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Nandini DB, Singh WT, Aparnadevi P, Ningombam DS. Epithelial-myoepithelial carcinoma ex pleomorphic adenoma of the parotid gland with unique histologic differentiation: A rare case report. J Oral Maxillofac Pathol 2022; 26:S34-S39. [PMID: 35450241 PMCID: PMC9017850 DOI: 10.4103/jomfp.jomfp_400_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/04/2022] Open
Abstract
Epithelial myoepithelial carcinoma (EMC) is an uncommon low-to-intermediate grade salivary gland malignancy that accounts for 1% of all tumors arising in salivary glands. About 80% of these tumors affect the parotid gland. These lesions either arise de novo or from existing pleomorphic adenoma (PA). Histologically, these tumors reveal a biphasic cell population with inner ductal epithelial cells and peripheral myoepithelial cells. There are many histologic variants of EMC, but sebaceous, verocay-like differentiation and high-grade transformation is very rarely reported. This article describes a 48-year-old female patient diagnosed with EMC ex PA with unique histologic differentiation.
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Affiliation(s)
| | - Wahengbam Tulsidas Singh
- Oral & Maxillofacial Surgery, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Potsangbam Aparnadevi
- Department of Oral Pathology & Microbiology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Deepak Singh Ningombam
- Oral Medicine and Radiology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
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2
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Hijab A, Taha T, Charas T, Bar-Sela G, Stein P, Agbarya A. Anti-androgen for myoepithelial tumor: a potent therapy yet a potential misleader. Anticancer Drugs 2022; 33:e747-e751. [PMID: 34387605 DOI: 10.1097/cad.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myoepithelial tumor is a rare form of cancer, mainly arising from the salivary glands and extremities. Due to its rarity, no formal treatment guidelines exist. Here we report a case of a male patient diagnosed with metastatic myoepithelial tumor which was successfully treated with an androgen-receptor (AR) antagonist (bicalutamide), based on the results of molecular testing. Six years after the initiation of bicalutamide, patient was diagnosed with metastatic prostate cancer. To our knowledge, this is the first case described in literature that demonstrate the effectiveness of anti-androgens in treating myoepithelial tumor. Vigilance should be maintained when screening these patients for prostate cancer as their 'true' prostate specific antigen levels might be masked by the ongoing endocrine therapy.
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Affiliation(s)
- Adham Hijab
- Division of Oncology, Rambam Health Care Center, Haifa
| | - Tarek Taha
- Division of Oncology, Rambam Health Care Center, Haifa
| | - Tomer Charas
- Division of Oncology, Rambam Health Care Center, Haifa
| | | | - Polina Stein
- Department of Pathology, Rambam Health Care Center, Haifa
| | - Abed Agbarya
- Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
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Okuyama K, Michi Y, Kashima Y, Tomioka H, Hirai H, Yokokawa M, Yamagata Y, Kuroshima T, Sato Y, Tsuchiya M, Kayamori K, Ikeda T, Harada H. Epithelial-Myoepithelial Carcinoma of the Minor Salivary Glands: Case Series with Comprehensive Review. Diagnostics (Basel) 2021; 11:diagnostics11112124. [PMID: 34829471 PMCID: PMC8619087 DOI: 10.3390/diagnostics11112124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 12/21/2022] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor that is histologically characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells, which is especially uncommon in the minor salivary glands (MSG). Because of its histologic variety, complexity, and heterogeneity, it is sometimes challenging to make the accurate diagnosis. Here, we report a literature review of EMC of the MSGs with our experience of two cases. Incisional biopsy was suggestive of pleomorphic adenoma in Case 1 and pleomorphic adenoma or a low-grade salivary gland carcinoma in Case 2. Both cases were performed intraoral tumor resection, and they have good postoperative courses and are alive with no evidence of local recurrence or metastasis at 31 and 16 months, respectively. Considering that the anatomy, structure, and size of salivary glands are quite different from MSGs, it might be difficult to predict EMCs of the MSG similarly to EMCs of the major salivary glands. This comprehensive review also reports the features of EMC of the MSG cases and the trends of diagnosis and discusses treatment strategy.
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Affiliation(s)
- Kohei Okuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
- Correspondence:
| | - Yasuyuki Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Yoshihisa Kashima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Misaki Yokokawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Yuko Yamagata
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Takeshi Kuroshima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Yuriko Sato
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Maiko Tsuchiya
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.T.); (K.K.); (T.I.)
- Department of Pathology, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Kou Kayamori
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.T.); (K.K.); (T.I.)
| | - Tohru Ikeda
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.T.); (K.K.); (T.I.)
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
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Nakaguro M, Tanigawa M, Hirai H, Yamamoto Y, Urano M, Takahashi RH, Sukeda A, Okumura Y, Honda S, Tasaki K, Shimizu A, Tsukahara K, Tada Y, Matsubayashi J, Faquin WC, Sadow PM, Nagao T. The Diagnostic Utility of RAS Q61R Mutation-specific Immunohistochemistry in Epithelial-Myoepithelial Carcinoma. Am J Surg Pathol 2021; 45:885-894. [PMID: 33481388 PMCID: PMC8192334 DOI: 10.1097/pas.0000000000001673] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland cancer characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells. Because of its histologic variety and overlap of histologic features with other salivary gland tumors, there are broad differential diagnoses. The HRAS Q61R mutation has been reported to be frequent in and specific to EMC. We evaluated the usefulness of RAS Q61R mutant-specific immunohistochemical (IHC) staining for detecting this genetic alteration in EMC. We investigated 83 EMC cases and 66 cases of salivary gland tumors with an EMC-like component, including pleomorphic adenoma, adenoid cystic carcinoma, basal cell adenoma/adenocarcinoma, and myoepithelial carcinoma. Sanger sequencing was performed for HRAS, KRAS, and NRAS. The diffuse and membranous/cytoplasmic RAS Q61R IHC expression was observed in 65% of EMC cases, in which all cases harbored the HRAS Q61R mutation. IHC-positive cases were present only in de novo EMCs (54/76 cases, 71%) but not in EMCs ex pleomorphic adenoma. The immunoreactivity was almost always restricted to the myoepithelial cells. Conversely, all EMC cases lacking the HRAS Q61R mutation were negative on IHC. In addition, only 3% of EMC-like tumors showed the abovementioned immunopositivity. None of the cases examined carried KRAS or NRAS mutations. IHC for RAS Q61R is highly sensitive and specific for detecting the HRAS Q61R mutation in EMC. Since significant immunopositivity was almost exclusively identified in nearly two thirds of EMCs but seldom in the histologic mimics, the IHC of RAS Q61R is a useful tool for diagnosing EMC in general pathology laboratories.
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Affiliation(s)
- Masato Nakaguro
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Hirai
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Yoshinari Yamamoto
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Makoto Urano
- Department of Diagnostic Pathology, Fujita Health University, School of Medicine, Toyoake, Japan
| | | | - Aoi Sukeda
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Yuki Okumura
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shogo Honda
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Koichiro Tasaki
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Akira Shimizu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - William C. Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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Abstract
Epithelial-myoepithelial carcinoma is an uncommon low-grade salivary gland carcinoma. It is classically characterized by biphasic tubular structures composed of inner eosinophilic ductal cells and outer clear myoepithelial cells. In addition, epithelial-myoepithelial carcinoma sometimes shows various histologic features, including a cribriform pattern, basaloid appearance, and sebaceous differentiation. Because clear myoepithelial cells are also noted in other benign and malignant salivary gland tumors, the histologic variety and similarity with other tumor entities make the diagnosis of epithelial-myoepithelial carcinoma challenging. A recent analysis revealed that HRAS hotspot point mutations are specifically identified in epithelial-myoepithelial carcinoma and the assessment of given genes facilitate the correct diagnosis.
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Affiliation(s)
- Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan. https://twitter.com/assamusic
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan.
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Gupta P, Rajwanshi A, Kakkar N. Metastatic Epithelial-Myoepithelial Carcinoma in a Female Presenting with Neck Mass and Lytic Lesion in Acetabulum: A Diagnostic Challenge on Cytology. Turk Patoloji Derg 2021; 37:84-88. [PMID: 32779157 PMCID: PMC10508920 DOI: 10.5146/tjpath.2020.01501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare, low-grade, malignant salivary neoplasm. Establishing an accurate cytological diagnosis is often challenging owing to its rarity, bland cytologic appearance and variable representation of cell populations in the smears. The diagnostic struggle is more so when the aspiration is from a metastatic site with an unknown primary, as in such cases the list of differential diagnoses expands further. A 58-year-old female presented with a low-back pain from last one month. On examination, she also had a level III, right cervical swelling for the last 20 years. Radiology revealed a lytic lesion in the left acetabulum. She had undergone surgery 35 years ago for a right-sided upper neck swelling, the medical records of which were not available. Fine needle aspiration (FNA) from the cervical swelling was performed. The smears were cellular and showed predominantly dispersed, round to polygonal tumor cells with mild pleomorphism, eccentric nuclei, coarse chromatin, occasional nucleoli and moderate cytoplasm with some showing vacuolations. The cell-block section revealed tumor cells arranged in the form of tubules lined by dual layer of tumor cells without any chondromyxoid stroma. On immunocytochemistry, the luminal cells showed positivity for CK7 (epithelial marker) and the abluminal cells showed positivity for p63 (myoepithelial marker). Based on these features, a final diagnosis of metastatic epithelial-myoepithelial carcinoma was rendered. The present report highlights the characteristic cytomorphological and immunocytochemical features of EMC and reiterates the diagnostic accuracy of FNAC for diagnosis of such challenging cases.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ngo MH, Krishnan V, Piché J, Berdugo J. Sebaceous Epithelial-Myoepithelial Carcinoma With Aggressive Behavior and Evidence of Preexisting Pleomorphic Adenoma. Int J Surg Pathol 2020; 29:524-528. [PMID: 33319619 DOI: 10.1177/1066896920980804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMCA) is a rare low-grade carcinoma of the salivary glands with multiple morphological variants. One such variant, sebaceous EMCA (SEMCA), has been reported in the literature. Distinguishing it from other tumors such as sebaceous carcinoma is crucial, as SEMCA typically behaves more indolently. We present a case of a SEMCA in the right parotid of a 71-year-old man that shows features of aggressive behavior such as facial nerve invasion and extraparenchymal extension. Also, we report evidence of preexisting pleomorphic adenoma within this tumor.
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Affiliation(s)
| | | | - Jean Piché
- Pierre-Boucher Hospital, Longueuil, Quebec, Canada
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Kusafuka K, Yamashita M, Muramatsu A, Arai K, Suzuki M. Epithelial-myoepithelial carcinoma ex-pleomorphic adenoma of the parotid gland: report of a rare case with immunohistochemical and genetic analyses. Med Mol Morphol 2020; 54:173-180. [PMID: 32749544 DOI: 10.1007/s00795-020-00262-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMCa) is a rare low-grade salivary malignancy. It is rare for EMCa to occur as the carcinomatous component of carcinoma ex-pleomorphic adenoma (PA). We examined one additional case of EMCa ex-PA, immunohistochemically and genetically. The patient was an 83-year-old female, who suffered from swelling of the right parotid region. Histologically, the tumor contained a hyalinized nodule, which displayed elastosis. The main tumor exhibited a bi-layered structure, involving inner ductal cells and clear outer myoepithelial cells. Immunostaining indicated that the inner cells were positive for epithelial membrane antigen, whereas the outer cells were positive for p40. On the genetic level, the carcinoma harbored no HRAS gene mutations, whereas fluorescence in situ hybridization (FISH) of the Pleomorphic Adenoma Gene1 showed splitting signals in the carcinomatous component. We diagnosed this case as EMCa ex-PA. It is necessary to differentiate EMCa ex-PA from myoepithelial carcinoma and clear cell carcinoma, and FISH is useful for such purposes.
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Affiliation(s)
- Kimihide Kusafuka
- Department of Pathology, Shizuoka General Hospital, 4-27-1 Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan.
| | - Masaru Yamashita
- Department of Head and Neck Surgery and Otorhinolaryngology, Shizuoka General Hospital, Shizuoka, Japan
| | - Aya Muramatsu
- Department of Pathology, Shizuoka General Hospital, 4-27-1 Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Kazumori Arai
- Department of Pathology, Shizuoka General Hospital, 4-27-1 Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Makoto Suzuki
- Department of Pathology, Shizuoka General Hospital, 4-27-1 Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
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Baněčková M, Uro-Coste E, Ptáková N, Šteiner P, Stanowska O, Benincasa G, Colella G, Vondrák J, Michal M, Leivo I, Skálová A. What is hiding behind S100 protein and SOX10 positive oncocytomas? Oncocytic pleomorphic adenoma and myoepithelioma with novel gene fusions in a subset of cases. Hum Pathol 2020; 103:52-62. [PMID: 32673681 DOI: 10.1016/j.humpath.2020.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
Oncocytomas (OCs) in salivary glands are rare benign tumors composed of mitochondria-rich epithelial cells (oncocytes), mostly localized in the parotid gland. The treatment of choice is simple excision. Extensive oncocytic metaplasia of pleomorphic adenoma (PA) and myoepithelioma (ME) can be diagnostically challenging and may camouflage the correct diagnosis. These tumors should be treated more carefully compared with OC, given the risk of frequent recurrences and the possibility of malignant transformation. We have investigated 89 oncocytic lesions from our files, including OC (n = 74) and metaplastic oncocytic variant of PA/ME (n = 15). All OCs were stained for S100 protein and SOX10. The tumors with immunohistochemical expression of one or both markers were tested by next-generation sequencing (NGS). The NGS results were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and/or fluorescence in situ hybridization (FISH). Ten cases originally diagnosed as OC, and 1 low-grade uncertain oncocytic tumor (11/74) revealed nuclear-cytoplasmic and/or nuclear positivity for S100 protein and/or SOX10, respectively. Fusion transcripts CHCHD7-PLAG1 and GEM-PLAG1 were found in 2 cases (1 fusion in each), and these were confirmed by RT-PCR and PLAG1 break-apart FISH probe, respectively. Another 5 cases were positive for PLAG1 rearrangement by FISH. In the control group of 15 oncocytic PA/ME, 4/15 tested tumors harbored gene fusions including NFT3-PLAG1, CHCHD7-PLAG1, FBXO32-PLAG1, and C1orf116-PLAG1 (1 fusion in each case) as detected by NGS. Two fusions were confirmed by RT-PCR, 1 case by FISH, and 1 case was not analyzable by FISH. We additionally tested 24 OCs negative for S100 protein and SOX10 by immunohistochemistry (IHC) and by FISH for rearrangement of PLAG1 gene, but none of them were positive. SOX10 and/or S100 protein immunopositivity in conjunction with rearrangement of the PLAG1 gene assisted in reclassification of a subset of oncocytomas as oncocytic variants of PA and ME. Therefore, we recommend to include S100 protein and SOX10 IHC when diagnosing tumors with predominantly oncocytoma-like differentiation. In addition, by NGS, 3 new gene fusions were detected in oncocytic ME, including NTF3-PLAG1, FBXO32-PLAG1, and GEM-PLAG1, and a new fusion C1orf116-PLAG1 was detected in oncocytic PA.
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Affiliation(s)
- Martina Baněčková
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic.
| | - Emmanuelle Uro-Coste
- Department of Pathology, Toulouse University Hospital, IUC-Oncopole, Toulouse, 31100, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, 31100, France
| | - Nikola Ptáková
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Petr Šteiner
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Olga Stanowska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 00 001, Poland
| | - Giulio Benincasa
- Department of Pathology, Clinic Pineta Grande, Castel Volturno (CE), 81030, Italy
| | - Giuseppe Colella
- Department of Maxillo-facial Surgery, University Della Campania "Luigi Vanvitelli", Policlinico Piazza Miraglia, Naples, 81100, Italy
| | - Jan Vondrák
- South Bohemian University, Ceske Budejovice, 37005, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, And Turku University Hospital, Turku, 20500, Finland
| | - Alena Skálová
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
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Diagnostic Significance of HRAS Mutations in Epithelial-Myoepithelial Carcinomas Exhibiting a Broad Histopathologic Spectrum. Am J Surg Pathol 2020; 43:984-994. [PMID: 30994537 DOI: 10.1097/pas.0000000000001258] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor that is histologically characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells. Because of its histologic variety, it is sometimes challenging to make an accurate diagnosis, and useful ancillary tests are essential for this purpose. We investigated 87 cases of EMC arising in the major and minor salivary glands and seromucinous glands in the nasal cavity or bronchus to describe the histologic features and mutation status of selected key oncogenes. Classic EMC accounted for 40.2% of all cases. Other cases showed various growth patterns and cytologic features in addition to the typical histology; cribriform patterns, a basaloid appearance, and sebaceous differentiation were relatively common (17.2% to 18.4%), whereas oncocytic/apocrine, papillary-cystic, double-clear, squamous, psammomatous, Verocay-like, and high-grade transformation were rare. HRAS mutations were found in 82.7% of EMCs and were concentrated in codon 61. There was no significant correlation between the HRAS mutation status and the histology. No EMC ex pleomorphic adenoma cases had HRAS mutations. PIK3CA and/or AKT1 mutations were the second most frequent mutations (20.7%, 6.5%, respectively) and almost always cooccurred with HRAS mutations. It is noteworthy that the HRAS mutation was not identified in any salivary gland tumor entities manifesting EMC-like features, including adenoid cystic carcinoma, pleomorphic adenoma, basal cell adenoma/adenocarcinoma, and myoepithelial carcinoma. We conclude that HRAS mutations are a frequent tumorigenic gene alteration in EMC, despite its histologic diversity. This study provides further insight into strategies for diagnosing EMC and discriminating it from its mimics.
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Xia S, Chen X, Yang S, Zheng X, Hu Y, Zhang J. Apocrine epithelial–myoepithelial carcinoma of the parotid gland with concurrent oncocytic change: a novel variant. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:530-537. [DOI: 10.1016/j.oooo.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022]
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12
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Perez D, Naous R. Fine-needle aspiration cytology of the apocrine variant of epithelial-myoepithelial carcinoma. Diagn Cytopathol 2019; 48:61-65. [PMID: 31433568 PMCID: PMC6972702 DOI: 10.1002/dc.24308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
Epithelial‐myoepithelial carcinoma (EMCa) is a rare neoplasm that most frequently afflicts the parotid gland. Histologically, a dual layer of inner, luminal epithelial cells and outer myoepithelial cells with associated background hyalinization characterize these tumors. Several variants of EMCa have been described, including the more recent description of the apocrine variant. We present here a case of a 71‐year‐old male with a parotid mass diagnosed on FNA as an apocrine epithelial‐myoepithelial carcinoma. To our knowledge, this is the first case report describing the cytomorphologic features of apocrine EMCa on FNA smears.
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Affiliation(s)
- Diandra Perez
- Department of PathologySUNY Upstate Medical UniversitySyracuseNew York
| | - Rana Naous
- Department of PathologySUNY Upstate Medical UniversitySyracuseNew York
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13
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Rupp NJ, Brada M, Skálová A, Bode B, Broglie MA, Morand GB, Rechsteiner M, Freiberger SN. New Insights into Tumor Heterogeneity: A Case of Solid-Oncocytic Epithelial-Myoepithelial Carcinoma of the Parotid Gland Harboring a HRAS and Heterogeneous Terminating ARID1A Mutation. Head Neck Pathol 2019; 14:554-558. [PMID: 31309433 PMCID: PMC7235098 DOI: 10.1007/s12105-019-01055-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) can be a challenging diagnosis due to a lack of obvious invasion and bland cytology. We report an unusual case of a low-grade EMC with prominent fibrous stroma, an extensive solid-oncocytic differentiation and limited areas of morphological clearly identifiable characteristic biphasic (tubular) differentiation, clear cells and PAS-positive secretions/calcifications. Both areas were investigated by next generation sequencing (Oncomine comprehensive assay) and revealed a typical concordant HRAS p.Q61R mutation. An additional heterogeneous ARID1A (p.E672*) terminating mutation with loss of heterozygosity, which could be visualized predominantly in the solid-oncocytic differentiation by immunohistochemical loss of ARID1A protein expression, was found. This is the first case of an EMC of the salivary gland to be described with two separate tumor clones involving concordant HRAS and heterogeneous ARID1A mutations. The latter seem to be a "second hit" and was predominantly found in the solid-oncocytic differentiation, suggesting a potential morpho-molecular association.
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Affiliation(s)
- Niels J. Rupp
- grid.412004.30000 0004 0478 9977Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Muriel Brada
- grid.412004.30000 0004 0478 9977Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Alena Skálová
- grid.4491.80000 0004 1937 116XSikl’s Department of Pathology, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic
| | - Beata Bode
- grid.412004.30000 0004 0478 9977Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091 Zurich, Switzerland ,grid.9851.50000 0001 2165 4204Institute of Pathology Enge, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Martina A. Broglie
- grid.412004.30000 0004 0478 9977Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Grégoire B. Morand
- grid.412004.30000 0004 0478 9977Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Markus Rechsteiner
- grid.412004.30000 0004 0478 9977Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Sandra N. Freiberger
- grid.412004.30000 0004 0478 9977Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
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Hamamoto Y, Harada H, Suzuki M, Fujii T, Nakatsuka SI. Salivary Duct Carcinoma of the Parotid Gland Originating from an Epithelial-Myoepithelial Carcinoma: Report of a Rare Case. Head Neck Pathol 2019; 14:283-289. [PMID: 30937832 PMCID: PMC7021872 DOI: 10.1007/s12105-019-01034-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
Salivary duct carcinoma (SDC) is a high-grade carcinoma with poor prognosis, especially among various salivary carcinomas. In this study, we report a rare case of SDC of the parotid gland originating from an epithelial-myoepithelial carcinoma (EMC). A 71-year-old Japanese man presented with swelling of the right parotid region and a right facial nerve paralysis for 10 months. He underwent extended total parotidectomy and chemoradiotherapy after the surgery. Histologically, a major part of the tumor was an androgen receptor (AR)-positive, human epidermal growth factor receptor 2 (HER2)-positive, gross cystic disease fluid protein-15 (GCDFP-15)-positive SDC, with a focus of a typical EMC component at the periphery of the lesion. In the transitional area of the two components, inner ductal cells of double-layered ducts showed similar morphology and immunophenotype to SDC. These findings suggest that SDC originated from the inner ductal cells of EMC. Because the tumor included an EMC as a low-grade carcinoma and an SDC as a high-grade carcinoma, we can consider our case as a dedifferentiated carcinoma as well as a hybrid tumor.
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Affiliation(s)
- Yuichiro Hamamoto
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka 541-8567 Japan
| | - Hiroshi Harada
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka 541-8567 Japan ,Department of Diagnostic Pathology, Seichokai Fuchu Hospital, 1-10-17, Hiko-Town, Izumi-City, Osaka 594-0076 Japan
| | - Motoyuki Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka 541-8567 Japan
| | - Shin-ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka 541-8567 Japan
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MYB Translocation Status in Salivary Gland Epithelial-Myoepithelial Carcinoma: Evaluation of Classic, Variant, and Hybrid Forms. Am J Surg Pathol 2019; 42:319-325. [PMID: 29135517 DOI: 10.1097/pas.0000000000000990] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a malignant salivary gland neoplasm comprised of a biphasic arrangement of inner luminal ductal cells and outer myoepithelial cells. Adenoid cystic carcinoma (AdCC) is also a biphasic tumor comprised of ductal and myoepithelial cells, but these components tend to be arranged in a more cribriform pattern. The occurrence of "hybrid carcinomas" that show mixed patterns of EMC and AdCC raises questions about the relationship of these morphologically overlapping but clinically distinct tumors. AdCCs frequently harbor MYB-NFIB gene fusions. Mapping of EMCs (including hybrid forms with an AdCC component) for this fusion could help clarify the true nature of EMC as a distinct entity or simply as some variant form of AdCC. Twenty-nine cases of EMC were evaluated including 15 classic low-grade EMCs, 7 intermediate-grade EMCs, 2 EMCs with myoepithelial anaplasia, 1 EMC with high-grade transformation, and 4 hybrid EMCs with an AdCC component. Break apart fluorescence in situ hybridization for MYB was performed, as was MYB immunohistochemistry. For the hybrid carcinomas and those with high-grade transformation, the divergent tumor components were separately analyzed. A MYB translocation was identified in 5 of 28 (18%) tumors including 3 of 4 (75%) hybrid carcinomas and 2 of 7 (29%) intermediate-grade EMCs. For the positive hybrid carcinomas, the fusion was detected in both the EMC and AdCC components. The MYB fusion was not detected in any of the classic EMCs (0/15) or in any of the EMCs with myoepithelial anaplasia (0/2) or high-grade transformation (0/1). The fluorescence in situ hybridization assay was unsuccessful in 1 case. MYB immunostaining was seen in 5 of 5 fusion-positive cases, and also 9 of 23 fusion-negative tumors. Classic low-grade EMCs are genetically distinct from AdCCs in that they do not harbor MYB fusions. The presence of a MYB fusion in EMCs showing hybrid features of AdCC or exhibiting highly infiltrative growth points to a subset of these tumors that may well be true AdCCs masquerading as EMCs.
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Nakaguro M, Urano M, Suzuki H, Yamada K, Sakaguchi A, Ogura K, Matsumoto T, Ono N, Asato T, Mikami Y, Imai H, Nagao T. Low-grade intraductal carcinoma of the salivary gland with prominent oncocytic change: a newly described variant. Histopathology 2018; 73:314-320. [DOI: 10.1111/his.13517] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Masato Nakaguro
- Department of Pathology and Laboratory Medicine; Nagoya University Hospital; Nagoya Japan
| | - Makoto Urano
- Department of Diagnostic Pathology; Fujita Health University, School of Medicine; Toyoake Japan
| | - Hiroaki Suzuki
- Department of Diagnostic Pathology; National Hospital Organisation Hokkaido Cancer Center; Sapporo Japan
| | - Kazuyuki Yamada
- Department of Head and Neck Surgery; National Hospital Organisation Hokkaido Cancer Center; Sapporo Japan
| | - Asumi Sakaguchi
- Department of Diagnostic Pathology; Juntendo University Nerima Hospital; Tokyo Japan
| | - Kanako Ogura
- Department of Diagnostic Pathology; Juntendo University Nerima Hospital; Tokyo Japan
| | - Toshiharu Matsumoto
- Department of Diagnostic Pathology; Juntendo University Nerima Hospital; Tokyo Japan
| | - Noritsugu Ono
- Department of Otorhinolaryngology; Juntendo University Nerima Hospital; Tokyo Japan
| | - Tsuguharu Asato
- Department of Diagnostic Pathology; Kumamoto University Hospital; Kumamoto Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology; Kumamoto University Hospital; Kumamoto Japan
| | - Hiroshi Imai
- Pathology Division; Mie University Hospital; Tsu Mie Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology; Tokyo Medical University; Tokyo Japan
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17
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Epithelial-Myoepithelial Carcinoma: Frequent Morphologic and Molecular Evidence of Preexisting Pleomorphic Adenoma, Common HRAS Mutations in PLAG1-intact and HMGA2-intact Cases, and Occasional TP53, FBXW7, and SMARCB1 Alterations in High-grade Cases. Am J Surg Pathol 2017; 42:18-27. [PMID: 29135520 DOI: 10.1097/pas.0000000000000933] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We hypothesized that there is a relationship between the preexisting pleomorphic adenoma [PA]), histologic grade of epithelial-myoepithelial carcinomas (EMCAs), and genetic alterations. EMCAs (n=39) were analyzed for morphologic and molecular evidence of preexisting PA (PLAG1, HMGA2 status by fluorescence in situ hybridization, FISH, and FGFR1-PLAG1 fusion by next-generation sequencing, NGS). Twenty-three EMCAs were further analyzed by NGS for mutations and copy number variation in 50 cancer-related genes. On the basis of combined morphologic and molecular evidence of PA, the following subsets of EMCA emerged: (a) EMCAs with morphologic evidence of preexisting PA, but intact PLAG1 and HMGA2 (12/39, 31%), (b) Carcinomas with PLAG1 alterations (9/39, 23%), or (c) HMGA2 alterations (10/39, 26%), and (d) de novo carcinomas, without morphologic or molecular evidence of PA (8/39, 21%). Twelve high-grade EMCAs (12/39, 31%) occurred across all subsets. The median disease-free survival was 80 months (95% confidence interval, 77-84 mo). Disease-free survival and other clinicopathologic parameters did not differ by the above defined subsets. HRAS mutations were more common in EMCAs with intact PLAG1 and HMGA2 (7/9 vs. 1/14, P<0.001). Other genetic abnormalities (TP53 [n=2], FBXW7 [n=1], SMARCB1 deletion [n=1]) were seen only in high-grade EMCAs with intact PLAG1 and HMGA2. We conclude that most EMCAs arose ex PA (31/39, 80%) and the genetic profile of EMCA varies with the absence or presence of preexisting PA and its cytogenetic signature. Progression to higher grade EMCA with intact PLAG1 and HMGA2 correlates with the presence of TP53, FBXW7 mutations, or SMARCB1 deletion.
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18
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Androgen Receptor Signaling in Salivary Gland Cancer. Cancers (Basel) 2017; 9:cancers9020017. [PMID: 28208703 PMCID: PMC5332940 DOI: 10.3390/cancers9020017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 11/17/2022] Open
Abstract
Salivary gland cancers comprise a small subset of human malignancies, and are classified into multiple subtypes that exhibit diverse histology, molecular biology and clinical presentation. Local disease is potentially curable with surgery, which may be combined with adjuvant radiotherapy. However, metastatic or unresectable tumors rarely respond to chemotherapy and carry a poorer prognosis. Recent molecular studies have shown evidence of androgen receptor signaling in several types of salivary gland cancer, mainly salivary duct carcinoma. Successful treatment with anti-androgen therapy in other androgen receptor-positive malignancies such as prostate and breast cancer has inspired researchers to investigate this treatment in salivary gland cancer as well. In this review, we describe the prevalence, biology, and therapeutic implications of androgen receptor signaling in salivary gland cancer.
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Hsieh MS, Chen JS, Lee YH, Chou YH. Epithelial-Myoepithelial Carcinoma of the Salivary Gland Harboring HRAS Codon 61 Mutations With Lung Metastasis. Int J Surg Pathol 2015; 24:227-31. [DOI: 10.1177/1066896915622261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Here, we report a case involving a 43-year-old man diagnosed with Burkitt lymphoma in 2007. At the same time, 2 small lung nodules were incidentally found; however, they presented no indication of growth throughout the follow-up period. However, a 1.5-cm nodule located in the right parotid gland in 2010 gradually increased in size to 2.8 cm by 2012. A parotidectomy revealed an epithelial-myoepithelial carcinoma, characterized by biphasic tubular structures and solid areas presenting myoepithelial overgrowth. Tumor necrosis and regional lymph node invasion were also observed. During clinical follow-up in 2013, a new 1.3-cm nodule was identified in the left lower lobe of the lung, which enlarged to 3 cm by 2014. Wedge resection of the left lung nodules revealed round nodes with well-defined borders. Histologically, these lung tumors predominantly comprised spindle-shaped myoepithelial cells with occasional tubular structures. Numerous cleft-like spaces lined by entrapped TTF-1-immunoreactive pneumocytes were observed inside the nodules. The lung nodules were characterized by a morphology similar to that of the parotid cancer. Epithelial-myoepithelial carcinoma with lung metastasis was confirmed by molecular testing, which revealed identical HRAS codon 61 (Q61K) mutations in the primary parotid tumor as well as in the lung metastases.
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Affiliation(s)
- Min-Shu Hsieh
- National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hsuan Lee
- National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
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Sentani K, Ogawa I, Uraoka N, Ikeda M, Hayashi N, Hattori T, Hattori Y, Oue N, Takata T, Yasui W. High-grade epithelial-myoepithelial carcinoma of the parotid gland with mucous cell differentiation. Pathol Int 2015; 65:490-4. [PMID: 26037059 DOI: 10.1111/pin.12315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor with a low-grade malignancy, and EMC with high-grade histopathological features is exceedingly rare. Furthermore, EMC with intracellular mucin is also extremely rare. We report an uncommon case of a high-grade EMC of the parotid gland with mucous cell differentiation in a 66-year old Japanese woman who noticed a right palpable parotid mass increasing in size within a one-year period. The cytological specimen showed a focally biphasic structure and included isolated or discohesive piled-up clusters with hyaline globules surrounded by neoplastic cells with nuclear atypia. The gross examination revealed a relatively well-demarcated, multinodular gray-whitish and solid mass. Histologically, the tumor consisted of variably sized solid nests or trabeculae with central necrosis and increased mitotic activity, and invaded into adjacent skeletal muscles. Immunohistochemically, the biphasic ductal and myoepithelial differentiation of this tumor confirmed the diagnosis of high-grade EMC. Furthermore, numerous small nests with d-PAS and alcian blue-positive mucous cells predominated in about 5% of the whole tumor, and these mucous cells were encompassed by neoplastic myoepithelial cells. We should recognize this variant of EMC because we can't rule out the possibility of EMC even in the presence of mucous cells.
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Affiliation(s)
- Kazuhiro Sentani
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ikuko Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Naohiro Uraoka
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | | | | | - Takuya Hattori
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yui Hattori
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naohide Oue
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takashi Takata
- Department of Oral and Maxillofacial Pathobiology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Salivary gland lesions: recent advances and evolving concepts. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:661-74. [DOI: 10.1016/j.oooo.2015.02.481] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 02/07/2015] [Accepted: 02/20/2015] [Indexed: 12/18/2022]
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Stålhammar G, Elmberger G. Sebaceous epithelial-myoepithelial carcinoma of the parotid gland: a case report of a new histologic variant. Ann Diagn Pathol 2014; 18:248-52. [DOI: 10.1016/j.anndiagpath.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
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23
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Konoglou M, Cheva A, Zarogoulidis P, Porpodis K, Pataka A, Mpaliaka A, Papaiwannou A, Zarogoulidis K, Kontakiotis T, Karaiskos T, Kesisis G, Kolettas A, Giouleka A, Madesis A, Vretzakis G, Sakkas L, Tsakiridis K. Epithelial-myoepithelial carcinoma of the trachea-a rare entity case report. J Thorac Dis 2014; 6 Suppl 1:S194-9. [PMID: 24672694 DOI: 10.3978/j.issn.2072-1439.2013.11.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 11/23/2013] [Indexed: 01/30/2023]
Abstract
Epithelial-myoepithelial tumors of the lung are rare neoplasms whose biological behavior and clinical course still remain to be defined. Epithelial-myoepithelial carcinoma (EMCa) is a low-grade malignant tumour. According to literature, most commonly occurs in salivary glands, particularly in parotic gland, but it can also occur in unusual locations such as breast, lachrymal gland, nose, paranasal sinus, lung, bronchus and, as in our case, trachea. There are no many documented case reports of a primary myoepithelial carcinoma in the trachea. We report a case of a 34-year-old man diagnosed with this unusual location of an epithelial-myoepithelial tumor. The tumour was removed by segmental tracheal resection and end-to-end anastomosis.
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Affiliation(s)
- Maria Konoglou
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Aggeliki Cheva
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Paul Zarogoulidis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Konstantinos Porpodis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Athanasia Pataka
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Aggeliki Mpaliaka
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Antonios Papaiwannou
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Konstantinos Zarogoulidis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Theodoros Kontakiotis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Theodoros Karaiskos
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Georgios Kesisis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Alexander Kolettas
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Alina Giouleka
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Athanasios Madesis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - George Vretzakis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Leonidas Sakkas
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
| | - Kosmas Tsakiridis
- 1 Intesive Care Unit, 2 Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 3 Pulmonary Department, 4 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Oncology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 6 Anesthesiology Department, "Saint" Luke Private Hospital, Thessaloniki, Greece ; 7 Anesthesiology Department, University Hospital of Larisa, Greece
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Chiosea SI, Miller M, Seethala RR. HRAS mutations in epithelial-myoepithelial carcinoma. Head Neck Pathol 2013; 8:146-50. [PMID: 24277618 PMCID: PMC4022927 DOI: 10.1007/s12105-013-0506-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
The molecular profile of epithelial-myoepithelial carcinomas (EMCa) has not been well studied, though a recent association with Harvey rat sarcoma viral oncogene homolog (HRAS) mutations has been noted. To confirm and validate this, we surveyed fifteen EMCa for HRAS codon 61 mutations and correlated HRAS status with clinicopathologic parameters. There were 11 females and 4 males and mean patient age was 64 (range 49-90). Parotid gland was most commonly involved (n = 10) and the most common histologic appearance was that of a 'classic' EMCa (7/15). Four of fifteen (26.7 %) cases demonstrated local recurrence, while 2/15 (13.3 %) demonstrated distant metastases. Other variant morphologies included EMCa arising from pleomorphic adenoma (3/15), and high grade EMCa (2/15). HRAS exon 3, codon 61 mutations, p.Q61R (n = 3) and p.Q61 K (n = 1) were identified in 4 of 15 successfully tested EMCAs (14 patients). Two cases were classic type, while the other cases consisted of one oncocytic variant, and one tumor with myoepithelial overgrowth, the latter of which showed the same mutation in both the primary and recurrence. Of note, the high grade EMCa and EMCa ex pleomorphic adenoma were negative for mutations. Given the small number of cases, there were no significant differences between mutation positive and mutation negative cases in terms of age, gender and outcome.
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Affiliation(s)
- Simion I. Chiosea
- grid.412689.00000000106507433Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Megan Miller
- grid.412689.00000000106507433Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Raja R. Seethala
- grid.412689.00000000106507433Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA
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Abstract
The field of anatomic pathology has changed significantly over the last decades and, as a result of the technological developments in molecular pathology and genetics, has had increasing pressures put on it to become quantitative and to provide more information about protein expression on a cellular level in tissue sections. Multispectral imaging (MSI) has a long history as an advanced imaging modality and has been used for over a decade now in pathology to improve quantitative accuracy, enable the analysis of multicolor immunohistochemistry, and drastically reduce the impact of contrast-robbing tissue autofluorescence common in formalin-fixed, paraffin-embedded tissues. When combined with advanced software for the automated segmentation of different tissue morphologies (eg, tumor vs stroma) and cellular and subcellular segmentation, MSI can enable the per-cell quantitation of many markers simultaneously. This article covers the role that MSI has played in anatomic pathology in the analysis of formalin-fixed, paraffin-embedded tissue sections, discusses the technological aspects of why MSI has been adopted, and provides a review of the literature of the application of MSI in anatomic pathology.
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Oncocytic and apocrine epithelial myoepithelial carcinoma: novel variants of a challenging tumor. Head Neck Pathol 2013; 7 Suppl 1:S77-84. [PMID: 23821213 PMCID: PMC3712087 DOI: 10.1007/s12105-013-0461-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 06/09/2013] [Indexed: 10/26/2022]
Abstract
Epithelial myoepithelial carcinoma (EMCa) is a rare but well characterized biphasic salivary gland malignancy with several variant morphologies. Oncocytic and apocrine EMCa are uncommon variants that constitute up to 8 % of all EMCa. Both variants invoke an eosinophilic or oncocytic differential diagnosis and challenge the traditional requirement of clear myoepithelial cells for EMCa. Oncocytic EMCa occurs in patients a decade older than conventional EMCa. This variant is often papillary with calcification and associated with sebaceous components and occurs in older individuals. Apocrine EMCa is named for its apocrine ductal component, which may be mistaken for salivary duct carcinoma. In this variant, the epithelial component often shows overgrowth in a cribriform or even solid pattern and is immunophenotypically defined by androgen receptor and gross cystic disease fluid protein 15 positivity. The most important aspect of differentiating both oncocytic and apocrine EMCa from other salivary oncocytic tumors is recognition of the biphasic nature of these variants and confirmation that the abluminal outer layer consists of plump, 'activated' myoepithelial cells, regardless of tinctorial characteristics. Both oncocytic and apocrine EMCa behave very indolently in the limited literature to date.
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A perspective of comparative salivary and breast pathology. Part I: microstructural aspects, adaptations and cellular events. Eur Arch Otorhinolaryngol 2013; 271:647-63. [PMID: 23649507 DOI: 10.1007/s00405-013-2488-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
This is the first part of a review comparing the pathology of salivary and mammary glands. Here, less obvious similarities and differences in functional histology and their influences on pathology are examined with emphasis on myoepithelial cells, stromal components, analogues of mucosa-associated lymphoid tissue, steroid receptors, and intraparenchymal cells of monocytic lineage. Particular cell phenotypes (oncocytic, apocrine, neuroendocrine and clear) are critically evaluated and responses to atrophy, infarction and fine-needle aspiration biopsy procedures are highlighted together with aspects of metaplasia, regeneration, ageing and microcalcification. Areas of controversy or uncertainty which may benefit from further investigations are also discussed.
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Seethala RR, Barnes EL. Rare Malignant and Benign Salivary Gland Epithelial Tumors. Surg Pathol Clin 2011; 4:1217-1272. [PMID: 26837791 DOI: 10.1016/j.path.2011.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although at least 24 distinct histologic salivary gland carcinomas exist, many of them are rare, comprising only 1% to 2% of all salivary gland tumors. These include epithelial-myoepithelial carcinoma, (hyalinizing) clear cell carcinoma, basal cell adenocarcinoma, cystadenocarcinoma, low-grade salivary duct carcinoma (low-grade cribriform cystadenocarcinoma), oncocytic carcinoma, and adenocarcinoma not otherwise specified. Few tumors (clear cell carcinoma and basal cell adenocarcinoma) have unique molecular correlates. Benign tumors, although histologically less diverse, are far more common, with pleomorphic adenoma and Warthin tumor the most common salivary gland tumors. Many benign tumors have malignant counterparts for which histologic distinction can pose diagnostic challenge.
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Affiliation(s)
- Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, A614.X PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - E Leon Barnes
- Department of Pathology, University of Pittsburgh Medical Center, A608 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Madorin C, Owen RP, Fraser WD, Pellitteri PK, Radbill B, Rinaldo A, Seethala RR, Shaha AR, Silver CE, Suh MY, Weinstein B, Ferlito A. The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol 2011; 269:1565-76. [PMID: 22101574 DOI: 10.1007/s00405-011-1833-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/30/2011] [Indexed: 01/22/2023]
Abstract
Secondary and tertiary hyperparathyroidism (HPT) develop in patients with renal failure due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1,25-dihydroxy vitamin D levels. Patients present with various bone disorders, cardiovascular disease, and typical laboratory abnormalities. Medical treatment consists of controlling hyperphosphatemia, vitamin D/analog and calcium administration, and calcimimetic agents. Improved medical therapies have led to a decrease in the use of parathyroidectomy (PTX). The surgical indications include parathyroid hormone (PTH) levels >800 pg/ml associated with hypercalcemia and/or hyperphosphatemia despite medical therapy. Other indications include calciphylaxis, fractures, bone pain or pruritis. Transplant recipients often show decreased PTH, calcium and phosphorus levels, but some will have persistent HPT. Evidence suggests that PTX may cause deterioration in renal graft function in the short-term calling into the question the indications for PTX in these patients. Pre-operative imaging is only occasionally helpful except in re-operative PTX. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages and disadvantages which are discussed. Intraoperative PTH monitoring has a high positive predictive value of cure but a poor negative predictive value and therefore is of limited utility. Hypocalcemia is the most common complication requiring aggressive calcium administration. Benefits of surgery may include improved survival, bone mineral density and alleviation of symptoms.
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Affiliation(s)
- Catherine Madorin
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Vera-Sempere F, Vera-Sirera B. Usefulness of antimitochondrial antibody 113-1 in diagnosis and classification of salivary gland tumours with oncocytic differentiation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/s2173-5735(11)70001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Vera-Sempere F, Vera-Sirera B. [Usefulness of antimitochondrial antibody 113-1 in diagnosis and classification of salivary gland tumours with oncocytic differentiation]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:1-9. [PMID: 21122825 DOI: 10.1016/j.otorri.2010.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 07/25/2010] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Salivary gland tumours usually show great variability both in their morphopathology as well as their clinical behaviour. In the present study, the usefulness of antimitochondrial monoclonal antibody 113-1 in the diagnosis and categorization of salivary tumours was studied. MATERIAL AND METHODS A series of 22 benign and malignant salivary tumours and 5 non-tumoral salivary gland specimens were immunohistochemically analysed using an antimitochondrial monoclonal antibody (Ab Mo 113-1), which recognises a non-glycosylated mitochondrial protein of 60 Kd. RESULTS The use of this antibody allowed us to recognize all salivary tumours with oncocytic differentiation. Two salivary tumours (1 papillary cystadenoma and 1 epithelial-myoepithelial carcinoma) (2/22; 10%) were also reclassified as oncocytic tumoral subtypes, in principle unidentified. CONCLUSION Our study highlights the usefulness of this antibody to facilitate the classification of salivary tumours, an aspect that may sometimes have not only diagnostic implications, but also prognostic.
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Affiliation(s)
- Francisco Vera-Sempere
- Departamento de Patología, Universidad de Valencia, Servicio de Anatomía Patológica, Hospital Universitario La Fe, Valencia, España.
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Simpson RH, Di Palma S. Selected recent advances in the pathology of salivary neoplasms. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mpdhp.2010.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Uro-Coste E. Tumeurs des glandes salivaires. État des lieux en 2009. Ann Pathol 2009; 29:274-85. [DOI: 10.1016/j.annpat.2009.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 07/22/2009] [Indexed: 11/29/2022]
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Salivary type tumors seen in consultation. Virchows Arch 2009; 454:457-66. [DOI: 10.1007/s00428-009-0742-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 01/27/2009] [Accepted: 01/29/2009] [Indexed: 11/27/2022]
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