Low‐grade intraductal carcinoma of the salivary gland with prominent oncocytic change: a newly described variant

Nakaguro, Masato; Urano, Makoto; Suzuki, Hiroaki; Yamada, Kazuyuki; Sakaguchi, Asumi; Ogura, K.; Matsumoto, Takeshi; Ono, Noritsugu; Asato, Tsuguharu; Mikami, Yoshiki; Imai, Hiroshi; Nagao, Toshitaka

doi:10.1111/his.13517

Cited by 25 publications

(30 citation statements)

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“…The tumour cells proliferate with a comedo‐like and cribriform pattern, and are typically diffusely immunoreactive for androgen receptor and often for HER2 . Both intraductal carcinoma and SP have non‐neoplastic basal cell rimming and intraductal papillary growth . However, the micropapillae of intraductal carcinoma often anastomose and form a Roman bridge or cribriform structure, and each duct is separated by dense sclerotic stroma, which constitutes the lobular architecture of this tumour .…”

Section: Discussionmentioning

confidence: 99%

Histopathological evaluation of minor salivary gland papillary–cystic tumours: focus on genetic alterations in sialadenoma papilliferum and intraductal papillary mucinous neoplasm

et al. 2019

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Aims Minor salivary gland tumours showing a predominant papillary–cystic structure are rare, and constitute a mixture of various types of neoplasm; thus, the histopathological assessment of these tumours poses a significant diagnostic challenge. We aimed to delineate the histological characteristics of these tumours and further mutational aspects with a particular focus on sialadenoma papilliferum (SP) and intraductal papillary mucinous neoplasm (IPMN). Methods and results We retrieved 28 papillary–cystic tumours of the minor salivary glands, and performed histological re‐evaluation and mutation analyses of several key oncogenes. The histological classifications were as follows: SP (n = 10), SP‐like intraductal papillary tumour (SP‐IPT) (n = 2), IPMN (n = 9), intraductal papilloma, cystadenoma, and cystadenocarcinoma (two, three and two respectively). Whereas SP typically consisted of a combination of exophytic squamous epithelium and endophytic intraductal papillary infoldings, SP‐IPT lacked the exophytic component. SP and SP‐IPT frequently harboured BRAF V600E mutations (75.0%), which were identified in both squamous and ductal components. IPMN was characterised by a well‐demarcated cystic lesion filled exclusively with a papillary proliferation of mucinous cells and a high rate of AKT1 E17K mutations (88.9%). Intraductal papillomas were unilocular cystic lesions with intraluminal papillary growth of bland columnar cells. In contrast, both cystadenomas and cystadenocarcinomas showed a multicystic appearance with a papillary configuration. Cystadenocarcinomas invaded the surrounding tissue and were composed of markedly atypical tumour cells. Conclusion The appropriate interpretation of histological findings and specific genetic alterations (e.g. BRAF V600E and AKT1 E17K in SP and IPMN) would be useful for the correct diagnosis of minor salivary gland papillary–cystic tumours.

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Section: Discussionmentioning

confidence: 99%

Histopathological evaluation of minor salivary gland papillary–cystic tumours: focus on genetic alterations in sialadenoma papilliferum and intraductal papillary mucinous neoplasm

et al. 2019

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“…Difficulties in classification may include cases with mixed morphological phenotype (apocrine/intercalated), discrepancies between the proposed immunophenotype and morphology (androgen receptor [AR]+ intercalated or S100+ apocrine areas) or concomitant S100/AR expression in the same tumour cells . Oncocytic IDCs could also mimic apocrine IDCs . We tried to classify the histological cases of this series according to this recent classification proposal (Table ) ,.…”

Section: Discussionmentioning

confidence: 99%

What do we know about the cytological features of pure intraductal carcinomas of the salivary glands?

Palicelli

2020

Cytopathology

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Objective Intraductal carcinomas (IDCs) are rare, poorly characterised salivary gland tumours. The cytological features of IDCs are even less known. In this paper, a systematic literature review of pure IDCs (without stromal invasion, not associated with other histotypes) of low‐grade (LG‐IDCs) and high‐grade (HG‐IDCs) was performed. Methods The bibliographic research included multiple databases (PubMed, Scopus, Web of Science). Mild‐moderate nuclear atypia favoured LG‐IDCs, severe atypia favoured HG‐IDCs. Results Preoperative fine‐needle aspiration cytology (FNAC) was performed in 13/94 published cases (14%): 10 parotid; two oral; one submandibular. All the cases were histologically LG‐IDCs, except two parotid IDCs. FNAC results included: negative for malignancy (three of 13 cases, 23%); tumour of uncertain malignant potential (seven of 13, 54%); malignancy (three of 13, 23%). The ductal component was identified in two cases; mucoepidermoid carcinoma was suggested in two additional cases. The grade was underestimated on FNAC evaluation in one HG‐IDC as focal high‐grade features were present on subsequent histological examination. The cases diagnosed as malignant tumours or describing intermediate atypia resulted in LG‐IDCs on subsequent histology. Occasional mitoses were described only in one HG‐IDC; this feature may have not been considered in the remaining published cases. Conclusions FNAC and clinico‐pathological correlation are important aids for clinicians and pathologists. FNAC could assist surgery even if an accurate diagnosis is sometimes impossible. Discrepancy in grading the nuclear atypia between the FNAC material and the resected specimen can occur, sometimes being unavoidable. Further studies are needed to better characterise this rare tumour.

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“…Histopathologic examination of salivary gland intra‐ductal carcinoma (Figure E,F) demonstrates multiple cyst‐like structures, lined by a p63‐positive myoepithelial layer and stratified neoplastic epithelial cells with eosinophilic cytoplasm, showing a solid growth or arranged in a cribriform/microcystic or pseudo‐papillary architecture . Low‐grade intra‐ductal carcinomas show a low Ki‐67 proliferation index (less than 10%) and a negative p53 staining, in addition to diffuse positivity for S100p, and general negativity for hormonal receptors (AR, ER, PR, and HER2) .…”

Section: Discussionmentioning

confidence: 99%

“…High‐grade intraductal carcinomas, on the other hand, demonstrate a more prominent apocrine differentiation with a Ki‐67 proliferation index of more than 10%, positivity for p53 staining and hormonal receptors, and negativity for S100p and SOX10 . Purely oncocytic intra‐ductal carcinoma of the salivary glands has been reported . This variant should be differentiated from intra‐ductal carcinoma with apocrine change, because, unlike the latter, it shows positivity for anti‐mitochondria antibody and S100p, and is negative for AR, with a low Ki‐67 proliferation index (less than 15%) .…”

Section: Discussionmentioning

confidence: 99%

“…Purely oncocytic intra‐ductal carcinoma of the salivary glands has been reported . This variant should be differentiated from intra‐ductal carcinoma with apocrine change, because, unlike the latter, it shows positivity for anti‐mitochondria antibody and S100p, and is negative for AR, with a low Ki‐67 proliferation index (less than 15%) . Based on differences in morphologic and biologic features, a recent study of 23 cases of intraductal carcinoma of the salivary glands demonstrated that this neoplasm can be divided into two types: The intercalated duct type (a possible equivalent of low‐grade intraductal carcinoma) and the apocrine type (a possible equivalent of high‐grade intraductal carcinoma) .…”

Section: Discussionmentioning

confidence: 99%

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Cytopathology approach to rare salivary gland lesions with oncocytic features

Hussein

Khader

2019

Diagnostic Cytopathology

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Salivary glands located in the head and neck area are known to have different lesions with prominent oncocytic features. Fine needle aspiration is usually the initial approach in the management of these lesions, whether they represent neoplastic or non‐neoplastic processes. Owing to the limited material present upon cytopathologic examination, knowledge of variants and subtypes of various oncocytic lesions that can occur in this area is of major importance to provide the most accurate interpretation to the patients and clinicians. In this article, we selected rare lesions of the salivary glands that may exhibit oncocytic changes, and provided a brief discussion of each one of them, with emphasis on challenges in navigating the differential diagnosis that these cases may pose, from the cytopathology standpoint.

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Low‐grade intraductal carcinoma of the salivary gland with prominent oncocytic change: a newly described variant

Abstract: Oncocytic LG-IDC should be recognised as a histologically unique variant of LG-IDC. Awareness of this entity is important to avoid erroneous diagnosis and inappropriate treatment for histological mimics.

Cited by 25 publications

References 26 publications

Histopathological evaluation of minor salivary gland papillary–cystic tumours: focus on genetic alterations in sialadenoma papilliferum and intraductal papillary mucinous neoplasm

Histopathological evaluation of minor salivary gland papillary–cystic tumours: focus on genetic alterations in sialadenoma papilliferum and intraductal papillary mucinous neoplasm

What do we know about the cytological features of pure intraductal carcinomas of the salivary glands?

Cytopathology approach to rare salivary gland lesions with oncocytic features

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