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Yadav U, Mahendru R, Sharma J, Kakkar A. Diagnosis of Adenoid Cystic Carcinoma with Striking Tubular Hypereosinophilia by MYB and EWSR1 Breakapart Fluorescence In Situ Hybridization. Head Neck Pathol 2023; 17:940-951. [PMID: 38010473 PMCID: PMC10739655 DOI: 10.1007/s12105-023-01596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Adenoid cystic carcinoma (AdCC), associated with MYB/MYBL1 gene rearrangements, shows epithelial and basaloid myoepithelial cells arranged in tubular, cribriform and solid patterns. Variations from this classic morphology make diagnosis challenging, necessitating molecular testing. AdCC with striking tubular hypereosinophilia (AdCC-STE) is one such recently described histological subtype. METHODS A 52-year-old female presented with a floor of mouth swelling for two months, diagnosed elsewhere as polymorphous adenocarcinoma (PAC). A biopsy was obtained. With a diagnosis of oncocytic neoplasm, wide excision of the tumor was undertaken. Histological examination, fluorescence in situ hybridization (FISH) and ultrastructural examination were performed. Archival cases of PAC and epithelial myoepithelial carcinoma (EMC) were reviewed, and MYB immunostaining and FISH were performed to identify potential AdCC-STE cases. RESULTS The excised tumor from the index patient showed bilayered tubules, micropapillae and cribriform pattern. Luminal cells with hypereosinophilic to clear cytoplasm were surrounded by flattened abluminal cells. Focally, basophilic matrix was seen within sharply demarcated pseudocystic spaces. FISH revealed MYB and EWSR1 gene rearrangements, confirmatory of AdCC-STE. Electron microscopy showed features consistent with AdCC; however, mitochondria were not prominent. Among 14 archival PACs, two showed MYB immunopositivity; one showed MYB rearrangement but was classical AdCC. Among 35 EMC, one case showed MYB immunoreactivity and eosinophilia of luminal cells but lacked MYB/MYBL1 rearrangement. CONCLUSION Awareness of unusual histological subtypes of AdCC, such as AdCC-STE, is imperative, as it may be misdiagnosed as PAC and EMC, among others. Presence of basophilic matrix and squamoid morules in a biphasic tumor even with hypereosinophilic rather than basaloid myoepithelial appearance should raise suspicion for AdCC-STE, and prompt molecular testing for confirmation. With wider accessibility, lower cost and significantly shorter turn-around-time when compared to RNA sequencing, FISH can be employed for confirmation of diagnosis, especially in low- and middle-income countries.
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Affiliation(s)
- Urvashi Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ria Mahendru
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jyoti Sharma
- Department of Surgical Oncology, National Cancer Institute - All India Institute of Medical Sciences, Jhajjar, 124105, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Chen T, Mamdani M, Vescan A, MacMillan C, Davies J. Cribriform adenocarcinoma of the minor salivary glands: a case report. J Med Case Rep 2023; 17:142. [PMID: 37069616 PMCID: PMC10110342 DOI: 10.1186/s13256-023-03875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Polymorphous adenocarcinoma is the third most common malignant salivary gland tumor. Within polymorphous adenocarcinoma, cribriform adenocarcinoma of salivary glands is a rare subtype and resembles papillary thyroid carcinoma histopathologically. Diagnostically, cribriform adenocarcinoma of salivary glands is challenging for pathologists and surgeons alike as initial presentation and cytologic nuclear features can be easily confused with papillary thyroid carcinoma arising from a thyroglossal duct remnant or lingual thyroid. CASE PRESENTATION A healthy 64-year-old Caucasian woman presented to a community otolaryngologist with a 4-year history of progressive postnasal drip, globus sensation, and eventual dysphonia. Flexible fiberoptic laryngoscopy showed a large, smooth, vallecular lesion filling the oropharynx. Computed tomography imaging of the neck showed a rounded heterogeneous mass centered within the right aspect of the oropharynx measuring 4.2 × 4.4 × 4.5 cm. Fine needle aspiration biopsy was suspicious for papillary carcinoma due to microscopic findings of malignant cells, nuclear grooves, and a powdery chromatin pattern. In the operating room, the tumor was resected en bloc using a lateral pharyngotomy approach with partial resection of the right lateral hyoid. A limited cervical lymphadenectomy was performed to facilitate the lateral pharyngotomy approach and two out of three lymph nodes demonstrated regional metastatic disease. Nuclear grooves, nuclear membrane notching, and occasional intranuclear pseudoinclusions were identified, which are overlapping histopathological characteristics of papillary thyroid carcinoma and cribriform adenocarcinoma of salivary glands. It was negative for thyroglobulin and thyroid transcription factor-1, which was in keeping with cribriform adenocarcinoma of salivary glands rather than papillary thyroid carcinoma. CONCLUSION It is difficult to distinguish cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma solely by cytology, and the distinct characteristics of regional lymph node metastasis coupled with nuanced histologic differences should be emphasized in the evaluation of patients presenting with neck lymphadenopathy and an unknown primary or tongue mass. If sufficient fine needle aspiration biopsy material is available, thyroid transcription factor-1, thyroglobulin, or molecular testing may prove useful in differentiating cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma. A misdiagnosis of papillary thyroid carcinoma may lead to inappropriate treatment including unnecessary thyroidectomy. Therefore, it is critical for both pathologists and surgeons to be aware of this uncommon entity to avoid misdiagnosis and subsequent mismanagement.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Mohammed Mamdani
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Allan Vescan
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Christina MacMillan
- Department of Laboratory Medicine & Pathobiology - Anatomic Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Joel Davies
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada.
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Fukumura M, Ishibashi K, Nakaguro M, Nagao T, Saida K, Urano M, Tanigawa M, Hirai H, Yagyuu T, Kikuchi K, Yada N, Sugita Y, Miyabe M, Hasegawa S, Goto M, Yamamoto H, Ohuchi T, Kusafuka K, Ogawa I, Suzuki H, Notohara K, Shimoda M, Tada Y, Kirita T, Takata T, Morinaga S, Maeda H, Warnakulasuriya S, Miyabe S, Nagao T. Salivary Gland Polymorphous Adenocarcinoma: Clinicopathological Features and Gene Alterations in 36 Japanese Patients. J Oral Pathol Med 2022; 51:710-720. [PMID: 35880805 DOI: 10.1111/jop.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Polymorphous adenocarcinoma (PAC) is a common intraoral minor salivary gland carcinoma in Western countries but is extremely rare in Japan. The current study aimed to characterize the clinicopathological features and status of molecular alterations of PAC-associated genes, such as (e.g., PRKD1/2/3, ARID1A, and DDX3X) in a large cohort of Japanese patients with PAC. MATERIALS AND METHODS We examined the cases of 36 Japanese patients with salivary gland PAC and 26 cases involving histopathological mimics. To detect gene splits, fluorescence in situ hybridization was carried out for PAC-associated genes. Additionally, we applied a SNaPshot multiplex assay to identify PRKD1 hotspot mutations. RESULTS This study revealed the indolent clinical course of PAC with a high 10-year overall survival rate (92.9%), accompanied by occasional local recurrences and cervical lymph node metastasis (both 23.3%). Twenty cases (55.6%) of PAC (but none of the mimics) exhibited alterations in at least one PAC-associated gene. Rearrangement of PAC-associated genes and PRKD1 E710D were identified in 17 (47.2%) and 4 (11.1%) cases, respectively; one case showed coexisting PRKD3 split and PRKD1 E710D. In the multivariate analysis, high clinical stage (P=0.0005), the presence of prominent nucleoli (P=0.0003), and ARID1A split positivity (P=0.004) were independent risk factors for disease-free survival. CONCLUSION Japanese patients with PAC showed clinicopathological features similar to those reported in Western countries. This study disclosed that PAC-associated genetic alterations were common and specific findings in PACs. The diagnostic role and possible prognostic significance of PAC-associated genetic alterations in PACs were suggested.
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Affiliation(s)
- Masahiro Fukumura
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Kenichiro Ishibashi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Kosuke Saida
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan.,Department of Oral and Maxillofacial Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Makoto Urano
- Department of Diagnostic Pathology, Bantane Hospital, Fujita Health University 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
| | - Takahiro Yagyuu
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Kentaro Kikuchi
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University, School of Dentistry, Saitama, Japan
| | - Naomi Yada
- Division of Oral Pathology, Kyushu Dental University, Fukuoka, Japan
| | - Yoshihiko Sugita
- Department of Oral Pathology/Forensic Odontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Megumi Miyabe
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Shogo Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Mitsuo Goto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Ohuchi
- Department of Diagnostic Pathology, Keiyukai Sapporo Hospital, Sapporo, Japan
| | | | - Ikuko Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroaki Suzuki
- Division of Diagnostic Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Okayama, Japan
| | - Masayuki Shimoda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | | | - Shojiroh Morinaga
- Department of Diagnostic Pathology, Hino Municipal Hospital, Hino, Japan
| | - Hatsuhiko Maeda
- Department of Oral Pathology/Forensic Odontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London and The WHO Collaborating Centre for Oral Cancer, London, UK
| | - Satoru Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Toru Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Nonaka T, Takei H. Immunohistochemical Profile of Polymorphous Adenocarcinoma of Minor Salivary Gland: A Systematic Review and Meta-Analysis. Head Neck Pathol 2022; 16:980-990. [PMID: 35507302 PMCID: PMC9729680 DOI: 10.1007/s12105-022-01453-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 12/16/2022]
Abstract
Polymorphous adenocarcinoma (PAC) is a rare variant of minor salivary gland tumors. Because of its architectural diversity, histological diagnosis of PAC can be difficult especially for small biopsies, and immunohistochemistry is of great help in differentiating it from its histologic mimics. The aim of this study is to conduct a systematic literature review to identify reliable immunohistochemical markers for PAC. We conducted an electronic literature search of the MEDLINE, ScienceDirect, SpringerLink, and Wiley Online Library databases, covering the literature published in the period between 1988 and 2021. The eligibility criteria included case reports and retrospective studies of PAC cases with details of immunohistochemical markers. Following the search and selection process, 32 studies with 409 cases were included in this systematic review. Overall, > 90% positivity was observed for pan-cytokeratin (CK) (97.3%), CK7 (96.8%), CK7/8 (97.4%), E-cadherin (90.0%), Vimentin (92.5%), S100 (97.0%), p63 (91.7%), and SOX10 (100%), while little to no positivity was observed for CK20 (0.0%), p40 (0.0%), and GFAP (5.0%). The average MIB-1 labeling index was 3.78%. The results of this systematic review indicate that CK7+/CK20-, p63+/p40-, S100+, Vimentin+, and GFAP- immunophenotype have diagnostic value for PAC. In addition, the use of S100, MSA, p40, and c-Kit provide additional layers of information helpful to differentiate PAC from adenoid cystic carcinoma, one of challenging differential diagnoses.
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Affiliation(s)
- Taichiro Nonaka
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA.
| | - Hidehiro Takei
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA
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Katsoulas NG, Tosios KI, Lynch HA, Uppgaard R, Koutlas IG. Polymorphous Adenocarcinoma, Low Grade Variant, Colliding with a Neurofibroma. Head Neck Pathol 2021; 16:602-606. [PMID: 34472013 PMCID: PMC9187840 DOI: 10.1007/s12105-021-01377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
Collision tumors, composed of two distinct benign or malignant neoplasms, are rarely reported in the oral cavity. We present a case of a 61-year-old female with an asymptomatic non-demarcated lump on the soft palate of unknown duration. An incisional biopsy revealed the presence of two neoplastic populations, a neurofibroma that was partially infiltrated by a polymorphous adenocarcinoma, low-grade variant. Total surgical excision was performed, with uneventful follow-up period. The development of collision tumors may be incidental, although molecular events may influence the pathogenetic mechanism of the phenomenon.
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Affiliation(s)
- Nikolaos G. Katsoulas
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I. Tosios
- Department of Oral Pathology, Medicine and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Hannah Afwerke Lynch
- Division of Oral and Maxillofacial Surgery, School of Dentistry, University of Minnesota, Minneapolis, MN USA
| | - Rachel Uppgaard
- Division of Oral and Maxillofacial Surgery, School of Dentistry, University of Minnesota, Minneapolis, MN USA
| | - Ioannis G. Koutlas
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, 515 Delaware Street SE #16-116B, Minneapolis, MN 55455 USA
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Abstract
Polymorphous adenocarcinoma (PAC) is typically originated from the minor salivary glands and is characterized by cytology uniformity and architectural diversity. PAC commonly harbors PRKD1 E710D mutation. PAC has an excellent prognosis. However, greater than or equal to 10% papillary or greater than or equal to 30% cribriform pattern is an independent adverse prognostic factor. Cribriform adenocarcinoma of salivary gland (CASG) is a controversial entity that is considered within the same histologic spectrum of PAC in current classification schemes; however, it is regarded by some pathologists as a separate entity. CASG shows a propensity to base of tongue location, a lobulated growth pattern, a predominant solid/cribriform architecture, and a high frequency of PRKD1/2/3 fusion.
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Affiliation(s)
- Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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7
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Civantos AM, Viswanathan S, Prasad A, Maldonado ST, Brody RM, Cannady SB, Newman JG, Shanti RM, Brant JA, Rajasekaran K. Role of elective neck dissection and adjuvant radiation therapy in patients with polymorphous adenocarcinoma. Eur Arch Otorhinolaryngol 2021; 278:3459-66. [PMID: 33388976 DOI: 10.1007/s00405-020-06539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the role of elective neck dissection (END) and of adjuvant radiation (aRT) in polymorphous adenocarcinoma (PAC), previously known as polymorphous low-grade adenocarcinoma (PLGA). METHODS Retrospective cohort study of patients in the National Cancer Database with a histology of PAC (coded as PLGA) at a head and neck site diagnosed between 2004 and 2015. Multivariable Cox proportional hazard modeling was used to assess overall survival in the overall population, and in sub-analyses of clinically N0 disease, positive resection margins, and late stage disease. RESULTS A total of 922 patients [66.8% female; mean (SD) age, 60.9 (13.9) years] met inclusion criteria. 74.7% of patients received surgery alone, and 18.0% received surgery and aRT. Only 7.6% of patients with clinically N0 disease received an END, with 10.6% of these having at least one positive node. END did not have a survival benefit compared to no END [HR 1.28 (0.61-2.68)]. Compared to surgery alone, aRT did not have significantly increased survival in the overall population or in late stage [HR 0.68 (0.39-1.19) and HR 0.46 (0.18-1.22), respectively]. On sub-analysis of patients with positive resection margins, aRT had a significant survival benefit compared to surgery alone [HR 0.37 (0.14-0.99)]. CONCLUSION PAC is a rare, slow-growing malignant tumor typically treated with surgical excision, with undefined indications for END or aRT. Our findings show END to not have a benefit to overall survival. In patients with positive resection margins, there was a survival benefit for aRT.
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Adkins BD, Geromes A, Zhang LY, Chernock R, Kimmelshue K, Lewis J, Ely K. SOX10 and GATA3 in Adenoid Cystic Carcinoma and Polymorphous Adenocarcinoma. Head Neck Pathol 2020; 14:406-411. [PMID: 31222589 PMCID: PMC7235140 DOI: 10.1007/s12105-019-01046-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
Differentiating between adenoid cystic carcinoma (AdCC) and polymorphous adenocarcinoma (PAC) can be difficult on small biopsies and cytologic specimens. As such, further characterization of their immunophenotype may aid in distinction. Previous studies have found AdCC to be SOX10+/GATA3 variable and PAC to be GATA3 negative. SOX10 expression in PAC has, as yet, not been established. We performed GATA3 and SOX10 immunohistochemistry on whole sections of 25 cases each of AdCC and PAC (including both classic PAC and the cribriform variant) to assess whether these markers are of diagnostic utility in distinguishing between these entities. SOX10 was found to be positive in 100% of PAC and AdCC whereas GATA 3 was immunoreactive in 45% of AdCCs and 20% of PAC. While this is the first series to compare SOX10 and GATA3 staining in these two tumor types, their frequent expression and similar staining patterns render them of limited value in discriminating between these neoplasms.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN CC3322, Nashville, TN, 37232-2561, USA
| | - Ariana Geromes
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN CC3322, Nashville, TN, 37232-2561, USA
| | - Lily Y Zhang
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca Chernock
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine Kimmelshue
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN CC3322, Nashville, TN, 37232-2561, USA
| | - James Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN CC3322, Nashville, TN, 37232-2561, USA
| | - Kim Ely
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN CC3322, Nashville, TN, 37232-2561, USA.
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Abstract
Evaluation of minor salivary gland biopsy can be fraught with a wide range of problems, including technical limitations due to the small size and distorted nature of tissue received and interpretive difficulties navigating the considerable morphologic and immunohistochemical overlap between widely disparate entities. As such, common pathologic findings can evoke a perplexing differential diagnosis that encompasses malignant, benign, and non-neoplastic processes. This review will present the diagnostic considerations that arise from four histologic patterns that are frequently encountered on minor salivary gland biopsies: squamous differentiation, tubular and cribriform growth, mucin production, and myxoid stroma. The discussion herein will emphasize practical strategies and priorities for navigating these differential diagnoses in a clinically-relevant and cost-effective manner.
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Affiliation(s)
- Lisa M. Rooper
- Departments of Pathology and Oncology, The Johns Hopkins Hospital, 401 N. Broadway, Weinberg 2242, Baltimore, MD 21231-2410 USA
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10
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Phattarataratip E, Kositkittiwanit N, Kajornkiatkul P, Yeunyong P, Ratanapitak R. P120 catenin expression and its correlation with E-cadherin in salivary gland neoplasms. J Oral Biol Craniofac Res 2018; 9:57-62. [PMID: 30258767 DOI: 10.1016/j.jobcr.2018.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/06/2018] [Accepted: 09/13/2018] [Indexed: 01/04/2023] Open
Abstract
Objectives Altered P120 catenin expression has been associated with E-cadherin loss and poor prognosis in several cancers. The objectives of this study were to examine the P120 catenin expression in salivary gland neoplasms in correlation with E-cadherin and assess the relationships between their expression levels and pathologic characteristics. Methods Fifty-two cases of salivary gland neoplasms, i.e. 25 mucoepidermoid carcinomas (MEC), 13 adenoid cystic carcinomas (ACC), 12 pleomorphic adenomas (PA) and 2 polymorphous adenocarcinomas (PAC) were included. The expression of P120 catenin and E-cadherin was investigated immunohistochemically. Results Both P120 catenin and E-cadherin were overexpressed in salivary gland neoplasms, compared to normal tissue. P120 catenin was primarily detected on the membrane of neoplastic cells in most cases. A significant correlation between levels of expression of both proteins was noted in MECs. In ACCs and PA, ductal cells showed positive immunoreactivity, whereas myoepithelial cells variably expressed both proteins. Increased P120 catenin expression was significantly associated with the solid subtype of ACCs. Conclusions The cadherin-catenin complex is preserved in the heterogenous tumor cell population in salivary gland neoplasms. Overexpression of P120 catenin may be involved in the progression to solid ACCs.
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Affiliation(s)
- Ekarat Phattarataratip
- Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
| | - Nicha Kositkittiwanit
- Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pruch Kajornkiatkul
- Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pataraporn Yeunyong
- Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
| | - Ratanatip Ratanapitak
- Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
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Abstract
The 2017 World Health Organization Classification of Head and Neck Tumors introduced for the first time the diagnostic terminology "cribriform variant of polymorphous adenocarcinoma". This nomenclature attempts to reconciliate the ongoing taxonomical controversy related to cribriform adenocarcinoma of tongue. In order to better understand this classification conundrum, it is imperative for pathologist to comprehend the historical evolution of polymorphous adenocarcinoma formerly known as polymorphous "low grade" adenocarcinoma. This review highlights our understanding of these tumors since their origins.
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12
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Vander Poorten V, Triantafyllou A, Skálová A, Stenman G, Bishop JA, Hauben E, Hunt JL, Hellquist H, Feys S, De Bree R, Mäkitie AA, Quer M, Strojan P, Guntinas-Lichius O, Rinaldo A, Ferlito A. Polymorphous adenocarcinoma of the salivary glands: reappraisal and update. Eur Arch Otorhinolaryngol 2018; 275:1681-1695. [PMID: 29761209 DOI: 10.1007/s00405-018-4985-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 12/29/2022]
Abstract
Although relatively rare, polymorphous adenocarcinoma (PAC) is likely the second most common malignancy of the minor salivary glands (MiSG). The diagnosis is mainly based on an incisional biopsy. The optimal treatment comprises wide surgical excision, often with adjuvant radiotherapy. In general, PAC has a good prognosis. Previously, PAC was referred to as polymorphous low-grade adenocarcinoma (PLGA), but the new WHO classification of salivary gland tumours has also included under the PAC subheading, the so-called cribriform adenocarcinoma of minor salivary glands (CAMSG). This approach raised controversy, predominantly because of possible differences in clinical behaviour. For example, PLGA (PAC, classical variant) only rarely metastasizes, whereas CAMSG often shows metastases to the neck lymph nodes. Given the controversy, this review reappraises the definition, epidemiology, clinical presentation, diagnostic work-up, genetics, treatment modalities, and prognosis of PAC of the salivary glands with a particular focus on contrasting differences with CAMSG.
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Affiliation(s)
- Vincent Vander Poorten
- Department of Oncology-Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium. .,Multidisciplinary Salivary Gland Society, Geneva, Switzerland.
| | - Asterios Triantafyllou
- School of Dentistry, University of Liverpool, Liverpool, UK.,Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK
| | - Alena Skálová
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Göran Stenman
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Pathology and Genetics, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Esther Hauben
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Henrik Hellquist
- Epigenetics and Human Disease Laboratory, CBMR, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Simon Feys
- Department of Oncology-Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Miquel Quer
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Orlando Guntinas-Lichius
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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13
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Ortega RM, Bufalino A, Almeida LY, Navarro CM, Travassos DC, Ferrisse TM, Carlos R, León JE. Synchronous Polymorphous Adenocarcinoma and Canalicular Adenoma on the Upper Lip: An Unusual Presentation and Immunohistochemical Analysis. Head Neck Pathol 2017; 12:145-149. [PMID: 28766110 PMCID: PMC5873492 DOI: 10.1007/s12105-017-0838-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022]
Abstract
Multiple salivary gland tumors (MSGTs) are most common in the major than minor salivary glands. The most MSGTs are synchronous, either benign or malignant. A 61-year-old woman was referred presenting nine submucosal nodules, firm to fluctuant, being five nodules on the right side and four nodules on the left side of the upper lip. An incisional biopsy was performed. Hematoxylin and eosin staining was performed in 5-µm sections for histopathologic analysis. Immunohistochemical reactions were carried out in 3-µm sections in accordance with manufacturer's instructions. The histopathological analysis showed focal area containing low-grade polymorphous adenocarcinoma (PAC) and multiple canalicular adenomas (CAs). Immunohistochemical analysis for each lesion was carefully investigated. Here, we present an unusual case of synchronous PAC and multiple CAs of the minor salivary glands, affecting the upper lip, which appears to be the first case showing PAC and CA.
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Affiliation(s)
- Rose Mara Ortega
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Universidade Estadual Paulista (UNESP), Araraquara, Sao Paulo Brazil ,Oral Medicine, Federal University of Juiz de Fora - UFJF/GV, Rua Israel Pinheiro, 2.000, Bairro Universitário, Governador Valadares, Minas Gerais 35020-220 Brazil
| | - Andréia Bufalino
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Universidade Estadual Paulista (UNESP), Araraquara, Sao Paulo Brazil
| | - Luciana Yamamoto Almeida
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Universidade Estadual Paulista (UNESP), Araraquara, Sao Paulo Brazil
| | - Claudia Maria Navarro
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Universidade Estadual Paulista (UNESP), Araraquara, Sao Paulo Brazil
| | - Daphine Caxias Travassos
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Universidade Estadual Paulista (UNESP), Araraquara, Sao Paulo Brazil
| | - Túlio Morandin Ferrisse
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Universidade Estadual Paulista (UNESP), Araraquara, Sao Paulo Brazil
| | - Roman Carlos
- Director of Centro Clínico de Cabeza y Cuello, Guatemala City, Guatemala
| | - Jorge Esquiche León
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo (USP), Ribeirao Preto, Sao Paulo Brazil
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14
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Westra WH, Lewis JS. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Oropharynx. Head Neck Pathol 2017; 11:41-47. [PMID: 28247229 PMCID: PMC5340734 DOI: 10.1007/s12105-017-0793-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/02/2017] [Indexed: 12/14/2022]
Abstract
The changes for oropharyngeal lesions in the 2017 edition of the WHO/IARC Classification of Head and Neck Tumours reference book are dramatic and significant, largely due to the growing impact of high risk human papillomavirus (HPV). The upcoming edition divides tumours of the oral cavity and oropharynx into separate chapters, classifies squamous cell carcinomas (SCC) of the oropharynx on the basis of HPV status, abandons the practice of histologic grading for oropharyngeal SCCs that are HPV positive, recognizes small cell carcinoma of the oropharynx, and combines polymorphous low grade adenocarcinoma and cribriform adenocarcinoma of tongue and minor salivary glands under the single term "polymorphous adenocarcinoma." This review not only calls attention to these changes, but describes the rationale driving these changes and highlights their implications for routine clinical practice.
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Affiliation(s)
- William H Westra
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
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