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Rammal R, Batson B, Spector ME, Chiosea SI, Seethala RR. Acinic cell Carcinoma with high-grade Squamoglandular and Chondrosarcomatous Transformation Mimicking 'Carcinosarcoma ex-pleomorphic Adenoma': A Wrinkle in the Proposed Nomenclature Revision for Sarcomatoid Salivary Gland Neoplasms. Head Neck Pathol 2024; 18:44. [PMID: 38775845 PMCID: PMC11111628 DOI: 10.1007/s12105-024-01650-5] [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: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
While acinic cell carcinoma (AciCC) can undergo high-grade transformation (HGT) to high-grade adenocarcinoma or poorly differentiated carcinoma, other morphologies such as spindle cell/sarcomatoid carcinoma are rare and not well-characterized. We herein report a novel case of AciCC with squamoglandular and chondrosarcomatous HGT mimicking a so-called 'carcinosarcoma ex-pleomorphic adenoma'. The patient is an 81-year-old male with a two-month history of neck swelling and referred otalgia who presented with a left parapharyngeal space mass extending into retropharyngeal space and pterygoid muscles. On resection, the tumor showed considerable morphologic diversity with high-grade serous and mucous acinar components as well as cribriform to solid apocrine-like components with comedonecrosis and squamous differentiation, all of which were embedded in a chondromyxoid background ranging from paucicellular and bland to a high-grade chondrosarcoma/pleomorphic sarcoma-like appearance. Only a minor conventional AciCC component was noted. Immunostains were negative for AR and only focally positive for GCDFP-15 arguing against a true apocrine phenotype, while PLAG1 and HMGA2 were negative arguing against an antecedent pleomorphic adenoma. On the other hand, SOX-10, DOG-1 and PAS after diastase highlighted serous acinar differentiation, and mucicarmine, and NKX3.1 highlighted mucous acinar differentiation. NR4A3 immunohistochemical staining and NR4A3 fluorescence in situ hybridization were positive in the carcinomatous and sarcomatoid components while sequencing analysis of both components revealed identical alterations involving TP53, PIK3CB, ARID1A, and STK11. This unique case warrants caution in designating all salivary sarcomatoid carcinomas with heterologous elements as part of the 'carcinoma ex-pleomorphic adenoma' family.
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Affiliation(s)
- Rayan Rammal
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Bethany Batson
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew E Spector
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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De Luca P, Di Stadio A, de Campora L, De Bonis E, Fermi M, Petruzzi G, Atturo F, Colangeli R, Scarpa A, Lo Manto A, Colizza A, Cintoli G, Togo G, Salzano G, Crescenzi D, Ralli M, Abbate V, Ricciardiello F, Magaldi L, D’Ecclesia A, di Massa G, Costarelli L, Merenda E, Corsi A, Covello R, Di Crescenzo RM, Duda L, Dimitri LM, Caputo A, Ferrara G, Lucante T, Longo F, Tassone D, Iemma M, Cassano M, Salzano FA, Califano L, Marchioni D, Pellini R, de Vincentiis M, Presutti L, Ionna F, de Campora E, Radici M, Camaioni A. A Retrospective Multicenter Italian Analysis of Epidemiological, Clinical and Histopathological Features in a Sample of Patients with Acinic Cell Carcinoma of the Parotid Gland. Cancers (Basel) 2023; 15:5456. [PMID: 38001716 PMCID: PMC10669973 DOI: 10.3390/cancers15225456] [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: 10/02/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The acinic cell carcinoma (AciCC) of the parotid gland is a rare tumor with an indolent behavior; however, a subgroup of this tumor presents an aggressive behavior with a tendency to recur. The aim of this multicenter study was to identify and stratify those patients with AciCC at high risk of tumor recurrence. METHODS A retrospective study was carried out involving 77 patients treated with surgery between January 2000 and September 2022, in different Italian referral centers. Data about tumor characteristics and its recurrence were collected. The histological specimens and slides were independently reviewed by a senior pathologist coordinator (L.C.) and the institution's local head and neck pathologist. RESULTS The patients' age average was 53.6 years, with a female prevalence in the group. The mean follow-up was 67.4 months (1-258, SD 59.39). The five-year overall survival (OS) was 83.2%. The 5-year disease-free survival (DFS) was 60% (95% CI 58.2-61.7). A high incidence of necrosis, extraglandular spread, lymphovascular invasion (LVI), atypical mitosis, and cellular pleomorphism was observed in the high-risk tumors compared to the low-risk ones. CONCLUSION AciCC generally had an indolent behavior, optimal OS, DFS with few cervical node metastases, and rare distant relapses. This multicenter retrospective case series provides evidence of the need for clinical-epidemiological-histological stratification for patients at risk of poor outcomes. Our results suggest that the correct definition of high-risk AciCC should include tumor size, the presence of necrosis, extraglandular spread, LVI, atypical mitosis, and cellular pleomorphism.
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Affiliation(s)
- Pietro De Luca
- Otolaryngology Department, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy; (D.C.); (M.R.)
| | | | - Luca de Campora
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
| | - Egidio De Bonis
- Otolaryngology Unit, San Giovanni di Dio e Ruggi D’Aragona Hospital, 84131 Salerno, Italy; (E.D.B.); (M.I.)
| | - Matteo Fermi
- Department of Otorhinolaryngology—Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.P.)
| | - Gerardo Petruzzi
- Department Otolaryngology Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), 00144 Rome, Italy; (G.P.); (R.P.)
| | - Francesca Atturo
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
| | - Roberta Colangeli
- Otolaryngology Department, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (A.S.); (F.A.S.)
| | - Alfredo Lo Manto
- Otolaryngology Department, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.L.M.); (D.M.)
| | - Andrea Colizza
- Department of Sense Organs, University Sapienza, 00161 Rome, Italy; (A.C.); (M.R.); (M.d.V.)
| | - Giulia Cintoli
- Otolaryngology Unit, University of Foggia, 71122 Foggia, Italy; (G.C.); (L.M.); (M.C.)
| | - Giulia Togo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | - Giovanni Salzano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | - Domenico Crescenzi
- Otolaryngology Department, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy; (D.C.); (M.R.)
| | - Massimo Ralli
- Department of Sense Organs, University Sapienza, 00161 Rome, Italy; (A.C.); (M.R.); (M.d.V.)
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | | | - Luciano Magaldi
- Otolaryngology Unit, University of Foggia, 71122 Foggia, Italy; (G.C.); (L.M.); (M.C.)
| | - Aurelio D’Ecclesia
- Maxillofacial and Otolaryngology Unit, IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo, 71013 Foggia, Italy; (A.D.); (F.L.)
| | - Gianluca di Massa
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Leopoldo Costarelli
- Department of Pathology, San Giovanni Addolorata-Hospital, 00184 Rome, Italy;
| | - Elisabetta Merenda
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (E.M.); (A.C.)
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (E.M.); (A.C.)
| | - Renato Covello
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Rosa Maria Di Crescenzo
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, 80131 Naples, Italy;
| | - Loren Duda
- Pathology Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Lucia Maria Dimitri
- Department of Pathology, IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Alessandro Caputo
- Pathology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, 84131 Salerno, Italy;
| | - Gerardo Ferrara
- Department of Pathology, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy;
| | - Teresina Lucante
- Department of Pathology, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy;
| | - Francesco Longo
- Maxillofacial and Otolaryngology Unit, IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo, 71013 Foggia, Italy; (A.D.); (F.L.)
| | - Domenico Tassone
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
| | - Maurizio Iemma
- Otolaryngology Unit, San Giovanni di Dio e Ruggi D’Aragona Hospital, 84131 Salerno, Italy; (E.D.B.); (M.I.)
| | - Michele Cassano
- Otolaryngology Unit, University of Foggia, 71122 Foggia, Italy; (G.C.); (L.M.); (M.C.)
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (A.S.); (F.A.S.)
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | - Daniele Marchioni
- Otolaryngology Department, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.L.M.); (D.M.)
| | - Raul Pellini
- Department Otolaryngology Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), 00144 Rome, Italy; (G.P.); (R.P.)
| | - Marco de Vincentiis
- Department of Sense Organs, University Sapienza, 00161 Rome, Italy; (A.C.); (M.R.); (M.d.V.)
| | - Livio Presutti
- Department of Otorhinolaryngology—Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.P.)
| | - Franco Ionna
- Maxillofacial Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy;
| | - Enrico de Campora
- Associazione Ospedaliera Italia Centro-Meridionale Otorinolaringoiatrica (AOICO), 00100 Rome, Italy;
| | - Marco Radici
- Otolaryngology Department, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy; (D.C.); (M.R.)
| | - Angelo Camaioni
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
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Dogan S, Xu B, Rana S, Chen H, Ghossein RA, Berger MF, Ho AL, Katabi N. Loss of CDKN2A/B is a Molecular Marker of High-grade Histology and is Associated with Aggressive Behavior in Acinic Cell Carcinoma. Mod Pathol 2023; 36:100150. [PMID: 36841437 PMCID: PMC10447625 DOI: 10.1016/j.modpat.2023.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/26/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
Acinic cell carcinoma (AciCC) is a rare salivary gland cancer with excellent prognosis in most cases. However, a subset of patients will develop distant metastasis and die of disease. Recently, a 2-tiered grading scheme in AciCC was proposed to recognize patients at risk of poor outcome. We performed a genetic analysis of AciCC to explore the underlying molecular correlates of the tumor grade and examined programmed death ligand 1 (PD-L1) expression to identify potential candidates for immunotherapy. A retrospective cohort of 55 patients included 34 high-grade (HG) and 21 low-grade AciCCs. Forty-three cases were subjected to targeted exome sequencing by Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets. PD-L1 immunohistochemistry was performed in 33 cases. Tumor mutation burden was low with a median of 1 and 2 mutations in low-grade and HG AciCCs, respectively. CDKN2A/B was the most frequently altered gene, and loss-of-function mutations were found only in HG but not in low-grade AciCCs (18/31 [58.1%] vs 0/12 [0%], P < .001). CDKN2A/B alterations were significantly associated with distant metastasis, which occurred in 16/18 (88.9%) CDKN2A/B mutants versus 11/25 (44%) wild-type cases (P = .004, Fisher exact test). Sequential profiling of multiple temporally distant samples from the same patient demonstrated intratumor heterogeneity, including the detection of CDKN2A/B deletion in the second, in HG metastasis only. ATM and PTEN mutations were detected in 6/31 (19.4%) and 5/31 (16.1%); ARID2, BIRC3, and FBXW7 mutations each in 4/31 (12.9%); and TP53, MTAP, and FAT1 each in 3/31 (9.7%) HG AciCC. PD-L1-positive labeling was more common in HG AciCC (9/17, 52.9% vs 3/16, 18.9%, P = .071). CDKN2A/B mutations in AciCC represent a molecular marker of HG histology and disease progression, providing a rationale for further studies to determine their prognostic and therapeutic significance in this salivary gland cancer. AciCC with ATM mutations may be amenable to targeted therapy. Immunotherapy can be considered to be a treatment option for a subset of patients with AciCC.
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Affiliation(s)
- Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Satshil Rana
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hui Chen
- Department of Pathology, MD Anderson Cancer Center, Houston, Texas
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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Xu B, Saliba M, Ho A, Viswanathan K, Alzumaili B, Dogan S, Ghossein R, Katabi N. Head and Neck Acinic Cell Carcinoma: A New Grading System Proposal and Diagnostic Utility of NR4A3 Immunohistochemistry. Am J Surg Pathol 2022; 46:933-941. [PMID: 35034042 PMCID: PMC10569115 DOI: 10.1097/pas.0000000000001867] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acinic cell carcinoma (AciCC) is traditionally considered as a low-grade salivary gland carcinoma. However, a subset demonstrates high-grade features with a higher mortality rate and distant metastasis. In this large retrospective study of 117 cases, we aimed to establish a histologic grading scheme for AciCC. Adverse independent prognostic factors identified on the multivariate analysis included older age, tumor necrosis, nuclear anaplasia, lymphovascular invasion, absence of tumor-associated lymphoid stroma, and high American Joint Committee on Cancer (AJCC) pT and pN stages. A 3-tiered grading scheme using 4 pathologic parameters (mitotic index, necrosis, tumor border, and fibrosis at the frankly invasive front) was subsequently applied. Compared with low/intermediate-grade, high-grade AciCC defined as a mitotic index ≥5/10 HPFs and/or necrosis was an independently adverse prognostic factor. The 5-year overall survival was 50% in high-grade AciCCs, and 100% in low-grade or intermediate-grade AciCCs. Compared with low-grade or intermediate-grade AciCC, high-grade tumors were associated with older age, larger tumor size, focal rather than diffuse zymogen granules, solid architecture, infiltrative tumor border, fibrosis at the frankly invasive front, lymphovascular invasion, perineural invasion, positive margin, high pT, and pN stages. NR4A3 was a highly sensitive and specific immunohistochemical stain for diagnosing AciCC with a sensitivity and specificity of 96% and 93%, respectively. In conclusion, although we proposed a 2-tiered grading system for AciCC with high-grade tumors defined by a mitotic count ≥5/10 HPFs and/or necrosis, more studies are needed to assess the prognostic value of intermediate grade. NR4A3 immunohistochemical stain is a useful diagnostic marker for AciCC.
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Affiliation(s)
- Bin Xu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Maelle Saliba
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan Ho
- Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kartik Viswanathan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Bayan Alzumaili
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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High-grade Transformation/Dedifferentiation in Salivary Gland Carcinomas: Occurrence Across Subtypes and Clinical Significance. Adv Anat Pathol 2021; 28:107-118. [PMID: 33825717 DOI: 10.1097/pap.0000000000000298] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
High-grade transformation (HGT) or dedifferentiation has been described in a variety of salivary gland carcinomas, including acinic cell carcinoma, secretory carcinoma, adenoid cystic carcinoma, epithelial-myoepithelial carcinoma, polymorphous adenocarcinoma, low-grade mucoepidermoid carcinoma, and hyalinizing clear cell carcinoma. High-grade (HG) transformed tumors are composed of a conventional low-grade component characterized by specific microscopic and immunohistochemical features for the given entity, intermingled with or juxtaposed to areas of HG morphology. This is usually either poorly differentiated adenocarcinoma, carcinoma not otherwise specified, or undifferentiated carcinoma, in which the original line of differentiation is lost. The HG component is composed of solid nests of anaplastic cells with large vesicular pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. Frequent mitoses and extensive necrosis may be present. The Ki-67 labeling index is consistently higher in the HG component. The molecular genetic mechanisms responsible for HGT of salivary gland carcinomas are largely unknown, though p53 inactivation and human epidermal growth factor receptor 2 overexpression and/or gene amplification have been demonstrated in the HG component in a few examples, the frequency varies for each histologic type. Salivary gland carcinomas with HGT are more aggressive than conventional carcinomas, with a higher local recurrence rate and a poorer prognosis. They have a high propensity for cervical lymph node metastasis suggesting a need for a wider resection and neck dissection. HGT of salivary gland carcinoma can occur either at initial presentation or less commonly at the time of recurrence, sometimes following postoperative radiotherapy. The potential for HGT in almost any type of salivary gland carcinoma warrants a thorough sampling of all salivary gland malignancies to prevent oversight of a HG component.
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Yassin-Kassab A, Gainor D, Sufyan AS. Atypical Presentation of Mammary Analogue Secretory Carcinoma of the Lip. EAR, NOSE & THROAT JOURNAL 2020; 101:NP212-NP217. [PMID: 32951456 DOI: 10.1177/0145561320957756] [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: 11/17/2022] Open
Abstract
Mammary analogue secretory carcinoma (MASC) of the salivary gland is a rare tumor that was first described by Skalova et al in 2010, and since then, only a few hundred cases have been reported in the literature. Prior to Skalova's report, MASC was histologically misclassified as acinic cell carcinoma (ACC), pleomorphic adenoma, mucoepidermoid carcinoma, or adenocarcinoma, not otherwise specified. Mammary analogue secretory carcinoma has a low incidence rate overall, accounting for less than 0.3% of all salivary gland tumors. Histopathologic and cytogenic analysis of MASC is identical to secretory carcinoma of the breast, leading to the proposed name by Skalova. The purpose of this case presentation is to describe an atypical presentation of MASC, to compare this case with the classic description of MASC, and to contrast the various features of MASC to ACC in order to improve the accuracy of future diagnoses and help guide treatment.
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