Maxillary Adenoid Cystic Carcinoma with Annulate Lamellae

Of 29 reviewed ultrastructural studies of adenoid cystic carcinoma, only 1 mentions the presence of annulate lamellae. The present report describes a 65-year-old woman who presented with an adenoid cystic carcinoma in her left maxillary sinus. At the light microscopic level, most of the connective tissue was loose and myxomatous and contained fine strands, cords, and islands of epithelium that in places had a cribriform pattern. The ultrastructural appearance was similar to that described by others. Two epithelial cell types predominated. The cytoplasm of one type contained mainly ribosomes, and that of the other type also had peripheral microfilaments. Also present were pseudocysts, lumina with microvilli, and replicated basal lamina. In addition, a number of both types of cells contained parallel arrays of cisternae that had regular small pores. These were annulate lamellae.     

Ultrastructural Distinction of Basaloid-Squamous Carcinoma and Adenoid Cystic Carcinoma

Basaloid-squamous carcinoma is a unique and infrequent variant of squamous cell carcinoma with a predilection for occurring in the upper aerodigestive tract. The cardinal diagnostic criteria are the presence of basaloid cells arranged in lobules or cords and a squamous component. Another feature that distinguishes basaloid-squamous carcinoma from conventional squamous cell carcinoma is the development of multiple foci of amorphous, eosinophilic, or mucinous materials among the basaloid tumor cells. It is this feature in basaloid-squamous carcinoma that causes confusion with adenoid cystic carcinoma, especially the solid variant of adenoid cystic carcinoma. To clarify the distinctive features of these two types of tumors, the ultrastructural findings in three basaloid-squamous carcinomas from the head and neck region were compared with three adenoid cystic carcinomas, one from the head and neck region and one each from trachea and bronchus. Widened intercellular spaces, tonofilaments, and replicated basal lamina were present in both types of tumor. However, the ultrastructural features of glandular differentiation were present only in adenoid cystic carcinoma, whereas the ultrastructural features of squamous cell differentiation were present only in basaloid-squamous carcinoma. The distinction between basaloid-squamous carcinoma and adenoid cystic carcinoma is important since basaloid-squamous carcinoma is a clinically aggressive, high-grade form of squamous cell carcinoma, generally with a worse prognosis than adenoid cystic carcinoma.     

Ultrastructural Distinction of Basaloid-Squamous Carcinoma and Adenoid Cystic Carcinoma

Basaloid-squamous carcinoma is a unique and infrequent variant of squamous cell carcinoma with a predilection for occurring in the upper aerodigestive tract. The cardinal diagnostic criteria are the presence of basaloid cells arranged in lobules or cords and a squamous component. Another feature that distinguishes basaloid-squamous carcinoma from conventional squamous cell carcinoma is the development of multiple foci of amorphous, eosinophilic, or mucinous materials among the basaloid tumor cells. It is this feature in basaloid-squamous carcinoma that causes confusion with adenoid cystic carcinoma, especially the solid variant of adenoid cystic carcinoma. To clarify the distinctive features of these two types of tumors, the ultrastructural findings in three basaloid-squamous carcinomas from the head and neck region were compared with three adenoid cystic carcinomas, one from the head and neck region and one each from trachea and bronchus. Widened intercellular spaces, tonofilaments, and replicated basal lamina were present in both types of tumor. However, the ultrastructural features of glandular differentiation were present only in adenoid cystic carcinoma, whereas the ultrastructural features of squamous cell differentiation were present only in basaloid-squamous carcinoma. The distinction between basaloid-squamous carcinoma and adenoid cystic carcinoma is important since basaloid-squamous carcinoma is a clinically aggressive, high-grade form of squamous cell carcinoma, generally with a worse prognosis than adenoid cystic carcinoma.     

Adenoid cystic carcinoma: a comparative pathologic study of tumors in salivary gland, breast, lung, and cervix

Histologic, histochemical, and ultrastructural features of eight adenoid cystic carcinomas arising at diverse sites were compared in order to determine diagnostic values and to investigate histogenetic mechanisms. These tumors originated in the salivary glands, breast, uterine cervix, and tracheobronchial tree. By light microscopy each tumor was seen to have morphologic features of adenoid cystic carcinoma, yet only five of the eight cases showed differential staining for the two mucin types, stromal and epithelial, which are reportedly present in these tumors. In contrast, every case showed a set of fine structural features which, in aggregate, are specific for adenoid cystic carcinoma. These features include pseudocysts, intercellular spaces, basal lamina, and true glandular lumens. The most prominent feature is the pseudocyst, which mimics a glandular lumen by light microscopy but is actually a rounded extracellular space containing basal lamina. Ultrastructurally, the variation in composition of the extracellular compartments, including pseudocysts and true lumens, appears to explain the lack of uniformity in the histochemical staining. The tumors also contained cytoplasmic microfilaments in parallel bundles, consistent with myofilaments. The presence of these filaments combined with basal lamina suggests myoepithelial differentiation, yet it is not known whether these tumors truly originate from myoepithelium or show differentiation toward myoepithelium as a part of the neoplastic process. Regardless of their histogenesis, this study shows that true adenoid cystic carcinomas do arise in different organs. Knowledge of the specific ultrastructural features of adenoid cystic carcinomas can be useful in classifying these tumors in some cases.     

Annulate lamellae in guinea pig Sertoli cells

Unilateral torsion of the spermatic cord was surgically induced in 24 Hartley strain guinea pigs. Groups of six animals were sacrificed 4, 8, 12, and 16 months after the surgery and testes were excised. Nine animals has severely damaged testes. Extensive study on the Sertoli cells of each of these nine animals was carried out after testicular tissues were processed for electron microscopy following the usual procedure. The majority of the affected seminiferous tubules contained a single layer of Sertoli cells without any differentiating germ cells. The Sertoli cells were vacuolated and contained highly lobulated nuclei. Each nucleus contained a nucleolus. The Sertoli cells contained an elaborate annulate lamellae system. The membranous portion of the annulate lamellae was associated with the rough and smooth endoplasmic reticulum. Close association of the annulate lamellae with the lysosomes and lipid droplets was found to be a consistent feature. Although it was not possible for us to predict the functional significance of these annulate lamellae, the present investigation clearly established for the first time, the presence of an annulate lamellae system in the Sertoli cell of a rodent species.     

Annulate lamellae of the jejunal absorptive cells in 21-day-starved rats

The ultrastructure of annulate lamellae of the jejunal absorptive cells in control and 21 d starved rats was investigated. Annulate lamellae were only rarely encountered in the jejunal absorptive cells of control rats, and then frequently in small stacks continuous with the rough-surfaced endoplasmic reticulum. In contrast, there was a relatively frequent incidence of annulate lamellae in the jejunal absorptive cells of 21 d starved rats, and larger stacks of annulate lamellae were also observed in spite of marked ultrastructural changes of these cells. The annulate lamellae were also continuous with the rough-surfaced endoplasmic reticulum, which was degenerating. The degenerative process of the absorptive cells following starvation might be related to the origin and function of the annulate lamellae.     

Ultrastructural similarities of adenoid cystic carcinoma and pleomorphic adenoma

Ultrastructural examination of five adenoid cystic carcinomas, three breast and two salivary gland, reveals identical patterns of tumour cell differentiation, organization and distribution of cellular products (Zaloudek, Oertel & Orenstein 1984). In both sites, there is proliferation of two populations of cells, one with characteristics and organization of duct-type luminal epithelial cells and a second that forms the principal proliferating component and has the overall organization and appearance that would suggest that they represent modified myoepithelial cells. Recent ultrastructural studies also indicate that tumour cell types and histological organization similar to those described for adenoid cystic carcinoma occur during histodifferentiation of salivary gland pleomorphic adenoma (Dardick et al. 1983a, b). The characteristic histological pattern of adenoid cystic carcinoma is dependent on the formation of pseudolumina containing proteoglycans and reduplicated basal lamina. Similar, but smaller, lumina of like organization and contents are evident in some cases of pleomorphic adenoma. Both the ultrastructural similarities of the tumour cell types and their organization, in adenoid cystic carcinoma and pleomorphic adenoma, suggest that these tumours have a similar histogenetic basis. The fact that one lesion is malignant and the other benign does not preclude common types of tumour cells and developmental processes.     

Adenoid cystic carcinoma (cylindroma) of the bronchi

Cytological, histological, and ultrastructural examinations of 6 cases of adenoid cystic carcinoma of the bronchi were carried out. Cytological studies demonstrated cells of two types: smaller, rounded or slightly elongated cells with hyperchromic nuclei and scarce basophilic cytoplasm, and larger cells with clear nuclei and basophilic, slightly vacuolated cytoplasm. The cells are located among oxyphilic homogeneous substance. Histologically the tumour has a typical cribrose appearance owing to glandular-like and cyst-like cavities among alveolar cell aggregates embedded into intensely developed but poor in cells and somewhat hyalinized stroma. The invasive growth of the tumour with its extension into the depth of the lung on interalveolar septae, perivascular and peribronchial spaces with outgrowth of the capsule was manifest in all cases. Electron microscopic studies showed the tumour elements to be lowly differentiated epithelial cells. No ultrastructural signs of myothelium or secretory mucous activity was found. The results of these studies indicate that this tumour should be designated as adenoid cystic carcinoma but not adenoma of cylindromatous type.     

Ultrastructural and immunocytochemical study of a case of invasive cribriform breast carcinoma.

A case of recurrent invasive cribriform carcinoma of the breast mimicked the histological and mucin staining characteristics of adenoid cystic carcinoma. The diagnosis was based on negative immunocytochemical staining for laminin and ultrastructural evidence of luminal differentiation by cells lining the cystic spaces. Accurate characterisation of this type of breast tumour can be facilitated by retrospective immunocytochemical or ultrastructural examination, or both.     

Adenoid cystic carcinoma of minor salivary glands. Analysis of 86 cases

Summary 819 salivary gland tumors in surgical pathology files over a 25-year period were reviewed. Among 117 adenoid cystic carcinomas, 86 were located in minor salivary glands and were selected for a clinico-pathological analysis. Complementary histoenzymological investigations and electron microscopic study were performed on specimens from 7 and 13 patients respectively.Adenoid cystic carcinoma occured in older patients (mean age of 54 years) than the other salivary neoplasms. The sex ratio was 1/1. The tumor was located more often in the palate and, to a lesser degree in the buccal floor, tongue or gums.Histologically, epithelial nests contained characteristic cyst-like spaces (cylinders) and 3 varieties of such cylinders were described (mucoid, mucohyalin and hyalin). According to the predominant pattern, 3 types of tumors were shown: basaloïd, cribriform and trabecular. A comparison between histological results and clinical behaviour, available in 67 patients, demonstrated positive correlations. The basaloïd form had always a poor prognosis (numerous early recurrences and metastases, frequent lethal evolution). The cribriform type had an intermediate prognosis, better than basaloïd type and less good than trabecular group (100% of patients still alive at 8 years).Histoenzymological studies revealed high level of acid phosphatase, alkaline phosphatase and leucine aminopeptidase activities round cylindromatous cavities. On the other hand, high oxidative enzyme activities were evenly distributed in all cell types.Ultrastructural findings emphasized the immature characters of epithelial tumor cells. These cells contained numerous ribosomes, but few other organelles. Some more differentiated glandular or epidermoid cells were scattered in neoplastic islands. Rare myoepithelial cells lay in periphery of lobules. Cylinder-like spaces were filled with replicated basal lamellae, mucopolysaccharidic granules and fibrillar structures (microfibrils and periodic collagen fibrils).In the light of these results the histogenesis of this neoplasm was discussed. Like the pleomorphic adenoma, adenoid cystic carcinoma was thought to arise from intercalated ducts. Unable to acquire any high degree of differentiation, this blastomatous tumor had a cellular component almost similar to that shown in intermediate stage of salivary gland embryogenesis.The authors wish to thank M.A. Leost and M. Tacnet for their technical assistance     

Adenoid cystic carcinoma of the breast

The clinical, histologic, cytologic, and ultrastructural features of three adenoid cystic carcinomas of the breast are presented. All three neoplasms occurred in postmenopausal women. One patient was treated by wide re-excision of the biopsy site. Two were treated by modified radical mastectomy; no axillary lymph node metastases were found. None of the neoplasms has recurred. Neither estrogen nor progesterone receptors were detected in any of the neoplasms. The histopathologic criteria for the diagnosis of adenoid cystic carcinoma are described, and the differential diagnosis is discussed. Since the cytopathologic features of adenoid cystic carcinoma of the breast appear to be distinctive, the neoplasm can be diagnosed by fine-needle aspiration based upon the presence of the following features: 1) a cellular smear; 2) a uniform population of small, basaloid tumor cells; and 3) small globules of mucoid material surrounded by a rim of neoplastic cells. Ultrastructurally, the predominant cell type has the appearance of a modified myoepithelial cell, but true lumina lined by microvillous epithelial cells are also present. The ultrastructural findings are consistent with the proliferation of neoplastic cells that have the capacity to produce all of the epithelial elements of the breast, i.e., ductal, acinar, and myoepithelial, and so recapitulate the complete ductal or acinar unit.     

Characterisation of adenoid cystic carcinoma of the breast by immunohistology.

An adenoid cystic carcinoma of the breast in a 78 year old woman was analysed immunohistologically for the production of type IV collagen, the expression of vimentin, epithelial membrane antigen (EMA) and steroid receptors, and the proliferative activity of the tumour cells. The data were compared with those obtained in eight adenoid cystic carcinomas of salivary glands and in ductal carcinomas of the breast with a cribriform growth pattern. The patients' ages were as follows: 45-80 years (mean 63.2) for the salivary gland carcinomas; 37-69 years (mean 50.6) for the ductal breast carcinomas. In contrast to the cribriform spaces of ductal carcinomas, the pseudocysts in adenoid cystic carcinomas were lined by type IV collagen. The opposite pattern was observed for EMA. Like the myoepithelium of normal breast, the myoepithelium-like cells of adenoid cystic carcinoma stained positive for vimentin while the ductular epithelium-like ones did not. All adenoid cystic carcinomas, including that of the breast, were negative for the oestrogen and progesterone receptors, unlike the ductal carcinomas. Proliferative activity of the adenoid cystic carcinoma of the breast was relatively low. These data broaden the range of antibodies suitable for differential diagnosis of both tumour types. They may explain the differences in prognosis, and they explain why hormonal treatment or radiotherapy of adenoid cystic carcinoma of the breast are often ineffectual.     

ULTRASTRUCTURE OF ADENOID CYSTIC CARCINOMA ARISING IN THE SALIVARY GLAND OF A CHILD

A case of adenoid cystic carcinoma which developed in the left parotid gland of an 11-year-old girl was studied by electron microscopy. Islands of tumor cells, showing glandular and cribriform appearances, infiltrated the surrounding tissue and nerves. True lumina and pseudocysts were present in the islands of tumor cells. Electron microscopic examination revealed two types of tumor cells; clear cells (secretory epithelial cells) and dark cells myoepithelium-like cells). Some of the tumor cells, showing a transitional form between the two types, formed a part of the luminal wall. There were many crystalline spicules, cellular debris, and fine stellate granules in the lumina. Pseudocysts were composed of replicated basal laminae, fine stellate granules, and a central core of microfilaments. Rarely, a capillary was noted in the center of the pseudocysts. It is speculated that ultrastructural features of adenoid cystic carcinoma in children may differ from the adult cases in the following ways; they contain numerous crystalline spicules in the lumina, dark cells with microvilli forming the luminal wall, and fine capillaries in the pseudocysts.     

Expression of KIT (CD117) in neoplasms of the head and neck: an ancillary marker for adenoid cystic carcinoma.

Adenoid cystic carcinoma is an indolent salivary gland malignancy that is associated with a poor long-term prognosis. The distinction of adenoid cystic carcinoma from other head and neck neoplasms can occasionally be problematic, particularly in small biopsies. Recent studies suggest that KIT (CD117) might be useful as an ancillary marker for adenoid cystic carcinoma; however, the expression of KIT in other benign and malignant head and neck neoplasms, including those that might mimic adenoid cystic carcinoma, has not been well studied. Here we use two different antibodies against KIT to evaluate its expression in a series of 66 adenoid cystic carcinomas compared with its expression in 98 other neoplasms of the head and neck. Overall, 94% (n = 62) of adenoid cystic carcinomas from various anatomic sites and of various histologic subtypes were positive for at least one of the KIT antibodies, and 77% (n = 50) of adenoid cystic carcinoma cases were positive for both antibodies. This contrasted with only 8% (n = 8) of other head and neck neoplasms that were positive for both KIT antibodies (P <.001). It was of note that certain neoplasms, including pleomorphic adenoma, basal cell adenoma, polymorphous low-grade adenocarcinoma, and basal cell carcinoma, that can show histologic overlap with adenoid cystic carcinoma had significantly less KIT immunoreactivity than did adenoid cystic carcinoma (P <.001). In contrast, KIT expression did not reliably distinguish adenoid cystic carcinoma from basal cell adenocarcinoma and basaloid squamous carcinoma (P >.05). The overall sensitivity of the two KIT antibodies for adenoid cystic carcinoma was 82-89%, and the specificity was 87-88%. The findings in this study support the potential use of KIT immunoexpression for distinguishing adenoid cystic carcinoma from many other benign and malignant head and neck neoplasms.     

Pseudoadenoid cystic carcinoma of the breast.

An example of a cribriform intraductal carcinoma that closely resembled adenoid cystic carcinoma is described. The true nature of the tumor was revealed by electron microscopy and the case is used to demonstrate that the diagnosis of this tumor cannot be safely made by routine histologic techniques alone. Review of conflicting views othe value of mucin histochemistry expressed in the literature suggest that ultrastructural examination is a useful alternative tool in the differentiation of adenoid cystic carcinoma of the breast from cribriform intraductal carcinoma.     

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.     

Electron Microscopic Study of Adenoid Cystic Carcinoma

This ultrastructural study is based on nine cases of adenoid cystic carcinoma arising from the salivary glands. Electron microscopically, the tumors consisted of five cell types: relatively differentiated intercalated duct cells, secretory cells, undifferentiated cells, cells of a squamous nature, and myoepithelial cells. Special attention was paid to the characteristic extracellular substances noted by light microscopic examination of these tumors. The hyaline material of the pseudocysts contained not only mucopolysaccharide granules but also fingerprintlike structures formed by replicated basement membrane. Some of these structures had a dense core, probably composed of mucopolysaccharide granules. Cell islands surrounded by elasticlike material also were found. The true lumina were usually filled with membranovesicular structures originating from fragments of the lining cells, mainly those with squamous differentiation. These membranovesicular structures included electron-dense rods, filamentous whorls, and structures displaying periodicity.     

Adenoid cystic carcinoma of the uterine cervix: ultrastructure, immunofluorescence, and criteria for diagnosis

An example of adenoid cystic carcinoma of the cervix was recently encountered in our laboratory and studied by histochemistry, electron microscopy, and immunofluorescence in order to compare the neoplasm with adenoid cystic tumors at other sites and to establish criteria for diagnosis. Histochemically, cervical adenoid cystic carcinoma showed the two types of mucin, epithelial and stromal, as expected in adenoid cystic carcinomas of other organs. Ultrastructurally, this tumor was characterized by redundant basal lamina forming pseudocysts, intercellular spaces, and occasional true lumens with microvilli. Immunofluorescence studies showed that the cells contain at least two antigenically different types of filaments, actin and keratin, and that the cells produce true basement membrane (collagen IV). The presence of actin suggests myoepithelial differentiation even though the tumor probably originated from the cervical reserve cells, and myoepithelium is not a known component of normal cervix. This study shows that cervical adenoid cystic carcinoma is a distinct entity which can be identified and separated from other types of cervical adenocarcinomas.     

Detection of integrated high risk human papillomavirus in adenoid cystic carcinoma of the uterine cervix.

AIM: To investigate the role of human papillomavirus (HPV) in adenoid cystic carcinoma of the uterine cervix. METHODS: Eleven archival, paraffin wax embedded specimens were analysed by non-isotopic in situ hybridisation (NISH) for HPV types 6, 11, 16, 18, 31, and 33 using digoxigenin labelled probes. The polymerase chain reaction (PCR) was carried out on each of the cases using consensus primers to HPV. RESULTS: A total of eight adenoid cystic carcinomas harboured the HPV genome by NISH, of which five were PCR positive. Integrated HPV 16 DNA was demonstrated in seven of the eight NISH positive cases. One adenoid cystic carcinoma showed integrated HPV 31. HPV DNA was not detected in the three remaining cases. CONCLUSIONS: Integrated high risk HPV genome, in particular type 16, is associated with this uncommon type of primary cervical cancer.     

Dedifferentiated adenoid cystic carcinoma: a clinicopathologic study of 6 cases.

Dedifferentiated adenoid cystic carcinomas are a recently defined, rare variant of adenoid cystic carcinomas characterized histologically by two components: conventional low-grade adenoid cystic carcinoma and high-grade "dedifferentiated" carcinoma. We examined six cases and analyzed their clinicopathologic profiles, including immunohistochemical features and p53 gene alterations. The 6 patients (3 men and 3 women) had a mean age of 46.8 years (range, 34-70 y). The mean size of the tumors was 3.5 cm (range, 1.7-6 cm). The submandibular gland, maxillary sinus, and nasal cavity were involved in 2 cases each. Postoperatively, 5 patients had local recurrence and 5 developed metastatic disease. Five patients died of disease at a mean of 33.7 months after diagnosis (range, 6-69 mo), and one other was alive with disease at 60 months. Histologically, the conventional low-grade adenoid cystic carcinoma component of the tumors consisted of a mixture of cribriform and tubular patterns with scant solid areas. The high-grade dedifferentiated carcinoma component was either a poorly differentiated adenocarcinoma (4 cases) or undifferentiated carcinoma (2 cases). Three tumors were studied immunohistochemically. Myoepithelial markers were expressed in low-grade adenoid cystic carcinoma but not in the dedifferentiated component. In 2 cases, diffusely positive p53 immunoreactivity together with HER-2/neu overexpression was restricted to the dedifferentiated component. Loss of pRb expression was demonstrated only in the dedifferentiated component of the 1 other case. The Ki-67-labeling index was higher in the dedifferentiated component than in the low-grade adenoid cystic carcinoma component. Furthermore, molecular analysis of 2 cases demonstrated the loss of heterozygosity at p53 microsatellite loci, accompanied by p53 gene point mutation, only in the dedifferentiated carcinoma component of 1 case, which was positive for p53 immunostaining. These results indicate that dedifferentiated adenoid cystic carcinoma is a highly aggressive tumor. Because of frequent recurrence and metastasis, the clinical course is short, similar to that of adenoid cystic carcinomas with a predominant solid growth pattern. Limited evidence suggests that p53 abnormalities in combination with HER-2/neu overexpression or loss of pRb expression may have a role in dedifferentiation of adenoid cystic carcinoma.