Fine-needle aspiration cytology of palisading adenocarcinoma: The first cytology report of a newly described salivary gland neoplasm

Here, we report the first cytology findings of the newly characterized entity, palisading adenocarcinoma of the salivary gland, diagnosed in the sublingual gland of a 61-year-old female. The liquid-based cytology showed a moderately cellular aspirate containing three-dimensional clusters and trabeculae of tumor cells of various sizes. The cells had dark ovoid nuclei, finely granular chromatin, inconspicuous to punctate nucleoli, and ample cyanophilic cytoplasm with indistinct cell borders. In conventional smears, the cells displayed frequent crush artifacts and anisonucleosis resembling endocrine-type atypia. The background was clean, devoid of secretions, and contained singly dispersed tumor cells with stripped nuclei. Interestingly, concentrically laminated globules of extracellular matrix surrounded by the tumor cells were identified. Mitotic figures and tumor necrotic debris were absent. The cytologic findings correlated with the histologic findings of the excision specimen. The cytologic differential diagnosis and tumor grading of palisading adenocarcinoma were briefly discussed.

Primary Carcinosarcoma of the Parotid Gland Mimicking as Parotid Abscess With Deep Neck Infection

Carcinosarcoma, true malignant mixed tumor, of the parotid is an extremely rare tumor. Pathologically, it is composed of malignant epithelial and malignant mesenchymal elements. The carcinosarcoma of the salivary glands comprised only 0.04% to 0.16% of all malignant salivary tumors with 65% occurring in the parotid gland. This tumor has an aggressive characteristic and is often regarded as a high-grade tumor with distant metastasis occurring in 54% of the patients. Patients usually present between 60 and 65 years of age and most series report no sex predominance. Radiologically, this tumor has a low attenuation center with a thick-enhancing wall and can be misdiagnosed deep neck infection in the parapharyngeal space. In this report, the authors report a patient of true malignant mixed tumor of the parotid gland mimicking as deep neck infection. Radiologic and histologic features including immunohistochemical results are discussed.

Neuroendocrine neoplasms of the head and neck: some suggestions for the new WHO classification of head and neck tumors

As knowledge and understanding in pathology evolve, classifications and nomenclature also change to reflect those advances. The 2005 World Health Organization Classification of Head and Neck Tumours was a significant step towards diagnostic standardization of head and neck neuroendocrine carcinomas; however, in the last 10 years there have been new data supporting the recognition of "large cell neuroendocrine carcinoma" as a distinctive high grade carcinoma in the head and neck, a lesion not included in the 2005 Classification. In addition, the terms "middle ear adenoma" and "carcinoid tumor of middle ear" are still widely used to describe a neoplasm that is neither a pure adenoma nor a carcinoid tumor but a lesion with variable mixed exocrine and endocrine differentiation. Largely using the diagnostic criteria of the WHO classification of neuroendocrine carcinomas of the lung, we propose the terms "neuroendocrine carcinoma, grade 1"; "neuroendocrine carcinoma, grade 2"; "neuroendocrine carcinoma, grade 3, large cell type"; and "neuroendocrine carcinoma, grade 3, small cell type" for the classification of neuroendocrine carcinomas of the head and neck in a future WHO classification. In addition, we also proposed the term "mixed epithelial neuroendocrine tumor" of the middle ear as an alternative for "middle ear adenoma" and "carcinoid tumor of the middle ear".

Moderately differentiated neuroendocrine carcinoma (atypical carcinoid) of the parotid gland: report of three cases with contemporary review of salivary neuroendocrine carcinomas

Primary neuroendocrine carcinomas (NECs) of the salivary glands are rare. Most reported NECs in that region are small cell carcinomas with few cases of large cell undifferentiated carcinoma and typical carcinoid tumors. Only two moderately differentiated NECs (atypical carcinoid tumors) have been previously reported. In the current series, the authors report three additional moderately differentiated NECs (atypical carcinoid tumors) of the parotid gland; two occurred in women and one in a man. All patients were initially treated with parotidectomy, with selective lymph node excision in one, and radiation therapy in another. Follow-up was available for two cases (18 and 79 months). One patient had two local recurrences, developing lymph node and liver metastases requiring further surgery and chemotherapy. Currently, she is alive with disease, on supportive care. The second patient is alive with no signs of recurrence. Patients' work-up excluded the possibility of metastatic NECs to the salivary glands in all cases. Histologically, the tumors demonstrated infiltrating nests, cords and trabeculae of round, oval to spindle shaped cells with moderate to focally abundant eosinophilic cytoplasm, small to prominent nucleoli and chromatin stippling. Scattered rosette-like structures were prominent in one tumor. The highest mitotic counts for the three tumors ranged from 5 to 8 mitotic figures/10 hpfs. Necrosis, focal but distinct, was noted in two tumors, vascular invasion in two tumors and perineural invasion in one tumor. Immunohistochemical staining was diagnostic of neuroendocrine carcinoma, showing uniform positive labeling with broad-spectrum cytokeratin (with a paranuclear punctuate pattern in one case), chromogranin and synaptophysin antibodies. CK20 was negative in two tumors and stained rare cells (<1%) in the third.

Neuroendocrine tumors of the submandibular gland: literature review and report of a case

Primary salivary neuroendocrine neoplasms are extremely rare, with only 1 case of carcinoid tumor and 7 cases of primary large-cell neuroendocrine carcinomas having been reported. Salivary small-cell neuroendocrine carcinomas are more frequent, accounting for less than 2% of all salivary malignancies. In addition to a literature review on the subject, the authors describe a rare case of malignant intermediate-grade neuroendocrine tumor of the submandibular gland.

Carcinoid tumour metastasis to the submandibular gland: a case report

Carcinoid tumours are slow growing tumours of neuroendocrine origin that primarily affect the gastrointestinal tract and pulmonary system. They can behave aggressively, with regional and distant metastases, although metastases to the head and neck region are uncommon. We present a rare case of carcinoid metastasis to the submandibular gland, which to the best of our knowledge has not been previously reported in the literature.

Primary Carcinoid Tumor of the Frontal Sinus: A Case Report

Carcinoid tumors are rare, indolent, neuroendocrine tumors that are most commonly found in the gastrointestinal tract and lungs. They occasionally develop in the head and neck, either as a primary tumor or, more commonly, as a metastasis. The most common sites of head and neck carcinoids are the larynx and middle ear. Only a few cases of carcinoid in the nasal cavity and paranasal sinuses have been reported. We describe a case of primary typical carcinoid of the frontal sinus in a 61-year-old man, and we review the clinical, imaging, surgical, and histochemical findings in this case. The patient was treated with endoscopic resection. A subsequent workup for metastatic and occult primary disease was negative, confirming that the frontal sinus was the primary source. At follow-up 12 months postoperatively, the patient remained without disease. To the best of our knowledge, this is the first report of a primary typical carcinoid tumor originating in the frontal sinus.

A Histone2BCerulean BAC transgene identifies differential expression of Phox2b in migrating enteric neural crest derivatives and enteric glia

The mammalian enteric nervous system (ENS) derives from migratory enteric neural crest-derived cells (ENCC) that express the transcription factor Phox2b. Studies of these enteric progenitors have typically relied on immunohistochemical (IHC) detection. To circumvent complicating factors of IHC, we have generated a mouse BAC transgenic line that drives a Histone2BCerulean (H2BCFP) reporter from Phox2b regulatory regions. This construct does not alter the endogenous Phox2b locus and enables studies of normal neural crest (NC) derivatives. The Phox2b-H2BCFP transgene expresses the H2BCFP reporter in patterns that recapitulate expression of endogenous Phox2b. Our studies reveal Phox2b expression in mature enteric glia at levels below that of enteric neurons. Moreover, we also observe differential expression of the transgene reporter within the leading ENCC that traverse the gut. Our findings indicate that the wavefront of migrating enteric progenitors is not homogeneous, and suggest these cells may be fate-specified before expression of mature lineage markers appears.