Glycogen-rich clear cell carcinoma of the breast. An autopsy case

An autopsy case of glycogen-rich clear cell carcinoma (GRCCC) which arose in the right breast of a 72-year-old woman is reported. Light microscopic examination of the small finger-tip-sized tumor revealed solid alveolar proliferation of clear cells containing abundant glycogen. Immunohistochemically, most of the clear tumor cells were stained for epithelial membrane antigen (EMA) and alpha-lactalbumin, whereas a few eosinophilic tumor cells were positive for S-100 protein, EMA and actin. Electron microscopically, aggregates of glycogen particles, numerous empty glycogen lakes, microvilli, tight junctions and basal lamina were identified. Autopsy disclosed marked metastases to the liver, lung, adrenal, skin and lymph nodes. Primary breast cancer was confirmed by exclusion of a primary at any other site. It is suggested that although rare, GRCCC of the breast is as aggressive as usual invasive ductal carcinoma, and is associated with severe nodal and blood-borne metastases, followed by death.     

Clear cell carcinoma of minor salivary glands

Two cases of carcinoma of the minor salivary glands are presented in which most cells had clear cytoplasm. Both patients had clinical histories in excess of 10 years and, in the one case with adequate follow-up, no recurrence had occurred after a further 11 years. Both tumours were locally invasive. The clear cells contained small amounts of glycogen, but no intracytoplasmic mucin. Immunohistochemical and ultrastructural studies showed epithelial features, with no evidence of myoepithelial differentiation. These tumours were very similar to the small number of previously reported cases, which were all considered to be low-grade carcinomas. Amongst the differential diagnoses, the most important is metastatic clear cell carcinoma of the kidney and this can only be confidently excluded clinically or by the use of imaging techniques. In summary, we consider intraoral clear cell carcinoma to be a distinct tumour of low malignant potential.     

Acinic cell carcinoma of minor salivary glands

Three cases of acinic cell carcinoma of minor salivary glands, located respectively in the larynx, base of the tongue, and right tonsil, were encountered at the Section of Pathology of the ENT Department of the University of Padua between 1974 and 1978. Such neoplasms arising in minor salivary gland tissue are extremely rare, but may be found in all sites containing normal or aberrant salivary gland tissue. The histological and histochemical characteristics of the tumour are discussed together with the differential diagnosis from other neoplasms, particularly clear-celled tumours such as glycogen rich adenocarcinoma, mucoepidermoid carcinoma, metastatic clear cell renal adenocarcinoma and clear cell squamous carcinoma. In general, acinic cell carcinoma can be defined as a tumour of low-grade malignancy, though not too rarely it may recur and occasionally metastasize.     

Basal cell adenocarcinoma arising from the minor salivary gland in the soft palate: a case report

Basal cell adenocarcinomas (BCACs) of the oral minor salivary gland are very rare neoplasms. We report on an 86-year-old woman with BCAC arising from the minor salivary gland in the soft palate. Histologically, the tumor was located in the submucosa and showed microinvasion into the adjacent soft tissue without encapsulation. It contained tiny tumor islands with solid and tubular patterns, as well as myxoid stroma. The neoplastic cells were basaloid cells and were composed of large pale cells and small dark cells. They were positive for alpha-smooth muscle actin, cytokeratin 14, and vimentin in the periphery of the tumor island, showing a myoepithelial differentiation. The myxoid stroma was positive for alcian blue and colloidal iron. Apical membranes of the neoplastic cells were positive for MUC1 and CEA. The present case is the 14th documented case of oral BCAC (the fifth case of palatal BCAC).     

Basal cell adenocarcinoma of minor salivary glands

Basal cell adenocarcinoma of minor salivary glands is a relatively rare slow-growing tumor with an infiltrating growth pattern. The infiltrating growth pattern and likelihood of vascular and perineural involvement distinguishes basal cell adenocarcinoma from basal cell adenoma. Other diagnostic considerations include adenoid cystic carcinoma and basaloid squamous carcinoma. Basal cell adenocarcinomas show strong immunoreactivity to cytokeratin 7 and variable myoepithelial staining with S100. It is necessary to differentiate basal cell adenocarcinoma from other basaloid cell tumors of the minor salivary glands because of the prognosis and potential differences in treatment, particularly adenoid cystic adenocarcinoma and basaloid squamous carcinoma. Surgical excision with a wide margin to ensure complete removal has been suggested as the primary treatment for basal cell adenocarcinoma. Radiotherapy has been proposed for lesions in the minor salivary glands because of the higher likelihood of vascular and neural invasion and for those that are diffusely infiltrative.     

Basal cell adenocarcinoma in minor salivary glands

Basal cell adenocarcinoma is a rare and relatively recently characterized malignant salivary gland tumour, the malignant counterpart of basal cell adenoma. Diagnosis depends on finding features similar to adenoma but with an infiltrative growth pattern and exclusion of adenoid cystic carcinoma, sialoblastoma and basaloid squamous carcinoma. Basal cell adenocarcinoma is very rarely reported in minor salivary glands. We report three cases of basal cell adenocarcinoma affecting the labial, buccal and palatal minor salivary glands. One recurred following complete removal but with lesional disruption and further local wide excision appeared curative. A further lesion failed to recur in 5 years' follow-up despite marginal excision and a third after 3 years' follow-up. Basal cell adenocarcinoma is considered a low-grade malignancy, and in the minor glands wide excision and radiotherapy are recommended. However, the reported lesions appear to have a more indolent behaviour than previously reported lesions in minor glands.     

Histogenesis of acinic cell carcinoma of the major and minor salivary glands. An ultrastructural study

This study describes the light microscopic, histochemical and electron-microscopic findings of 10 acinic cell carcinomas from the major and minor salivary glands. Ultrastructurally, four cell types were identified: secretory acinar cells, intercalated duct-like cells, pluripotential reserve/stem cells and myoepithelial cells. This cellular composition suggests that the tumours are derived from neoplastic proliferation, cytodifferentiation and functional maturation of pluripotential reserve/stem cells which normally reside at the acinar-intercalated duct junctions and/or in the intercalated ducts proper of adult salivary glands. This study further supports the concept that different salivary gland tumours recapitulate various developmental stages in the normal embryogenesis of the salivary glands.     

Papillary tumours of the minor salivary glands.

The clinical and histological features of oncocytic adenomatous hyperplasia, papillary adenoma, and papillary adenocarcinoma of the oral cavity are described, and the literature is reviewed. Histological features which may be of value in distinguishing between benign and malignant variants are described, and in view of the slow growth rate of most of these tumours, the importance of long-term follow-up is stressed.     

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     

Stromal melanocytosis of an adenoid cystic carcinoma arising from the palatal minor salivary gland

An unusual case of adenoid cystic carcinoma arising from the palatal minor salivary gland in a 63-year-old Japanese female is reported. In addition to the characteristic histopath-ologic features of adenoid cystic carcinoma, spindle- and dendritic-shaped cells containing excessive amounts of melanin pigment were densely and widely distributed in the stroma resulting in a blue nevus-like appearance. Neither melanocytes nor melanin pigments were seen within the parenchyma. The possible histogenesis of melanocytes in the stroma of the salivary gland carcinoma is discussed, although no firm conclusion could be drawn.     

EWSR1 rearrangement is not specific for hyalinizing clear cell carcinoma of salivary glands

ObjectiveIn this study, we investigate the molecular rearrangement of EWSR1 in hyalinizing clear cell carcinoma (HCCC) (with and without eosinophilia) and clear cell variant of mucoepidermoid carcinoma (MEC) of salivary glands.MethodWe performed a molecular detection of HCCC (Group 1) and clear cell variant of MEC (Group 2). Group 1 consisted of 5 cases of typical HCCC and 5 cases of HCCC with eosinophilia. Group 2 encompassed 5 cases of clear-cell MEC. For both groups, we conducted a FISH analysis using EWSR1 dual color break-apart FISH probe (ZytoLight®, 22q12.2) and MAML2 dual color break-apart FISH probe (ZytoLight®, 11q21).ResultsAll analyzable cases of HCCC with or without eosinophilic components were negative for EWSR1 translocation. All cases of clear-cell MEC were positive for MAML2 translocation. No translocation was observed in HCCC.ConclusionOur study showed that clear cells could cause diagnostic uncertainty and that EWSR1 can be detected in many primary neoplasms of salivary glands and metastatic tumors that were reported in salivary glands. We suggest that recommending EWSR1 as a diagnostic molecular marker for HCCC should be reconsidered.     

Synchronous benign epithelial tumors arising in the palatal minor salivary gland. First report of an unusual minor salivary gland lesion

A review of the literature shows that unilateral benign salivary gland tumors of different histologic types in a single gland are so rare as to be curiosities, and all of such reported tumors have arisen in the parotid gland. The present paper reports a case of synchronous benign epithelial tumors of different histologic type arising in the palatal minor salivary gland of a 57-year-old woman who had first noted palatal swelling about 20 years previously. Pathologically, the lesion was composed of two distinct tumors, pleomorphic adenoma and lumenless trabecular adenoma, which were sharply demarcated from each other by a thin layer of fibrous connective tissue. Foci of tumor cells with cellular atypia were seen in some areas of the pleomorphic adenoma. The present case is thought to represent a previously undescribed component within the spectrum of minor salivary gland tumors.