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Raddaoui E, Al-Hujaily AS, Al-Dhahri SF. Low-grade malignant myoepithelioma arising in a pleomorphic adenoma: a rare case. Ann Saudi Med 2012; 32:209-12. [PMID: 22366836 PMCID: PMC6086638 DOI: 10.5144/0256-4947.2012.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Malignant myoepithelioma is a very rare salivary gland tumor that can arise de novo or within a pre-existing pleomorphic adenoma. We report a case of malignant myoepithelioma most probably arising in a pre-existing pleomorphic adenoma of the left parotid gland. The patient was a 60-year-old man who presented with a multinodular mass lesion over left side of the face and neck. He had undergone removal of a pleomorphic adenoma of the left parotid gland twice (8 and 22 years ago). Histological examination showed locally concentrated highly invasive myoepithelial cells with bland-looking morphology and no evidence of mitosis or necrosis. Immunohistochemistry confirmed the myoepithelial differentiation (S- 100+, SMA+) and a low Ki-67 labeling index (<5%).
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Affiliation(s)
- Emad Raddaoui
- Department of Pathology, King Khalid University Hospital, Riyadh, Saudi Arabia.
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Vékony H, Röser K, Löning T, Ylstra B, Meijer GA, van Wieringen WN, van de Wiel MA, Carvalho B, Kok K, Leemans CR, van der Waal I, Bloemena E. Copy number gain at 8q12.1-q22.1 is associated with a malignant tumor phenotype in salivary gland myoepitheliomas. Genes Chromosomes Cancer 2009; 48:202-12. [PMID: 19009612 DOI: 10.1002/gcc.20631] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Salivary gland myoepithelial tumors are relatively uncommon tumors with an unpredictable clinical course. More knowledge about their genetic profiles is necessary to identify novel predictors of disease. In this study, we subjected 27 primary tumors (15 myoepitheliomas and 12 myoepithelial carcinomas) to genome-wide microarray-based comparative genomic hybridization (array CGH). We set out to delineate known chromosomal aberrations in more detail and to unravel chromosomal differences between benign myoepitheliomas and myoepithelial carcinomas. Patterns of DNA copy number aberrations were analyzed by unsupervised hierarchical cluster analysis. Both benign and malignant tumors revealed a limited amount of chromosomal alterations (median of 5 and 7.5, respectively). In both tumor groups, high frequency gains (> or =20%) were found mainly at loci of growth factors and growth factor receptors (e.g., PDGF, FGF(R)s, and EGFR). In myoepitheliomas, high frequency losses (> or =20%) were detected at regions of proto-cadherins. Cluster analysis of the array CGH data identified three clusters. Differential copy numbers on chromosome arm 8q and chromosome 17 set the clusters apart. Cluster 1 contained a mixture of the two phenotypes (n = 10), cluster 2 included mostly benign tumors (n = 10), and cluster 3 only contained carcinomas (n = 7). Supervised analysis between malignant and benign tumors revealed a 36 Mbp-region at 8q being more frequently gained in malignant tumors (P = 0.007, FDR = 0.05). This is the first study investigating genomic differences between benign and malignant myoepithelial tumors of the salivary glands at a genomic level. Both unsupervised and supervised analysis of the genomic profiles revealed chromosome arm 8q to be involved in the malignant phenotype of salivary gland myoepitheliomas.
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Affiliation(s)
- Hedy Vékony
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Academic Centre for Dentistry (ACTA), VU University Medical Center, Amsterdam, The Netherlands
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Vékony H, Röser K, Löning T, Raaphorst FM, Leemans CR, Van der Waal I, Bloemena E. Deregulated expression of p16INK4aand p53 pathway members in benign and malignant myoepithelial tumours of the salivary glands. Histopathology 2008; 53:658-66. [DOI: 10.1111/j.1365-2559.2008.03184.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Shiomori T, Udaka T, Tokui N, Morio T, Ohbuchi T, Suzuki H. Giant myoepithelioma of the upper lip. Acta Otolaryngol 2005; 125:894-8. [PMID: 16099771 DOI: 10.1080/00016480510035458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Myoepithelioma is a relatively rare form of salivary gland tumor composed entirely of myoepithelial cells. This tumor was formerly considered to be a subtype of pleomorphic adenoma; however, in the latest World Health Organization classification of 1991 it is listed as an independent entity. We report herein an extremely rare case of myoepithelioma of the upper lip. A 78-year-old Japanese female presented with a huge, painless mass on her upper lip. CT and MRI revealed a 50 x 40 mm(2) well-defined ovoid tumor. A benign minor salivary gland tumor was clinically suspected, and the patient underwent complete resection of the tumor under general anesthesia. The surgical defect was immediately reconstructed using an Abbe-Estlander flap. The tumor was histopathologically diagnosed as a benign myoepithelioma of the minor salivary gland. Immunohistochemically, the tumor cells were positive for vimentin, cytokeratins, alpha-smooth muscle actin and S-100 protein, confirming the morphological diagnosis of myoepithelioma. The patient's postoperative clinical course was uneventful, and satisfactory results were obtained both functionally and esthetically. The pathology, clinical manifestations and treatment of myoepithelioma are reviewed.
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Affiliation(s)
- Teruo Shiomori
- Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Nagao T, Sugano I, Ishida Y, Tajima Y, Matsuzaki O, Konno A, Kondo Y, Nagao K. Salivary gland malignant myoepithelioma: a clinicopathologic and immunohistochemical study of ten cases. Cancer 1998; 83:1292-9. [PMID: 9762928 DOI: 10.1002/(sici)1097-0142(19981001)83:7<1292::aid-cncr4>3.0.co;2-l] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Malignant myoepithelioma (MME) of the salivary gland, also known as myoepithelial carcinoma, is rare and its biologic behavior has not been clarified fully. METHODS Ten cases of MME were analyzed for their clinicopathologic features and immunohistochemical characteristics, focusing on prognostic factors and tumor differentiation. In addition, six cases of benign myoepithelioma (BME) also were examined for comparison. RESULTS The ten patients with MME (3 men and 7 women) ranged in age from 48-81 years (mean, 61.9 years). Seven cases of MME arose in the parotid salivary gland, two in the submandibular salivary gland, and one in minor salivary glands of the soft palate. In the current series, the incidence of MME was 0.45% among 1945 cases of major salivary gland tumors. Seven cases of MME developed from a benign preexisting tumor (six in pleomorphic adenoma and one in BME). Four of nine patients with MME died of the disease and two patients developed a recurrence. It was shown that MMEs were comprised of one cell type or a combination of two cell populations; these included, in order of incidence, epithelioid, spindle, and plasmacytoid cells. Patients with MME with marked cellular pleomorphism and perineural invasion had a poor prognosis. Immunohistochemically, putative myoepithelial markers such as muscle actins, cytokeratin 14, vimentin, and calponin, and S-100 protein were expressed highly in MME. High and low molecular weight cytokeratins and epithelial membrane antigen also frequently were positive in MME. p53 expression was observed in five MME cases, four of which either recurred or were fatal. Cellular proliferative activity assessed by mitotic count and the Ki-67 labeling index was significantly higher in MME cases than in BME cases. In limited cases, such cellular proliferative activity was shown to have prognostic value. Ultrastructurally, the tumor cells displayed certain myoepithelial characteristics. CONCLUSIONS MME is a rare salivary gland tumor showing clinicopathologic diversity and presenting with various stages of myoepithelial differentiation. Histologic aggressiveness, marked cellular pleomorphism, p53 expression, and high cell proliferative activity were found to be correlated with a poor clinical outcome.
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Affiliation(s)
- T Nagao
- Department of Surgical Pathology, Teikyo University, School of Medicine, Ichihara Hospital, Chiba, Japan
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Dardick I, Burford-Mason AP. Pathology of the salivary glands: the contribution of electron microscopy. Microsc Res Tech 1994; 27:46-60. [PMID: 8155904 DOI: 10.1002/jemt.1070270104] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Electron microscopy has a limited role in the diagnosis of primary salivary gland tumors, although it can be helpful in metastatic lesions of possible salivary gland origin. The diversity of subtypes in salivary gland tumors, as well as the range of histomorphology within any one subtype, is unparalleled in any other human tumor. This and their relative infrequency causes diagnostic problems for pathologists. Ultrastructural techniques have been of major importance in determining the inter-relationship of these tumors for classification purposes, revealing the subtle variations in common cellular differentiation pathways, determining the organization of tumor cells, and displaying the importance of extracellular matrix materials in establishing diagnostic criteria for each of the many subtypes. Electron microscopy has also been valuable in non-neoplastic salivary gland disease and has an increasing role in experimental studies involving tissue from human and animal salivary parenchyma.
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Affiliation(s)
- I Dardick
- Department of Pathology, University of Toronto, Ontario, Canada
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Abstract
This ultrastructural study is based on nine cases of adenoid cystic carcinoma arising from the salivary glands. Electron microscopically, the tumors consisted of five cell types: relatively differentiated intercalated duct cells, secretory cells, undifferentiated cells, cells of a squamous nature, and myoepithelial cells. Special attention was paid to the characteristic extracellular substances noted by light microscopic examination of these tumors. The hyaline material of the pseudocysts contained not only mucopolysaccharide granules but also fingerprint-like structures formed by replicated basement membrane. Some of these structures had a dense core, probably composed of mucopolysaccharide granules. Cell islands surrounded by elasticlike material also were found. The true lumina were usually filled with membranovesicular structures originating from fragments of the lining cells, mainly those with squamous differentiation. These membranovesicular structures included electron-dense rods, filamentous whorls, and structures displaying periodicity.
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Affiliation(s)
- J Ormos
- Department of Pathology, Albert Szent-Györgyi University of Medicine, Szeged, Hungary
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Ibrahim R, Bird DJ, Sieler MW. Malignant myoepithelioma of the larynx with massive metastatic spread to the liver: an ultrastructural and immunocytochemical study. Ultrastruct Pathol 1991; 15:69-76. [PMID: 1707193 DOI: 10.3109/01913129109021305] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A malignant myoepithelioma arising in the submucosal glands of the larynx of a 71-year-old man is reported. The patient presented with a neck mass and massive metastatic involvement of the liver. Light microscopy of a liver biopsy specimen and fine-needle aspiration sample of the neck mass revealed a poorly differentiated carcinoma. Electron microscopic study of a second liver biopsy specimen demonstrated unequivocal features of myoepithelial differentiation; this was further confirmed by the strong cytokeratin and S-100 protein positivity and carcinoembryonic antigen negativity of the tumor cells. Myoepitheliomas are rare tumors, and most reported cases have been benign or of low-grade malignancy. The present case is unique because of its mode of presentation and fulminant course. It also underscores the usefulness of electron microscopy as a diagnostic modality in the work-up of metastatic lesions.
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Affiliation(s)
- R Ibrahim
- Department of Laboratory Service, Harvard Medical School, Boston, Massachusetts
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Abstract
Two patients developed nodular, well-circumscribed tumors of the breast, discovered by mammography. They were fibroadenoma-like by gross examination and biphasic by light microscopy, containing both tubular glands and spindled myoid cells. Immunocytochemical studies revealed cytokeratin and S-100 immunoreactivity in both the spindled myoid cells and in the tubuloglandular cells (S-100 was focal in the latter). In addition, the spindled myoid cells were immunoreactive for vimentin but negative for desmin. Ultrastructural studies showed the tubular glands to be composed of luminal epithelial cells focally surrounded by myoepithelial cells, but the stroma contained spindled myoepithelial cells admixed with occasional fibroblasts. The diagnostic term, "adenomyoepithelioma," is appropriate for biphasic tumors having both glandular and myoepitheliomatous differentiation. Although additional experience is necessary to be conclusive regarding the biologic behavior of these unusual lesions, the authors believe the adenomyoepitheliomas described here are benign. They were well circumscribed without invasion of adjacent breast, contained neither mitotic figures nor cytologic atypia, and have not recurred or metastasized (6 and 10 months after removal).
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Affiliation(s)
- N Weidner
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115
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Mair IW, Stalsberg H. Basal cell adenomatosis of minor salivary glands of the upper lip. ARCHIVES OF OTO-RHINO-LARYNGOLOGY 1988; 245:191-5. [PMID: 3178569 DOI: 10.1007/bf00464025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The basal cell adenoma is one of the more commonly occurring types of salivary tumors in the upper lip. A case with multiple (five) tumors is presented and the literature reviewed. This lesion would be more correctly designated as an adenomatosis. In spite of its frequent multicentricity, recurrence is unusual following surgical removal.
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Affiliation(s)
- I W Mair
- Department of Otorhinolaryngology, University of Tromsø, Norway
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Chen JC, Gnepp DR, Bedrossian CW. Adenoid cystic carcinoma of the salivary glands: an immunohistochemical analysis. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1988; 65:316-26. [PMID: 2451197 DOI: 10.1016/0030-4220(88)90116-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adenoid cystic carcinoma is a specific variant of adenocarcinoma with a characteristic cribriform appearance. The tumor may arise from salivary glands and various other sites, but the origin and cellular composition of this unique neoplasm have been controversial. A potential use of immunohistochemistry is to provide additional information on the origin of various cellular components of tumors by comparing them with corresponding normal tissues. Immunohistochemical distributions of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), keratin, low molecular weight keratin (54 kd), S100 protein, muscle-specific actin, laminin, and type IV collagen were evaluated in 20 adenoid cystic carcinomas arising in major and minor salivary glands. Anti-CEA, anti-EMA, anti-keratin, and anti-S100 antibodies strongly stained cells lining true lumina. Muscle-specific actin, a marker for myoepithelial cells, was found in lining cells of pseudocysts, in tumor cells proper, and in nonluminal cells with a tubular growth pattern. A monoclonal antibody against 54 kd keratin stained almost all cells in the neoplasms. In pseudocysts, replicated basal lamina reacted with antisera to laminin and to type IV collagen. The present study demonstrates that there are at least two populations of tumor cells in adenoid cystic carcinoma: luminal cells that express CEA and EMA, thus indicating their ductal character, and nonluminal cells that express muscle-specific actin characteristic of myoepithelium.
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Affiliation(s)
- J C Chen
- Department of Pathology, St. Louis University School of Medicine, Mo
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Watanabe H, Katsuda S, Okada Y, Ooi A, Ueno H. Pleomorphic adenoma with a predominantly myoepithelial proliferation of the vagina. ACTA PATHOLOGICA JAPONICA 1987; 37:685-92. [PMID: 3039795 DOI: 10.1111/j.1440-1827.1987.tb00403.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case of pleomorphic adenoma of the vagina in a 44-year-old woman was described. The tumor was a submucosal mass measuring 3.5 X 2 X 2 cm and located in the left lateral wall 1.5 cm inside the introitus. Histologically, it was predominantly composed of sheets and strands of spindle-shaped or polygonal cells focally dispersed in the myxoid tissue to form pseudomicrocysts. Ultrastructure demonstrated the basal lamina, desmosomes, variable amounts of filaments of both intermediate and microfilament, and occasionally microvilli in these tumor cells indicating that dominant cells were myoepithelial in nature. With immunohistochemical studies, keratin and cytokeratin were positive, whereas, S-100 protein, glial fibrillary acidic protein, vimentin, secretory component, and lysozyme were negative. The previously published cases were reviewed and compared with the present case.
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Dardick I, George D, Jeans MT, Wittkuhn JF, Skimming L, Rippstein P, van Nostrand AW. Ultrastructural morphology and cellular differentiation in acinic cell carcinoma. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1987; 63:325-34. [PMID: 3295648 DOI: 10.1016/0030-4220(87)90199-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acinic cell carcinomas, in some instances, contain a component of intercalated duct cells. However, the manner in which this element is integrated within the more obvious acinar cells, as well as the role neoplastic intercalated duct cells play in determining morphologic patterns in acinic cell tumors, has not been fully investigated. Ultrastructural study and immunostaining with antibodies to cytokeratins and to S-100 protein carried out in nine cases of parotid acinic cell carcinoma suggest two basic differentiation patterns. In three cases, the lesions were essentially composed of acinar cells (with variation in the number and form of secretory granules), and one of these tumors was unique in having ultrastructural evidence of differentiated myoepithelial cells. In the second group of six cases, there was light microscopic, ultrastructural, and immunohistochemical evidence of a significant component of intercalated duct cells. By means of both immunostaining (intercalated ducts were positive for keratin and S-100 protein; acinar cells were negative for both antigens) and electron microscopy, flattened-to-cuboidal intercalated duct cells were noted to enclose and, presumably, to be involved in the formation of microcystic spaces. Acinic cell carcinomas with a more solid growth pattern contained groups of intercalated duct cells positive for keratin and S-100 protein. Ultrastructurally, these cells were organized into well-formed ducts related to nests of acinar cells. Acinic cell carcinoma is another class of salivary gland tumor in which there can be an integrated proliferation of intercalated duct and acinar cells and, infrequently, of myoepithelial cells, all organized in a simulation of the intercalated duct-acinar unit of the normal salivary gland.
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