Mammary analogue secretory carcinoma of the salivary glands: a diagnostic dilemma

Abstract

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms 1 Mammary analogue secretory carcinoma of the salivary glands: a diagnostic dilemma AbstractMammary analogue secretory carcinoma (MASC) is a recently identified salivary gland neoplasm that can mimic other salivary gland tumours such as acinic cell carcinoma and cystadenocarcinoma. It is distinguished from these by differences in immunohistochemical profile and the identification of an ETV6-NTRK3 translocation (12;15)(p13;q25), which is also found in secretory carcinomas of the breast. Previous publications have suggested that MASC tumours have similar biological behaviour to acinic cell carcinoma. We report two cases of MASC that affected the upper lip, and showed an infiltrative and locally aggressive growth pattern that required several operations to ensure clearance of microscopic tumour cells. We report two cases of MASC of the upper lip, which showed locally aggressive biological behaviour and required a more aggressive treatment than that adopted for histological mimics such as acinic cell carcinoma. Keywords Case 1An otherwise healthy 27-year-old woman presented with a one-year history of a slowgrowing 1.5 cm lump, on her right upper lip. Cytological analysis of ultrasound-guided fine needle aspirate suggested a salivary gland neoplasm that raised the possibility of acinic cell carcinoma. The lesion was excised and histopathological analysis confirmed the diagnosis of MASC after immunohistochemical studies had stained for S100 and mammaglobin. It did not stain for DOG1. Fluorescent in situ hybridisation confirmed rearrangement of the ETV6 gene.Staging scans showed no evidence of metastases. The margins of the specimen were invaded on histopathological analysis despite the impression of macroscopic clearance at operation.She subsequently had a wedge excision of the scar with a 1cm margin but then required a repeat resection after microscopic identification of residual dispersed islands of tumour that had reached the margins. The patient had no signs of local or regional recurrence nine months after her operation (Figs. 1-3). Case 2A 51-year-old man who used to smoke and had no other relevant medical history presented with a three-year history of an asymptomatic, firm, mobile lump in his upper right labial mucosa. Histopathological examination of an excisional biopsy specimen together with immunohistochemical profile and fluorescent in situ hybridisation again suggested a diagnosis of MASC. Staging scans showed no abnormality. 3The patient had a further excision of the scar with a 1cm margin under general anaesthetic.Final histopathological analysis again showed residual tumour with a close margin at the deeper aspect of the specimen. The patient declined any further intervention so a policy of close follow-up was adopted. There were no signs of local or regional recurrence at hi...

Characterization of novel genetic alterations in salivary gland secretory carcinoma

“…In our screening for secretory carcinoma candidates, we noted that zymogen granule-poor tumors that were initially diagnosed as acinic cell carcinoma constituted the largest source of secretory carcinomas, as reported in previous studies [4][5][6][7][8][9][10][11][12][13][14]. Although secretory carcinoma is the disease entity most commonly mimicked by acinic cell carcinoma [2,38], we confirmed that secretory carcinoma had several distinct features.…”

“…The histologic features of secretory carcinoma include a variety of architectural growth patterns, the presence of intracytoplasmic vacuoles, mucin-like and colloid-like eosinophilic secretions, and a lack of intracytoplasmic periodic acid-Schiff + (PAS + ) zymogen granules. Immunohistochemistry analyses have shown that most secretory carcinomas are positive for S100 and mammaglobin and negative for DOG1 [2,[4][5][6][7][8][9][10][11][12][13][14][15]. Secretory carcinoma reveals relatively frequent rates of lymph node metastasis in as many as 25% of cases at presentation [2].…”

Mammary Analogue Secretory Carcinoma of Salivary Glands: Diagnostic Pitfall with Distinct Immunohistochemical Profile and Molecular Features

“… 1 Since then, more than 70 additional cases have been reported, 2 often in small series of 10 cases or fewer. 3 , 4 MASC are mostly located in the parotid region but can appear in any location of the head and neck region. 5 Patients at all age are affected, including children and young adults.…”

“… 6-10 MASC are considered to be of low-grade malignancy; however, high-grade transformation and aggressive clinical behaviour has been described. 3 , 6 , 11 , 12 The prognostic impact of MASC is not clear as yet, although evidence exists that MASC has a comparable prognosis to other (low-grade) salivary gland tumors. 1 , 13 MASC are mostly small tumours measuring typically only a few centimeters in diameter.…”

Clinicopathological characteristics and outcomes of 23 patients with secretory carcinoma of major salivary glands

“…The diagnosis of secretory carcinoma of salivary glands (SCSGs), a recently-described rare malignant tumor, was introduced by Skálová et al in 2010 [1]. These tumors were originally classi ed as mammary analogue secretory carcinomas of salivary glands because their histomorphological and immunohistochemical features are similar to those of secretory carcinoma of the breast [2]. The updated World Health Organization (WHO) Classi cation of Head and Neck Tumors (4th edition, 2017) substituted secretory carcinoma for the previous mammary analogue secretory carcinoma designation [3].…”