Patterns of Care and Outcome of Clear Cell Carcinoma of the Head and Neck

Hyalinizing clear cell carcinoma of the sublingual gland: A case report and literature review

RATIONALE

Hyalinizing clear cell carcinoma (HCCC) of the salivary glands is a rare low-grade malignant tumor. This type of tumor is particularly uncommon in the sublingual glands.

PATIENT CONCERNS

A 57-year-old female with a mass on the left side of the floor of the mouth that had been present for 2 months. The computed tomography scan of the neck revealed a nodular abnormal density shadow in the left sublingual area, measuring approximately 2.6 cm × 1.9 cm.

DIAGNOSES

Primary HCCC of the sublingual gland.

INTERVENTIONS

The patient underwent surgical treatment and reconstruction using a left anterolateral femoral free flap, which showed immunohistochemical positivity for CK 5/6, CK 7, CK (AE1/AE3), and Ki-67 (<5%), but negative for SMA and S-100.

OUTCOMES

No recurrence was observed during the 12-month postoperative follow-up period.

LESSONS

The absence of characteristic clinical manifestations makes HCCC highly susceptible to misdiagnoses. This case presents a rare instance of HCCC in the sublingual gland, providing a reference for the clinical diagnosis and treatment of the disease.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

BACKGROUND

Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field.

METHODS

In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication.

RESULTS

The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.

CONCLUSION

As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.

Clinical and Histopathologic Analyses of Nasopharyngeal Hyalinizing Clear Cell Carcinoma: A Series of 26 Cases With Molecular Confirmation

The aim of this study was to evaluate the clinicopathologic features, molecular characteristics, treatment strategy, and prognosis of nasopharyngeal hyalinizing clear cell carcinoma (HCCC). Retrospective observational case series. Institutional pathology records between 2006 and 2022 were searched for all cases of nasopharyngeal HCCC. We included 10 male and 16 female patients aged 30 to 82 years (median: 60.5 y, mean: 54.6 y). The most common symptoms were blood-stained rhinorrhea and nasal obstruction. Tumors most often involved the lateral wall of the nasopharynx, followed by the superior posterior wall. Microscopically, all tumor cells were arranged in sheets, nests, cords, and single cells in a hyaline/myxoid/fibrous stroma. The tumor cells were polygonal, with or without distinct cell borders, and displayed abundant clear-to-eosinophilic cytoplasm. All 26 cases were positive for pancytokeratin, CK7, p40, and p63 but negative for myoepithelial differentiation markers. Ki-67 labeling was low and ranged from 1% to 10%. All 26 cases demonstrated EWSR1 and EWSR1-ATF1 rearrangements, and no case demonstrated MAML2 rearrangement. Complete follow-up data were available for 23 patients: 14 patients underwent endoscopic surgery alone, 5 underwent radiation therapy followed by endoscopic surgery, 3 underwent radiation therapy followed by biopsy, and 1 underwent cisplatin chemotherapy before endoscopic surgery. Clinical follow-up ranged from 6 to 195 months; 13 patients (56.5%) were alive without tumor, 5 patients (21.7%) died of disease, 5 patients (21.7%) survived with tumor. HCCCs of the nasopharynx are rare tumors. The definitive diagnosis depends on histopathology, immunohistochemistry, and molecular studies. The optimal treatment for patients with nasopharyngeal HCCC is wide local excision. Radiation and chemotherapy might be good options for managing locally advanced cases. Nasopharyngeal HCCC is less indolent than previously thought. Tumor stage and the choice of treatment are key factors affecting the prognosis of nasopharyngeal HCCC patients.

Clinicopathological and molecular study of 10 salivary gland clear cell carcinomas, with emphasis on rare cases with high grade transformation and occurring in uncommon sites

Background

As a rare salivary gland malignancy, clear cell carcinoma (CCC) is easily misdiagnosed. This study identified the features that allow better recognition of the clinicopathological and molecular characteristics and the prognosis of CCC, focusing on high-grade transformation (HGT) in this tumor and cases arising in uncommon sites.

Methods

Clinicopathological and follow-up data for 10 CCC samples were retrieved. Immunohistochemical (IHC) staining was performed, and fluorescence in situ hybridization (FISH) was used to detect EWSR1 gene rearrangements, EWSR1–ATF1 gene fusions, and MAML2 gene rearrangements.

Results

Histologically, typical CCCs comprised bland polygonal or round cells with clear cytoplasm. In contrast with typical CCCs, HGT tumor cells exhibited nuclear pleomorphism, high nuclear-to-cytoplasmic ratios, high mitotic activity, and necrosis. Rare morphologic features such as pseudopapillae, gland-like spaces, and entrapped ducts were also observed. Occasionally, tumors involving the oral cavity might arise from the overlying epithelium of the mucosal surface. Immunohistochemically, all the cases expressed p63, p40, and CK5/6, while myoepithelial-related markers were uniformly negative in all cases. HGT exhibited a wild type p53 expression pattern. FISH demonstrated EWSR1 rearrangement (10/10) and EWSR1–ATF1 fusion (4/5); however, MAML2 remained intact (0/3).

Conclusions

CCCs with HGT or occurring in uncommon sites are extremely rare. Combining morphology based IHC and molecular detection provided reliable evidence that the HGT component represented a transformation of CCC rather than the coexistence of another tumor and helped differentiating CCCs in uncommon sites from their mimics, avoiding potential misdiagnosis and inappropriate therapy. The overall prognosis for CCCs is good, except for the HGT cases, which needed continued treatment.

Impact of tumor site on the prognosis of salivary gland neoplasms: A systematic review and meta-analysis

In numerous types of cancer, the primary tumor site can show a correlation with disease behavior and survival outcomes. In salivary gland tumors (SGTs) this association remains controversial. This study assessed the association between primary sites of SGTs and prognosis. Studies from five databases were assessed and a meta-analysis was performed using studies that presented 95 % confidence interval (95 % CI), hazard ratio (HR) and survival analysis. Gathered information from 46,361 patients showed that site had a prognostic impact on SGTs. Tumors involving minor salivary glands showed worse overall survival (HR = 1.60; 95 % CI = 1.17-2.19; p = 0.003), disease-specific survival (HR=1.63; 95 % CI = 1.12-2.37; p = 0.01), and cause-specific survival (HR=2.10; 95 % CI = 1.72-2.55; p = 0.00001). Tumors from major salivary glands showed better recurrence-free survival (HR=2.31; 95 % CI = 1.77-3.02; p = 0.00001), and locoregional control of disease (HR=2.66; 95 % CI = 1.20-5.91; p = 0.02). Our results showed that the primary site of SGTs has an impact on patient prognosis.

Does Nodal Metastasis and Perineural Invasion Affect Local Control in Hyalinizing Clear Cell Carcinoma of the Oral Cavity? A Case Report with Long Term Follow-Up

Hyalinizing clear cell carcinoma (HCCC) is a rare, low-grade neoplasm accounting for approximately 1% of salivary gland neoplasms. Histologically, it is characterized by a monomorphous population of clear cells arranged in sheets, nests, or cords, lacking ductal structures. Until recently, clear cell carcinoma of the oral cavity (OC) represented a diagnosis of exclusion when other head and neck pathologic entities such as epithelial-myoepithelial carcinoma or mucoepidermoid carcinoma could be ruled out, making definitive diagnosis by light microscopy and immunoprofiling a challenge. As a result, initial biopsies are often misclassified, and could result in under- or overtreatment. More recently, the presence of the EWSR1-ATF1 gene fusion has been adopted to definitively diagnose HCCC. Typically, HCCC demonstrates clinical indolence and responds well to curative surgical excision alone for localized disease, with adjuvant radiotherapy (RT) reserved for high risk features including perineural invasion, lymphovascular invasion, and regional cervical metastasis. The literature, however, lacks consensus regarding the role of adjuvant radiotherapy. In this article, we report a case of HCCC in a rare site involving the ventral tongue, with high risk features of perineural invasion and cervical nodal metastasis. The patient underwent surgical excision alone; declining adjuvant radiotherapy despite the high risk features, and was alive with no evidence of disease at the 42-month mark. Furthermore, we provide an update on the current prognostic indicators for HCCC, and emphasize the need for chromosomal analysis to achieve a definitive diagnosis.

John MA. Primary Clear Cell Adenocarcinoma of the Head and Neck: A Population-Based Analysis

Objective

To characterize the epidemiology and clinicopathologic determinants of survival following the diagnosis of clear cell adenocarcinoma in the head and neck region.

Study Design

Retrospective cohort study.

Setting

The Surveillance, Epidemiology, and End Results registry (1994 to 2014).

Subjects and Methods

A total of 173 cases were identified. Study variables included age, sex, race, tumor subsite, tumor stage, tumor grade, surgical excision, and regional and distant metastases. Survival measures included overall survival (OS) and disease-specific survival (DSS).

Results

Median age at diagnosis was 63 years, 48% were female, and 80.2% were white. Fourteen percent of patients presented with regional lymph node metastases, while 3.3% of patients presented with distant metastases. Most of the tumors presented in the oral cavity, salivary glands, and pharynx. Kaplan-Meier analysis demonstrated OS and DSS of 77.2% and 83.7% at 5 years, respectively. Median OS after diagnosis was 153 months. Bivariate analysis showed that surgical excision was associated with 5-fold increased OS and DSS, whereas advanced age, high tumor grade, advanced stage, larger tumor size, nodal disease, and distant metastases were all significant predictors of decreased OS and DSS.

Conclusions

Clear cell adenocarcinoma is a rare neoplasm that typically affects white individuals in their early 60s, with a generally favorable prognosis. It most commonly arises in the oral cavity, major salivary glands, and pharynx. Surgical excision is associated with 5-fold survival benefit, whereas advanced age, high tumor grade, advanced stage, nodal disease, and distant metastases are independently associated with worse OS and DSS.

Hyalinizing clear cell carcinoma-a rare entity in the oral cavity: A case report

BACKGROUND

Hyalinizing clear cell carcinoma (HCCC) is an uncommon tumor that originates in the salivary glands. This neoplasia constitutes less than 1% of minor salivary gland tumors.

CASE SUMMARY

A 67-year-old female visited the maxillofacial surgery department owing to a smooth, slightly yellowish protruding mass on the left side of the floor of the mouth, at the level of the molars; the tumor mass had a soft consistency on palpation and did not adhere to deep planes. The microscopical analysis of the excisional biopsy showed that the lesion was composed of sheets and cords of clear cells separated by thick eosinophilic bands of hyaline collagen. Normal glandular tissue was absent, periodic acid-Schiff with and without diastase stains, and immunohistochemical reactions were performed to confirm the diagnosis. This is the second case reported in the literature of HCCC arising in the floor of the mouth.

CONCLUSION

HCCC is a rare salivary gland tumor that has not been studied extensively. Its diagnosis is usually challenging, because clinically, it can be confused with a benign neoplasm.

Clinical characteristics and treatment-associated survival of head and neck Ewing sarcoma

OBJECTIVES

Ewing sarcoma of the head and neck (ESHN) is a rare malignancy for which limited data exists. Herein we examine anatomic distribution of ESHN, demographic characteristics, and multi-modal therapy as potential determinants in the overall survival (OS) of patients with ESHN.

METHODS

A retrospective study of the National Cancer Database (NCDB) from 2004-2016 was performed. A multivariate Cox regression and univariate Kaplan-Meier survival analyses were conducted.

RESULTS

We identified 284 patients with ESHN eligible for demographic analysis and 223 for survival analysis. Approximately half (50.3%) of patients with ESHN were under the age of 18. Pediatric patients (<18) were less likely to present with distant metastases (≤8.0% vs. 9.5-19.0%, P = .006) and more likely to present with osseous disease (90.2% vs. 75.2%, P = .001) than adults. Adult age (HR: 2.727, 95% CI, 1.381-5.384, P = .004) and distant metastatic disease at the time of presentation (HR: 8.161, 95% CI, 2.922-22.790, P < .001) were independently associated with worse OS. The addition of local therapy (either surgery, radiotherapy, or both) to chemotherapy was not associated with improved survival when compared to treatment with chemotherapy alone.

CONCLUSION

Predictors of OS in patients with ESHN included age < 18 years and non-metastatic disease at the time of diagnosis. Tumor site of origin (osseous vs. extraosseous primary) or the addition of local therapy to chemotherapy had no impact on OS. Our analysis suggests that chemotherapy serves as the primary modality in treating ESHN, while further study of this rare malignancy is required to discern the utility of combined systemic and local therapy. Laryngoscope, 130:2385-2392, 2020.