Merkel cell carcinoma of the parotid gland associated with Warthin tumour: report of two cases

AIMS: Two cases of Merkel cell carcinoma occurring simultaneously and in close association with a Warthin tumour of the parotid gland are reported. METHODS AND RESULTS: The patients were a 65-year-old man and a 70-year-old man, respectively. The Merkel cell carcinoma component was immunoreactive for chromogranin and keratin 20 and contained neuroendocrine-type granules at the ultrastructural level. CONCLUSIONS: The histogenesis of this heretofore undescribed combination is discussed.     

Epstein-Barr virus (EBV)-associated undifferentiated carcinoma of the parotid gland

A case of undifferentiated carcinoma of the salivary gland occurring in the parotid gland of a southern Chinese was reported. Tumour cells showed immunofluorescence for Epstein-Barr virus (EBV)-associated nuclear antigen, and DNA hybridization demonstrated the presence of EBV-DNA in tumour tissue. The findings in this case, together with previous reports, suggest a causal relationship between EBV and salivary gland carcinoma. The relationships between EBV and undifferentiated epithelial tumours of the salivary glands, nasopharynx and thymus are also discussed.     

Salivary duct carcinoma in situ of the parotid gland

Aims: To describe three cases of purely in situ salivary duct carcinoma, so as better to define the entity. Methods and results: Three primary tumours of the parotid gland are presented, in each case composed of cysts and ducts and lined by high nuclear grade epithelial cells. All parts of each tumour were surrounded by a myoepithelial cell rim and there was no evidence of invasion. The tumour cells expressed immunohistochemical markers seen in invasive salivary duct carcinoma of usual (high‐grade) type. In two cases the androgen receptor (AR) reaction was strong, but there was no immunohistochemical expression of HER2 protein or gene amplification by in situ hybridization. In the remaining case, fewer nuclei stained for AR, but both HER2 protein and gene amplification were demonstrated. Conclusions: Salivary duct carcinoma in situ is morphologically similar to breast ductal carcinoma in situ and, although our cases are few, salivary duct carcinoma in situ can possibly be subdivided into luminal and non‐luminal cell types, as can analogous mammary neoplasms. The present study cannot determine whether low‐grade cribriform cystadenocarcinoma, architecturally similar but immunohistochemically different, is part of the spectrum of salivary duct carcinoma in situ, or whether it represents a separate entity.     

Aggressive invasive micropapillary salivary duct carcinoma of the parotid gland

The presence of invasive micropapillary component has been reported to be associated with salivary duct carcinoma and poor outcomes. Herein is described a rare case of invasive micropapillary salivary duct carcinoma of the parotid gland in a 60-year-old man. The micropapillary component was approximately 70% of the area of the tumor. Squamous differentiation was focally seen adjacent to the micropapillary component. On immunohistochemistry the ordinary salivary duct carcinoma component was positive for gross cystic disease fluid protein-15 (GCDFP-15), androgen receptor (AR), and HER2/neu, whereas both micropapillary and squamous components were negative for GCDFP-15 and AR. Immunohistochemical staining for D2-40 highlighted the lymph vessel invasion of tumor cells. This patient developed metastases in the lymph nodes of the neck, and also in the liver, lung, and brain. The lymph nodes and liver metastases had both ordinary salivary duct carcinoma and micropapillary components. The patient died of tumor 11 months after the initial surgical operation. The results support that the presence of micropapillary component is associated with more aggressive behavior of salivary duct carcinoma. It is also important for pathologists to recognize that GCDFP-15 and AR expression can be reduced in micropapillary carcinoma in the differential diagnosis of metastatic tumor.     

Fine-needle aspiration biopsy in the diagnosis of parotid gland lesions: Evaluation of 438 biopsies

The usefulness of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of salivary gland lesions is still controversial. The 438 FNABs taken at the Turku University Central Hospital between 1984–1991 were reviewed. Of these FNABs, 218 had been confirmed histologically. Within this subset, 136 FNABs were taken from benign neoplasms, and of these, 103 were correct (sensitivity 76%, specificity 83%). Only 26 of the 47 FNABs from malignant lesions were cytologically considered to be malignant (sensitivity 55%) and 11 samples raised a false suspicion of malignancy (specificity 92%). Out of 35 FNABs from non-neoplastic lesions, 27 were correct (sensitivity 77%, specificity 80%). There were 175 patients (217 FNABs), who had not been operated on: the follow-up of these patients showed that false malignant and false benign findings were rare. FNAB was safe and no serious complications occurred. However, there was a delay in the treatment of six patients probably because of the physicians' limited understanding of the diagnostic role of FNAB. FNAB offers valuable information about the type of parotid lesion, but the clinician must know how to interpret the cytologic statement, and the decision to use operative and other treatment should not be based solely on the result of FNAB. Diagn Cytopathol 1996;15:185–190. © 1996 Wiley-Liss, Inc.     

Hepatocellular carcinoma diagnosed by fine-needle aspiration of the parotid gland

Hepatocellular carcinoma rarely metastasizes to the salivary glands. We report a case of a 47-yr-old man who presented with a right parotid lesion that was diagnosed by fine-needle aspiration (FNA) biopsy as a metastatic lesion suggestive of hepatocellular carcinoma with similar findings in a subsequent intraoral incisional biopsy. The patient's serum alpha-fetoprotein level was within normal limits at the time of diagnosis. CT scan revealed a mass in the liver, but a liver biopsy was not performed. The patient deteriorated rapidly and died about 4 mo later. An autopsy confirmed the presence of hepatocellular carcinoma with distant metastases to unusual sites, including the parotid gland, orbit, and calvarium, bypassing more common sites such as the lungs. This is the second known reported case in which hepatocellular carcinoma presented as a salivary gland metastasis. In both cases the diagnosis was made by FNA biopsy, illustrating the utility of this method for diagnosing uncommon metastatic salivary gland lesions.     

Mcl-1 expression is up-regulated in malignancies of the parotid gland

The anti-apoptotic protein Mcl-1 is highly expressed in various types of malignant tumors. Overexpression is reported to correlate with poor prognosis and disease progression. We report the expression levels of Mcl-1 in tumor samples of the parotid gland. A retrospective study containing 108 patients was performed. A tissue microarray of six malignancies of the parotid gland and pleomorphic adenoma as control was constructed. Parotid gland tumor samples were immunohistochemically stained for Mcl-1 and expression intensities were assessed. Statistical analysis included correlation to patients' clinical data and comparison of malignancies to the adenoma. All malignancies had significantly higher expression of Mcl-1 than the pleomorphic adenomas. The intensity, however, had no significant correlation to overall survival. Our immunohistochemical findings indicate that parotid gland malignancies produce high levels of Mcl-1 protein. Therefore, Mcl-1 might serve as a predictive co-marker in tumors of the parotid gland.     

Mucoepidermoid carcinoma arising in Warthin's tumour of the parotid gland: report of two cases with histopathological, ultrastructural and immunohistochemical studies

Aims : Malignant transformation of Warthin's tumour (WT) is a rare event. We present two cases of mucoepidermoid carcinoma (MEC) arising in WT in the parotid gland.  

Methods and results

Two cases of MEC arising in WT, which were found in 185 cases of WT of the parotid gland, were investigated by light and electron microscopy, and immunohistochemistry. Both cases had largely similar macroscopic and histological features with some differences. Histologically, the tumours consisted mainly of WT with multilayered hyperplastic arrangements of oncocytic cells and focal squamous and goblet cell metaplasia. In the same tumour mass, however, the features of MEC were observed with invasion to adjacent adipose tissue. A transitional zone between WT and MEC was evident. Both patients were alive and well without evidence of recurrence 30 and 34 months after surgery, respectively. Electron microscopy revealed that cyst lining epithelial cells in WTs had abundant mitochondria whereas some of the MEC cells contained numerous tonofilaments and mucinous granules. Immunohistochemically, oncocytic cells of WTs were strongly positive for mitochondria and Salyl-Tn was extensively stained in MECs. The labelling index for Ki67 was obviously higher in the carcinoma cells than the epithelial cells of WT.  

Conclusions

Our cases confirmed the possibility of malignant transformation of the epithelial component in WT to MEC.     

Oncocytic mucoepidermoid carcinoma of the parotid gland: report of a case with DNA ploidy analysis and review of the literature

A 44-year-old female presented with a painful mass in the left parotid gland. Histologic examination revealed the characteristic picture of oncocytic mucoepidermoid carcinoma (OMEC) composed mainly of sheets of oncocytic cells with uniform nuclei and eosinophilic cytoplasm, focally smaller epidermoid cells surrounding poorly formed glandular spaces, and a few cystic structures lined by well-differentiated mucous cells with intracytoplasmic mucin. Immunohistochemical staining with antimitochondrial antibody showed granular cytoplasmic positivity in oncocytic cells. The resulting histogram for DNA ploidy analysis was of diploid type. OMEC of the parotid gland is a recently described rare neoplasm. Only six cases have been previously reported in the literature. For an accurate approach in the management of patients, OMEC should be considered in the differential diagnosis of oncocytic lesions of the parotid gland, most of which are benign.     

Investigation of the amino-acid reserves in parotid gland cells with rhythmic function

The dynamics of uptake of labeled amino acids by rhythmically functioning acinar cells of the rat parotid gland was studied. The amino-acid reserves in the parotid, gland cells fluctuate regularly. However, the period of intake of the amino acids into the cell, unlike the periods of fluctuation, of the intensity of protein synthesis, is independent of the animals' training program: In all the experiments the periods were the same and were equal to the endogenous period of the change in intensity of protein synthesis in the cells. The regular fluctuation of the total amino-acid reserves of the cell cannot be regarded as a direct regulator of synthesis of the protein assimilated by the cells during the experiment.Laboratory of Cytology, Institute of Biology of Development, Academy of Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR, A. P. Avtsyn.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 78, No. 9, pp. 47–49, September, 1974.     

Pleomorphic adenoma of the parotid gland with extensive bone formation

We report an unusual case of pleomorphic adenoma with extensive bone formation, occurring in the parotid gland of a 58-year-old Japanese man. The tumor was a well-circumscribed mass that measured 20 x 20 x 15 mm and contained extensive bone formation. Histologically, most of the tumor was composed of bone and chondroid tissues. The bone formation with a marrow-like structure occupied half the volume of the tumor. The chondroid tissues merged continuously into bone tissues. The bone tissue seemed to be formed within areas of chondral tissue by a process of enchondral ossification. Except for the unusual amount of large bone formation, the tumor showed histology of pleomorphic adenoma, particularly at the periphery of the tumor. These histological findings suggest the possibility of extensive enchondral ossification in pleomorphic adenoma.     

Hyalinizing clear cell carcinoma of the parotid gland: Report of a recurrent case with aggressive cytomorphology and behavior diagnosed on fine‐needle cytology sample

A case of recurrent hyalinizing clear cell carcinoma (HCCC) of the parotid gland in a 46‐year‐old female is here introduced. The patient had undergone a left superficial parotidectomy 6 months ago in another institution for an alleged benign, circumscribed mass 2.4 cm in diameter of the left parotid gland. Histopathological examination revealed a poorly differentiated HCCC bearing a EWSR‐1 translocation on FISH examination. Fine Needle Cytology (FNC) was performed on three separate soft tissue masses in the pre‐masseterine area and a cytological diagnosis of recurrent, poorly differentiated, possibly aggressive variant of HCCC, was rendered. FISH performed on a destained Diff Quik stained smear demonstrated an ESWR‐1 translocation, which supported the cytopathological diagnosis. The cytomorphologic features and the differential diagnosis of this aggressive variant of HCCC are briefly discussed. Diagn. Cytopathol. 2014;42:63–68. © 2013 Wiley Periodicals, Inc.     

Unusual hemangioendothelioma of the liver with epithelioid morphology associated with marked eosinophilia: autopsy case

Vascular neoplasms characterized by epithelioid endothelial cells consist of several different entities from benignity to high-grade malignancy. Because of histological overlap between them, there is substantial difficulty in classifying them correctly. The present patient, a 33-year-old man, presented with hepatomegaly, striking eosinophilia and elevated serum interleukin-5 level. Biopsy and autopsy revealed an unusual epithelioid vascular tumor in the liver, which is histologically distinct from epithelioid hemangioma, epithelioid hemangioendothelioma, or epithelioid angiosarcoma. The tumor cells had vasoformative and partly solid growth with no severe nuclear atypia and very low mitotic activity, and the histological features were similar to those of the entity recognized as hemangioendothelioma of bone. Organs other than the liver, for example the testes and bone, were also involved. This tumor should be considered in the differential diagnosis of severe eosinophilia.     

Massive crystal-storing histiocytosis associated with low-grade malignant B-cell lymphoma of MALT-Type of the parotid gland

Massive crystal deposition is unusual in lymphoproliferative disorders. In this report, a mucosa-associated lymphoid tissue (MALT) low-grade B-cell lymphoma of the parotid gland containing large numbers of crystal-storing histiocytes is described. The patient, an 81-yr-old female, presented with a history of long-standing left parotid gland enlargement. FNA cytology of the tumor showed a lymphoplasmacytic infiltrate and sheets of large benign histiocytes with abundant eosinophilic intracytoplasmic inclusions. Paraffin-section immunohistochemistry performed on the cell block demonstrated that the histiocytic cells were immunoreactive for the KP-1 (CD-68) antibody and monotypic for cytoplasmic IGM and L-light chain. The cytological diagnosis was consistent with a low-grade B-cell lymphoma with plasmacytic differentiation associated with crystal-storing histiocytosis. A periparotid lymph node was biopsied and showed involvement by a monocytoid B-cell lymphoma with plasmacytic differentiation and crystal-storing histiocytosis in the pericapsular region. Diagn. Cytopathol. 17:148–152, 1997. © 1997 Wiley-Liss, Inc.     

Multinucleated giant cells in HIV‐associated benign lymphoepithelial cyst‐like lesions of the parotid gland on FNAC

Benign lymphoepithelial cyst‐like lesion (BLEL), a previously rare lesion of the parotid gland consisting of marked lymphoid hyperplasia with accompanying squamous‐lined cysts, has been described in patients with the acquired immune deficiency syndrome (AIDS) or AIDS risk factors. Histologically, these cysts are lined by a squamous or cuboidal epithelium. The lumen contains a pale homogenous material with foamy macrophages and lymphocytes with the cyst wall having germinal centers and a dense infiltrate of lymphoid cells. On FNAC, the aspirates are mostly cystic with the presence of reactive lymphoid tissue, numerous histiocytes, and metaplastic cell clusters. Multinucleated giant cells (MGCs) are also rarely seen in such lesions. We report a case of HIV‐associated BLEL with numerous large sized multinucleated giant cells. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Castleman’s disease of the left parotid gland: a case report

Castleman’s disease is a very rare heterogeneous group of lymphoproliferative disorders characterized by non-neoplastic growths. It is unknown about the pathophysiology of the Castleman’s disease. Previous studies demonstrated that Castleman’s disease can be divided into two groups according to clinical classification, including unicentric Castleman disease (UCD) and multicentric Castleman disease (MCD). The hyaline vascular type is most common in the head and neck, and is abbreviated as UCD. In the present case, a woman complained that a mass in her parotid gland was growing and it was painless seven months ago. The computed tomography (CT) showed that the superficial lobe of the parotid gland on the left had an elliptical soft tissue density shadow, about 2.5×3.5 cm, with clear boundaries and no obvious abnormalities in the surrounding bone. The CT scan showed no obvious abnormalities in the shape and density of the right parotid and bilateral submandibular glands. After the operation, combined with the results of immunohistochemistry, the final diagnosis was Castleman tumor. The patient recovered smoothly, after the operation and during follow-up. The patient maintained good health without recurrence or metastasis.