Immunophenotypic comparison of salivary gland oncocytoma and metastatic renal cell carcinoma

OBJECTIVES/HYPOTHESIS: The differential diagnosis of oncocytic neoplasms of salivary glands includes both primary and metastatic tumors, one of which is renal cell carcinoma. This study compared immunohistochemical staining characteristics of oncocytomas arising from salivary gland to metastatic renal cell carcinoma using a panel of markers. STUDY DESIGN: Immunohistochemistry for cytokeratin 7 (CK7), cytokeratin 20 (CK20), epithelial membrane antigen (EMA), vimentin, CD10, and renal cell carcinoma marker (RCC) was performed on 10 oncocytomas and compared with ten metastatic renal cell carcinomas. RESULTS: There were overlapping histologic findings in the oncocytomas and metastatic renal cell carcinomas, with oncocytomas displaying clear cell changes in 2 of 10 cases. CK7 was positive in 9 of 10 oncocytomas and CK20 in 8 of 10 (7/10 stained for both), and vimentin was only weakly positive in 4 of 10 oncocytomas. All oncocytomas were EMA positive, with membranous staining, and all were negative for CD10 and RCC. Metastatic renal cell carcinoma was strongly positive for vimentin, EMA, and CD10 in most cases. RCC and CK7 were variably positive in metastatic renal cell carcinomas (4/10), and only 1 of 10 showed weak staining with CK20. CONCLUSIONS: Salivary gland oncocytomas and metastatic renal cell carcinomas share some similar histologic and immunohistochemical characteristics. CD10 and CK20 were the most useful markers to distinguish metastatic renal cell carcinoma from oncocytomas in the salivary gland, whereas RCC, EMA, CK7, and vimentin are not as useful.     

Clinical analysis of acinic cell carcinoma in parotid gland

Objectives

Acinic cell carcinoma (AciCC) is a rarely encountered malignancy in parotid gland. Because AciCC is rare and was recently recognized as the entity of malignancy, AciCC has been difficult to study. We aimed to analyze the diagnosis and treatment experience for this malignancy in our hospital.

Methods

We retrospectively reviewed medical records of the 20 patients with AciCC of parotid gland diagnosed from 1990 to 2009. The preoperative computed tomography scan, preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section results were compared with the final diagnosis. The survival and recurrence were analyzed with the cancer stages and treatment modalities.

Results

There were 10 males and 10 females, with a mean age of 44.4 years, ranging 8-77 years. The AJCC tumor stage distributions of the patients were 70%, 15%, and 15% for stages I, II, and IV, respectively. The sensitivity of FNAC and intraoperative frozen section was 26.7% and 50.0% respectively. The 10-year survival rate was 90.9% with a mean follow-up of 111 months, ranging 17-251 months. The 10-year disease free survival rate was 74.2% and the mean duration of recurrence from initial surgery was 92.3 months.

Conclusion

AciCC of the parotid gland is a rare malignancy that has features of less aggressive behavior, and good prognosis. Intraoperative frozen section examination may be helpful in the diagnosis of AciCC of the parotid gland because of the low sensitivity of preoperative computed tomography scan and FNAC. Surgery with adjuvant postoperative radiotherapy is satisfactory for disease control.     

Metastatic renal cell carcinoma to the nose

A rare case of metastasis of a renal carcinoma to the nasal cavity is presented.     

Metastatic renal cell carcinoma presenting with epistaxis

Renal cell carcinoma is a slow growing malignancy of the kidney that has a high propensity for metastasis. It is the most common metastasis reported in the paranasal sinuses. A fifty six year old male patient, an operated case of left renal cell carcinoma presented seven years later with epistaxis. Computerized tomography of the paranasal sinuses and of the abdomen showed a metastatic lesion involving the left nasosinus region and a lesion involving the right kidney with lung metastasis, respectively. Due to the poor prognosis palliative radiotherapy was given.     

Sclerosing mucoepidermoid carcinoma of the parotid gland

Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland. Its clinical behavior is determined by the relative ratio of mucous and epidermoid cells with pathologic high-grade tumors containing a greater proportion of epidermoid cells. Sclerosing mucoepidermoid carcinoma is a rarely reported variant with unclear long-term clinical behavior. A 23-year-old female was found to have a deep lobe parotid mass on imaging studies. Preoperative evaluation was non-diagnostic. Intraoperatively, the tumor was found to be adherent to the lower division of the facial nerve and portions of the posterior digastric muscle. Frozen section specimens showed only squamous metaplasia with background inflammatory fibrosis. Final pathological analysis demonstrated multiple solid and cystic nests and glands within a background of dense, sclerotic, collagenized stroma and inflammatory infiltrate consistent with low-grade sclerosing mucoepidermoid carcinoma. Sclerosing mucoepidermoid carcinoma is a very rare salivary gland tumor with uncertain behavior. Complete surgical excision with tumor-free margins with preservation of the facial nerve (in the absence of clinical invasion) is recommended. Postoperative radiation therapy is suggested for positive or close margins given the adherent nature of the tumor and the risk of recurrence and distant disease found in some case reports. Patients should be followed closely with serial MRI imaging studies of the tumor bed with complete clinical evaluation of the regional lymphatics and chest to evaluate for evidence of recurrence or metastasis.There is no grant support for this project. This report has not been presented at any scientific meeting.     

Metastatic renal cell carcinoma presenting as epistaxis

Metastatic tumors in the nasal and paranasal sinuses are very rare. The origin of metastatic tumors in the nasal or paranasal sinuses is often renal cancer. Renal cell carcinomas are known for their tendency to early metastasis, and symptoms due to the metastatic lesion may be the only initial manifestation. In this paper we deal with the case of a 73-year-old patient who presented with recurrent epistaxis. The presence of a primary renal cell carcinoma was recognized only after surgical removal of the metastatic tumor. The presentation, difficulties in diagnosis and treatment of this tumor are discussed, with a review of the literature.     

Parotid gland metastasis from renal cell carcinoma

OBJECTIVE: To discuss the diagnosis and management of metastatic renal cell carcinoma presenting as a parotid mass by studying such cases. STUDY DESIGN: Retrospective review. METHODS: Identification of 24 previously reported cases of renal cell carcinoma metastatic to the parotid gland in the English language literature and an analysis of a total of 25 patients including our case. RESULTS: Parotid metastasis was the initial presenting sign of the malignancy in the kidney in 14 of 25 (56%) cases; 11 of 25 (44%) cases presented with metachronous metastasis to the parotid. The most common presenting complaint was parotid mass. No case presented with facial paralysis. In three of six (50%) patients, fine-needle aspiration biopsy was diagnostic. CONCLUSIONS: In the majority of cases, parotid metastases are the first clinical sign of the renal cell carcinoma. Fine-needle aspiration biopsy can provide crucial information without parotidectomy as in our case. Parotidectomy with facial nerve preservation should be considered as a therapeutic option for solitary parotid metastasis.     

Distant metastases on acinic cell carcinoma of the parotid gland after 12 years symptom-free interval

Acinic cell carcinoma of parotid gland as cause of distant metastases are rare. The patient was a 60-year-old woman who had in 1993 a acinic cell carcinoma of right parotid gland. Tumour can be resected through total parotidectomy with facial nerve anastomosis and modified radical neck dissection (T (3) N (2b) M (0)). Since the operation the patient has remained symptom-free without any sign of tumour recurrence. After 12 years the patient noted swelling in the region of sternum and biopsy was necessary. Histologically and immunohistochemically the diagnosis of distant metastase on acinic carcinoma of the parotid gland was confirmed.     

Metastatic renal cell carcinoma to the head and neck

OBJECTIVES: The objectives of the study were to present four cases of renal cell carcinoma (RCC) metastatic to the head and neck, to recognize the appearance on radiographic studies, to understand the importance of preoperative embolization, and to review the results of treatment. STUDY DESIGN: Retrospective review of patients diagnosed with metastatic RCC to the head and neck. METHODS: The records of four patients diagnosed with metastatic RCC at a tertiary medical center over a 5-year period from 1996 to 2001 were reviewed and analyzed for demographic and outcomes data. RESULTS: Metastatic RCC to the head and neck was seen in the following locations: nasal cavity, lower lip, hard palate, tongue, and maxillary sinus. Presenting signs were loose upper molars, dysphagia, nasal obstruction, lower lip lesion, recurrent epistaxis, and foul nasal drainage. Histological studies confirmed metastasis of RCC in all four patients. Treatment consisted of preoperative radiation therapy, embolization, and local excision with adjunct chemotherapy. CONCLUSIONS: Metastatic RCC to the head and neck is rare but can have serious consequences if not recognized before biopsy. We present several treatment options with local excision as the primary mode of treatment.     

Acinic cell carcinoma of the parotid gland in children

Acinic cell carcinoma is an infrequent malignancy of salivary gland tissue in adults that is very rare in children. Review of the English literature reveals only 25 reported cases of this neoplasm in pediatric populations. This is a case report of the youngest known child to undergo parotidectomy and facial nerve dissection for an acinic cell carcinoma. The unusual clinical and surgical findings might suggest the need for changes in approach to treatment of a tumor that has been previously described as relatively benign.     

Metachronous bilateral mucoepidermoid carcinoma of the parotid gland

We report a very rare case of bilateral muco-epidermoid carcinoma of the parotid gland that underwent bilateral parotidectomy with neck dissections and radiotherapy. This case has done well for three years and suggests that metachronous bilateral mucoepidermoid carcinoma of the parotid gland, if treated as per the merits of each side, has a reasonable survival.     

Squamous liver metastases from a carcinoma arising within a pleomorphic adenoma of the parotid gland

A case of liver metastases from a squamous carcinoma arising within a pleomorphic adenoma is presented. The literature is reviewed and the clinical features, pathology and treatment of these tumours are discussed briefly.     

A rare malignancy of the parotid gland: oncocytic carcinoma

Oncocytic carcinomas are uncommon; they represent 11% of all oncocytic salivary gland neoplasms, 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. A 65-year-old woman was admitted to our ENT clinic with a history of a painless left preauricular mass. No lymph node was palpable on either side of her neck. Computed tomography demonstrated a 3×3-cm solid lesion in the left parotid gland. As oncocytes and atypical cells were seen at the cytologic examination of a fine-needle aspiration biopsy, this finding suggested a malignant epithelial tumor. Total parotidectomy by preserving the facial nerve was performed. The result of the pathologic examination was oncocytic carcinoma regarding histopathologic and immunohistochemical findings and especially the invasive growth pattern. We preferred a close follow-up to an elective neck dissection, and reserved the neck dissection for a recurrence. The prognosis of oncocytic carcinomas is not well known because of their low incidence. Further investigation of the prognosis of patients with oncocytic carcinoma of the parotid gland is warranted as more cases are reported.     

Primary squamous cell carcinoma of the parotid gland: a case report with electron microscopic findings

Primary squamous cell carcinoma of the parotid gland is a rare tumor. Histological and ultrastructural features of a primary squamous cell carcinoma arising in the right parotid gland is presented. Light microscopically the tumor consisted of poorly differentiated squamous cell nests. PAS reaction was negative. Ultrastructurally the tumor cells were oval or spindle shaped and the cytoplasmic processes were frequently found. The majority of the tumor cells contained numerous intermediate filaments in their cytoplasm. No secretory granule was found. The desmosomes were well developed. It is known that mucoepidermoid carcinoma may be often misdiagnosed as squamous cell carcinoma. These findings can enable us to distinguish primary squamous cell carcinoma from mucoepidermoid carcinoma of the parotid gland.     

Nasopharyngeal presentation of renal cell carcinoma

In this case report, we present a 50-year- old woman, who presented with severe headache as her only presenting clinical symptom due to nasopharyngeal mass. Histo-pathological evaluation of the biopsy from nasopharyngeal mass revealed clear cell carcinoma. On further evaluation, an asymptomatic mass was detected in the left kidney. The metastatic lesion was treated with palliative radiotherapy. A search of the literature revealed no reports of such unusual metastasis in the nasopharynx from a primary carcinoma of the renal origin.     

Histopathological predictors of occult lymph node metastases in supraglottic squamous cell carcinomas

Lymph node metastasis appears to be the most important factor determining survival in patients with squamous cell carcinoma of the larynx. Supraglottic laryngeal carcinomas have a known tendency to metastasize to cervical lymph nodes because of the extensive lymphatic network present. This retrospective cohort study was conducted to define possible histopathological parameters affecting cervical lymph node metastasis and then using these parameters to create a scale to predict occult lymph node metastasis in supraglottic squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pattern of tumor margins, perineural invasion and lymphocytic infiltration. Grade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To define the risk factors for occult metastasis, a grading scale was created by using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) findings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% of N0 patients with a GLM value that was more than zero. These findings indicate that patients with high-grade tumors having infiltrating borders and lymphatic-vascular invasion have a high risk for occult metastasis so that elective treatment of the neck either by neck dissection or radiotherapy should be added to therapy. Serial sections of specimens are needed to avoid missing metastatic loci of disease. Received: 19 February 1999 / Accepted: 30 December 1999