Fine-Needle Aspiration Cytology of Cellular Basaloid Neoplasms of the Salivary Gland.

CONTEXT.­: Cellular basaloid neoplasms of the salivary gland represent a diverse group of benign and malignant neoplasms with significant cytomorphologic overlap on fine-needle aspiration cytology. All are marked by the presence of monotonous and usually bland basaloid epithelium. Distinction between basaloid neoplasms on fine-needle aspiration cytology is based on the presence or absence of additional features, including a second cell population (eg, myoepithelial cells), an acellular stromal component, and/or cytologic atypia within the basaloid epithelium. This review highlights the cytomorphologic features of the most common cellular basaloid neoplasms of the salivary gland, with an emphasis on classification and subclassification within the Milan System. OBJECTIVE.­: To provide a comprehensive review of the cytologic features of basaloid epithelial neoplasms of the salivary gland, with an emphasis on classification within the Milan System for Reporting Salivary Gland Cytopathology. DATA SOURCES.­: Peer-reviewed literature, recent textbooks, and personal experiences of the author. CONCLUSIONS.­: Some basaloid neoplasms, in particular pleomorphic adenomas and adenoid cystic carcinomas, may have characteristic findings on fine-needle aspiration that allow for definitive diagnosis. In other cases, however, fine-needle aspiration can confirm a neoplastic basaloid process, but specific classification of a benign or malignant neoplasm cannot be rendered. The Milan System for Reporting Salivary Gland Cytopathology acknowledges this difficulty, and recommends benign or malignant classification only when definitive diagnostic features of a specific neoplasm are present. For indeterminate cases, the subcategorization of salivary neoplasm of uncertain malignant potential is recommended.

Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours.

INTRODUCTION: A vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, for several reasons, this has not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour. METHODS: A search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically. RESULTS: Pleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur. CONCLUSIONS: A correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types of basal cell adenoma can occasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.

Submandibular gland pleomorphic adenoma: Histopathological capsular characteristics and correlation with the surgical outcome.

Pleomorphic adenoma (PA) of the submandibular gland is known to have a very low recurrence rate. The aim of this study was to investigate the histopathological and capsular characteristics of submandibular gland PA, looking for any differences between submandibular PA and the reported data for PA of the parotid gland as possible explanation for its low recurrence rate. We reviewed 72 submandibular gland PAs resected at our center between 2000 and 2016. Patient age ranged from 14 to 77 years (mean, 47.2). At least follow (range, 12 to 170 months; mean, 82), none of the 72 patients developed a local recurrence. Histologically, all of the tumors were encased by a complete and intact anatomical capsule (100%). Pseudopodia were detected in 11 (15.3%) and satellite nodules in 3 (4.2%) cases. The histological subtype (according to Seifert et al.) was classic (mixed) in 39 (54.2%), stroma-rich/myxoid in 18/72 (25%) and cellular in 15 (20.8%) cases. A complete rim of healthy pericapsular tissue encasing the tumor and its capsule was observed in only 23/72 (31.9%) cases. In conclusion, submandibular PAs are characterized by consistent presence of an intact anatomical capsule, infrequent occurrence of pseudopodia, a remarkably infrequent occurrence lower frequency of secondary satellite tumor nodules and a comparatively lower proportion of the fragile risky myxoid subtype. Despite the fact that surgery of the submandibular gland can frequently lead to focal capsular exposure, the aforementioned capsular characteristics of submandibular gland PA are probably responsible for the excellent oncologic results.

MYB expression: Potential role in separating adenoid cystic carcinoma (ACC) from pleomorphic adenoma (PA).

BACKGROUND: Basaloid tumors of the salivary gland both benign and malignant comprise ACC, cellular PA, basal cell adenoma (BCA), and basal cell adenocarcinoma. Rendering a diagnosis given a limited biopsy or fine needle aspiration (FNA) sample proves challenging. Activation of MYB by gene fusion has been found in salivary gland ACCs; therefore we investigated the utility of MYB immunohistochemistry (IHC) as a tool for distinguishing ACCs from other basaloid neoplasms. METHODS: We selected 48 cases of ACC (11 FNA blocks [CB]), 37 histologic resections [HR]), 74 PA (36 CB, 38 HR), and 18 BCA (7 CB, 11 HR). FNA CB showed 82% of ACCs (N = 9 of 11) as positive for MYB nuclear staining whereas 68% of ACCs (N = 25 of 37) were positive in HR. RESULTS: All PA were negative for MYB nuclear staining in both CB (N = 0 of 36) and HR (N = 0 of 38). CB showed 29% of BCA (N = 2 of 7) as positive for MYB nuclear staining and 55% (N = 6 of 11) positive in HR. Both ACC and BCA showed significantly higher mean staining intensity than PA in both CB and HR (P < 0.0001). When comparing ACC and BCA, significantly higher mean staining intensity was observed in CB (P = 0.02382) but not in HR (P = 0.42952). CONCLUSION: MYB nuclear staining may prove useful in separating ACC from PA and BCA, especially in limited cellular samples. Diagn. Cytopathol. 2016;44:799-804. © 2016 Wiley Periodicals, Inc.

Histological reclassification of parotid gland carcinomas: importance for clinicians.

Reassessment of histological specimens of salivary gland carcinomas is associated with a change of primary diagnosis in a significant number of patients. The authors evaluated the relation between reclassification/verification of histological diagnosis and the clinical course of parotid gland carcinomas. Histological and immunohistochemical examinations of 111 specimens of parotid gland carcinomas operated on during the years 1992-2010 were revised and in some cases supplemented with cytogenetic tests (FISH), to verify the diagnosis and potentially reclassify the tumours. Analysis of the clinical documentation and follow-up data of patients whose diagnosis was changed was then carried out. The prognostic factors taken into account in the evaluation of the clinical course included the T and N stage, the tumour grade and the extent of resection. The primary diagnosis was changed on review in 28 patients (25.2 %). In 16 patients, the change involved a different histological type of cancer. In six cases, what was thought to be a primary salivary gland cancer was reclassified as a secondary tumour. In four other cases, the change was made from a malignant to a benign tumour and in one case to a non-neoplastic lesion (necrotizing sialometaplasia). Additionally, in two patients with carcinoma ex pleomorphic adenoma, the malignant component was found to be of in situ type. A potentially atypical clinical course was observed in 4 out of 28 patients whose diagnosis was changed. In the case of 2 patients, the course of disease was more aggressive (dissemination, death) than predicted and less aggressive in rest of the patients. Histological reclassification/verification of parotid gland carcinomas can explain the cause of an atypical clinical course in some patients and sometimes enables doctors to implement a change in therapy.

[Salivary gland-type lung tumor: An update]. / Tumeurs de type glandes salivaires du poumon.

"Salivary gland-type" tumors arising from the bronchi and lung are rare but not exceptional entities. They are mostly represented by malignant entities such as cystic adenoid carcinoma, mucoepidermoid carcinoma and epithelial/myoepithelial carcinoma. Benign tumors are rare, mainly encompassing pleomorphic adenomas, which are to differentiate from mucous gland adenomas, another entity arising specifically from the peri-bronchial glands. These tumours develop in the proximal bronchi and are not associated with smoke abuse. Their main treatment is surgery. It is important to differentiate them from other broncho-pulmonary tumours as they do not share the same prognosis and therapeutic. This article will review the WHO 2015 classification of these tumours as well as recent updates from the literature to help define diagnosis criteria for these uncommon entities.

Fine-Needle Aspiration Biopsy of Salivary Gland Lesions.

CONTEXT: Fine-needle aspiration (FNA) is a well-established diagnostic approach for salivary gland lesions; however, lack of a standard system of terminology for classification of salivary gland neoplasms collected by FNA and the relatively high frequency of uncertainty of diagnosis are likely partly responsible for current confusion in the interpretation of these FNA samples. OBJECTIVE: To propose a novel classification system for reporting salivary gland FNA samples and summarize recent progress in application of molecular and immunohistochemical markers in selected salivary gland neoplasms. DATA SOURCES: Literature review and authors' personal practice experience. CONCLUSIONS: The new classification system provides a more succinct, standardized interpretation of results and will ultimately assist in communication between clinicians, clinical decision making, and preoperative patient counseling. Impressive advances have been made in recent years in the understanding of molecular pathogenesis of salivary gland tumors. With the newly acquired diagnostic tools, significant improvement in diagnostic accuracy of salivary gland FNA can certainly be expected.

A more appropriate clinical classification of benign parotid tumors: investigation of 425 cases.

CONCLUSIONS: It is appropriate to clinically classify benign parotid tumors into three groups, i.e. superficial tumors, deep tumors, and lower pole tumors. OBJECTIVE: It is important to classify benign parotid tumors based on location when deciding the surgical strategy and conducting clinical research. In this study, we examined a classification of benign parotid tumors that was useful for clinical practice. METHODS: We studied 425 patients with benign parotid tumors who underwent surgery at our hospital. Their age, gender, tumor histopathology, maximum tumor diameter, postoperative facial nerve paresis, operating time, and blood loss were investigated after classifying the tumors as superficial tumors, deep tumors, or lower pole tumors. We also investigated the same parameters after dividing the lower pole tumors into superficial and deep types. RESULTS: Lower pole tumors had distinct characteristics from superficial and deep tumors. The incidence of facial nerve paresis was significantly higher and the operating time was significantly longer for deep tumors than for either superficial or lower pole tumors, while there were no significant differences between superficial and lower pole tumors. In addition, there were no significant differences in any of the parameters between the superficial and deep types of lower pole tumor.

[Cutaneous adnexal and salivary gland tumours. Similarities and differences]. / Hautadnex- vs. Speicheldrüsentumoren. Analoges und Divergentes.

Despite major discrepancies in basic microscopic anatomy, remarkable similarities are manifest within the wide spectrum of cutaneous adnexal and salivary gland tumors. In this study salivary gland and adnexal tumors were identified and investigated with respect to similarities in histology, terminology and pathogenesis. Histological similarities of certain types of salivary gland tumors relate to eccrine, apocrine and rarely sebaceous (but not trichofollicular) types of adnexal tumors. The most striking similarity was found with salivary gland pleomorphic adenoma and cutaneous mixed tumor. Multistep carcinogenesis starting with intraductal carcinoma, identified in carcinoma ex pleomorphic adenoma is identical to that found in cutaneous carcinoma ex spiradenoma. Further histological and terminological similarities are shown for mucinous and mucoepidermoid carcinoma, for lymphadenoma and lymphoepithelial carcinoma, for sebaceous adenoma and carcinoma, for adenoid-cystic carcinoma, as well as for salivary gland basal cell adenoma versus cutaneous spiradenoma. Manifest diagnostic problems related to histologically similar salivary gland and adnexal tumors are rare and are topographically limited to the parotid and oral areas.

Analysis of Elastic Tissue in Histological Variants of Pleomorphic Salivary Adenoma seen at the Lagos University Teaching Hospital over a period of 35 Years.

BACKGROUND: Pleomorphic salivary adenoma (PSA), is known for its morphologic diversity. While reports of elastic tissue in PSA have been documented, the distribution of this tissue in histological variants of the tumour has not been documented. Perhaps such features may influence biological behaviour of these variants. OBJECTIVE: To classify PSA in our series into histological variants, and determine possible variation in elastic tissue distribution in them. METHODS: Eighty eight histologically diagnosed cases of PSA in the oral biopsy archives of the department of Oral Biology and Pathology, Lagos University Teaching Hospital, were retrieved. New H&E sections were cut to reconfirm diagnosis and Verhoeff-Van Gieson's stained sections were cut for demonstration of elastic tissue. Seifert et al.'s (1976) histological classification was applied and elastic tissue presence was determined and quantified for each case. Parameters studied included; sex, age, site, histological subtypes and presence of elastic tissue. Statistical analysis was undertaken using the EPI-INFO version 3.4. RESULTS: Male:female ratio was 1:1.3. Most cases (63.6%) occurred in the age group of 21-40 years. Generally, palate (42.0%) was the most commonly affected site, while 53.4% of cases were in the minor salivary glands. Seifert et al. classified subtype II lesions were the most frequently observed (39.7%) and elastic tissue was confirmed in 91.0% of cases. No association was noted between proportion of elastic tissue and histological variants. CONCLUSION: Seifert et al subtype II was the most frequently observed and no association was observed between proportion of elastic tissue and the histological variant of PSA.

Siringoma condroide de la región maseterina: revisión de la bibliografía y presentación de un caso clínico / Chondroid syringoma of the masseteric region: review of the literature and report of a clinical case

El siringoma condroide es un tumor anexial de muy baja frecuencia de aparición, correspondiendo al 0,01% de los tumores primarios de piel.Es una entidad análoga al adenoma pleomorfo de glándulas salivales.El diagnóstico clínico es prácticamente inexistente debido a la ausencia de características morfológicas distintivas.El tratamiento es quirúrgico.

Stromal differences in salivary gland tumors of a common histopathogenesis but with different biological behavior: a study with picrosirius red and polarizing microscopy.

Salivary gland neoplasms - pleomorphic adenoma, polymorphous low-grade adenocarcinoma, and adenoid cystic carcinoma - share a common histogenetic trait, but differ markedly in their biological properties. The objective of the study was to assess the polarization colors of picrosirius red-stained stromal collagen fibers in these salivary gland neoplasms to evaluate their possible role in the histopathogenesis of the tumors and to evaluate the potential usefulness of this approach as a diagnostic tool. Ten cases of each tumor type and 10 cases of mucous extravasation phenomenon (control) were examined using picrosirius red staining and polarizing microscopy. In each case, at least 50 thin ( approximately 0.8 microm) and 50 thick (1.6-2.4 microm) collagen fibers were counted and classified as green-yellow or yellow-orange, the mean percentage was calculated and statistical differences analyzed by one-way ANOVA. Results showed a similar thin fiber distribution in all tumor types and controls (82-88% green-yellow, 12-18% yellow-orange, p>0.05). Thick fibers showed a different distribution in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma (approximately 50% green-yellow) compared to pleomorphic adenoma and mucous extravasation phenomenon (approximately 13% green-yellow) (p=0.001). Thick fiber distribution was similar in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma (p>0.05). We conclude that with picrosirius red staining and polarizing microscopy, stromal collagen fibers differ significantly in pleomorphic adenoma from those in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma, but not from mucous extravasation phenomenon. Similarity between polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma may indicate that these tumor types represent a single entity with a broad spectrum of biological behavior.

Tumoral stroma of salivary pleomorphic adenoma -- histopathological, histochemical and immunohistochemical study.

The aims of our paper were to establish the main histopathological, histochemical and immunohistochemical aspects of tumoral stroma from salivary pleomorphic adenomas. For this purpose we investigated 103 cases by the classical histopathological technique with paraffin embedding and staining with Hematoxylin-Eosin (HE), Hematoxylin-Eosin-Safranin (HES), trichromic Masson, trichromic Goldner Szeckelly, orcein and Periodic Acid Schiff-Blue Alcian (PAS-AA). Immunohistochemically, they were investigated for AE1-AE3, MNF116, CK8, EMA, vimentin, alpha-actin calponin, S-100, GFAP, collagen IV, and PCNA. The results of our study suggest the key role of neoplastic myoepithelial cell in the achievement of diverse morphological aspects of stroma in such neoplasms.

Adenocarcinoma ex adenoma pleomorfo de gándula submaxilar / Adenocarcinoma ex pleomorphic adenoma of the submaxilar gland

No disponible

New proposal for T classification of gingival carcinomas arising in the maxilla.

When the current T classification of the UICC (1987 and 1997) is used to stage carcinomas arising the upper alveolus and gingival and hard palate, most cases are classified as T4 because of their anatomic characteristics, similar to carcinomas arising in the lower alveolus and gingiva. This study compared the following two methods for classifying the T stage of maxillary carcinomas: (1) the original T classification criteria proposed by the UICC (1987 and 1997), and (2) a new T classification criteria, called the sinus and nasal floor (SNF) criteria. We found that the SNF criteria were more closely related to tumor control and survival than were the UICC criteria in patients with carcinomas arising in the upper alveolus and gingival and hard palate. Increased use of the SNF criteria is expected to improve staging of gingival tumors arising in the maxilla and increase the accuracy of diagnosis, especially of T4 tumors.

Plasmacytoid cells in salivary-gland pleomorphic adenomas: evidence of luminal cell differentiation.

To determine the cellular origin of plasmacytoid cells in salivary gland adenomas, immunohistochemistry was performed on sections from 12 pleomorphic adenomas rich in these cells. In normal salivary glands included in these sections, the myoepithelial cells (MECs) expressed alpha-smooth muscle actin (alphaSMA) and smooth muscle myosin heavy chain (SMMHC), whereas the duct luminal cells expressed keratins 19, 18 and 8. Some of the salivary duct basal cells expressed these keratins, and the acinar cells expressed keratins 18 and 8. The expression profile was similar in rat salivary glands not only after but also during development. The immature MECs never expressed the keratins nor did the immature duct cells express alphaSMA. In seven cases, up to 60% of the plasmacytoid cells expressed keratin 19. In three of these cases, about 10% of the plasmacytoid cells expressed keratin 18. No plasmacytoid cells expressed alphaSMA, SMMHC or keratin 8. These results indicate that plasmacytoid cells originate from luminal cells and not from MECs. Furthermore, in addition to the luminal tumor cells, the non-luminal cells could express keratins 19, 18 and 8. Therefore, it is necessary to re-evaluate the prevailing notion that non-luminal cells are modified MECs. Keratin 14, basic calponin, vimentin and p63 were bi-specific for the MECs and the duct cells. Therefore, expression of these proteins by significant numbers of the non-luminal tumor cells and the plasmacytoid cells never denied the above notion.