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Weissferdt A, Moran CA. Primary thymic adenoid cystic carcinoma with high-grade transformation: A clinicopathological and immunohistochemical analysis of 4 cases. Pathol Res Pract 2024; 259:155356. [PMID: 38810375 DOI: 10.1016/j.prp.2024.155356] [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: 04/14/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
Four cases of a distinct carcinoma of the thymic gland are presented. The patients were 4 adult males with an age range from 40 to 47 years (mean, 43.5 years). Clinically, all patients presented with non-specific respiratory symptoms. None of the patients had any prior history of head and neck neoplasm or surgery in that anatomic area. Large anterior mediastinal masses were found on diagnostic imaging with concurrent metastatic disease to pleura, lungs, regional lymph nodes and bones. Microscopically, all tumors were composed of a solid proliferation of hyperchromatic, monomorphic small cells with focal cytoplasmic clearing embedded in a fibromyxoid stroma. In one case, occasional duct-like structures were identified. Immunohistochemically, the tumors were positive for pancytokeratin, CD117 and MYB and negative for myoepithelial markers. Systemic chemotherapy was initiated in all patients. Despite therapy, clinical follow-up revealed that all 4 patients died of their disease 11-23 months after their initial diagnosis. The cases in this series highlight a tumor that is different from conventional thymic carcinoma and that has the morphological and immunohistochemical features commonly seen in adenoid cystic carcinomas with high-grade transformation. Correct diagnosis is essential for patient management.
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Affiliation(s)
- Annikka Weissferdt
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - Cesar A Moran
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
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Zhang W, Wang XX, Wang XL, Zhang Y, Li XF, Li Y, Cai YY, Ren HQ, Zhang YX, Hao FR. Epithelial–myoepithelial carcinoma of the nasopharynx: A case report and review of the literature. Front Oncol 2022; 12:923579. [PMID: 35992786 PMCID: PMC9389165 DOI: 10.3389/fonc.2022.923579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEpithelial–myoepithelial carcinoma (EMCa) is a rare low-grade malignant tumor that most commonly occurs in the salivary glands, with approximately 320 cases having been reported worldwide. Here, we report the third case of EMCa occurring in the nasopharynx. Rare cases in the breast, pituitary gland, lacrimal gland, nose, paranasal sinus, nasal cavity, trachea and bronchus, lung, and even the pleura mediastinalis have also been reported. Histopathology and immunohistochemistry are useful for confirming the diagnosis of EMCa, which is characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells and stains for different markers in each layer. However, because of the rarity of EMCa, the clinicopathological characteristics and treatment of these patients remain unclear.Case presentationWe report a rare case of EMCa of the nasopharynx. A 51-year-old man presented with a 5-month history of pain while swallowing and aggravation accompanied by right ear tinnitus lasting for 1 month. Nasopharyngoscopy and magnetic resonance imaging (MRI) of the nasopharynx and neck revealed a 5.6 cm × 3.4 cm × 3.1 cm mass in the nasopharyngeal space, invasion of the right cavernous sinus, and lymph node enlargement in the right retropharyngeal space. On 17 April 2019, based on the histopathological and immunohistochemical features, a final diagnosis of EMCa of the right nasopharynx was made. The patient underwent concurrent chemoradiotherapy (CCRT), and his symptoms were relieved after treatment. On 10 January 2022, nasopharynx MRI and biopsy revealed local recurrence, but chest and abdominal computed tomography (CT) showed no obvious signs of metastasis. The local recurrence-free survival (LRFS) period was 33 months.ConclusionTo the best of our knowledge, this is the third reported case of EMCa in the nasopharynx and the only case of EMCa in the nasopharynx treated with CCRT, and a partial response was achieved. Therefore, to improve the quality of life and prognosis of patients with unresectable tumors, we believe that CCRT is a suitable option. Further clinical observations are required to elucidate the pathophysiology and prognosis of EMCa.
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Affiliation(s)
- Wei Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Xiao-xiao Wang
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Xiao-li Wang
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yan Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Xiu-feng Li
- Department of Pathology, Weifang People’s Hospital, Weifang, China
| | - Yang Li
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yuan-yuan Cai
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Hui-qi Ren
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yun-xiang Zhang
- Department of Pathology, Weifang People’s Hospital, Weifang, China
- *Correspondence: Fu-rong Hao, ; Yun-xiang Zhang,
| | - Fu-rong Hao
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China
- *Correspondence: Fu-rong Hao, ; Yun-xiang Zhang,
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Alqaidy D, Moran CA. Thymic Carcinoma: A Review. Front Oncol 2022; 12:808019. [PMID: 35463355 PMCID: PMC9024054 DOI: 10.3389/fonc.2022.808019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of thymic carcinoma may pose significant problems not necessarily in the histopathological diagnosis but rather in assigning the thymus as specific origin. Often the tissue available for interpretation is obtained via a mediastinocopic biopsy, which raises two different issues -minimal tissue and lack of specific features to make a carcinoma of thymic origin. In addition, if to that conundrum we add that there is no magic immunohistochemical stain that will unequivocally lead to the interpretation of thymic carcinoma, then we are left with a true clinical-radiological-pathological correlation. In this review, we will highlight some of those challenges that diagnostic surgical pathologists may encounter in the histopathological assessment of thymic carcinoma as well as in the staging of these tumors.
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Affiliation(s)
- Doaa Alqaidy
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Cesar A. Moran
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
- *Correspondence: Cesar A. Moran,
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Kumar V, Soni P, Garg M, Goyal A, Meghal T, Kamholz S, Chandra AB. A Comparative Study of Primary Adenoid Cystic and Mucoepidermoid Carcinoma of Lung. Front Oncol 2018; 8:153. [PMID: 29868475 PMCID: PMC5962707 DOI: 10.3389/fonc.2018.00153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/24/2018] [Indexed: 12/15/2022] Open
Abstract
Background Pulmonary mucoepidermoid carcinoma (PMEC) and pulmonary adenoid cystic carcinoma (PACC) are the two major types of primary salivary gland-type (PSGT) lung cancers. The demographic profile, clinicopathological features, and predictors of survival as an overall group have not been described for PSGT cancers of lung. Methods In this study, we analyzed demographic, clinical, and survival data from 1,032 patients (546 PMEC and 486 PACC) who were diagnosed of PSGT lung cancer in the Surveillance, Epidemiology and End Results database from 1973 to 2014. Results The PSGT constituted 0.09% of all lung cancers with age-adjusted incidence rate of 0.07 per 100,000 person-years and change of −32% from 1973 to 2014. The incidence of PMEC was slightly higher than PACC but there were no differences in the age and sex distribution. PACCs (55%) were significantly higher at trachea and main bronchus while PMECs were more common at peripheral lungs (85%). Most of the tumors were diagnosed at an early stage and were low grade irrespective of histology. As compared to PMEC, significantly higher number of patients with PACC underwent radical surgery and received adjuvant radiation. The 1- and 5-year cause-specific survival was 76.6 and 62.8%, respectively. On multivariate analysis, the survival was affected by age at diagnosis, tumor stage, histological grade, period of diagnosis, and surgical resection. The histology showed strong interaction with time and hazard ratio of patients with PACC was significantly worse than patients with PMEC only after 5 years. Conclusion The incidence of pulmonary PSGT cancer is 7 cases per 10 million population in the United States and is decreasing. There was no difference between demographic profile of patients with PMEC and PACC but pathological features were diverse. The difference in the survival of patients with the two histological types surfaced only after 5 years when survival of patients with PMEC was better than PACC.
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Affiliation(s)
- Vivek Kumar
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Parita Soni
- Department of Internal Medicine, Maimonides Cancer Center, New York, NY, United States
| | - Mohit Garg
- Department of Internal Medicine, Maimonides Cancer Center, New York, NY, United States
| | - Abhishek Goyal
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Trishala Meghal
- Department of Hematology and Oncology, Maimonides Cancer Center, New York, NY, United States
| | - Stephan Kamholz
- Department of Internal Medicine, Maimonides Cancer Center, New York, NY, United States
| | - Abhinav Binod Chandra
- Department of Hematology and Oncology, Yuma Regional Medical Center Cancer Center, Yuma, AZ, United States
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Kalhor N, Moran CA. Pulmonary mucoepidermoid carcinoma: diagnosis and treatment. Expert Rev Respir Med 2018; 12:249-255. [DOI: 10.1080/17476348.2018.1428563] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Neda Kalhor
- Department of Pathology, The University of Texas, M D Anderson Cancer Center, Houston, TX, USA
| | - Cesar A. Moran
- Department of Pathology, The University of Texas, M D Anderson Cancer Center, Houston, TX, USA
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