RESUMO
Since the first description of sinonasal undifferentiated carcinoma (SNUC) as a distinctive highly aggressive sinonasal neoplasm with probable origin from the sinonasal mucosa (Schneiderian epithelium), SNUC has been the subject of ongoing study and controversy. In particular, the SNUC category gradually became a "wastebasket" for any undifferentiated or unclassifiable sinonasal malignancy of definite or probable epithelial origin. However, with the availability of more specific and sensitive immunohistochemical antibodies and increasing implementation of novel genetic tools, the historical SNUC category became the subject of progressive subdivision leading to recognition of specific genetically defined, reproducible subtypes. These recently recognized entities are characterized by distinctive genetic aberrations including NUTM1-rearranged carcinoma (NUT carcinoma) and carcinomas associated with inactivation of different members of the SWI/SNF chromatin-remodeling gene complex such as SMARCB1-deficient and less frequently SMARCA4-deficient carcinoma. The ring became almost closed, with recent studies highlighting frequent oncogenic IDH2 mutations in the vast majority of histologically defined SNUCs, with a frequency of 82%. A review of these cases suggests the possibility that "true SNUC" probably represents a distinctive neoplastic disease entity, morphologically, phenotypically, and genetically. This review addresses this topic from a historical perspective, with a focus on recently recognized genetically defined subsets within the SNUC spectrum.
Assuntos
Biomarcadores Tumorais/genética , Carcinoma/diagnóstico , Carcinoma/epidemiologia , Carcinoma/genética , DNA Helicases/genética , Humanos , Neoplasias do Seio Maxilar/diagnóstico , Neoplasias do Seio Maxilar/epidemiologia , Neoplasias do Seio Maxilar/genética , Proteínas Nucleares/genética , Proteína SMARCB1/genética , Fatores de Transcrição/genéticaRESUMO
Well-differentiated neuroendocrine carcinoma (also known as "carcinoid") of the larynx is an exceedingly rare tumor that has an epithelial origin. These tumors are malignant and have a low, but definite, risk of metastasis. Although it can be challenging, this tumor should be differentiated from moderately differentiated neuroendocrine carcinoma (also known as "atypical carcinoid"). The clinical and pathologic features of this tumor, as well as treatment and prognosis, are reviewed in detail.
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Tumor Carcinoide/patologia , Carcinoma Neuroendócrino/patologia , Neoplasias Laríngeas/patologia , Laringe/patologia , Tumores Neuroendócrinos/patologia , Tumor Carcinoide/diagnóstico , Carcinoma Neuroendócrino/diagnóstico , Humanos , Neoplasias Laríngeas/diagnóstico , Tumores Neuroendócrinos/diagnóstico , IncertezaRESUMO
Salivary myoepithelial cells bear particular appendages and are involved in processes that have received incomplete attention in previous reviews. Here, cilia on myoepithelial cells are reviewed as regards substructure, occurrence, detection (electron microscopy, double immunofluorescence together with confocal microscopy), and roles (sensory reception, evolutionary homology, paracrine interaction). Attention is drawn to regressive changes affecting those cells (e.g. accumulation of lipofuscin), possible alterations of their cytoskeleton, internalization of apoptotic bodies and haemosiderin, and role in salivary microcalcification. The ability of differentiated salivary myoepithelial cells to divide is re-examined, particularly its increase in chronic inflammation and under experimental conditions. Caution with regard to histogenetic models of salivary neoplasia is re-emphasized; methodological deficiencies and areas of controversy are outlined; and lines of future research are suggested.
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Citoesqueleto/ultraestrutura , Células Epiteliais/citologia , Epitélio/ultraestrutura , Neoplasias das Glândulas Salivares/patologia , Imunofluorescência/métodos , Humanos , Músculo Liso/patologiaRESUMO
Laryngeal carcinogenesis is a multistep process, characterized by an accumulation of genetic changes associated with architectural and cytologic alterations, ranging from squamous hyperplasia to carcinoma in situ and encompassed by the terminology of squamous intraepithelial lesions (SILs). The etiology, classification, genetic changes, and malignant progression of these lesions are reviewed. Tobacco remains the principal etiological factor with gastroesophageal reflux disease recently considered as a possible factor. In contrast, there is little evidence that microbiological agents, especially human papillomavirus infection, are frequently involved in laryngeal carcinogenesis and probably <10% of SILs are driven by biologically active human papillomavirus infection. Light microscopy, despite a degree of subjectivity, remains the mainstay of accurate diagnosis, prognosis, and guidance for a patient's treatment. The currently used classifications, the dysplasia system, squamous intraepithelial neoplasia, and the Ljubljana classification, reflect different standpoints on this important topic. The modified Ljubljana classification, with good interobserver agreement, could be considered as a proposal for a unified classification of laryngeal SILs. This review also briefly discusses recently discovered genetic changes, such as CDKN2A and CTNNB1 genes, and chromosome instability of chromosomes 1 and 7; however, none of these can at present improve histologic diagnosis. Malignant progression of precursor lesions varies from 2% to 74%, according to different studies. Cold-steel microinstruments, CO2 laser, and radiotherapy are used to treat the different grades of precursor lesions. There is as yet no worldwide agreement on the treatment of high-grade lesions and carcinoma in situ.
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Neoplasias Laríngeas/etiologia , Lesões Pré-Cancerosas/etiologia , Humanos , Neoplasias Laríngeas/classificação , Neoplasias Laríngeas/terapia , Lesões Pré-Cancerosas/classificação , Lesões Pré-Cancerosas/terapiaRESUMO
Paraneoplastic syndromes are associated with a variety of malignant neoplasms and are systemic and non-metastatic manifestations that develop in a minority of cancer patients. This review examines all published cases of paraneoplastic syndromes associated with neuroendocrine carcinomas of the larynx. There are a total of ten patients reported with paraneoplastic syndromes associated with laryngeal neuroendocrine carcinomas in the literature. Of these, nine died and the tenth is alive with liver metastases. There were five cases of small-cell neuroendocrine carcinoma, four cases of moderately differentiated neuroendocrine carcinoma, and one case of well-differentiated neuroendocrine carcinoma associated with paraneoplastic syndromes. As these syndromes have significant clinical relevance, physicians should be aware of the possible presence of paraneoplastic syndromes in the diagnostic process of patients with neuroendocrine carcinoma of the larynx.
Assuntos
Carcinoma Neuroendócrino/complicações , Neoplasias Laríngeas/complicações , Síndromes Paraneoplásicas/etiologia , Humanos , Síndrome de Secreção Inadequada de HAD/etiologia , Síndrome Miastênica de Lambert-Eaton/etiologia , Síndrome do Carcinoide Maligno/etiologia , PrognósticoRESUMO
The clinical significance of papillary or follicular thyroid tissue incidentally discovered in cervical lymph nodes during pathological assessment of neck dissections for non-thyroid cancers of the upper aero-digestive tract is critically reviewed. Special emphasis is given to controversies over normal-looking, nodal, thyroid follicles. Arguments for and against the benign nature of these follicles are considered together with processes that could be involved in their formation. The admittedly limited evidence suggests that benign, thyroid follicular inclusions rarely occur in cervical lymph nodes. Histological criteria that could be helpful in recognizing the inclusions, which include assessing their extent in conjunction with the size of the node, are discussed. Finally, an algorithm based on collaboration between specialists, correlating histological findings with imaging and loco-regional control of the upper aero-digestive tract cancer, is suggested for the management of patients with incidentally discovered, nodal thyroid tissue.
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Coristoma/patologia , Achados Incidentais , Linfonodos/patologia , Linfadenopatia/patologia , Glândula Tireoide , Adulto , Algoritmos , Carcinoma Papilar/secundário , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço , Esvaziamento Cervical , Neoplasias da Glândula Tireoide/patologia , TireoidectomiaRESUMO
Head and neck squamous cell carcinoma (HNSCC) is a common malignancy that continues to be difficult to treat and cure. In many organ systems and tumor types, there have been significant advances in the understanding of the molecular basis for tumorigenesis, disease progression and genetic implications for therapeutics. Although tumorigenesis pathways and the molecular etiologies of HNSCC have been extensively studied, there are still very few diagnostic clinical applications used in practice today. This review discusses current clinically applicable molecular markers, including viral detection of Epstein-Barr virus and human papillomavirus, and molecular targets that are used in diagnosis and management of HNSCC. The common oncogenes EGFR, RAS, CCND1, BRAF, and PIK3CA and tumor suppressor genes p53, CDKN2A and NOTCH are discussed for their associations with HNSCC. Discussion of markers with potential future applications is also included, with a focus on molecular alterations associated with targeted therapy resistance.
Assuntos
Biomarcadores Tumorais/genética , Carcinoma de Células Escamosas/genética , Regulação Neoplásica da Expressão Gênica , Neoplasias de Cabeça e Pescoço/genética , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/virologia , Classe I de Fosfatidilinositol 3-Quinases , Ciclina D1/genética , Infecções por Vírus Epstein-Barr/diagnóstico , Genes erbB-1 , Genes p16 , Genes p53 , Genes ras , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Infecções por Papillomavirus/diagnóstico , Fosfatidilinositol 3-Quinases/genética , Proteínas Proto-Oncogênicas B-raf/genética , Receptores Notch/genética , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
Lymphadenomas (LADs) are rare salivary gland tumors. Their clinicopathologic characteristics and etiopathogenesis are poorly understood. We examined 33 LADs in 31 patients (17 women and 14 men) aged 11-79 years (median 65 years). There were 22 sebaceous LADs in 21 patients (9 women and 12 men) and 11 non-sebaceous LADs in 10 patients (8 women and 2 men). Two patients had synchronous double tumors. Twenty-six tumors (79%) arose in parotid, three in the neck, and two each in submandibular gland and oral cavity. Extraparotid tumors were seen in 2 of 21 (10%) patients with sebaceous and 4 of 10 (40%) patients with non-sebaceous LADs. Seven of twenty-three (30%) patients had immunosuppressive therapy for unrelated diseases. The tumors were well circumscribed, encapsulated (n=28, 84%) painless masses, varying in size from 0.6 to 6 cm (median 2.2). The cut surfaces were gray-tan to yellow, homogeneous and multicystic (n=24, 72%). The epithelial cells were basaloid, squamous and glandular, forming solid nests, cords, tubules, and cysts. Sebaceous differentiation was restricted to sebaceous lymphadenoma. The epithelial cells expressed basal cell markers (p63, 34BE12, and/or CK5/6, 18/18, 100%) and the luminal glandular cells expressed CK7 (12/12, 100%). Myoepithelial cells were absent (n=10/16, 63%) or focal. The lymphoid stroma was reactive, with germinal centers in 28 (84%). There was no evidence of HPV (0/11), EBV (0/7), and HHV-8 (0/8). Malignant transformation to sebaceous and basal cell adenocarcinoma was seen in one patient each. None of the 11 patients with follow-up (1-8 years) recurred. In summary, sebaceous and non-sebaceous LADs are benign, encapsulated, solid and cystic tumors affecting older adults. Non-sebaceous LADs affect women and extraparotid sites more frequently than sebaceous LADs. Altered immune status may have a role in their etiopathogenesis. Multiple synchronous tumors, origin in buccal mucosa, and malignant transformation may rarely occur.
Assuntos
Adenolinfoma/química , Adenolinfoma/patologia , Biomarcadores Tumorais/análise , Imuno-Histoquímica , Neoplasias Primárias Múltiplas/química , Neoplasias Primárias Múltiplas/patologia , Neoplasias das Glândulas Salivares/química , Neoplasias das Glândulas Salivares/patologia , Adenocarcinoma/química , Adenocarcinoma/patologia , Adenocarcinoma Sebáceo/química , Adenocarcinoma Sebáceo/patologia , Adenolinfoma/imunologia , Adenolinfoma/virologia , Adolescente , Adulto , Idoso , Transformação Celular Neoplásica/química , Transformação Celular Neoplásica/patologia , Criança , Células Epiteliais/química , Células Epiteliais/patologia , Feminino , Herpesvirus Humano 4/isolamento & purificação , Herpesvirus Humano 8/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/imunologia , Neoplasias Primárias Múltiplas/virologia , Papillomaviridae/isolamento & purificação , Prognóstico , Neoplasias das Glândulas Salivares/imunologia , Neoplasias das Glândulas Salivares/virologia , Células Estromais/química , Células Estromais/patologia , Fatores de Tempo , Carga Tumoral , Estados Unidos , Adulto JovemRESUMO
Some laryngeal epithelial precursor lesions progress to invasive carcinoma and others do not. Routine light microscopic classification has limited value in predicting the evolution of these lesions. This article reviews the experience to date with the use of molecular markers for the prognostic evaluation of laryngeal epithelial precursor lesions. We conducted a thorough review of the published literature to identify those studies using biomarkers to predict malignant progression of laryngeal epithelial precursor lesions. Of the 336 studies identified in this systematic search, 15 met the inclusion criteria and form the basis of this review. Limited studies suggest that certain biomarkers are potentially reliable predictors of malignant progression including various regulators of cell adhesion and invasion (e.g. FAK, cortactin, osteopontin, and CD44v6) and proliferation-associated markers such as TGF-ßRII and Kv3.4. The predictive value of these markers, however, has yet to be confirmed in large-scale prospective studies. Although the cell cycle-related proteins are the most frequently studied markers, none have been consistently reliable across multiple studies. The absence of standardization in methodologies, test interpretation, and other parameters may contribute to study inconsistencies. Various biomarkers have proved to have potential prognostic value and could be clinically relevant. The utility and prognostic power of these biomarkers should be confirmed in large, well-designed, standardized prospective studies.
Assuntos
Biomarcadores Tumorais/sangue , Transformação Celular Neoplásica , Mucosa Laríngea/patologia , Laringe/patologia , Neoplasias Faríngeas/sangue , Lesões Pré-Cancerosas/sangue , Progressão da Doença , Humanos , Neoplasias Faríngeas/patologia , Lesões Pré-Cancerosas/patologia , Valor Preditivo dos Testes , PrognósticoRESUMO
AIMS: To determine clinicopathological and morphometric features that discriminate between mucin-producing primary salivary gland carcinomas. MATERIALS AND RESULTS: Fifteen mucin-producing tumours were stratified into five colloid carcinomas (CCs), four mucinous cystadenocarcinomas (MCAs), three mucin-rich salivary duct carcinomas (SDCs) and three mucin-rich mucoepidermoid carcinomas (MECs). The mean patient age was 70, 58, 43 and 63 years for CC, MCA, SDC and MEC, respectively. Eleven of 15 patients were female. The majority of CC cases originated from major salivary glands; MCA showed a predilection for the minor salivary glands. No disease-related mortality was observed in the CC group; one patient died in the MCA group, and one in the SDC group. Receiver-operating characteristic curve analysis revealed an optimal cut-off point of 17% of the tumour cells in contact with stroma that best distinguished between the CC and MCA. Histomorphometric measurements revealed that CC was best differentiated from MCA by smaller nuclear size and more regular chromatin. CONCLUSIONS: Strict morphological criteria of CC coupled with assessment of the tumour cell/stroma relationship and the nuclear features facilitate discrimination between mucinous tumours of salivary gland.
Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma/patologia , Mucinas/metabolismo , Neoplasias das Glândulas Salivares/patologia , Glândulas Salivares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias das Glândulas Salivares/metabolismoRESUMO
During the last 60 years numerous significant attempts have been made to achieve a widely acceptable terminology and histological grading for laryngeal squamous intraepithelial lesions. While dysplasia was included in the pathology of the uterine cervix already in 1953, the term dysplasia was accepted in laryngeal pathology first after the Toronto Centennial Conference on Laryngeal Cancer in 1974. In 1963 Kleinsasser proposed a three-tier classification, and in 1971 Kambic and Lenart proposed a four-tier classification. Since then, four editions of the World Health Organisation (WHO) classification have been proposed (1978, 1991, 2005 and 2017). Several terms such as squamous intraepithelial neoplasia (SIN) and laryngeal intraepithelial neoplasia (LIN) are now being abandoned and replaced by squamous intraepithelial lesions (SIL). The essential change between the 2005 and 2017 WHO classifications is the attempt to induce a simplification from a four- to a two-tier system. The current WHO classification (2017) thus recommends the use of a two-tier system with reasonably clear histopathological criteria for the two groups: low-grade and high-grade dysplasia. Problems with interobserver variability apart, subjectivities and uncertainties remain, but to a lesser degree. Ongoing and additional molecular studies may help to clarify underlying events that will increase our understanding and possibly can facilitate our attempts to obtain an even better classification. The classification needs to be easier for the general pathologist to perform and easier for the clinician to interpret. These two objectives are equally important to provide each patient the best personalised treatment available for squamous intraepithelial lesions.
Assuntos
Carcinoma in Situ , Classificação/métodos , Doenças da Laringe , Neoplasias Laríngeas , Lesões Pré-Cancerosas/classificação , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , História , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/patologia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologiaRESUMO
AIMS: To describe seven cases of sinonasal seromucinous hamartoma. MATERIALS AND RESULTS: The clinicopathological and immunohistochemical features of seven seromucinous hamartomas were analysed. There were four men and three women. Six lesions involved the posterior nasal septum and one the lateral wall. Size ranged from 6 to 40 mm. Four patients had no recurrences. One patient had local recurrences 24 and 60 months after diagnosis. The masses were covered by respiratory epithelium. Their stroma was oedematous to fibrous and contained invaginated respiratory epithelium forming glands and cysts, cysts with cuboidal to flat epithelium, and small serous glands, ducts and tubules with lobular and irregular haphazard patterns. One case had numerous glands surrounded by hyalinized basement membrane with features of respiratory epithelial adenomatoid hamartoma (REAH). One case had focal REAH-like changes. Both respiratory and serous components were positive for cytokeratin (CK) 7 and CK19. The serous component lacked myoepithelial cells when stained for CK14, p63, calponin and muscle-specific antigen in five cases. CONCLUSIONS: Seromucinous hamartomas show a broader histopathological appearance than previously reported. The serous proliferation in these lesions lacks myoepithelial cells. The presence of occasional REAH-like features and common location in the posterior nasal septum suggest a spectrum from pure seromucinous hamartoma to REAH.
Assuntos
Hamartoma/patologia , Seios Paranasais/patologia , Mucosa Respiratória/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hamartoma/metabolismo , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Seios Paranasais/metabolismo , Mucosa Respiratória/metabolismoAssuntos
Comportamento Cooperativo , Comunicação Interdisciplinar , Neoplasias Otorrinolaringológicas/patologia , Encaminhamento e Consulta , Atitude do Pessoal de Saúde , Carcinoma de Células Escamosas/patologia , Current Procedural Terminology , Erros de Diagnóstico , Eficiência Organizacional , Alemanha , Linfonodos/patologia , Programas Nacionais de Saúde , Invasividade Neoplásica , Otorrinolaringopatias/patologia , Garantia da Qualidade dos Cuidados de Saúde , Terminologia como Assunto , Carga de TrabalhoRESUMO
The International Collaboration on Cancer Reporting is a nonprofit organization whose goal is to develop evidence-based, internationally agreed-upon standardized data sets for each anatomic site, to be used throughout the world. Providing global standardization of pathology tumor classification, staging, and other reporting elements will lead to achieving the objective of improved patient management and enhanced epidemiologic research. Salivary gland carcinomas are relatively uncommon, and as such, meaningful data about the many histologic types are not easily compared. Morphologic overlap between tumor types makes accurate classification challenging, but there are often significant differences in patient outcomes. Therefore, issues related to tumor type, tumor grading, high-grade transformation, extent of invasion, number and size of nerves affected, and types of ancillary studies are discussed in the context of daily application to specimens from these organs. This review focuses on the data set developed for salivary gland carcinomas with discussion of the key core and noncore elements developed for inclusion by an international expert panel of head and neck and oral-maxillofacial pathologists and surgeons.
Assuntos
Carcinoma/patologia , Conjuntos de Dados como Assunto , Patologia Clínica/normas , Guias de Prática Clínica como Assunto , Neoplasias das Glândulas Salivares/patologia , Conjuntos de Dados como Assunto/normas , Humanos , Projetos de Pesquisa/normasRESUMO
OBJECTIVES: Laryngeal neuroendocrine carcinomas are heterogeneous neoplasms characterized by neuroendocrine differentiation. Their prognoses are dependent on tumor type, therefore different classifications have been developed. Moreover, other tumors have overlapping pathologic features posing a range of diagnostic possibilities. METHODS: A review of the literature was performed to comprehensively understand the classification and diagnosis of these tumors. RESULTS: We review the past and present classification systems, with emphasis to the latest 2017 World Health Organization Classification of Head and Neck Tumors. We highlight salient clinicopathologic features and discuss the presumptive etiologic role of human papilloma virus. We share a practical algorithmic approach to the diagnosis of suspected neuroendocrine neoplasms of the larynx including a novel marker for neuroendocrine differentiation, insulinoma-associated protein 1. CONCLUSIONS: Accurate diagnosis and grading of laryngeal neuroendocrine carcinomas is critical for prognostication and therapeutic decision making. The use of an algorithm is instrumental in assuring the exclusion of mimickers.
Assuntos
Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/patologia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Carcinoma Neuroendócrino/classificação , Humanos , Neoplasias Laríngeas/classificaçãoRESUMO
High-grade neuroendocrine carcinomas of the head and neck overlap significantly in morphology with both basaloid squamous and solid-type adenoid cystic carcinomas. High-grade neuroendocrine carcinomas have sheets of small cells with scant cytoplasm, granular chromatin, and inconspicuous nucleoli. Basaloid squamous and adenoid cystic carcinomas are aggressive variants of their respective tumor types which both have nests of basaloid tumor cells with round nuclei, little cytoplasm, and inconspicuous nucleoli. As the management and prognosis of these tumors are very different, it is important to differentiate them. We performed high molecular weight cytokeratin (CK) and p63 immunohistochemistry on 19 neuroendocrine carcinomas, 18 basaloid squamous carcinomas, and 11 solid-type adenoid cystic carcinomas. All tumors were immunostained for p63, CK 34betaE12, CK 5/6, synaptophysin, chromogranin-A, S-100, and smooth muscle actin. All basaloid squamous and adenoid cystic carcinomas were positive for CK 5/6 and 34betaE12. Only 4 and 5 of the 19 neuroendocrine carcinomas, respectively, were positive for these markers. Staining was focal in the neuroendocrine cases when positive, whereas almost all basaloid squamous and adenoid cystic carcinomas showed strong staining. Almost all tumors of each type were positive for p63, including neuroendocrine carcinomas, but with different staining patterns. Basaloid squamous carcinomas were diffusely positive, neuroendocrine carcinomas were diffusely positive, but with weak staining, and adenoid cystic carcinomas showed a distinct pattern with staining at the periphery of the cell nests only. We conclude that high molecular weight cytokeratin immunostaining is helpful in distinguishing high-grade neuroendocrine carcinomas from similar tumor types.
Assuntos
Biomarcadores Tumorais/análise , Carcinoma Basoescamoso/diagnóstico , Carcinoma Neuroendócrino/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Queratinas/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basoescamoso/patologia , Carcinoma Neuroendócrino/patologia , Diagnóstico Diferencial , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imuno-Histoquímica , Queratina-5/análise , Queratina-6/análise , Masculino , Proteínas de Membrana/análise , Pessoa de Meia-Idade , Peso MolecularRESUMO
Sinonasal and oral malignant melanomas are rare malignancies accounting for less than 2% of all melanomas. Matrix metalloproteinases (MMPs) are proteolytic enzymes required for extracellular matrix degradation in a variety of physiological and pathologic processes including wound healing, embryogenesis, tumor invasion, and metastases. We studied the correlation between expression of MMPs, nucleolar diameter of melanoma cells, different clinical and histologic parameters, and patient's outcome. Seventeen cases of sinonasal and oral malignant melanoma were studied. The expression of MMP2, MMP9, MMP13, and MMP14 was assessed immunohistochemically on paraffinized sections and measured by computer morphometry as well as silver-stained nucleolar diameter. A significant correlation was found between MMP2 and MMP14 expression and patient's outcome. Greater overall survival was seen in patients with average MMP2 expression less than 8000 microm(2)/x20 high-power field (P = .016). In patients with negative MMP14 staining, survival rate by the end of the follow-up was 38% compared with patients with positive MMP14 staining where survival rate was 0 (P = .03). A correlation with age at onset was also found; patients younger than 66 years had better overall survival rates than patients aged 66 years or older (P = .03). The maximal nucleolar diameter (MaxND) was another parameter that significantly correlated with clinical outcome. Patients with MaxND of 8 microm or larger showed a significant worse prognosis compared with the group with MaxND less than 8 microm (P = .0009). Our pilot study demonstrates that MMP2, MMP14, MMP9, and MaxND might be used as prognostic markers in patients with sinonasal and oral malignant melanoma.
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Biomarcadores Tumorais/análise , Metaloproteinases da Matriz/biossíntese , Melanoma/enzimologia , Neoplasias Bucais/enzimologia , Neoplasias dos Seios Paranasais/enzimologia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Feminino , Expressão Gênica , Humanos , Processamento de Imagem Assistida por Computador , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Metaloproteinase 13 da Matriz/biossíntese , Metaloproteinase 14 da Matriz/biossíntese , Metaloproteinase 2 da Matriz/biossíntese , Metaloproteinase 9 da Matriz/biossíntese , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/patologia , Projetos Piloto , Prognóstico , Análise de Sobrevida , Taxa de SobrevidaRESUMO
Heterotopic salivary gland tissue (HSGT) consists of salivary tissue outside of the major and minor salivary glands and typically presents as a draining sinus and/or asymptomatic nodule of the neck along the lower anterior sternocleidomastoid muscle. There are a limited number of case series exploring this rare entity. To further delineate the clinicopathologic characteristics of this lesion, we present 11 cases of HSGT in the neck, many with cutaneous involvement. Anatomic pathology files from Lifespan-affiliated hospitals (Rhode Island Hospital and Miriam Hospital) were retrospectively reviewed for all cases meeting criteria for HSGT from 1983 through 2005, and 11 patients were identified: 4 female and 7 male, ages 5 months to 64 years, with 8 patients younger than 18 years; 7 patients presented with a draining sinus. Of note, 8 of 11 cases occurred on the right side. In general, microscopic examination revealed mucinous and serous salivary glandular structures with an associated duct; no cytologic atypia was observed. All cases stained positive for smooth muscle actin and calponin, highlighting a myoepithelial layer similar to that seen in minor and major salivary glands. As in our series, most cases of cervical HSGT occur near the anterior sternocleidomastoid muscle with a right-sided predilection. Cases generally present by early childhood, although 3 cases in our series were diagnosed in adulthood. Although cancers arising in these lesions are fairly uncommon, most clinically apparent foci of HSGT are excised. This entity should be considered in the dermatologist's differential diagnostic considerations for a draining sinus and a lateral, especially right-sided, neck mass.
Assuntos
Coristoma/patologia , Pescoço , Glândulas Salivares , Adolescente , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Estudos RetrospectivosRESUMO
Primary cutaneous adenoid cystic carcinoma is a rare, slow-growing malignancy first described by Boggio in 1975. This tumor characteristically consists of basophilic cells with a distinct adenoid or cribriform pattern in the mid to deep reticular dermis. Modified myoepithelial cells with prominent basement membrane material often surround true lumina. Definitive diagnosis relies on the characteristic histologic features and the exclusion of metastatic disease. We describe two patients who presented with painful papules of the scalp and were successfully treated with wide local excision.