|
1
|
Ma TY, Wu J, He SZ, Wang XL, Yang GL, Zhang SJ, Zhou J, Ding YM, Li LF, Liu HF, Xuan LL, Chen XH. High-grade transformation of head and neck adenoid cystic carcinoma demonstrates distinctive clinicopathological features and an unfavorable prognosis: a matched case-control study of the largest series in China. Clin Transl Oncol 2024; 26:1338-1347. [PMID: 38097822 DOI: 10.1007/s12094-023-03357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 05/22/2024]
Abstract
PURPOSE Amidst the rarity of High-grade transformation (HGT) in adenoid cystic carcinoma (ACC), this study offers unprecedented insights into its aggressive nature and clinical implications. METHODS A 1:1 match comparison between 23 HGT patients and non-HGT counterparts was extracted from 412 ACC cases, focusing on dissecting distinctive clinicopathological features and prognostic outcomes. RESULTS The predominant sites of HGT were the sinonasal and lacrimal glands (30.4% each). Notably, the solid subtype was the most prevalent pattern within HGT, accounting for 69.6% of cases. Compared to non-HGT, the HGT cohort exhibited significantly higher rates of lymph node metastasis (39.1% vs. 8.7%; P < 0.05), perineural invasion (60.9% vs. 26.1%; P < 0.05), and increased Ki-67 proliferation index (35.0% vs. 10.0%; P < 0.05). Moreover, HGT regions typically showed reduced or absent p63 expression, along with high-grade pathomorphology. HGT was associated with increased recurrence (55.0%) and distant metastasis (78.3%), leading to an average survival of 35.9 months and a 3-years mortality rate of 35.0%. Overall and progression-free survival rates were significantly decreased in the HGT group. CONCLUSION This study represents the largest single-center cohort of HGT cases to our knowledge, highlighting its frequent occurrence in the sinonasal and lacrimal glands and association with poorer outcomes. The findings support classifying HGT in ACC as Grade 4, reflecting its severity.
Collapse
Affiliation(s)
- Ting-Yao Ma
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Jun Wu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Shi-Zhi He
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Xue-Lian Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Guo-Liang Yang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Shu-Jing Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Jin Zhou
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Yi-Ming Ding
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Li-Feng Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Hong-Fei Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China
| | - Lan-Lan Xuan
- Department of Pathology, Anqing Medical Center, Anhui Medical University, Anqing Municipal Hospital, Anqing, 246003, People's Republic of China.
| | - Xiao-Hong Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, People's Republic of China.
| |
Collapse
|
|
2
|
Rammal R, Batson B, Spector ME, Chiosea SI, Seethala RR. Acinic cell Carcinoma with high-grade Squamoglandular and Chondrosarcomatous Transformation Mimicking 'Carcinosarcoma ex-pleomorphic Adenoma': A Wrinkle in the Proposed Nomenclature Revision for Sarcomatoid Salivary Gland Neoplasms. Head Neck Pathol 2024; 18:44. [PMID: 38775845 PMCID: PMC11111628 DOI: 10.1007/s12105-024-01650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
While acinic cell carcinoma (AciCC) can undergo high-grade transformation (HGT) to high-grade adenocarcinoma or poorly differentiated carcinoma, other morphologies such as spindle cell/sarcomatoid carcinoma are rare and not well-characterized. We herein report a novel case of AciCC with squamoglandular and chondrosarcomatous HGT mimicking a so-called 'carcinosarcoma ex-pleomorphic adenoma'. The patient is an 81-year-old male with a two-month history of neck swelling and referred otalgia who presented with a left parapharyngeal space mass extending into retropharyngeal space and pterygoid muscles. On resection, the tumor showed considerable morphologic diversity with high-grade serous and mucous acinar components as well as cribriform to solid apocrine-like components with comedonecrosis and squamous differentiation, all of which were embedded in a chondromyxoid background ranging from paucicellular and bland to a high-grade chondrosarcoma/pleomorphic sarcoma-like appearance. Only a minor conventional AciCC component was noted. Immunostains were negative for AR and only focally positive for GCDFP-15 arguing against a true apocrine phenotype, while PLAG1 and HMGA2 were negative arguing against an antecedent pleomorphic adenoma. On the other hand, SOX-10, DOG-1 and PAS after diastase highlighted serous acinar differentiation, and mucicarmine, and NKX3.1 highlighted mucous acinar differentiation. NR4A3 immunohistochemical staining and NR4A3 fluorescence in situ hybridization were positive in the carcinomatous and sarcomatoid components while sequencing analysis of both components revealed identical alterations involving TP53, PIK3CB, ARID1A, and STK11. This unique case warrants caution in designating all salivary sarcomatoid carcinomas with heterologous elements as part of the 'carcinoma ex-pleomorphic adenoma' family.
Collapse
Affiliation(s)
- Rayan Rammal
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Bethany Batson
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew E Spector
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
|
3
|
Fathima SD, Gururaj N, Sivapathasundharam B, Vennila AA, Keerthik Lavanya MK, Sarayushivani U. Histopathological significance of necrosis in oral lesions: A review. J Oral Maxillofac Pathol 2023; 27:340-347. [PMID: 37854904 PMCID: PMC10581306 DOI: 10.4103/jomfp.jomfp_39_23] [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: 01/29/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 10/20/2023] Open
Abstract
Necrosis is a localized area of tissue death followed by degradation of tissue by hydrolytic enzymes released from the dead cells, resulting in swelling of organelles, rupture of the plasma membrane, eventual cell lysis, and leakage of intracellular contents into the surrounding tissue. It is always accompanied by an inflammatory reaction. Necrosis is caused by various factors such as hypoxia, physical factors, chemical agents, immunological agents, and microbial agents. Still now, there is no literature review regarding the necrotic lesions of the oral cavity. In this paper, the oral lesions associated with necrosis are categorized under the headings such as odontogenic cysts, odontogenic tumors, salivary gland pathology, and epithelial malignancies. In addition, the histopathological significance of necrosis in oral lesions has been discussed. By suggesting that spotting necrosis in the histopathology aids in determining the diagnosis, tumor behavior, and prognosis of oral lesions.
Collapse
Affiliation(s)
- S Deenul Fathima
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - N Gururaj
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - B Sivapathasundharam
- Department of Oral and Maxillofacial Pathology, Priyadharshini Dental College and Hospital, Pandur, Tamil Nadu, India
| | - A Alagu Vennila
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - M. K. Keerthik Lavanya
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - U Sarayushivani
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| |
Collapse
|
|
4
|
Nishida H, Kusaba T, Kawamura K, Oyama Y, Daa T. Histopathological Aspects of the Prognostic Factors for Salivary Gland Cancers. Cancers (Basel) 2023; 15:cancers15041236. [PMID: 36831578 PMCID: PMC9954716 DOI: 10.3390/cancers15041236] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Salivary gland cancers (SGCs) are diagnosed using histopathological examination, which significantly contributes to their progression, including lymph node/distant metastasis or local recurrence. In the current World Health Organization (WHO) Classification of Head and Neck Tumors: Salivary Glands (5th edition), malignant and benign epithelial tumors are classified into 21 and 15 tumor types, respectively. All malignant tumors have the potential for lymph node/distant metastasis or local recurrence. In particular, mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), salivary duct carcinoma, salivary carcinoma, not otherwise specified (NOS, formerly known as adenocarcinoma, NOS), myoepithelial carcinoma, epithelial-myoepithelial carcinoma, and carcinoma ex pleomorphic adenoma (PA) are relatively prevalent. High-grade transformation is an important aspect of tumor progression in SGCs. MEC, AdCC, salivary carcinoma, and NOS have a distinct grading system; however, a universal histological grading system for SGCs has not yet been recommended. Conversely, PA is considered benign; nonetheless, it should be cautiously treated to avoid the development of metastasizing/recurrent PA. The aim of this review is to describe the current histopathological aspects of the prognostic factors for SGCs and discuss the genes or molecules used as diagnostic tools that might have treatment target potential in the future.
Collapse
|
|
5
|
Vasudevan G, John AM, D K V, Vallonthaiel AG. Adenoid cystic carcinoma of the breast with late recurrence and high-grade transformation. BMJ Case Rep 2023; 16:e252336. [PMID: 36759039 PMCID: PMC9923282 DOI: 10.1136/bcr-2022-252336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Breast cancers have broad histological subtypes with varied molecular expression, which determines the management. Although ductal and lobular breast carcinomas constitute the significant 90% of these tumours, other subtypes constitute about 10% of breast cancers. Adenoid cystic carcinoma (AdCC) is a salivary gland-type tumour described in breast, constituting less than 1% of all breast carcinomas. These tumours have a favourable prognosis and are surgically managed by either lumpectomy or mastectomy. Solid-basaloid and AdCC with high-grade transformation are the sporadic subtypes of AdCC, in addition to the classic type. We report a case of recurrent AdCC which was surgically managed by modified radical mastectomy initially and presented with recurrence and high-grade transformation 11 years later.
Collapse
Affiliation(s)
- Gowtham Vasudevan
- General Surgery, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Ann Mary John
- Pathology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Vijaykumar D K
- Breast Clinic and Surgical Oncology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | | |
Collapse
|
|
6
|
Shah SA, Parikh L, Solanki R, Bhojani J, Gohil R. Lacrimal Gland Adenoid Cystic Carcinoma with High Grade Transformation: A Case Report and Current Concepts in Multi Modality Management. Indian J Otolaryngol Head Neck Surg 2022; 74:2599-2606. [PMID: 36452811 PMCID: PMC9702296 DOI: 10.1007/s12070-020-02277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022] Open
Abstract
Lacrimal gland adenoid cystic carcinoma (AdCC) is associated with an aggressive clinical course and grave prognosis. A high grade transformation within adenoid cystic carcinoma of lacrimal gland is a rare condition which is even more locally aggressive with frequent neck and distant metastasis. We present a case of left lacrimal gland adenoid cystic carcinoma with high grade transformation to adenocarcinoma NOS type presenting with orbital pain and proptosis. After thorough evaluation for locoregional and distant spread of the disease, the patient underwent left orbital exenteration with orbitectomy and neck dissection with free flap reconstruction. Patient received adjuvant radiation therapy and is presently disease free for last 6 months. A multi-modality management protocol involving surgery, radiotherapy and chemotherapy has been proposed for management of lacrimal gland AdCC with high grade transformation. We report the 4th case in the literature of lacrimal gland adenoid cystic carcinoma with high grade transformation.
Collapse
Affiliation(s)
- Siddharth A. Shah
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Loma Parikh
- Department of Histo-Pathology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat India
| | - Raghuvir Solanki
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Jatin Bhojani
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Raviraj Gohil
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| |
Collapse
|
|
7
|
Lv JJ, Ren M, Cai X, Hu J, Kong JC, Kong YY. Primary cutaneous adenoid cystic carcinoma: a clinicopathologic, immunohistochemical, and fluorescence in-situ hybridisation study of 13 cases. Histopathology 2021; 80:407-419. [PMID: 34519081 DOI: 10.1111/his.14565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023]
Abstract
AIMS This study aimed to investigate the clinical, histological, immunohistochemical and chromosomal features of primary cutaneous adenoid cystic carcinoma (PCACC). METHODS AND RESULTS We retrospectively analysed 13 cases identified on their clinicopathological features and performed fluorescence in-situ hybridisation (FISH) on six available cases. Head and neck (46.2%) were most commonly involved. The median age was 53 years, with a male predilection. Histologically, tumours were classified as grades 1 (eight), 2 (four) and 3 with high-grade transformation (HGT) (one). The HGT component was demonstrated as poorly differentiated carcinoma with multifocal necrosis and myoepithelial differentiation. Patients with one of the following factors: longest diameter of the lesion (≥ 1 cm), involvement of subcutaneous fat tissue and widely infiltrative border had a relatively higher rate of local recurrence, distant metastasis and death. Five of six cases were confirmed to have MYB translocation, while nuclear staining for MYB proto-oncogene, transcription factor (MYB) protein was found in four cases. During the follow-up (median = 64 months), two patients experienced local recurrences. One patient, who was classified as grade III PCACC with HGT, developed multiple metastases and died of disease. Another patient was alive with multiple metastases. CONCLUSIONS This is the largest single-institution study, to our knowledge, of PCACC in an Asian population. We describe the first case of scalp PCACC with HGT, which is the only death case in our series. PCACC tends to recur locally and has metastatic potential. PCACC with HGT has a poor prognosis.
Collapse
Affiliation(s)
- Jiao-Jie Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jue Hu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Cheng Kong
- Department of Pathology, First People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
|
8
|
Zhu Y, Zhu X, Xue X, Zhang Y, Hu C, Liu W, Lu H. Exploration of High-Grade Transformation and Postoperative Radiotherapy on Prognostic Analysis for Primary Adenoid Cystic Carcinoma of the Head and Neck. Front Oncol 2021; 11:647172. [PMID: 33898317 PMCID: PMC8063729 DOI: 10.3389/fonc.2021.647172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background Despite Adenoid cystic carcinoma (ACC) with cribriform or tubular components being recognized as a potentially indolent malignancy, ACC displaying solid or, more rarely, high-grade transformation (HGT) components is considered a more aggressive variant of the disease. As it is difficult to measure the proportion of the solid component objectively, and the role of HGT in the current grading system remains unclear, the prognostic influence of tumor grading remains controversial. In addition, postoperative radiotherapy (PORT) has been proven to be effective in local control of ACC of the head and neck (ACCHN) with a high rate of nerve invasion and close surgical margin. However it remains to be explored that whether PORT could improve the survival of patients with ACC, particularly those with HGT. Methods A series of 73 surgically treated primary ACCHN cases were retrospectively accessed. Immunohistochemical staining was performed to observe the biphasic ductal-myoepithelial differentiation and to identify the HGT components of ACC for tumor grading. The correlation between tumor grading and clinicopathological characteristics was analyzed. Univariate and multivariate prognostic analysis were performed for progression-free survival (PFS) and overall survival (OS). Results Of the 73 included cases, 47 were grade I-II ACC and 26 were grade III ACC. Among the grade III cases, 14 with loss of biphasic ductal-myoepithelial differentiation identified by immunostaining were classified as HGT, and could be distinguished from conventional grade III cases. These HGT cases were correlated with a high propensity of lymph node metastases and more advanced stage. Univariate analysis demonstrated that tumor grading, perineural invasion, T stage, stage groups, and PORT were predictors for PFS, whereas tumor grading, margin status, and PORT were predictors for OS. However, only tumor grading and PORT were independent predictors for PFS and OS. The patients with HGT had significantly worse prognosis than those with conventional ACC. Moreover, disease progression tended to occur more frequently in younger patients. Among the patients with HGT, those who received PORT had a longer median survival time than those who did not. Conclusion HGT ACC identified by loss of biphasic differentiation should be considered in tumor grading. Tumor grading and PORT were independent predictors for disease progression and OS in surgically treated ACCHN patients.
Collapse
Affiliation(s)
- Yuelu Zhu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyi Zhu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuemin Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunfang Hu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenchao Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haizhen Lu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
|
9
|
Nakaguro M, Faquin WC, Baloch ZW, Cantley RL, Compton ML, Ely KA, Holmes BJ, Hu R, Kerr DA, Montone KT, Nishino M, Pantanowitz L, Rossi ED, Sadow PM. Fine needle aspiration of salivary gland carcinomas with high-grade transformation: A multi-institutional study of 22 cases and review of the literature. Cancer Cytopathol 2020; 129:318-325. [PMID: 33211402 DOI: 10.1002/cncy.22388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND High-grade transformation (HGT) is a rare process whereby conventional low- to intermediate-grade salivary gland carcinomas (SGC) transform into high-grade, poorly or undifferentiated malignancies with focal or complete loss of their conventional histomorphologic features. Because tumors with HGT are associated with a worse prognosis than their conventional counterparts, preoperative recognition of HGT may be of benefit for optimal patient management. Using a multi-institutional approach, we describe the largest fine needle aspiration (FNA) cohort of salivary gland carcinomas with HGT. METHODS The archives of 9 large academic medical centers were searched, and 22 cases of SGC with HGT were identified by surgical excision accompanied by preoperative FNA. Clinical and cytomorphologic features were retrospectively reviewed. RESULTS The male-to-female ratio was 14:8, and the mean patient age was 60.2 years. The average tumor size was 3.6 cm, and 19 cases were from the parotid gland. Acinic cell carcinoma with HGT was the most common tumor subtype, comprising 12 cases with HGT, followed by adenoid cystic carcinoma, secretory carcinoma, and other subtypes. Eighteen cases were classified as malignant; however, a specific diagnosis of HGT was not made. Sixteen cases contained a high-grade cytologic component, and 7 cases had a mixture of both conventional and high-grade components retrospectively. CONCLUSIONS SGC with HGT should be considered in the differential diagnosis of a salivary gland aspirate exhibiting high-grade cytomorphologic features. The presence of distinct tumor populations, conventional and high-grade, should prompt consideration of HGT, especially when the conventional component is acinic cell carcinoma or adenoid cystic carcinoma.
Collapse
Affiliation(s)
- Masato Nakaguro
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - William C Faquin
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard L Cantley
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, Michigan
| | - Margaret L Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim A Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brittany J Holmes
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Kathleen T Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michiya Nishino
- Departments of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Liron Pantanowitz
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, Michigan
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
|
10
|
Chia N, Petersson F. Adenoid cystic carcinoma with dedifferentiation/expansion of the luminal cell component and preserved biphasic morphology - Early high-grade transformation. Ann Diagn Pathol 2020; 50:151650. [PMID: 33254086 DOI: 10.1016/j.anndiagpath.2020.151650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022]
Abstract
We present two patients (29 and 67 years) with histomorphologic and immunohistochemical evidence of early high-grade transformation of adenoid cystic carcinoma in the nasal cavity and floor of mouth, respectively. The component of early high-grade transformation was characterized by 1) selective expansion of the luminal (CK7+, c-kit+, p63-) cell component with severe cytologic atypia and significantly increased Ki-67 proliferation index, and 2) retained albeit attenuated abluminal (CK7-, c-kit-, p63+) cells, surrounding nests of high-grade luminal cells.
Collapse
Affiliation(s)
- Noel Chia
- Department of Pathology, National University Hospital, Singapore, 5 Lower Kent Ridge Road, Main Building Level 3, S(119074)
| | - Fredrik Petersson
- Department of Pathology, National University Hospital, Singapore, 5 Lower Kent Ridge Road, Main Building Level 3, S(119074).
| |
Collapse
|