hospital of Southwest Medical University, Luzhou,Sichuan Province,China
| | - Jun Jiang
- The Department of General Surgery (Department of Thyroid Surgery), the Affiliated Hospital of Southwest Medical University, Luzhou,Sichuan Province,China
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Kim JY, Jung EJ, Kim JM, Lee HS, Park T, Jeong SH, Jeong CY, Ju YT. Ectopic cervical thymic squamous cell carcinoma misdiagnosed as thyroid cancer: a case report. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2022; 18:89-92. [PMID: 36945245 PMCID: PMC9942761 DOI: 10.14216/kjco.22012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
Ectopic thymic neoplasm, particularly ectopic thymic carcinoma, is a rare disease that presents as a neck mass. Here, we present a case of ectopic thymic squamous carcinoma in a 65-year-old man who presented with persistent hoarseness. After fine needle aspiration cytology, the patient underwent total thyroidectomy with lymph node dissection. The final histopathological examination revealed the ectopic thymic squamous carcinoma. The patient was discharged without any postoperative complications. The patient received adjuvant radiation therapy and did not progress during the 1-year follow-up period.
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Affiliation(s)
- Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju,
Korea
| | - Eun Jung Jung
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon,
Korea
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju,
Korea
| | - Han Shin Lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon,
Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon,
Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon,
Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju,
Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju,
Korea
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Abstract
Ectopic thymic tissue outside its core position in the antero-superior mediastinum is quite common owing to the complexity of embryonal thymus development, whereby reported prevalence values (1 to 90%) are heavily dependent on the method of investigation and the intensity of the workup. The debated prevalence and relevance of ectopic thymic tissue and its accessibility underlie the ongoing discussion whether modern, minimally invasive thymectomy strategies can match the proven benefit of the radical transsternal thymectomy procedure for the treatment of Myasthenia gravis. In this context, the following article covers the etiology, prevalence, and location of normal-looking, reactive, and neoplastic ectopic thymic tissue. Furthermore, ectopic tissues and tumors inside or adjacent to the thymus are mentioned.
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Goh GH, Wang FF, Loh KS, Petersson F. Ectopic cervical well differentiated thymic carcinoma: report of a diagnostically challenging rare case. Pathology 2018; 51:122-125. [PMID: 30477879 DOI: 10.1016/j.pathol.2018.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Giap Hean Goh
- Department of Pathology, National University Hospital, Singapore
| | - Fei Fan Wang
- Department of Otolaryngology - Head and Neck Surgery (ENT), National University Hospital, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology - Head and Neck Surgery (ENT), National University Hospital, Singapore
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Zhu H, Lei Y, Zou J, Su C, Zeng B, Li Y, Luo H. Ectopic right parietal pleural thymic carcinoma: a rare case and review of the literature. J Thorac Dis 2017; 9:E609-E613. [PMID: 28840026 DOI: 10.21037/jtd.2017.06.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ectopic thymic carcinoma is extremely rare. We present a case of a 73-year-old male patient with ectopic right parietal pleural thymic carcinoma and performed a literature review. Computed tomography (CT) of the chest demonstrated a sharp-edged soft tissue mass with intense enhancement measuring 47 mm × 29 mm with a broader base adjacent to the right axillary chest wall at the level of the 5th rib. There was no hilar or mediastinal lymphadenopathy or evidence of a mediastinal tumor or pleural nodules. A totally extra-pleural tumor resection and partial right lung resection was performed. Histological examination demonstrated infiltrative growth typical of carcinoma cells with a nest-like distribution locally invading the surface of the lung tissue. Immunohistochemical examination confirmed the diagnosis of thymic squamous carcinoma positive for CD5. Mediastinal radical radiotherapy (60 Gy) was performed postoperatively. The patient was followed for 17 months without any evidence of recurrence or metastasis.
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Affiliation(s)
- Haoshuai Zhu
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yiyan Lei
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Jianyong Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Chunhua Su
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Bo Zeng
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yan Li
- Department of Pathology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Honghe Luo
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
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Matsuoka K, Murata Y, Ueda M, Miyamoto Y. Ectopic thymic carcinoma presenting as an intrathoracic mass. Asian Cardiovasc Thorac Ann 2016; 24:480-3. [PMID: 27072863 DOI: 10.1177/0218492316643842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An asymptomatic 83-year-old man was found to have a right intrathoracic tumor. Computed tomography demonstrated a soft-tissue density mass measuring 55 × 25 × 22 mm adjacent to the right anterior chest wall. At surgery, the tumor was found to adhere to the diaphragm and right lung, contiguous with the mediastinal fat tissue. Histology of the resected specimen demonstrated proliferation of spindle and sarcomatous cells with multinucleated giant cells. Thus the tumor was diagnosed as undifferentiated thymic carcinoma and was considered to have arisen from ectopic thymic tissue. At 2 years postoperatively, the patient had no evidence of recurrence.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Hyogo, Japan
| | - Yoshitake Murata
- Department of Thoracic Surgery, National Hospital Organization Nagara Medical Center, Gifu City, Gifu, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Hyogo, Japan
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A rare case of ectopic laterocervical thymoma. J Craniomaxillofac Surg 2012; 41:7-9. [PMID: 22687955 DOI: 10.1016/j.jcms.2012.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 04/19/2012] [Accepted: 04/23/2012] [Indexed: 11/23/2022] Open
Abstract
The ectopic cervical thymoma is a rare site for a thymus neoplasm. It is frequently confused with cyst or with later neck mass of uncertain diagnosis until a histological diagnosis is made. Thymic neoplasms normally arise in the mediastinum, causing signs and symptoms of compression of the adjacent structures. Although rare, malignant thymomas may develop from an ectopic thymus, situated in the thyroid gland (Miyauchi et al., 1985; Matsuura et al., 2004), the neck (Yan et al., 2010; Yao et al., 2010; Jung et al., 1999), the lungs (Myers et al., 2007), and the heart (Miller et al., 2005). It is thought to be caused by the persistence of embryological organ portions along its route of physiological descent from the neck into the mediastinum during embryological development. The incidence of ectopic thymoma is around 4%. The thymus is a lympho-epithelial organ that is the centre of the development and maturation of the T lymphocytes. It develops from the ventral portion of the third and fourth pharyngeal pouches and by the sixth week of gestation it descends into the anterior mediastinum. It has a lobular structure with an external or cortical portion, richly populated by immature T cells, thymocyte and an internal medullary part.
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