Expression of epidermal growth factor receptor, transforming growth factor-alpha and Ki-67 in relationship to malignant transformation of pleomorphic adenoma

Dendritic cell subpopulations in carcinoma ex-pleomorphic adenoma: A multicenter study

OBJECTIVE

Carcinoma ex-pleomorphic adenoma (CEXPA) represents a malignant transformation from a recurrent or primary pleomorphic adenoma (PA), and the immune response may be essential in this process. Therefore, in this study, we aimed to identify and quantify subpopulations of dendritic cells (DCs) in CEXPA, residual PA in CEXPA (rPA), and PA.

MATERIALS AND METHODS

A multicenter study was performed collecting salivary gland tumor (SGT) samples from three Oral and Maxillofacial Pathology Centers. A tissue microarray containing 41 samples of CEXPA and 22 samples of PA was included in this study and submitted to immunohistochemical reactions against CD1a, CD83, CD207, and Ki67 antibodies.

RESULTS

Both PA and rPA showed a higher quantification of CD207+ and CD83+ cells when compared to CEXPA (p < 0.001 and p < 0.01, respectively). There was also a difference when comparing the cell proliferation index between PA/rPA and CEXPA using the Ki-67 marker (p = 0.043). However, there was no difference in the DC population regarding clinical parameters such as sex, anatomical location, size, and metastases (p > 0.06).

CONCLUSIONS

Immunohistochemical profile of DC subpopulations and cell proliferation biomarkers in SGTs can contribute as an important tool in the differentiation of benign and malignant tumors or detection of initial areas with malignant transformation.

Molecular Factors in Carcinoma Ex Pleomorphic Adenoma: Systematic Review and Meta-Analysis

OBJECTIVE

Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor. Although multiple reviews have been published on salivary gland malignancies, it has been a decade since the last dedicated systematic review pertaining to CXPA alone was published. This study examines molecular factors in CXPA diagnosis.

DATA SOURCES

MEDLINE, CINAHL, Embase, Scopus, Web of Science (BIOSIS), Cochrane CENTRAL, Health Collection (Informit), OpenDOAR, and GreyNet International.

REVIEW METHODS

Systematic review and meta-analysis from inception to October 31, 2022 for all English language studies pertaining to "carcinoma ex pleomorphic adenoma." Predicted incidence of each biomarker was calculated with meta-analysis. Comparison against pleomorphic adenoma (PA) and salivary duct carcinoma (SDC) when reported within the same study are performed. Risk of bias performed with JBI tool for prevalence studies.

RESULTS

Of 19151 unique studies undergoing abstract screening, 55 studies (n = 1322 patients) underwent data analysis. Biomarkers with >3 studies were p53, HER2, AR, EGFR, PLAG1, ERBB, ER, PR, HMGA2, p16, p63, a-SMA, RAS, PTEN, PDL1, BRAF, PIK3CA, and c-kit. Highest incidence was seen in AR, EGFR, p16, and p53. Significant differences were demonstrated compared with PA and SDC. There was high heterogeneity and overall high risk of bias within studies.

CONCLUSION

Molecular factors are an area of interest in the diagnosis of CXPA. Our study results support examining CXPA as a discrete cohort in future targeted therapy trials. Laryngoscope, 134:1042-1053, 2024.

Proliferation in pleomorphic adenoma: Lights and shadow on this parameter, in a neoplasm showing unpredictable behavior-An immunohistochemical study and review of the literature

BACKGROUND

Pleomorphic adenoma accounts for the majority of benign tumors of the salivary gland. It is also called mixed tumor because it is composed by ductal epithelial and myoepithelial cells, variably intermixed within a chondromyxoid stroma. The recurrence rate is around 3.4% and 6.3%, respectively at 5 and 10 years and, to date, there are no valuable predictive factors. Aim of our study was to assess the role of Ki67 proliferative index in our cases and through meta-analysis.

METHODS

Immunohistochemistry with Ki67 antibody was performed on 28 cases. A manual count of the signal was performed, to establish the proliferative activity. Statistical tests were applied to assess the correlation between the score and clinico-pathologic parameters. Further data were extrapolated from studies published on Pubmed, Cochrane and Web of Science database.

RESULTS

Higher values of Ki67 were found among cases with larger size (p value = 0.0061) and showing greater cellularity (p value=0.0004). 19 papers were selected from the bibliographic search, concerning a total of 1187 patients affected by pleomorphic adenoma. In most of them, a higher Ki67 was detected among relapsing forms but results were controversial. In each study, several count methods were applied.

CONCLUSION

The role of Ki67 in pleomorphic adenoma of the salivary glands remains unclear. The lack of homogeneity of the data makes it very difficult to standardize them in order to draw a conclusion. It would therefore be desirable to carry out a comparison study of the various possible methods of Ki67 counting.

Anlotinib is effective in the treatment of advanced carcinoma ex pleomorphic adenoma of the submandibular gland

Background: Carcinoma ex pleomorphic adenoma (CXPA), a very rare malignancy found mostly in the major salivary glands, has no established standardized treatment.

Case presentation: This report describes a 67-year-old male with advanced CXPA who was effectively treated by anlotinib. Pleomorphic adenoma of the submandibular gland was first diagnosed in 1976 after a surgical resection of a mass underneath the jaw. The patient underwent re-excision 3 years later due to a recurrent pleomorphic adenoma. CXPA was first diagnosed in 2016 after a surgical removal of the left submandibular mass. A lung nodule was found on a chest CT scan in January 2018. Following a CT-guided lung biopsy that demonstrated findings consistent with pulmonary metastasis, the patient underwent local therapy (microwave ablation and radioactive seed implantation) but suffered a recurrence of disease approximately 6 months later. Anlotinib was administered orally at a dose of 12 mg daily on a 2 weeks on/1 week off schedule. A partial response was observed after two cycles of treatment. The disease remains in continued partial response after completion of his sixth cycle.

Conclusion: This is the first report for anlotinib in treating CXPA. Further pre-clinical and clinical studies are needed to validate the efficacy and safety of anlotinib in the treatment of CXPA.

Cellular Proliferation Index between Carcinoma Ex-Pleomorphic Adenoma and Pleomorphic Adenoma

<p>Carcinoma ex pleomorphic adenoma (CXPA) has been considered an interesting model of carcinogenesis, presenting various histological subtypes and invasiveness phase. The objective was to determine the proliferative index of CXPA and comparing to pleomorphic adenoma (PA). Thirty six cases of CXPA (36 PA) and 22 areas of PA in CXPA (residual PA) were studied by Ki-67 expression. All CXPA cases were classified according to invasiveness phase (intracapsular, minimally and frankly invasive) and histopathological subtypes. Data was statistically analyzed by Wilcoxon, Mann-Whitney and Kruskal-Wallis tests. CXPA included 5 intracapsular, 9 minimally invasive and 22 frankly invasive cases. Fifteen cases corresponded to salivary duct carcinoma, 7 to adenocarcinoma NOS, 7 myoepithelial, 5 epithelial-myoepithelial, one case of squamous cell and one case of sarcomatoid carcinoma. The Ki-67 index of PA and residual PA were significantly lower than CXPA. Intracapsular and minimally invasive showed smaller proliferative index than frankly invasive. Considering the subtypes of CXPA, there was not a statistic difference among them. Ki-67 is a useful marker in the differential diagnosis of PA and CXPA, even when in the early invasive phase.</p>

Activation of the interleukin-6/Janus kinase/STAT3 pathway in pleomorphic adenoma of the parotid gland

The interleukin-6 (IL-6)/Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) pathway is of crucial importance in promoting tumorigenesis in several malignant tumors but may also be active in benign tumors, e.g., of pleomorphic adenoma (PA). In this study we characterize the expression of the pathway components with immunohistochemistry and selected mRNAs and microRNAs (miRNAs) regulated by this pathway in isolated duct- and myoepithelial cells in PA. 46 PAs were immunostained and 10 of these were used for in situ hybridization (ISH). Six frozen specimens were analyzed using reverse transcription-polymerase chain reaction (RT-PCR). Using immunohistochemistry, IL-6, JAK1, JAK2 and STAT3 were detected significantly more frequently in PA cells than in cells from normal salivary gland tissue. Using RT-PCR cyclin D1, fibroblast growth factor 2, and p21 were found to be overexpressed while matrix metallopeptidase 9 was detected at low levels in PA compared to normal salivary gland. ISH showed significant overexpression of miR-181b in PA, while miR-21 was undetectable in PA and normal tissue. Overexpression of the pathway components and its mRNA and miRNA products provide important clues regarding the growth of PAs. Our findings brings us one step closer to targeted treatment of this tumor entity, although in vitro studies are warranted to confirm this.

Metastasizing pleomorphic adenoma: a fascinating enigma

Among salivary gland neoplasms, metastasizing pleomorphic adenoma (MPA) constitutes an extremely rare group of tumors. The present paper reports a case of pleomorphic adenoma (PA) in submandibular gland that, after more than 30 years of initial treatment, recurred and metastasized to ipsilateral neck lymph nodes and parotid gland. In an attempt to elucidate the malignant behavior of metastasizing pleomorphic adenoma, we performed Ki-67, p53, p16, and bcl-2 immunohistochemistry staining of our case sample. Many immunohistochemistry staining studies have been done on malignant salivary gland tumors. However, to the best of our knowledge no immunohistochemistry staining of the aforementioned markers has been previously performed on metastasizing pleomorphic adenoma.

Comparison of Ki-67, cyclin E, and p63 in benign and malignant human pleomorphic adenoma

OBJECTIVE

A set of cell proliferation-related molecular markers was used to detect the differences in proliferative activity between benign pleomorphic adenoma (PA) and carcinoma ex pleomorphic adenoma (CXPA).

STUDY DESIGN

Seventy samples comprising 53 PAs, 10 noninvasive and 7 widely invasive (WI) CXPAs were selected. Immunohistochemical staining was used to detect Ki-67, cyclin E, and p63 expression.

RESULTS

The average Ki-67 labeling index of WI CXPAs was higher than that of PAs and the malignant component of noninvasive CXPAs (M-noninvasive CXPA; P < .01). An increased cyclin E-positive staning was observed in M-noninvasive CXPAs and WI CXPAs compared with PAs (P = .006). The p63 expression levels were notably decreased in M-noninvasive CXPAs and WI CXPAs compared with PAs (P = .007).

CONCLUSIONS

The data support that increased or decreased expression of Ki-67, cyclin E, and p63 may indicate the proliferative differences between PA and CXPA.

Carcinoma ex pleomorphic adenoma: a comprehensive review of clinical, pathological and molecular data

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. It often poses a diagnostic challenge to clinicians and pathologists. This study intends to review the literature and highlight the current clinical and molecular perspectives about this entity. The most common clinical presentation of CA ex PA is of a firm mass in the parotid gland. The proportion of adenoma and carcinoma components determines the macroscopic features of this neoplasm. The entity is difficult to diagnose pre-operatively. Pathologic assessment is the gold standard for making the diagnosis. Treatment for Ca ex PA often involves an ablative surgical procedure which may be followed by radiotherapy. Overall, patients with Ca ex PA have a poor prognosis. Accurate diagnosis and aggressive surgical management of patients presenting with Ca ex PA can increase their survival rates. Molecular studies have revealed that the development of Ca ex PA follows a multi-step model of carcinogenesis, with the progressive loss of heterozygosity at chromosomal arms 8q, then 12q and finally 17p. There are specific candidate genes in these regions that are associated with particular stages in the progression of Ca ex PA. In addition, many genes which regulate tumour suppression, cell cycle control, growth factors and cell-cell adhesion play a role in the development and progression of Ca ex PA. It is hopeful that these molecular data can give clues for the diagnosis and management of the disease.

Histologic grading and prognostic biomarkers in salivary gland carcinomas

Both the variety and rarity of salivary gland carcinomas pose challenge for using histologic grade and biomarkers to predict outcome. Mucoepidermoid carcinoma is the histologic subtype for which grading is most prognostically and therapeutically relevant. This tumor is graded using standard schemes in a 3-tier manner with the intermediate-grade category shows the most variability between grading systems and thus the most controversy in management. The t(11;19)(q21; p13) MECT1-MAML2 translocation may be an objective marker that can help to further stratify difficult cases. Adenoid cystic carcinomas are graded based on pattern with solid areas correlating with a worse prognosis. Occasionally, adenoid cystic carcinomas may undergo transformation to highly aggressive pleomorphic high-grade carcinomas with frequent nodal metastases. Comparative genomic hybridization has revealed several chromosomal regions (such as 1p32-p36, 6q23-q27) of prognostic interest in adenoid cystic carcinoma. Carcinoma ex-pleomorphic adenoma is actually a category of tumors rather than a single tumor type with both aggressive and indolent versions. These tumors should be further qualified as to type/grade of carcinoma and extent, as intracapsular and minimally invasive tumors behave favorably. Acinic cell carcinomas, although generally considered low grade, can recur, metastasize, or even prove lethal in a significant number of cases suggesting amenability to a grading scheme to separate these biologic groups. Although aggressive histologic parameters (anaplasia, necrosis, and mitoses) are predictive of poor outcome, a standard grading scheme does not yet exists. Acinic cell carcinomas can also undergo high-grade transformation.

Quantitative promoter methylation differentiates carcinoma ex pleomorphic adenoma from pleomorphic salivary adenoma

Background:

Potential epigenetic biomarkers for malignant transformation to carcinoma ex pleomorphic adenoma (Ca ex PSA) have been sought previously with and without specific comparison with the benign variant, pleomorphic salivary adenoma (PSA). Previous analysis has been limited by a non-quantitative approach. We sought to demonstrate quantitative promoter methylation across a panel of tumour suppressor genes (TSGs) in both Ca ex PSA and PSA.

Methods:

Quantitative methylation-specific real-time polymerase chain reaction (qMSP) analysis of p16^INK4A, CYGB, RASSF1, RARβ, human telomerase reverse transcriptase (hTERT), Wilms’ tumour 1 (WT1) and TMEFF2 gene promoters was undertaken on bisulphite-converted DNA, previously extracted from archival fixed tissue specimens of 31 Ca ex PSA and an unrelated cohort of 28 PSA. All target regions examined had formerly been shown to be hypermethylated in salivary and/or mucosal head and neck malignancies.

Results:

The qMSP demonstrated abnormal methylation of at least one target in 20 out of 31 (64.5%) Ca ex PSA and 2 out of 28 (7.1%) PSA samples (P<0.001). RASSF1 was the single gene promoter for which methylation is shown to be a statistically significant predictor of malignant disease (P<0.001) with a sensitivity of 51.6% and a specificity of 92.9%. RARβ, TMEFF2 and CYGB displayed no apparent methylation, while a combinatory epigenotype based on p16, hTERT, RASSF1 and WT1 was associated with a significantly higher chance of detecting malignancy in any positive sample (odds ratio: 24, 95% CI: 4.7–125, P<0.001).

Conclusions:

We demonstrate the successful application of qMSP to a large series of historical Ca ex PSA samples and report on a panel of TSGs with significant differences in their methylation profiles between benign and malignant variants of pleomorphic salivary adenoma. qMSP analysis could be developed as a useful clinical tool to differentiate between Ca ex PSA and its benign precursor.

Satellite tumors surrounding primary pleomorphic adenomas of the parotid gland

The occasional local recurrence of benign pleomorphic adenoma (PA) has generally been attributed to the vulnerability of the tumor capsule. Although some reports have also noted the presence of satellite tumors associated with PA recurrence, only few reports have focused on this issue. We paid special attention to the satellite lesions apart from the main tumors and discussed their frequency, origin, nature and the ways of treating them. A total of 108 specimens of primary parotid gland PA resected at the Okayama Saiseikai General Hospital from 1988 to 2008 were microscopically reviewed. Four (3.7%) patients displayed a main mass with satellite tumors in a single parotid gland. The immunohistochemical analysis of p53 and Ki-67 index showed no distinct difference between PAs with satellite tumors and those without. Satellite tumors surrounding the main mass of parotid PA is relatively rare. In most cases, such satellite tumors will arise from capsular perforation of the primary tumor cells. Preoperative evaluation to recognize the existence of satellite tumors would be important and capsular dissection should be discouraged. We could not find any evidence suggesting that primary PA with satellite tumors could be more biologically aggressive than those without.

Ki67 and salivary cancer

We examined Ki67 expression in salivary malignancies of 75 patients with a follow-up period of up to 20 years. Correlations between enhanced Ki67 and enhanced p53 and TUNEL and heparanase staining levels were significant. Median survival for reduced-stained-tumor patients (< or = 5%) was 163 months, dropping significantly to 39 months (p = 0.0005) for enhanced stained tumors (> 5%); 5 year survival probability was 93% and 33%, respectively, 45% and 16%, respectively, (p = 0.0005) at 20 years. Significant correlation between poor survival and concurrently altered expression rates of Ki67 and p53, p27 Skp2, TUNEL and heparanase in the salivary malignancies indicates a biological role in salivary cancer pathogenesis.

Expression of transforming growth factor α and Cyclin E and their correlation in chronic gastric lesion tissues from patients with different TCM types

AIM: To explore the expression of transforming growth factor α (TGF-α) and Cyclin E in chronic gastric lesion tissues from patients with different types of traditional Chinese medicine (TCM), and analyze the correlation between TGF-α and Cyclin E expression.

METHODS: The patients (n = 135) with chronic gastric diseases were classified to 4 groups according to different TCM types such as disharmony between liver and stomach (group A), spleen-stomach cold deficiency (group B), stomach-yin deficiency (group C), and mixed cold and heat (group D). Immunohistochemical staining was used to examine the expression of TGF-α and Cyclin E in the lesion tissues and the correlation between TGF-α and Cyclin E expression was also ssessed.

RESULTS: The positive rates of TGF-α expression in the lesion tissues of group A, B, C and D were 25.0%, 18.6%, 47.1% and 42.1%, respectively, and there was significant difference between group B and C (P < 0.05). The positive rates of Cyclin E expression were 20.0%, 7.0%, 26.5% and 31.6%, respectively, and there was marked difference between group B and D (P < 0.05). Both TGF-α and Cyclin E expression were the lowest in group B, and there existed a positive correlation between the expression of TGF-α and Cyclin E.

CONCLUSION: TGF-α and Cyclin E are differentially expressed in chronic gastric lesion tissues of patients with different TCM types, and the expression of TGF-α and Cyclin E are positively correlated.