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He L, Zhang J, Zhu T, Zhao P, Mou P, Tang S. Incidence, clinical features, and survival outcomes of primary malignant lacrimal gland tumors: A population-based analysis. Cancer Med 2024; 13:e6831. [PMID: 38230983 PMCID: PMC10905223 DOI: 10.1002/cam4.6831] [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: 08/31/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Studies on the epidemiological information and prognosis of primary malignant lacrimal gland tumors (MLGTs) are rare for its low occurrence. The goal of our research was to investigate the epidemiological characteristics and survival outcomes of patients with MLGTs. METHODS Incidence and demographic information of patients with MLGTs were collected from the Surveillance, Epidemiology, and End Results (SEER) database. To identify independent prognostic factors for disease-specific survival (DSS) and overall survival (OS), univariate and multivariate Cox regression analysis were performed. RESULTS The overall incidence of primary MLGTs from 1975 to 2020 was 0.413/1,000,000 (according to the 2000 American standard population), with a steadily increasing incidence over years. A total of 964 patients with primary MLGTs were diagnosed, with an average age of 59.3 years. Of these, 53.2% were aged ≥60 years, 57.4% were female, and 77.1% were whites. Multivariate Cox regression analysis demonstrated that year of diagnosis, age, sex, histological type, SEER stage, surgery, and chemotherapy were independent prognostic factors of DSS or OS. CONCLUSIONS Although primary MLGT is rare, its incidence has steadily increased in the past 46 years, and surgery was related to a better prognosis.
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Affiliation(s)
- Lin‐feng He
- Department of OphthalmologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Jin‐di Zhang
- Department of OphthalmologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Teng‐fei Zhu
- Department of AnesthesiologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Peng‐cheng Zhao
- Department of AnesthesiologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Pei Mou
- Department of OphthalmologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Shi‐yi Tang
- Department of OphthalmologyGongli Hospital of Shanghai Pudong New AreaShanghaiChina
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Reilly S, Ellard R, O'Sullivan M, Khan R, Kennedy S. Recurrent lacrimal gland pleomorphic adenoma. Orbit 2023; 42:635-640. [PMID: 35546531 DOI: 10.1080/01676830.2022.2064515] [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: 11/11/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
Pleomorphic adenoma is the most common tumour of the lacrimal gland. Correct preoperative diagnosis is essential as the tumour should be removed en bloc. Incisional biopsy is contraindicated due to risk of recurrence and subsequent risk of malignancy. We identified 13 patients who were diagnosed with lacrimal gland pleomorphic adenoma in our institution over a 31-year period from 1990 to 2021. Of these, we describe four patients, three males and one female, who underwent incisional biopsy. One of these patients had a number of recurrences and required an orbital exenteration. The other two were treated with radiation to the orbit and experienced severe dry eye post-radiotherapy. All three patients are currently disease-free. The fourth patient underwent an incisional biopsy of his lacrimal gland pleomorphic adenoma (LGPA) within the last 6 months and has been referred for radiotherapy. The reasons for a lack of preoperative diagnosis of LGPA included clinical uncertainty and broad radiologic differential. None of the patients who had an en bloc resection experienced recurrence. We recommend that a fine needle aspirate (FNA) biopsy in lieu of a tissue biopsy should be performed where LGPA is included in the clinical and radiological differential diagnosis. If incisional biopsy is required, the suture track should be marked so that the entire biopsy track is removed with the specimen.
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Affiliation(s)
- Sinéad Reilly
- School of Biotechnology, Dublin City University, Dublin, Ireland
- National Ophthalmic Pathology Laboratory, Royal Eye and Ear Hospital, Dublin, Ireland
| | - Ruth Ellard
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Máire O'Sullivan
- National Ophthalmic Pathology Laboratory, Royal Eye and Ear Hospital, Dublin, Ireland
| | - Rizwana Khan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Susan Kennedy
- National Ophthalmic Pathology Laboratory, Royal Eye and Ear Hospital, Dublin, Ireland
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Aryasit O, Amornthatree P, Tsutsumi WD, Sittivarakul W, Geater AF, Tengtrisorn S, Prapakornkovit V. Clinical characteristics, radiologic features, and histopathology of biopsied lacrimal gland tumors. Sci Rep 2023; 13:16615. [PMID: 37789105 PMCID: PMC10547680 DOI: 10.1038/s41598-023-43817-0] [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: 05/02/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Herein, we described the clinicopathologic and radiologic features of biopsied lacrimal gland tumors. A retrospective case series of 79 patients treated between 2004 and 2021 was reviewed. The median age was 48.9 years (range 18.3-88.3 years), with 51.9% females. The histopathologic diagnoses were as follows: immunoglobulin G4-related disease (IgG4-RD) = 23, reactive lymphoid hyperplasia = 14, lymphoma = 14, nonspecific inflammation = 10, adenoid cystic carcinoma (ACC) = 9, and pleomorphic adenoma = 9. The proportion of histopathologic diagnoses did not differ significantly over the range of symptom durations (≤ 1 month, > 1-3 months, > 3 months). Patients with ACC had significantly shorter symptom duration and more frequent proptosis than those with pleomorphic adenoma (p = 0.040 and p = 0.009, respectively). Patients with IgG4-RD were older (median 54.3 years) than those with nonspecific inflammation (36.2 years; p = 0.046). Patients with ACC were more likely to present with diplopia than those with lymphoma (p < 0.001). The superior wedge sign increased the likelihood of ACC compared with that of non-epithelial non-malignant lacrimal gland tumors (relative risk ratio = 13.44, p = 0.002). The overall survival of patients with ACC and lymphoma did not differ significantly. Although these patients present with a short symptom duration, urgent orbital imaging, tissue biopsy, and prompt treatment should be performed in patients with lacrimal gland tumors.
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Affiliation(s)
- Orapan Aryasit
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Kohong, Hat Yai, 90110, Songkhla, Thailand.
| | - Pawarin Amornthatree
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Kohong, Hat Yai, 90110, Songkhla, Thailand
| | - Wantanee Dangboon Tsutsumi
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Kohong, Hat Yai, 90110, Songkhla, Thailand
| | - Wantanee Sittivarakul
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Kohong, Hat Yai, 90110, Songkhla, Thailand
| | - Alan Frederick Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Kohong, Hat Yai, 90110, Songkhla, Thailand
| | - Supaporn Tengtrisorn
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Kohong, Hat Yai, 90110, Songkhla, Thailand
| | - Virintorn Prapakornkovit
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Kohong, Hat Yai, 90110, Songkhla, Thailand
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Emerick C, Mariano FV, Vargas PA, Nör JE, Squarize CH, Castilho RM. Adenoid Cystic Carcinoma from the salivary and lacrimal glands and the breast: different clinical outcomes to the same tumor. Crit Rev Oncol Hematol 2022; 179:103792. [PMID: 35973662 DOI: 10.1016/j.critrevonc.2022.103792] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 10/31/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is a biphasic malignant lesion that can develop at various anatomical sites. Salivary and lacrimal ACC lesions have a high risk of local invasion, metastasis, and poor prognosis. In more distant organs, such as the breast, ACC is a rarer and less aggressive lesion. One of the major predictors of mortality of ACC is perineural invasion, which can be seen in 30% of breast lesions, 85% of salivary lesions, and almost 100% of lacrimal gland tumors. The biological differences between these three ACC tumors are still poorly understood. We focused on the current understanding of the genetic variations observed on ACC tumors and prognostic differences associated with distinct anatomical sites. A special effort was made to present the currently available therapies alongside the emerging strategies under development.
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Affiliation(s)
- Carolina Emerick
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil; Department of Periodontics and Oral Medicine, Laboratory of Epithelial Biology, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Fernanda Viviane Mariano
- Department of Pathology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Jacques E Nör
- Department of Cariology, Restorative Sciences, and Endodontics, Angiogenesis Research Laboratory, University of Michigan School of Dentistry Ann Arbor, Michigan, USA; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA; University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Cristiane H Squarize
- Department of Periodontics and Oral Medicine, Laboratory of Epithelial Biology, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA; University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Rogerio M Castilho
- Department of Periodontics and Oral Medicine, Laboratory of Epithelial Biology, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA; University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.
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Guo J, Li Z, Qu X, Xian J. Value of MRI-based radiomics analysis for differentiation of benign and malignant epithelial neoplasms in the lacrimal gland: a retrospective study. Acta Radiol 2021; 62:743-751. [PMID: 32660315 DOI: 10.1177/0284185120940258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is essential to distinguish malignant from benign epithelial neoplasms in the lacrimal gland for different treatment options and prognosis. PURPOSE To retrospectively assess the performance of magnetic resonance imaging (MRI)-based radiomics features in the differentiation of benign and malignant epithelial neoplasms in the lacrimal gland. MATERIAL AND METHODS Seventy-six consecutive patients with histopathology-proven epithelial neoplasms of the lacrimal gland were enrolled in the study, including 41 benign and 35 malignant neoplasms. Radiomics features were extracted from T2-weighted and post-contrast T1-weighted imaging. The least absolute shrinkage and selection operator method was used to select imaging features and reduce data dimension to discriminate malignant from benign neoplasms in the lacrimal gland. Diagnostic performance of the radiomics model was assessed by receive operation characteristic (ROC) curve and compared with that of radiologists. RESULTS Four quantitative image features including inverse difference moment normalized (IDMN), mean deviation (MD), standard deviation (SD), and long-run emphasis (LRE) were selected to distinguish malignant from benign epithelial neoplasms in the lacrimal gland. Area under the curve (AUC) of these four features were 0.88, 086, 0.88, and 0.86, respectively, with 0.93 for the combination model. The model identified malignant epithelial neoplasms from benign group with 89% sensitivity, 93% specificity, and 89% accuracy. There was a significant difference in the diagnostic performance of radiomics model and the radiologists, with AUC of 0.70 for radiologists. The diagnostic performance of radiomics is superior to that of radiologists. CONCLUSION MRI-based radiomics analysis has potential for differentiation of benign and malignant epithelial neoplasms in the lacrimal gland.
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Affiliation(s)
- Jian Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
| | - Xiaoxia Qu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
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Ford JR, Rubin ML, Frank SJ, Ning J, Debnam JM, Bell D, El-Naggar A, Ferrarotto R, Esmaeli B. Prognostic factors for local recurrence and survival and impact of local treatments on survival in lacrimal gland carcinoma. Br J Ophthalmol 2021; 105:768-774. [PMID: 32680839 DOI: 10.1136/bjophthalmol-2020-316142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify prognostic factors for local recurrence, distant metastasis and disease-specific survival (DSS) for lacrimal gland carcinoma. METHODS All consecutive patients with lacrimal gland carcinoma treated from January 1998 through December 2018 were included. Log-rank tests and univariate Cox proportional hazards regression models were used to study risk factors and survival. RESULTS Overall, 55 patients were included in this study, and 5 patients were excluded from the survival analysis. Median age was 46 years (range: 10-76). 43 patients (78%) had adenoid cystic carcinoma (ACC). 31 patients (56%) had T2 disease at presentation. 28 patients (51%) underwent orbital exenteration with or without adjuvant radiotherapy or chemoradiation, 26 (47%) underwent eye-sparing surgery with or without adjuvant radiotherapy or chemoradiation, and 1 received palliative chemoradiation. 11 patients (22%) experienced local recurrence; 14 (29%) experienced distant metastasis. Five- and 10-year local-recurrence-free survival rates were 0.71 (95% CI 0.58 to 0.88), and 5- and 10-year distant-metastasis-free survival rates were 0.67 (95% CI 0.53 to 0.85) and 0.49 (95% CI 0.30 to 0.81), respectively. There was no significant difference in risks of local recurrence, distant metastasis or DSS between ACC patients who had orbital exenteration and those who had eye-sparing surgery. Perineural invasion was negatively associated with local-recurrence-free survival (p=0.02). Among patients with ACC, basaloid/solid histologic type was associated with significantly worse DSS than non-basaloid/solid histologic type (p<0.01). CONCLUSIONS For lacrimal gland carcinoma, orbital exenteration with adjuvant therapy and eye-sparing surgery with adjuvant therapy are associated with similar recurrence outcomes. Eye-sparing surgery is associated with better DSS. Perineural invasion is a risk factor for local recurrence. ACC with basaloid/solid subtype correlates with worse DSS.
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Affiliation(s)
- Joshua Richard Ford
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Maria Laura Rubin
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Steven Jay Frank
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Diana Bell
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adel El-Naggar
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Lv M, Dong ZJ, Tong YX, Li T, Hei Y, Yang XJ, Dong WL. Retrospective Analysis of Clinicopathological Characteristics of Lacrimal Gland Pleomorphic Adenoma and Mechanism of Tumorigenesis by the Imbalance Between Apoptosis and Proliferation. Med Sci Monit 2021; 27:e929152. [PMID: 33737504 PMCID: PMC7986817 DOI: 10.12659/msm.929152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Lacrimal gland pleomorphic adenoma (LGPA) is the most common clinically benign epithelial tumor of the lacrimal gland and is predominantly comprised of epithelial cells and interstitial components. At present, the exact pathogenesis of LGPA remains unclear. Previous research has indicated that the occurrence of LGPA may be related to excessive cell proliferation. MATERIAL AND METHODS This study observed the clinicopathological characteristics of LGPA and investigated the tumorigenesis mechanism of cell over-proliferation caused by the imbalance between apoptosis and proliferation. A total of 27 cases were collected from the Department of Ophthalmology of the Affiliated Hospital of Chengde Medical University and the Third Medical Center of Chinese PLA General Hospital from April 2017 to November 2019. Hematoxylin-eosin (HE) staining and immunohistochemical staining were used to observe the pathological characteristics and analyze the expression of bcl-2 and bax in the lacrimal gland. RESULTS Compared with normal lacrimal gland tissues, LGPA tumor tissues had obvious changes in pathological morphology. The expression of bcl-2 in LGPA lesion tissues was dramatically higher (P<0.001), the expression of bax was not significantly different between groups (P=0.25), but the ratio of bcl-2/bax was significantly higher in tumor tissues (P=0.01). CONCLUSIONS We found that the lacrimal gland tumor tissues had obvious excessive proliferation in pathomorphology, which revealed the necessity of complete surgical removal of the capsule from the perspective of pathological morphology and provided a theoretical basis for the hypothesis that the imbalance between apoptosis and proliferation could lead to cell hyperproliferation.
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Affiliation(s)
- Meng Lv
- Department of Ophthalmology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
| | - Zhi-Jun Dong
- Department of Ophthalmology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
| | - Yue-Xin Tong
- Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
| | - Tian Li
- Department of Ophthalmology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
| | - Yan Hei
- The Institute of Orbital Disease, The Third Medical Center of Chinese PLA General Hospital, Beijing, China (mainland)
| | - Xin-Ji Yang
- The Institute of Orbital Disease, The Third Medical Center of Chinese PLA General Hospital, Beijing, China (mainland)
| | - Wei-Li Dong
- Department of Ophthalmology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
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Milman T, Ida CM, Zhang PJ, Eagle RC. Gene Fusions in Ocular Adnexal Tumors. Am J Ophthalmol 2021; 221:211-225. [PMID: 32800827 DOI: 10.1016/j.ajo.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To highlight the increasing importance of gene fusions in the diagnosis, prognosis, and therapy of ocular adnexal tumors. DESIGN Perspective. METHODS A focused review of gene fusions, their pathogenic mechanism, and gene fusion detection methods in lacrimal gland and primary orbital and ocular adnexal soft tissue tumors; reappraisal of diagnostic, prognostic, and therapeutic approach to ocular adnexal tumors in light of emerging molecular genetic data. RESULTS The widespread implementation of fluorescence in situ hybridization and next-generation sequencing methods in pathology practice has led to identification of recurrent gene rearrangements and fusions in a variety of tumors. As a result, molecular genetic methods have become the gold standard for diagnosis of tumors with overlapping histology and immunophenotype, such as small round blue cell tumors. Identification of canonic gene fusions has led to development of sensitive and specific immunohistochemical markers, such as STAT6 in solitary fibrous tumor. In addition to diagnostic accuracy, gene fusions have prognostic implications, such as unfavorable prognosis of PAX3-FOXO1 fusion in alveolar rhabdomyosarcoma. Finally, recognition of gene fusions as a driving mechanism in neoplasia has led to development of U.S. Food and Drug Administration-approved targeted therapies, such as TRK inhibitors for NTRK fusion-positive cancers. CONCLUSION The discovery of recurrent gene fusions in various tumors, including those involving ocular adnexa, has led to a deeper insight into the molecular mechanisms of these neoplasms, revolutionizing our approach to their diagnosis, prognostication, and therapy.
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Akbaba S, Lang K, Held T, Herfarth K, Rieber J, Plinkert P, Auffarth GU, Rieken S, Debus J, Adeberg S. Carbon-ion radiotherapy in accelerated hypofractionated active raster-scanning technique for malignant lacrimal gland tumors: feasibility and safety. Cancer Manag Res 2019; 11:1155-1166. [PMID: 30774443 PMCID: PMC6362930 DOI: 10.2147/cmar.s190051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction We evaluated treatment outcomes of CIRT in an active raster-scanning technique alone or in combination with IMRT for lacrimal gland tumors. Methods A total of 24 patients who received CIRT for a malignant lacrimal gland tumor at the HIT between 2009 and 2018 were analyzed retrospectively for LC, OS, and distant progression-free survival (DPFS) using Kaplan-Meier estimates. Toxicity was assessed according to the CTCAE version 5. Results Median follow-up was 30 months and overall median LC, OS, and DPFS 24 months, 36 months, and 31 months, respectively. Two-year LC, OS, and DPFS of 93%, 96%, and 87% with CIRT was achieved for all patients. Local failure occurred only in patients with ACC and after a median follow-up of 30 months after the completion of RT (n=5, 21%; P=0.09). We identified a significant negative impact of a macroscopic tumor disease, which was diagnosed on planning CT or MRI before RT, on LC (P=0.026). In contrast, perineural spread (P=0.661), T stage (P=0.552), and resection margins in operated patients (P=0.069) had no significant impact on LC. No grade ≥3 acute or grade >3 chronic toxicity occurred. Late grade 3 side effects were identified in form of a wound-healing disorder 3 months after RT in one patient and temporal lobe necrosis 6 months after RT in another (n=2, 8%). Conclusion Accelerated hypofractionated active raster-scanning CIRT for relative radio-resistant malignant lacrimal gland tumors results in adequate LC rates and moderate acute and late toxicity. Nevertheless, LC for ACC histology remains challenging and risk factors for local recurrence are still unclear. Further follow-up is necessary to evaluate long-term clinical outcome.
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Affiliation(s)
- Sati Akbaba
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Kristin Lang
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Thomas Held
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Klaus Herfarth
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Juliane Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Peter Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Gerd U Auffarth
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Juergen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
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Asahina M, Saito T, Hayashi T, Fukumura Y, Mitani K, Yao T. Clinicopathological effect of PLAG1 fusion genes in pleomorphic adenoma and carcinoma ex pleomorphic adenoma with special emphasis on histological features. Histopathology 2018; 74:514-525. [PMID: 30307055 DOI: 10.1111/his.13759] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/24/2018] [Indexed: 01/05/2023]
Abstract
AIMS Pleomorphic adenoma gene 1 (PLAG1) rearrangement is well known in pleomorphic adenoma (PA), which is histologically characterised by admixed epithelial and mesenchymal components. Multiple fusion variants of PLAG1 and HMGA2 have been reported; currently, however, little is known regarding the clinicopathological impacts of these fusion types METHODS AND RESULTS: We examined the PLAG1- and HMGA2-related fusion status in 105 PAs and 11 cases of carcinoma ex PAs (CXPA) arising from salivary glands and lacrimal glands to elucidate their correlation to the clinicopathological factors. Forty cases harboured PLAG1 fusion genes: CTNNB1-PLAG1 in 22 cases, CHCHD7-PLAG1 in 14 cases and LIFR-PLAG1 in four cases. Only two cases possessed HMGA2 fusion genes. The mean age of LIFR-PLAG1-positive cases was significantly higher than that of CTNNB1-PLAG1- and CHCHD7-PLAG1-positive cases (P = 0.0358). PAs located in the submandibular gland demonstrated CTNNB1-PLAG1 fusion at a significantly higher rate than other fusions (P = 0.0109). Histologically, PLAG1 fusion-positive cases exhibited chondroid formation and plasmacytoid features more commonly (P = 0.043, P = 0.015, respectively) and myxoid abundant feature less frequently (P = 0.031) than PLAG1 fusion-negative cases. For CXPAs, four CTNNB1-PLAG1 fusions were detected in two salivary duct carcinomas and two myoepithelial carcinomas. Ductal formation was observed frequently (90.9%) in residual PA. CONCLUSIONS The presence of PLAG1 fusion was associated with specific histological features in PA. Detecting the PLAG1 fusion gene and searching residual ductal formation in salivary gland malignant tumours with extensive hyalinisation could be useful for diagnosis.
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Affiliation(s)
- Miki Asahina
- Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Takuo Hayashi
- Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Fukumura
- Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Keiko Mitani
- Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
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11
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Xia F, Ling W, Zhang J, Zhang Y, Ma X. Primary poorly differentiated lacrimal gland adenocarcinoma in left ocular region: A rare case report. Medicine (Baltimore) 2018; 97:e12198. [PMID: 30212949 PMCID: PMC6156032 DOI: 10.1097/md.0000000000012198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Primary poorly differentiated lacrimal gland adenocarcinoma in the orbital region is an extremely rare type of neoplasm with only 1 related case in the literature. Its high grade of malignancy makes the timely data reported necessary. Hence, we present an extremely rare disease with biopsy results and recommendations on clinical treatment in an elderly male with Chinese descent. PATIENT CONCERNS A 66-year-old Chinese man presented with swelling in the left ocular region and eyeball proptosis. On physical examination, the patient had redness, tenderness, and swelling of the left eye. A surgical incision was noted on the left orbital region. Left eye movements were restricted. DIAGNOSES Immunohistochemical examination revealed pan-cytokeratin (PCK, +), p63 (partial, +), cytokeratin 7 (CK7, +), cytokeratin 14 (CK14, +), epithelial membrane antigen (EMA, +), protein expressed by erythroblast transformation-specific related gene (ERG, -), S-100 (, -), Epstein-Barr virus-encoded small RNA (EBER, -), smooth muscle actin (SMA, -), and Ki-67 (with a proliferation index approximately 40%). After carefully reviewed the manifestations, imaging findings, and immunohistochemical evidences, a diagnosis of poorly differentiated adenocarcinoma of lacrimal gland was made. INTERVENTION Based on the gene sequencing results, we started the patient with an intensive PF chemotherapy including a combination of cisplatine, fluorouracil, and epirubicin. Two months later, radiotherapy was introduced to the therapy regimen. OUTCOMES The patient responded well to the treatment without severe adverse events. MRI scan showed remarkable remission. LESSONS This rare case report will help raise the awareness of high grade lacrimal gland cancer, and subsequently aid the diagnosis in future cases. Positive immunohistochemical markers of CK7, CK14, EMA, p63, and high proliferation index of Ki-67 can help establishing a diagnosis, and cisplatine-fluorouracil program is proved feasible. We share the difficulties we have encountered, hoping to improve patient care in the future.
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Affiliation(s)
- Fan Xia
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy
- Department of Neurosurgery
| | | | | | - Yifan Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy
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12
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Katabi N, Xu B, Jungbluth AA, Zhang L, Shao SY, Lane J, Ghossein R, Antonescu CR. PLAG1 immunohistochemistry is a sensitive marker for pleomorphic adenoma: a comparative study with PLAG1 genetic abnormalities. Histopathology 2017; 72:285-293. [PMID: 28796899 DOI: 10.1111/his.13341] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/07/2017] [Indexed: 12/16/2022]
Abstract
AIMS Pleomorphic adenoma gene 1 (PLAG1) gene rearrangement is the most common genetic abnormality in pleomorphic adenoma (PA), resulting in overexpression of PLAG1 protein. PA and carcinoma ex pleomorphic adenoma (CA ex-PA) can mimic various benign and malignant salivary gland tumours. The aims of this study are to evaluate the sensitivity and specificity of PLAG1 immunohistochemistry (IHC) in the differential diagnosis of PA and CA ex-PA and to compare the PLAG1 immunohistochemical results to PLAG1 gene abnormalities as detected by fluorescence in-situ hybridisation (FISH). METHODS AND RESULTS PLAG1 immunostaining was performed on 83 salivary gland tumours, including 23 PA, 15 CA ex-PA and 45 other salivary gland tumours. In addition, PLAG1 FISH was performed in 44 cases for the presence of gene rearrangements/amplifications. The results showed high sensitivity of PLAG1 IHC in 96% of PA; however, discordant results between PLAG1 FISH abnormalities and IHC were noted in 15 of 44 cases (34%). Seven PA, four de-novo myoepithelial carcinomas and one basal cell adenocarcinoma had negative FISH results, but were positive for IHC; while three salivary duct carcinomas (SDC) ex-PA were positive for FISH but negative for IHC. PLAG1 IHC can differentiate CA ex-PA from de-novo SDC (P = 0.02), but not from de-novo myoepithelial carcinoma. PLAG1 IHC is a sensitive marker for PA. This could be due to PLAG1 gene abnormalities beyond FISH resolution. CONCLUSIONS A negative PLAG1 IHC might be helpful in excluding a PA diagnosis. Interestingly, in the context of CA ex-PA, FISH is more sensitive than IHC in detecting PLAG1 abnormalities.
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Affiliation(s)
- Nora Katabi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lei Zhang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sung Y Shao
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jason Lane
- 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
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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13
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Dorbandt DM, Lundberg AP, Roady PJ, Huey JA, Phillips H, Hamor RE. Surgical excision of a feline orbital lacrimal gland adenocarcinoma with adjunctive cryotherapy and carboplatin-impregnated bead implantation. Vet Ophthalmol 2017; 21:419-425. [DOI: 10.1111/vop.12501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel M. Dorbandt
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
| | - Alycen P. Lundberg
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
| | - Patrick J. Roady
- Veterinary Diagnostic Laboratory; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 2001 S. Lincoln Avenue Urbana IL 61802 USA
| | - Jane A. Huey
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
- Memphis Veterinary Specialists; 555 Trinity Creek Cove Cordova TN 38018 USA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
| | - Ralph E. Hamor
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
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14
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Unusual pleomorphic adenoma of the lacrimal Gland: Immunohistochemical demonstration of PLAG1 and HMGA2 oncoproteins. Surv Ophthalmol 2017; 62:219-226. [DOI: 10.1016/j.survophthal.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/28/2016] [Accepted: 08/05/2016] [Indexed: 12/23/2022]
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15
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Maamari RN, Custer PL, Harocopos GJ. Incidentally Discovered Adenoid Cystic Carcinoma of the Lacrimal Gland with Isolated Liver Metastases. Ocul Oncol Pathol 2017; 3:262-266. [DOI: 10.1159/000461585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/05/2017] [Indexed: 11/19/2022] Open
Abstract
<b><i>Aim:</i></b> To report a rare presentation of adenoid cystic carcinoma (ACC) of the lacrimal gland. <b><i>Method:</i></b> This is a case report presenting clinical, radiographic, and histopathologic findings. <b><i>Results:</i></b> A 72-year-old female with no reported ocular symptoms was found to have an incidental right orbital mass on imaging. Additional studies revealed multiple liver lesions, which were biopsied and found to be consistent with ACC. She was then referred to the ophthalmology service, where ocular examination demonstrated 2.5 mm of right proptosis with elevation and abduction deficits. Diplopia could be elicited in extreme upgaze and right lateral gaze. An excisional biopsy of the orbital mass was performed, with histopathology confirming the diagnosis of primary ACC of the lacrimal gland, thereby also supporting the initial suspicion that the hepatic ACC lesions represented metastases. <b><i>Conclusion:</i></b> The authors describe a rare presentation of ACC of the lacrimal gland, initially asymptomatic, with metastatic lesions restricted to the liver at the time of diagnosis. Three previous cases of ACC with isolated metastatic hepatic lesions at the time of diagnosis have been reported; all of these cases localized the primary tumor to the salivary glands.
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16
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Lecler A, Boucenna M, Lafitte F, Koskas P, Nau E, Jacomet PV, Galatoire O, Morax S, Putterman M, Mann F, Héran F, Sadik JC, Picard H, Bergès O. Usefulness of colour Doppler flow imaging in the management of lacrimal gland lesions. Eur Radiol 2016; 27:779-789. [PMID: 27271920 DOI: 10.1007/s00330-016-4438-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 03/03/2016] [Accepted: 05/23/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the role of colour Doppler flow imaging (CDFI) in the diagnosis and management of lacrimal fossa lesions. METHODS Institutional ethical committee approval was obtained. Fifty-one patients with 62 lacrimal fossa lesions were retrospectively included from 2003-2015. All patients underwent conventional ultrasonography and CDFI, with a qualitative and quantitative analysis of the vascularization. All patients had lacrimal gland surgery. Definitive diagnosis was based on pathological examination. RESULTS The study included 47 non-epithelial lesions (NEL) and 15 epithelial lesions (EL), with 24 (39 %) malignant lesions and 38 (61 %) benign lesions. NEL were significantly more likely to present with septa (p < 0.001), hypoechogenicity (p < 0.001), high vascular intensity (p < 0.001), both central and peripheral vascularization (p < 0.001), tree-shape vascularization (p < 0.05) and a low resistance index (RI) (p < 0.0001). EL were significantly more likely to present with the presence of cysts (p < 0.001), and a higher RI. Receiver operating characteristic curves identified a RI value of 0.72 as the best cut-off to differentiate NEL from EL, with a sensitivity and specificity of 100 %. CONCLUSION CDFI is a valuable tool in the differential diagnosis of lacrimal fossa lesions. Resistance index measurement enables substantial distinction between EL and NEL, thus providing crucial data for surgical management. KEY POINTS • CDFI is a valuable tool in lacrimal fossa lesions. • Resistance Index measurement enables substantial distinction between epithelial and non-epithelial lesions. • Management of patients becomes more appropriate.
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Affiliation(s)
- A Lecler
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France.
| | - M Boucenna
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - F Lafitte
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - P Koskas
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - E Nau
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - P V Jacomet
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - O Galatoire
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Morax
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Putterman
- Department of Pathology (M.P.), Necker-Enfants Malades Hospital APHP, Paris, France
| | - F Mann
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Héran
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - J C Sadik
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - H Picard
- Clinical Research Unit, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - O Bergès
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
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Abstract
PURPOSE OF REVIEW Oculoplastic genetic diseases can be divided into eyelid, lacrimal, and orbital disorders. The purpose of this review is to develop a rational approach to the categorization of genetic diseases that affect the orbit and review the most recent developments. RECENT FINDINGS Genetic disorders that affect the orbit can simply be divided into whether they cause proliferation or arrest of orbital structures. Proliferative conditions include vascular, neural, bony, mesenchymal, and lymphoid. Conditions that cause arrest can be subcategorized into whether they cause soft tissue or bony arrest of development. The genetics of many of these conditions have been elucidated and novel treatments, based on the molecular defects, have been utilized with some success. SUMMARY Molecular advances may result in substitution of a molecular categorization scheme for the one proposed in this manuscript. Delineation of the underlying molecular causes of these disorders will result in earlier, less invasive procedures than those that are currently employed.
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18
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Jeon SJ, Kim SA, Paik JS, Yang SW. A Case of Carcinoma Ex Pleomorphic Adenoma at 1st Operation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.4.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Soo Ji Jeon
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su Ah Kim
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Sun Paik
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Suk Woo Yang
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
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