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Mahomed F, de Bruin J, Ngwenya S, Bouwer N. Carcinomas with clear cell features and EWSR1 rearrangements: a report of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:293-300. [PMID: 38155013 DOI: 10.1016/j.oooo.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023]
Abstract
Salivary gland and odontogenic neoplasms with extensive clear cell change are rare lesions but have been increasingly characterized over the past decade. Among this heterogeneous group of neoplasms, hyalinizing clear cell carcinoma (HCCC), clear cell odontogenic carcinoma (CCOC), and clear cell myoepithelial carcinoma (CCMC) share a monophasic clear cell morphology and an EWSR1 gene rearrangement. While HCCC is relatively well characterized, there are a limited number of EWSR1-reaarranged CCMC of salivary glands reported, and its clinicopathologic features in relation to HCCC and nonclear cell myoepithelial carcinoma (MC) have not been clarified. This report describes the clinical, morphologic, and immunophenotypic features of 3 carcinomas composed predominantly of clear cells and with EWSR1 rearrangements by fluorescence in situ hybridization. A comparative literature analysis suggests that HCCC, CCMC, and nonclear cell MC of salivary glands are clinically, histopathologically, and molecularly distinct.
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Affiliation(s)
- Farzana Mahomed
- Department of Oral Pathology, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jana de Bruin
- Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sizakele Ngwenya
- Department of Oral Pathology, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nikki Bouwer
- Department of Molecular Medicine and Haematology, National Health Laboratory Services, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Guan L, Tang Y, Yang Z, Guo L, Yang S. Hyalinizing clear cell carcinoma of the sublingual gland: A case report and literature review. Medicine (Baltimore) 2024; 103:e39150. [PMID: 39058814 PMCID: PMC11272283 DOI: 10.1097/md.0000000000039150] [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: 03/26/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Hyalinizing clear cell carcinoma (HCCC) of the salivary glands is a rare low-grade malignant tumor. This type of tumor is particularly uncommon in the sublingual glands. PATIENT CONCERNS A 57-year-old female with a mass on the left side of the floor of the mouth that had been present for 2 months. The computed tomography scan of the neck revealed a nodular abnormal density shadow in the left sublingual area, measuring approximately 2.6 cm × 1.9 cm. DIAGNOSES Primary HCCC of the sublingual gland. INTERVENTIONS The patient underwent surgical treatment and reconstruction using a left anterolateral femoral free flap, which showed immunohistochemical positivity for CK 5/6, CK 7, CK (AE1/AE3), and Ki-67 (<5%), but negative for SMA and S-100. OUTCOMES No recurrence was observed during the 12-month postoperative follow-up period. LESSONS The absence of characteristic clinical manifestations makes HCCC highly susceptible to misdiagnoses. This case presents a rare instance of HCCC in the sublingual gland, providing a reference for the clinical diagnosis and treatment of the disease.
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Affiliation(s)
- Li Guan
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Oral and Maxillofacial Surgery, Suining Central Hospital, Suining, China
| | - Yuyang Tang
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Oral and Maxillofacial Surgery, Suining Central Hospital, Suining, China
| | - Zhenglin Yang
- Department of Oral and Maxillofacial Surgery, Suining Central Hospital, Suining, China
| | - Lijuan Guo
- Department of Medical Cosmetology, Suining Central Hospital, Suining, China
| | - Sen Yang
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Oral and Maxillofacial Surgery, Suining Central Hospital, Suining, China
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3
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Xhori O, Deol N, Rivera CM, Zavras J, Weil SG, Zafari H, Thierauf JC, Faquin WC, Choy E, Rivera MN, John Iafrate A, Jaquinet A, Troulis MJ. A Comparison of Clear Cell Sarcoma to Jaw and Salivary Tumors Bearing EWS Fusions. Head Neck Pathol 2024; 18:25. [PMID: 38526767 DOI: 10.1007/s12105-024-01625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/04/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To review tumors identified as "clear cell sarcoma" in order to determine similarities to the rare EWS fusion positive jaw and salivary gland tumors clear cell odontogenic carcinoma (CCOC) and clear cell carcinoma of the salivary gland (CCC). METHODS PubMed was used to collect all reports of clear cell sarcoma (CCS). Search parameters were "clear cell sarcoma" and "CCS." References in the publications were screened and cross-referenced. Data extracted included demographic characteristics, presenting signs and symptoms, radiographic findings, histological and immunohistochemical features and known molecular/genetic aberrations. RESULTS Clear cell sarcoma has several similarities to CCOC and CCC. All three tumor types have similar histologic appearances including the presence of clear cells, as well as similar genetic profiles in that all harbor an EWSR1-CREB family fusions. Additionally, these tumors appear in soft tissue as well as bone, and can have a prolonged clinical course. CCS can appear anywhere in the body, including the head and neck region. All three tumors appear to have a predilection to women, although CCS may have a slight younger age of onset as compared to CCOC and CCC (3rd vs 5th decade of life, respectively). CONCLUSION Gaining a better understanding of the similarities and differences between these three tumors may lead to a better understanding of each one.
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Affiliation(s)
- Ornela Xhori
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, 02113, USA
| | - Navkiran Deol
- Harvard School of Dental Medicine, DMD'25, 188 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, 02113, USA.
| | - Camron M Rivera
- Harvard School of Dental Medicine, DMD'25, 188 Longwood Avenue, Boston, MA, 02115, USA
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, 02113, USA
| | - Jason Zavras
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Sophia G Weil
- Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Hirad Zafari
- Harvard School of Dental Medicine, DMD'25, 188 Longwood Avenue, Boston, MA, 02115, USA
| | - Julia C Thierauf
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02113, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02113, USA
- Harvard Medical School, 27 Shattuck Street, Boston, MA, 02115, USA
| | - Edwin Choy
- Harvard Medical School, 27 Shattuck Street, Boston, MA, 02115, USA
- Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA, 02113, USA
| | - Miguel N Rivera
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02113, USA
- Harvard Medical School, 27 Shattuck Street, Boston, MA, 02115, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02113, USA
- Harvard Medical School, 27 Shattuck Street, Boston, MA, 02115, USA
| | | | - Maria J Troulis
- Harvard School of Dental Medicine, DMD'25, 188 Longwood Avenue, Boston, MA, 02115, USA
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, 02113, USA
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Takamura T, Koyasu S, Sugimoto A, Yamamoto T, Nakamoto Y. Hyalinizing Clear Cell Carcinoma in the Sphenoid Sinus. Clin Nucl Med 2024; 49:287-288. [PMID: 38170933 DOI: 10.1097/rlu.0000000000005017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
ABSTRACT A 39-year-old man presented with a 1-month history of headaches. Imaging revealed a mass with extensive destruction. T2-weighted imaging displayed mixture of low and sponge-like high intensities and also dark area, with FDG PET/CT showing uneven but intense accumulation. Biopsy confirmed EWSR1 rearrangement, and hyalinizing clear cell carcinoma (HCCC) was diagnosed. HCCC, recently renamed from clear cell carcinoma in the fifth edition of the World Health Organization Classification of Head and Neck Tumors, is a rare tumor. This case describes the features of T2-weighted imaging and FDG PET patterns in HCCC, possibly contributing to their consideration in the differential diagnosis.
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Affiliation(s)
| | - Sho Koyasu
- From the Departments of Diagnostic Imaging and Nuclear Medicine
| | - Akihiko Sugimoto
- Diagnostic Pathology, Graduate School of Medicine, Kyoto University
| | | | - Yuji Nakamoto
- From the Departments of Diagnostic Imaging and Nuclear Medicine
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Zhai C, Yuan C, Sun J, Song W, Wang S, Lin L. Clinical and Histopathologic Analyses of Nasopharyngeal Hyalinizing Clear Cell Carcinoma: A Series of 26 Cases With Molecular Confirmation. Am J Surg Pathol 2023; 47:1168-1175. [PMID: 37377124 DOI: 10.1097/pas.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
The aim of this study was to evaluate the clinicopathologic features, molecular characteristics, treatment strategy, and prognosis of nasopharyngeal hyalinizing clear cell carcinoma (HCCC). Retrospective observational case series. Institutional pathology records between 2006 and 2022 were searched for all cases of nasopharyngeal HCCC. We included 10 male and 16 female patients aged 30 to 82 years (median: 60.5 y, mean: 54.6 y). The most common symptoms were blood-stained rhinorrhea and nasal obstruction. Tumors most often involved the lateral wall of the nasopharynx, followed by the superior posterior wall. Microscopically, all tumor cells were arranged in sheets, nests, cords, and single cells in a hyaline/myxoid/fibrous stroma. The tumor cells were polygonal, with or without distinct cell borders, and displayed abundant clear-to-eosinophilic cytoplasm. All 26 cases were positive for pancytokeratin, CK7, p40, and p63 but negative for myoepithelial differentiation markers. Ki-67 labeling was low and ranged from 1% to 10%. All 26 cases demonstrated EWSR1 and EWSR1-ATF1 rearrangements, and no case demonstrated MAML2 rearrangement. Complete follow-up data were available for 23 patients: 14 patients underwent endoscopic surgery alone, 5 underwent radiation therapy followed by endoscopic surgery, 3 underwent radiation therapy followed by biopsy, and 1 underwent cisplatin chemotherapy before endoscopic surgery. Clinical follow-up ranged from 6 to 195 months; 13 patients (56.5%) were alive without tumor, 5 patients (21.7%) died of disease, 5 patients (21.7%) survived with tumor. HCCCs of the nasopharynx are rare tumors. The definitive diagnosis depends on histopathology, immunohistochemistry, and molecular studies. The optimal treatment for patients with nasopharyngeal HCCC is wide local excision. Radiation and chemotherapy might be good options for managing locally advanced cases. Nasopharyngeal HCCC is less indolent than previously thought. Tumor stage and the choice of treatment are key factors affecting the prognosis of nasopharyngeal HCCC patients.
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Affiliation(s)
- Changwen Zhai
- Department of Pathology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
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Lanic MD, Guérin R, Sater V, Durdilly P, Ruminy P, Skálová A, Laé M. A novel SMARCA2-CREM fusion expending the molecular spectrum of salivary gland hyalinazing clear cell carcinoma beyond the FET genes. Genes Chromosomes Cancer 2023; 62:231-236. [PMID: 36504225 DOI: 10.1002/gcc.23114] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
Hyalinizing clear cell carcinoma (HCCC) is a rare salivary gland carcinoma with a generally indolent behavior, characterized by recurrent chromosomal translocation involving EWSR1 (22q12.2) leading to two fusion genes EWSR1::ATF1 or EWSR1::CREM. We report one case of HCCC with a novel SMARCA2::CREM fusion, identified by targeted RNA next generation sequencing by LD-RT-PCR, which has until now never been described in salivary glands. The exon 4 of SMARCA2 is fused to exon 5 of CREM. This fusion has been described previously in only one tumor, a central nervous system tumor (intracranial mesenchymal tumor) but not in other FET::CREB fused tumors. This fusion was confirmed by CREM break-apart FISH and reverse transcriptase polymerase chain reaction (RT-PCR). The tumor cells showed retained expression of INI1, SMARCA2, and SMARCA4 by immunohistochemistry. We compare its clinical, histopathological, immunophenotypic, genetic features with those previously described in HCCC, FET::CREB fusion-positive. Our results added data suggesting that different histomolecular tumor subtypes seem to be included within the terminology "HCCC, FET::CREB fusion-positive," and that further series of cases are needed to better characterize them.
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Affiliation(s)
- Marie-Delphine Lanic
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France
| | - René Guérin
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Vincent Sater
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France.,Department of Pathology, Centre Henri Becquerel, Rouen, France
| | | | - Philippe Ruminy
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France
| | - Alena Skálová
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic.,Bioptic Laboratory, Ltd, Plzen, Czech Republic
| | - Marick Laé
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France.,Department of Pathology, Centre Henri Becquerel, Rouen, France
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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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Li J, Jin Q, Shang Y, Yu P. Multiple metastases of clear cell sarcoma at diagnosis presented in bone marrow aspirate: A case report. Diagn Cytopathol 2023; 51:E105-E108. [PMID: 36533698 DOI: 10.1002/dc.25091] [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: 11/03/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Clear cell sarcoma (CCS) is a rare and aggressive soft-tissue sarcoma that arises most commonly in adolescents and young adults of both sexes. CCS presents a diagnostic challenge due to its morphological and immunohistochemical similarity to malignant melanoma. We present a rare and severe case of CCS simultaneously with multiple bone and lymph node metastases at the time of initial diagnosis in a previously healthy 15-year-old Chinese man. Detailed information on clinical manifestations, laboratory profiles, histopathological findings and poor outcome were described. The cytomorphology of bone marrow aspirate in CCS in Wright-Giemsa staining smear was first depicted in this case. The diagnostic difficulties of the rare case was also discussed.
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Affiliation(s)
- Jianlan Li
- Department of Internal Medicine Laboratory, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Qianni Jin
- Department of Internal Medicine Laboratory, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Yangwei Shang
- Department of Pathology, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Peixia Yu
- Department of Laboratory Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Verdeja R, Stauffer E, Lombardi T. Unusual Presentation of Clear Cell Odontogenic Carcinoma: Case Report and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12041019. [PMID: 35454067 PMCID: PMC9024627 DOI: 10.3390/diagnostics12041019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/17/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023] Open
Abstract
Clear cell odontogenic carcinoma (CCOC) is a rare, aggressive epithelial neoplasm of the jaw first described in 1985 by Hansen and classified as an odontogenic malignant tumor in the 2005 WHO classification. To date, only 117 cases have been reported in the literature written in English. In this paper, we report the atypical presentation of a pericoronal localized tumor in the right mandibular wisdom tooth discovered during a routine radiologic examination. The patient, a 44-year-old healthy female, was referred by her general dental practitioner for examination of temporomandibular dysfunction and recurrent myofascial pain. Anamnesis and clinical examination did not suggest tumoral disease. The osteolytic lesion was removed, and histological examination revealed a clear cell odontogenic tumor (CCOT) of the right posterior lower jaw. Segmental lower jaw resection was performed, and a free iliac crest bone transplant was fixed with mandibular reconstruction plate. No cervical neck dissection was needed. A five-year follow-up examination shows excellent local and systemic recovery and no sign of tumor recurrence. The patient still suffers from bruxism and myofascial related pain, which are treated conservatively with a Michigan splint and physiotherapy. Based on this additional case, we review the literature and discuss the challenging diagnostic aspects, the unusual clinical presentation, and the treatment of CCOC.
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Affiliation(s)
- Raúl Verdeja
- Department of Surgery, Service of Maxillofacial and Oral Surgery, University Hospital and Faculty of Medicine, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-26-321-20-87
| | - Edouard Stauffer
- Private Pathology Institute (Promed), 1700 Fribourg, Switzerland;
| | - Tommaso Lombardi
- Unit Oral Medicine and Maxillo-Facial Pathology, Department of Surgery, Service of Maxillofacial and Oral Surgery, University Hospital and Faculty of Medicine, 1205 Geneva, Switzerland;
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Aljerian K. EWSR1 rearrangement is not specific for hyalinizing clear cell carcinoma of salivary glands. Ann Diagn Pathol 2022; 59:151946. [DOI: 10.1016/j.anndiagpath.2022.151946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
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