Cytomorphologic features of intraductal salivary gland carcinoma: A multi‐institutional study of 13 FNA cases with histologic, molecular, and clinical correlations

Viswanathan, Kartik; Sadow, Peter M.; Maleki, Zahra; Nishino, Michiya; Baloch, Zubair W.; Abbott, Todd; Rao, Rema; Faquin, William C.

doi:10.1002/cncy.22504

Cited by 9 publications

(29 citation statements)

References 29 publications

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“…Although typical intercalated‐type IDC has banal appearing “low grade” nuclei, the apocrine subset has large nuclei, granular eosinophilic cytoplasm, and macronucleoli 2,70 . To further complicate the morphologic distinction between IDC and SDC, McLean‐Holden et al 71 have described examples of invasive carcinoma ex‐IDC some of which “were indistinguishable from SDC, with clear‐cut apocrine differentiation.” A recently described cytologic series (13 cases of IDC) showed features in the H‐G form that strongly imitate those of classic SDC 72 . The authors admit that due to overlapping features with other SG neoplasms, a definitive FNA diagnosis of IDC using only cytomorphology is not possible, and a firm diagnosis requires ancillary IHC and probably molecular profiling.…”

Section: Discussionmentioning

confidence: 99%

“…A recently described cytologic series (13 cases of IDC) showed features in the H-G form that strongly imitate those of classic SDC. 72 The authors admit that due to overlapping features with other SG neoplasms, a definitive FNA diagnosis of IDC using only cytomorphology is not possible, and a firm diagnosis requires ancillary IHC and probably molecular profiling. Yet, they present evidence illustrating a biphasic population in many examples highlighting a second population of smaller myoepithelial cells that does not exist in SDC, and when present possibly could help exclude SDC from consideration.…”

Section: Discussionmentioning

confidence: 99%

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Salivary duct carcinoma: A report of 70 FNA cases and review of the literature

Wakely

2022

Cancer Cytopathology

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BACKGROUND:Although usually recognized as malignant, fine-needle aspiration (FNA) biopsy of salivary duct carcinoma (SDC) has been confused with other primary salivary gland (SG) neoplasms. This article undertook an analysis of a large collection of SDC FNA cases to assess diagnostic accuracy, specificity, and cytopathology. METHODS: Cytopathology files were searched for SDC with histopathologic validation. FNA biopsy smears were performed using standard techniques. RESULTS:Seventy cases from 56 patients (M:F, 1.9:1; age range, 26-92 years; mean age, 65 years) met inclusion criteria. All had tissue confirmation of SDC. FNA sites included: parotid gland (42, 60% cases), neck (10), submandibular gland (7), pre-/ post-auricular area (5), face/cheek (3), mediastinal lymph nodes (2), and clavicle (1). Aspirates were from primary (52, 74%), metastatic (12, 17%), and locally recurrent (6, 9%) neoplasms. FNA diagnoses included: SDC (19, 27%), favor/suspicious for SDC (7, 10%), high-grade carcinoma (11), adenocarcinoma ( 9), carcinoma ( 6), malignant (6), SG neoplasm (5), atypia (3), SDC versus another malignancy (2), and pleomorphic adenoma (2). Large polygonal cells in groups and single forms showed cribriforming, variable necrosis, pseudopapillae, and oncocytic change. Androgen receptor staining was positive in all cases.CONCLUSIONS: FNA biopsy is accurate and reliable in classifying SDC as a malignant neoplasm, but much less so for identification as a specific tumor type. Using the Milan system, 86% of aspirates were classified as either malignant or suspicious for malignancy. A recurring pitfall includes sampling error in cases of SDC ex pleomorphic adenoma. Cancer Cytopathol 2022;130:595-608.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Salivary duct carcinoma: A report of 70 FNA cases and review of the literature

Wakely

2022

Cancer Cytopathology

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“…Central comedonecrosis is more common in the apocrine type, but is also seen in the intercalated duct-type. Importantly, a precursor lesion (such as pleomorphic adenoma, sclerosing polycystic adenoma, and papillary cystadenoma) is absent, although an adjacent, second tumor (pleomorphic adenoma) has been reported 46,49…”

Section: Nomenclature Developmentmentioning

confidence: 99%

“…4). 26,32,44,49 This subtype may show myoepithelial cells within the intraductal compartment and not just at the periphery. 32 Overall, histologic invasion is reported in about 28%, highest in the hybrid (45%; Fig.…”

Section: Microscopic Featuresmentioning

confidence: 99%

“…6,9,[11][12][13]26,30,32,33,49,50,83 When reported, the epithelial cells are reactive with pancytokeratin (AE1/AE3), CAM5.2, 34ßE12 (K903), CK7, EMA, and CK19. 6,9,[11][12][13]26,30,32,33,49,50,83 Variable reactivity is reported with GATA3 and DOG1 (although only rarely positive for the latter). 26,29,34,43,49,50 Neoplastic cells are nonreactive with estrogen receptor and progesterone receptor.…”

Section: Immunohistochemistry and In Situ Hybridization Findingsmentioning

confidence: 99%

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Salivary Gland Intraductal Carcinoma: How Do 183 Reported Cases Fit Into a Developing Classification

Thompson

Bishop

2022

Advances in Anatomic Pathology

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Salivary gland intraductal carcinoma (IDC) is a very uncommon group of neoplasms. Many names, variations in diagnostic criteria, and newly observed molecular findings (including NCOA4::RET, TRIM27::RET, HRAS point mutations, and PIK3CA pathway alterations) have generated further confusion in being able to recognize and categorize this group of tumors. Different histologic appearances and patterns of growth suggest there is more than one tumor category, with intercalated duct, apocrine, oncocytic, and hybrid features seen. Frankly destructive invasion further complicates the category, as the name "intraductal" would suggest an "in situ" neoplasm. Recent evidence on fusion-positive IDC demonstrates the same molecular underpinnings in both the ductal and the myoepithelial cells, which aids in further separating these tumors. This article summarizes the historical group of 183 neoplasms classified under the umbrella of IDC and highlights the unique histologic, immunohistochemistry, and molecular features that may further guide nomenclature standardization and harmonization.

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IDK what's next for IDC: The unfolding saga of intraductal carcinoma of salivary glands

Bishop

2021

Cancer Cytopathology

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The salivary gland tumor currently known as intraductal carcinoma (IDC) has had a tortuous history. Originally described as IDC by Chen et al in 1983, 1 this tumor was subsequently called "low-grade salivary duct carcinoma" and "low-grade cribriform cystadenocarcinoma" until the 2017 World Health Organization classification, which went full circle and came back to the original IDC terminology. 2,3 Conceptually, IDC was believed for years to represent the salivary gland analogue of breast atypical ductal hyperplasia or ductal carcinoma in situ, and much attention was historically given to what relationship, if any, IDC had with salivary duct carcinoma.Much has been learned recently about IDC. It has become clear that IDC is not a homogeneous entity but rather exists as at least 3 subtypes: 1) classic intercalated duct-like, 2) purely apocrine, and 3) mixed or hybrid. There is a fourth type, oncocytic IDC, which has yet to be characterized completely, and it is possible that even more subtypes may be discovered. It has been shown that each subtype of IDC has unique molecular underpinnings, with intercalated duct-type and mixed/hybrid IDC usually harboring unique RET fusions, with oncocytic IDC harboring RET fusions or BRAF V600E, and with pure apocrine IDC having complex genetics mirroring salivary duct carcinoma. [4][5][6][7][8][9][10] We now know that IDC can show foci of traditional invasion with a loss of myoepithelial cells. 5,6,11 Although this appears to be common in pure apocrine IDC where the invasive component is salivary duct carcinoma, it is rare in the other types, where the significance is unclear, and there is no accepted terminology. We also know that although RET rearrangements are common in IDC and are targetable by new systemic agents, the most common (NCOA4-RET) is easily missed on break-apart fluorescence in situ hybridization because this alteration is a tight inversion. Finally, perhaps most surprisingly, it has been shown that for fusion-positive IDC, the characteristic fusion is present not only in the ductal cells known to be neoplastic, but also in the surrounding myoepithelial cells previously presumed to be native. 12 Accordingly, although pure apocrine IDC may indeed represent the in situ form of salivary duct carcinoma, the other IDC types are apparently biphasic neoplasms, either benign or possibly low-grade malignant.In this issue of Cancer Cytopathology, Viswanathan et al 13 further unravel the IDC concept by detailing the cytopathologic features of 13 cases, the largest series to date. This group found that IDC is usually classified as salivary gland neoplasm of uncertain malignant potential or malignant in the current Milan classification. Moreover, they found distinct differences between the cellular features of low-grade intercalated duct-like IDC and high-grade apocrine IDC. Particularly interesting was the fact that the myoepithelial cells of IDC are also present on fine-needle aspiration (FNA) smears, and as a result, IDC must now be included in the FNA differential diagnosi...

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Cytomorphologic features of intraductal salivary gland carcinoma: A multi‐institutional study of 13 FNA cases with histologic, molecular, and clinical correlations

Cited by 9 publications

References 29 publications

Salivary duct carcinoma: A report of 70 FNA cases and review of the literature

Salivary duct carcinoma: A report of 70 FNA cases and review of the literature

Salivary Gland Intraductal Carcinoma: How Do 183 Reported Cases Fit Into a Developing Classification

IDK what's next for IDC: The unfolding saga of intraductal carcinoma of salivary glands

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