Histologic Classification and Molecular Signature of Polymorphous Adenocarcinoma (PAC) and Cribriform Adenocarcinoma of Salivary Gland (CASG): An International Interobserver Study.

Polymorphous adenocarcinoma (PAC) shows histologic diversity with streaming and targetoid features whereas cribriform adenocarcinoma of salivary gland (CASG) demonstrates predominantly cribriform and solid patterns with glomeruloid structures and optically clear nuclei. Opinions diverge on whether CASG represents a separate entity or a variant of PAC. We aimed to assess the level of agreement among 25 expert Head and Neck pathologists in classifying these tumors. Digital slides of 48 cases were reviewed and classified as: PAC, CASG, tumors with ≥50% of papillary architecture (PAP), and tumors with indeterminate features (IND). The consensus diagnoses were correlated with a previously reported molecular alteration. The consensus diagnoses were PAC in 18/48, CASG in16/48, PAP in 3/48, and IND in 11/48. There was a fair interobserver agreement in classifying the tumors (κ=0.370). The full consensus was achieved in 3 (6%) cases, all of which were classified as PAC. A moderate agreement was reached for PAC (κ=0.504) and PAP (κ=0.561), and a fair agreement was reached for CASG (κ=0.390). IND had only slight diagnostic concordance (κ=0.091). PAC predominantly harbored PRKD1 hotspot mutation, whereas CASG was associated with fusion involving PRKD1, PRKD2, or PRKD3. However, such molecular events were not exclusive as 7% of PAC had fusion and 13% of CASG had mutation. In conclusion, a fair to moderate interobserver agreement can be achieved in classifying PAC and CASG. However, a subset (23%) showed indeterminate features and was difficult to place along the morphologic spectrum of PAC/CASG among expert pathologists. This may explain the controversy in classifying these tumors.

The effect of coenzyme Q10 on venous ischemia reperfusion injury.

BACKGROUND: Coenzyme Q10 (CoQ10) is a lipid-soluble benzoquinone with antioxidant features that make it important in the treatment of ischemia reperfusion injury. In this study, we aimed to investigate the beneficial effect of CoQ10 in the treatment of venous ischemia/reperfusion injury. METHODS: Eighteen Sprague-Dawley male rats were randomly divided into two equal groups: the control group and an experimental group (n = 9 rats). The experimental group received CoQ10 orally, and the control group received a control diet for 8 wk. An inferior epigastric island flap was raised, and the inferior epigastric vein was clamped for 9 h; the flap was then reperfused. All rats were sacrificed on postoperative day 5. The flap survival rate and levels of CoQ10, malondialdehyde, glutathione, and superoxide dismutase were assessed, and flap tissues were examined under a light microscope (×200 magnification) after being stained with Hematoxylin & Eosin. RESULTS: The flap survival rate and levels of CoQ10, glutathione, and superoxide dismutase were significantly higher, but level of malondialdehyde was lower in the experimental group. The mean flap survival rates and plasma levels of CoQ10 were 51% ± 24% and 251 ± 11 ng/mL in the control group, whereas they were 88% ± 7% and 692.8 ± 79.7 ng/mL in the experimental group with statistically significant differences (P < 0.001). Polymorphonuclear leukocyte infiltration was higher, and surface epithelial integrity was more impaired in the control group. CONCLUSIONS: We concluded that CoQ10 supplementation has a beneficial effect on venous ischemia and/or reperfusion injury and improves flap survival rate.