RESUMEN
KEY POINTS: Hispanic-American patients with chronic rhinosinusitis with nasal polyps have a comparable level of tissue eosinophilia compared to their Caucasian counterparts in the United States. Mixed inflammation involving both neutrophils and eosinophils is more common in this population compared to Caucasians. Findings from this study may indicate that Hispanic-American patients have a unique endotype or endotypes that deserves further investigation.
RESUMEN
Microsecretory adenocarcinoma (MSA) is a recently described salivary gland tumor with a characteristic histologic and immunophenotypic profile and recurrent MEF2C-SS18 fusions. Because only six cases of MSA have been published, its complete clinicopathologic spectrum is unclear, and its biologic behavior has not been documented. Here, we present an updated and expanded experience of 24 MSA cases. All cases of MSA were obtained from the authors' files. Immunohistochemistry for S100, SOX10, p63, p40, SMA, calponin, and mammaglobin was performed. Molecular analysis was performed by targeted RNA sequencing, SS18 break apart fluorescence in situ hybridization, and/or reverse transcriptase polymerase chain reaction for MEF2C-SS18 fusion. Clinical follow-up was obtained from medical records. A total of 24 MSA cases were collected, from 13 women and 11 men, ranging from 17 to 83 years (mean 49.5 years). The vast majority (23 of 24) arose in the oral cavity, with the palate (n = 14) and buccal mucosa (n = 6) as the most frequent subsites. Tumors showed consistent histologic features including: (1) microcystic tubules, (2) flattened intercalated duct-like cells, (3) monotonous oval hyperchromatic nuclei, (4) abundant basophilic luminal secretions, (5) fibromyxoid stroma, and (6) circumscribed borders with subtle infiltration. The tumors were very consistently positive for S100 (24 of 24), p63 (24 of 24), and SOX10 (14 of 14) and negative for p40 (0 of 21), calponin (0 of 12) and mammaglobin (0 of 16), while SMA (4 of 20) was variable. MEF2C-SS18 fusion was demonstrated in 21 of 24 cases; in the remaining 3 cases with insufficient RNA, SS18 break apart FISH was positive. Treatment information was available in 17 cases, all of which were managed with surgery only. In 14 cases with follow-up (1-216 months, mean 30), no cases recurred or metastasized. MSA is a distinct salivary gland neoplasm with remarkably consistent clinical, histologic, immunophenotypic, and genetic features that generally behaves in an indolent manner following surgery alone. These observations solidify MSA as a unique, low-grade salivary gland carcinoma that warrants inclusion in the next version of the WHO classification of head and neck tumors.
Asunto(s)
Adenocarcinoma/metabolismo , Neoplasias de las Glándulas Salivales/metabolismo , Actinas/metabolismo , Adenocarcinoma/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proteínas de Unión al Calcio/metabolismo , Femenino , Humanos , Inmunohistoquímica , Masculino , Proteínas de Microfilamentos/metabolismo , Persona de Mediana Edad , Proteínas S100/metabolismo , Factores de Transcripción SOXE/metabolismo , Neoplasias de las Glándulas Salivales/patología , Factores de Transcripción/metabolismo , Proteínas Supresoras de Tumor/metabolismo , Adulto Joven , CalponinasAsunto(s)
Enfermedades Maxilares/diagnóstico , Quistes no Odontogénicos/diagnóstico , Enfermedades Nasales/diagnóstico , Paladar Duro , Anciano de 80 o más Años , Diagnóstico Diferencial , Humanos , Masculino , Enfermedades Maxilares/patología , Enfermedades Maxilares/cirugía , Quistes no Odontogénicos/patología , Quistes no Odontogénicos/cirugía , Enfermedades Nasales/patología , Enfermedades Nasales/cirugía , Paladar Duro/patología , Paladar Duro/cirugíaAsunto(s)
Úlceras Bucales/diagnóstico , Sífilis/diagnóstico , Enfermedades de la Lengua/diagnóstico , Anciano , Biopsia/métodos , Tejido Conectivo/microbiología , Tejido Conectivo/patología , Diagnóstico Diferencial , Humanos , Masculino , Úlceras Bucales/microbiología , Enfermedades de la Lengua/microbiología , Treponema pallidum/aislamiento & purificaciónAsunto(s)
Neoplasias Gingivales/diagnóstico , Sarcoma Mieloide/diagnóstico , Diferenciación Celular , Diagnóstico Diferencial , Enfermedades de las Encías/diagnóstico , Neoplasias Gingivales/patología , Granuloma/diagnóstico , Humanos , Leucemia Mieloide Aguda/diagnóstico , Masculino , Persona de Mediana Edad , Monocitos/patología , Neoplasias Primarias Múltiples/diagnóstico , Sarcoma Mieloide/patologíaAsunto(s)
Ameloblastoma/patología , Neoplasias Mandibulares/patología , Diente no Erupcionado/patología , Adolescente , Ameloblastoma/diagnóstico por imagen , Ameloblastoma/cirugía , Femenino , Humanos , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/cirugía , Radiografía , Diente no Erupcionado/diagnóstico por imagenRESUMEN
A 45 years old male patient presented with an asymptomatic right mandibular mass that extended from the angle to the premolar area. It had been present for 3 months at the time of the initial presentation. Panoramic radiograph revealed an ill-defined unilocular radiolucency. Previous dental treatment included molar extractions and antibiotic therapy. Considerable bleeding was encountered during incisional biopsy.