Advances in salivary gland pathology

An unusual case of mucoepidermoid carcinoma (MEC) of intraoral minor salivary gland origin with spindled morphology was presented. A fascicular stream of bland spindle cells from typical MEC areas amounted to more than 70% of the tumor. Spindle population had features consistent with immunohistochemical and ultrastructural profiles of intermediate cells and lacked overexpression of p53 and cyclin D1. There was no difference in the Ki-67 index between two distinct components. Awareness of extensive spindle cell change replacing a significant portion of low-grade MEC is crucial to avoid an erroneous interpretation of dedifferentiated sarcomatoid transformation.

Section: Discussionmentioning

confidence: 81%

“…In addition to the multiplicity of cell types, complex and varied architectural patterns are also the hallmark of MEC [2]. Although several histologic variants have been proposed [1][2][3][4], MEC seldom consists of a predominant population of spindled cells [2].…”

Section: Introductionmentioning

confidence: 99%

Mucoepidermoid Carcinoma with Spindle Cell Change: A Low-grade Lesion Potentially Mistaken for Sarcomatoid Dedifferentiation

Ide

Mishima

2008

“…However, definitive evidence in this regard will have to await further study. Of interest is the discovery within the last few years that most MECs exhibit a t(11:19)(q21:p13) translocation resulting in the MECT1:MAML2 fusion protein [41][42][43][44]. Recently, this translocation has also been reported in CMEC [45,46].…”

Section: Discussionmentioning

confidence: 99%

Glandular Odontogenic Cyst: Analysis of 46 Cases with Special Emphasis on Microscopic Criteria for Diagnosis

Fowler

Brannon

Kessler

et al. 2011

135

172

The glandular odontogenic cyst (GOC) is now a relatively well-known entity with recent reviews indicating over 100 cases reported in the English literature. The GOC's importance relates to the fact that it exhibits a propensity for recurrence similar to the odontogenic keratocyst, and that it may be confused microscopically with central mucoepidermoid carcinoma (CMEC). Numerous histopathologic features for the GOC have been described, but the exact microscopic criteria necessary for diagnosis have not been universally accepted. Furthermore, some of the microscopic features of GOC may also be found in dentigerous, botryoid, radicular, and surgical ciliated cysts. The purpose of this multicenter retrospective study is to further define the clinical, radiographic, and microscopic features of GOC, to determine which microscopic features may be helpful for diagnosis in problematic cases, to determine the most appropriate treatment, and to determine if GOC and CMEC share a histopathologic spectrum. In our series of 46 cases, the mean age at diagnosis was 51 years with 71% of cases in the 5th-7th decades. No gender predilection was noted. 80% of cases occurred in the mandible, and 60% of the lesions involved the anterior regions of the jaws. Swelling/expansion was the most common presenting complaint, although some cases were asymptomatic. Radiographically, most cases presented as a well-defined unilocular or multilocular radiolucency involving the periapical area of multiple teeth. Some lesions displayed a scalloped border. Cases also presented in dentigerous, lateral periodontal, and ''globulomaxillary'' relationships. The canine area was a common location for maxillary cases. All cases were treated conservatively (enucleation, curettage, cystectomy, excision). Follow-up on 18 cases revealed a recurrence rate of 50% (9/18), with 6 cases recurring more than once (range of follow-up: 2 months to 20 years; average length of follow-up: 8.75 years). The mean interval from initial treatment to first recurrence was 8 years, and from first recurrence to second recurrence was 5.8 years. Two cases recurred three times and the interval from second to third recurrence was 7 years (exact interval only documented in one case). All cases exhibited eosinophilic cuboidal (hobnail) cells, a feature not specific for GOC, but necessary for diagnosis, in our opinion. Univariate analysis indicated several features that are most helpful in distinguishing GOC from GOC mimickers in problematic cases, including: (1) the presence of microcysts (P \ 0.0001); (2) epithelial spheres 123Head and Neck Pathol (2011) 5:364-375 DOI 10.1007 (P \ 0.0001); (3) clear cells (P = 0.0002); (4) variable thickness of the epithelial cyst lining (P = 0.0002); and (5) multiple compartments (P = 0.006). Stratified analysis indicated that when microcysts are present, epithelial spheres and multiple compartments are still significant, and clear cells are marginally significant in distinguishing GOCs from GOC mimickers. The presence of microcysts (P = 0.00...

“…While it is not clear that they are related, there have also been tumors with similar morphology labeled ''salivary duct carcinoma in situ'' in the literature [4]. Currently the World Health Organization (WHO) classifies these tumors as a variant of cystadenocarcinoma, which has generated some controversy, with some authors still believing that they represent a ductal tumor [8,13]. Wayne et al compared IDC to cystadenocarcinoma, NOS, in abstract form at the United States and Canadian Academy of Pathology's (USCAP) annual meeting and found some overlap between these tumors and concluded that they were more closely related to eachother than to conventional salivary duct carcinoma (SDC) [7].…”

Section: Discussionmentioning

confidence: 99%

Intraductal Carcinoma of Salivary Gland (So-Called Low-Grade Cribriform Cystadenocarcinoma) Arising in an Intraparotid Lymph Node

Weinreb

2011

Since the first description of an entirely intraductal epithelial proliferation of salivary gland by Chen in 1983 as an ''intraductal carcinoma'', there have been several dozen reported cases with the same and various additional names including ''low-grade salivary duct carcinoma'', ''low-grade cribriform cystadenocarcinoma'' and ''carcinoma in situ'' of salivary gland. These refer to a combination of nests and cysts of varying size formed by a cellular proliferation resembling atypical ductal hyperplasia or ductal carcinoma in situ of the breast. The lesions are generally entirely intraductal with low, intermediate or high-grade dysplasia. Occasional benign tumors of salivary gland, particularly Warthin tumor and rare salivary carcinomas may arise within an intraparotid lymph node. In addition, intraparotid lymph nodes are a routine location for metastatic disease. A case of a 59-year-old female with a parotid mass is described, which grossly had the appearance of a Warthin tumor. Microscopically, it was an entirely intranodal proliferation of cells with diffuse AE1/ AE3 and S100 positivity. The nests and cysts were completely surrounded by a rim of non-neoplastic myoepithelial cells, which were positive for CK14, p63, SMA, MSA and calponin. The tumor cells were negative for these markers. The cells were only focally positive for AR and BRST-2. They showed negligible MIB-1 staining. This report describes, for the first time, an entirely intranodal location for a low-grade intraductal carcinoma (so-called low-grade cribriform cystadenocarcinoma).