Journal of Pathology and Translational Medicine

Original Article

Frequent apocrine changes in pleomorphic adenoma with malignant transformation: a possible pre-malignant step in ductal carcinoma ex pleomorphic adenoma: Joon Seon Song, Yeseul Kim, Yoon-Se Lee, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim, Kyung-Ja Cho; J Pathol Transl Med. 2023;57(3):158-165. Published online May 10, 2023; DOI: https://doi.org/10.4132/jptm.2023.03.13

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Background
The most common type of carcinoma ex pleomorphic adenoma (CPA) is histologically equivalent to salivary duct carcinoma, which has an apocrine phenotype. Invasive CPA is often accompanied by non-invasive or in situ carcinoma, an observation that suggests the presence of precursor lesions. The aim of this study was to identify candidate precursor lesions of CPA within pleomorphic adenoma (PA).
Methods
Eleven resected cases of CPA with residual PA and 17 cases of PA with atypical changes were subjected to immunohistochemistry (IHC) for p53, human epidermal growth factor receptor 2 (HER2), androgen receptor (AR), pleomorphic adenoma gene 1, gross cystic disease fluid protein-15 (GCDFP-15), and anti-mitochondrial antibody.
Results
Invasive or in situ carcinoma cells in all CPAs were positive for AR, GCDFP-15, and HER2. Atypical foci in PAs corresponded to either apocrine or oncocytic changes on the basis of their reactivity to AR, GCDFP-15, and anti-mitochondrial antibody. Atypical cells in PAs surrounding CPAs had an apocrine phenotype without HER2 expression.
Conclusions
Our study identified frequent apocrine changes in residual PAs in CPA cases, suggesting a possible precursor role of apocrine changes. We recommend the use of HER2 IHC in atypical PAs, and that clinicians take HER2 positivity into serious consideration.

Citations

Citations to this article as recorded by

Characterization of a Molecularly Distinct Subset of Oncocytic Pleomorphic Adenomas/Myoepitheliomas Harboring Recurrent ZBTB47-AS1::PLAG1 Gene Fusion
Ziyad Alsugair, Jimmy Perrot, Françoise Descotes, Jonathan Lopez, Anne Champagnac, Daniel Pissaloux, Claire Castain, Mihaela Onea, Philippe Céruse, Pierre Philouze, Charles Lépine, Marie-Delphine Lanic, Marick Laé, Valérie Costes-Martineau, Nazim Benzerdj
American Journal of Surgical Pathology.2024; 48(5): 551. CrossRef

Case Reports

Fine Needle Aspiration Cytology of Salivary Duct Carcinoma with Calcification in Submandibular Gland: A Case Report .: Ki Jung Yun, Weon Cheol Han, Hyang Jeong Jo, Kwang Man Lee; Korean J Cytopathol. 2001;12(1):49-52.

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Abstract PDF: Salivary duct carcinoma is an uncommon aggressive malignant epithelial neoplasm with similarity to intraductal carcinoma of the breast. This neoplasm occurs most often in the parotid gland of middle-aged and older males. About 7% of reported tumors occured in the submandibular gland. The report of salivary duct carcinoma with calcification is rare. We report a case of salivary duct carcinoma with calcification in the submandibular gland. The patient was a 73-year-old male with a mass of the right submandibular gland for 1 year. On the fine needle aspiration cytology, the aspirate showed scant cellularity, small clusters of tumor cells, and scattered small calcifications. Nuclei of the tumor cells showed mild pleomorphism and round to oval in shape, and cytoplasm was abundant and finely granular. Nucleoli were indistinct and necrosis was not noted. There were no cribriform or papillary arrangements of tumor cells. Cytologic findings of salivary duct carcinoma are variable depending on histologic findings, and calcifications could be an additional cytologic finding.

Salivary Duct Carcinoma with Mucin Containing Cells: Report of a Case Misdiagnosed as Mucoepidermoid Carcinoma on Fine Needle Aspiration Cytology.: Haeryoung Kim, Hyunki Kim, Hoguen Kim, Jin Kim, Soon Won Hong, Se Hoon Kim; Korean J Cytopathol. 2006;17(1):56-62.

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Abstract PDF: Salivary duct carcinoma (SDC) is a rare primary salivary gland malignancy characterized by histological features similar to those of ductal carcinomas of the breast. It is regarded as a high-grade malignancy associated with frequent local recurrences and early distant metastases that require aggressive treatment. The typical fine needle aspiration cytology (FNAC) findings in SDC include cellular smears showing tumor cells with eccentric pleomorphic nuclei and a granular cytoplasm arranged in flat sheets or cribriform patterns against a necrotic background. However, the presence of mucin-containing cells in SDC has been rarely described. We report the FNAC findings in a patient with histologically confirmed SDC that demonstrated numerous mucin-containing cells and was subsequently misdiagnosed as a high-grade mucoepidermoid carcinoma. Here we discuss the problems involved in distinguishing SDC from high-grade mucoepidermoid carcinoma on the basis of cytologic findings alone.

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