DOCSLIB.ORG

Salivary Gland FNA: New Markers and New Opportunities for Improved Diagnosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Salivary Gland FNA: New Markers and New Opportunities for Improved Diagnosis Salivary Gland FNA: New Markers and New Opportunities for Improved Diagnosis W.C. Faquin, M.D., Ph.D. Director, Head and Neck Pathology Massachusetts General Hospital Massachusetts Eye and Ear Infirmary Harvard Medical School Boston, MA Welcome to Boston….First day of Spring! The view from my window at home …. In Boston, SNOW is a 4-letter word! Disclosure of Relevant Financial Relationships The USCAP requires that anyone in a position to influence or control the content of all CME activities disclose any relevant relationship(s) which they or their spouse/partner have, or have had within the past 12 months with a commercial interest(s) [or the products or services of a commercial interest] that relate to the content of this educational activity and create a conflict of interest. Complete disclosure information is maintained in the USCAP office and has been reviewed by the CME Advisory Committee. Dr. Faquin declares he has no conflict(s) of interest to disclose. Salivary gland tumors are one of the most heterogeneous groups of neoplasms – So what role is there for FNA? SALIVARY GLAND FNA Rationale for FNA: –Guide the clinical management/pre-op strategy: » Non-neoplastic Clinical follow-up » Benign tumor/low-grade carcinoma Limited resection » Metastatic disease to parotid LNs LN resection » Lymphoma Heme-Onc referral » High-grade primary carcinoma Radical resection CAUTION! While most salivary gland tumors can be readily diagnosed in resection specimens, caution is warranted when interpreting small biopsies and FNAs! SALIVARY GLAND FNA: How Far Can We Go Using Cytomorphology Alone? Usually Specific Diagnosis Sometimes Specific Diagnosis Usually Descriptive Diagnosis Pleomorphic adenoma Adenoid cystic carcinoma Basal cell adenoma, tubulotrabecular and solid types Warthin tumor LG mucoepidermoid carcinoma HG mucoepidermoid carcinoma Basal cell adenoma, Acinic cell carcinoma Polymorphous low grade adenocarcinoma Membranous type Acute and chronic sialadenitis Carcinoma ex PA Salivary duct carcinoma Reactive lymph node Small cell carcinoma Basal cell adenocarcinoma Lymphoma Mucocele Epithelial-myoepithelial carcinoma Metastatic carcinoma to LN Oncocytoma LESA SALIVARY GLAND FNA Effectiveness of Cytomorphology alone: » Sensitivity: 86-100% Part of the reason for the high accuracy: A majority» Accuracy: of SG neoplasms are pleomorphic adenomas, » Benign/lowWarthin tumor, grade or metastatic vs HG malignant: cancer 81-98% » Specific lesion: 48-94% Salivary Gland FNA With an expanded array of IHC and new molecular advances, FNA and small biopsies are becoming more effective. Increasing Availability of Molecular Markers For Salivary Gland Tumors Mammary analogue secretory carcinoma: ETV6-NKRT; t(12:15) Pleomorphic adenoma & Ca ex PA: PLAG1; t(3;8) HMGA2 rearrangement Clear cell carcinoma: EWSR1-ATF1; t(12:22) Mucoepidermoid carcinoma: MECT1/MAML2; t(11:19) Cribriform Cystadenocarcinoma: PRKD rearrangement Adenoid cystic carcinoma: MYB-NFIB; t(6:9) Ancillary Studies to Improve the FNA Diagnosis of Salivary Gland Tumors Immunocytochemistry LBP Smears Cell block FISH RT-PCR Next Generation Sequencing NORMAL SALIVARY GLAND Immunohistochemical Markers SOX10 Ker 7, CAM 5.2 Ker 7, 19, CAM 5.2, EMA Ker 5/6, S-100, p63, calponin, SM actin Ker 5/6, p63 Molecular Analysis at MGH NGS‐SNaPshot Panel • Anchored Multiplex PCR (AMP) • ~190 target amplicons across 39 genes • High‐quality sequence: ‐ Staggered start sites ‐ >100X target coverage ‐ Molecular indexing ‐ Bi‐template coverage ‐ ~2% analytical sensitivity • Fast turn‐around (~2 weeks) • Cost‐effective (<$500) • Small tissue amounts (5‐10 ng) Molecular Analysis at MGH NGS‐Translocation Panel Master fusion panel (research) ADCK4 FGR PDGFB AKT3 INSR PDGFRA ALK INSRR PIK3CA AR JAK1 PKN1 ARHGAP26 JAK2 PLAG1 ARHGAP6 MAML2 PPARG AXL MAST1 PRKACA BRAF MAST2 PRKCA BRD4 MET PRKCB CCDC6 MUSK RAF1 CD74 NFIB RET CHTOP NOTCH1 RHOA EGFR NOTCH2 ROS1 ERBB2 NRG1 TMPRSS2 ERBB4 NTRK1 EWSR1 NTRK2 FGFR1 NTRK3 quality controls: B2M FGFR2 NUMBL CTBP1 FGFR3 NUTM1 GAPDH IHC and Molecular Analysis Applied to Selected Salivary Gland Tumors Pleomorphic Adenoma Pleomorphic Adenoma (aka Benign Mixed Tumor) • Most common salivary gland tumor in both children and adults • 75-80% of parotid tumors & 50% of all salivary tumors • 5-10% risk of malignant transformation • FNA is highly accurate (>90%) • DDX includes other matrix-producing tumors Most Pleomorphic Adenomas Are Accurately Diagnosed by FNA METACHROMATIC MATRIX ON DIFF-QUIK Pleomorphic Adenoma Immunohistochemistry: • Markers of both ductal and myoepithelial cells: • Positive for keratin 7, CEA, EMA, SOX10 – Positive for myoepithelial markers: • Smooth muscle actin • Calponin • S-100 • Keratin 5/6 • P63 • GFAP Pleomorphic Adenoma Cytogenetics: • PLAG1 rearrangements (50-60%) – Present in PAs in different tissues – Nuclear localization – Functions to activate transcription (Zn finger) • HMGA2 rearrangements (10%) http://www.uniprot.org/uniprot/Q6DJT9 PLAG-1 Immunoreactivity: Overexpressed in 94% of PA Does not distinguish benign from malignant Contributed by Dr. J. Krane, BWH Carcinoma Ex Pleomorphic Adenoma: Most cases have PLAG1 or HMGA2 Rearrangements Salivary duct carcinoma ex PA PLAG-1 Immunoreactivity and FISH in Ca Ex PA: Bahrami et al, HN Pathology, 2012;6:328 Diagnostic Problems Arise from Variants of PA • Cellular PA with sparse matrix • Focal adenoid cystic–like areas • Cytologic atypia • Metaplasia – Squamous – Mucinous – Sebaceous – Oncocytic Pleomorphic Adenoma with Mucinous Metaplasia: Can be difficult to distinguish from MEC Distinguished from MEC by: *Presence of myoepithelial cells *PLAG1 positive *p63 not useful Cellular Pleomorphic Adenoma: Can be difficult to distinguish from AdCC Distinguished from AdCC by: *PLAG1 positive *CD117 & MYB +/- Adenoid Cystic Carcinoma Adenoid Cystic Carcinoma • 4-10% of all salivary gland neoplasms • 30-50 year-old women • Indolent behavior but very poor long-term survival (<30-40% survival at 10 years) • 3 histologic subtypes: Cribriform, tubular, solid • FNA is most accurate for the cribriform type Adenoid Cystic Carcinoma: Classic Cribriform Pattern Adenoid Cystic Carcinoma Immunohistochemistry: • Positive for keratin 7, CEA, EMA • Positive for myoepithelial markers: – Smooth muscle actin – Calponin – S-100 – Keratin 5/6 – P63 • SOX10+ • CD117 (KIT) + • MYB + Adenoid Cystic Carcinoma CD117 Immunohistochemistry: • Over 90% are strongly positive for CD117 (KIT) • Protein overexpression but no mutation identified • Useful for all variants including solid forms • Unusual IHC pattern Immunoreactivity for CD117 (KIT) in AdCC: Unusual Staining Pattern Luminal Cells + Adenoid Cystic Carcinoma: Recent Advance – MYB Translocation Cytogenetics: • t(6:9) MYB oncogene-NFIB transcription factor • 64% MYB-NFIB fusion transcripts • Detectable by FISH or NGS The combination of CD117+ and MYB+ has high specificity for AdCC • MYB Immunohistochemistry: – 82-89% AdCC (+) – 14% non-AdCC tumors tested (+) – Nuclear stain Pusztaszeri et al, Cancer Cytopathol (2014) – Very effective in ETOH smears Persson et al PNAS (2009) and Mitani et al. Clin Cancer Res (2010) Salivary Gland Carcinoma With High Grade Transformation • First described in 1988 for acinic cell carcinoma • “Undifferentiated” appearance • Very aggressive clinical course • Can occur in different types of salivary gland carcinoma • Often express elevated p53 and Ki-67 Adenoid Cystic Carcinoma With High Grade Transformation Loses characteristic baseline IHC profile but will retain Molecular features of the primary tumor such as MYB rearrangement Mammary Analogue Secretory Carcinoma Mammary Analogue Secretory Carcinoma First described by Skalova et al in 2010 Analogous to secretory carcinoma of breast Previously classified as acinic cell carcinoma or adenocarcinoma, NOS Absence of true serous-type acinar differentiation- lacks zymogen granules Most common in the parotid gland Low-grade biologic behavior FNA of Mammary Analogue Secretory Carcinoma Mammary Analogue Secretory Carcinoma: Numerous small cytoplasmic vacuoles MASC Immunohistochemistry: • Positive for: – S-100 – Mammaglobin – Keratin 7, 8, 19 – EMA – GCDFP-15 – MUC1, MUC4 • Negative for: – Myoepithelial markers (p63 etc) – Androgen receptor – DOG1 +/- MASC: Immunohistochemical Studies GCDFP-15+ S-100+ Distinguished from MEC by S-100+, Mammoglobin+ Mammaglobin+, but p63 - Mammary Analogue Secretory Carcinoma: For difficult cases, test for rearrangement ETV6-NKRT Translocation: T(12:15)(p13;q25) MASC is only known salivary gland primary Detected on histology or cytology using: FISH RT-PCR Next-Gen Sequencing Acinic Cell Carcinoma Acinic Cell Carcinoma 2-6% of all salivary gland neoplasms Low-grade malignancy F>M >90% parotid Serous acinar & intercalated duct differentiation PAS/D+ zymogen granules No specific molecular changes identified FNA of Acinic Cell Carcinoma Acinic cell carcinoma with low N:C ratio cells, basophilic cytoplasm, and cytoplasmic vacuoles Acinic Cell Carcinoma Immunohistochemistry: • Positive for: – Keratin 7 – CAM 5.2 – DOG1 – SOX10 – Keratin 7, 8, 19 – EMA • Negative for: – Myoepithelial markers (p63 etc) DOG1 and Acinic Cell Carcinoma Discovered on GIST Calcium-activated chloride channel protein Strong diffuse staining seen in most acinic cell carcinomas SOX-10 and Acinic Cell Carcinoma SRY-related HMG-box 10 (SOX10) protein Transcription factor: neural crest formation, and maintenance of Schwann cells and melanocytes. Acinar cells and intercalated ducts
Load more

Recommended publications
  • H&N Grand Rounds
    H&N Grand Rounds December 2, 2011 Unusual Salivary Neoplasms Presentation, Diagnosis, Management Presenters Drs. Dario Kunar, Ray Blanco, Carole Fakhry Discussants Drs. Fred Yegeneh, Marshall Levine, Geoffrey Neuner, James Sciubba Case History Dr. Carole Fakhry CC: Palatal mass HPI: 42 year old female with a four-year history of unusual sensation in the mouth. On dental examination one year ago was noted to have an irregularity of hard palate. Upon follow-up examination, the mass was noted to be persistent and was biopsied. She has no other complaints and denies any symptoms. James J. Sciubba, DMD, PhD LF • Cc: • palate mass • HPI: • 42 year old female with a four-year history of unusual sensation in the mouth. • On dental examination one year ago was noted to have an irregularity of hard palate. • Upon follow-up examination, the mass was noted to be persistent and was biopsied. • She has no other complaints and denies any symptoms. James J. Sciubba, DMD, PhD LF • PMH: • Hodgkin’s Lymphoma- chemotherapy 20 years ago • Medication: none • NKDA • SH: 20 py, Etoh: heavy use James J. Sciubba, DMD, PhD Differential Diagnosis Clinical • Benign mixed tumor • Monomorphic adenoma • Mucoepidermoid carcinoma • Adenoid cystic carcinoma • PLGA • Metastatic breast carcinoma James J. Sciubba, DMD, PhD Imaging Dr. Fred Yegeneh LF LF LF Imaging Summary Treatment • Primary therapy is surgical • Extent of primary therapy is controversial in literature • Radiation reported, though rarely used • Long term surveillance • Local recurrence rate between 17-33%, regional recurrence 9-18% James J. Sciubba, DMD, PhD Pathology Cytologic Features • Cuboidal to columnar cells • Nuclei ovoid to elongated and bland • Vesicular to stippled chromatin • Indistinct cell borders • Rare mitotic figures James J.
    [Show full text]
  • Primary Oncocytic Carcinoma of the Salivary Glands: a Clinicopathologic and Immunohistochemical Study of 12 Cases
    Oral Oncology 46 (2010) 773–778 Contents lists available at ScienceDirect Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology Primary oncocytic carcinoma of the salivary glands: A clinicopathologic and immunohistochemical study of 12 cases Chuan-Xiang Zhou a,1, Dian-Yin Shi b,1, Da-quan Ma b, Jian-guo Zhang b, Guang-Yan Yu b, Yan Gao a,* a Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing 100081, PR China b Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China article info summary Article history: Oncocytic carcinoma (OC) of salivary gland origin is an extremely rare proliferation of malignant onco- Received 31 May 2010 cytes with adenocarcinomatous architectural phenotypes, including infiltrative qualities. To help clarify Received in revised form 26 July 2010 the clinicopathologic and prognostic features of this tumor group, herein, we report 12 OC cases arising Accepted 27 July 2010 from the salivary glands, together with follow-up data and immunohistochemical observations. There Available online 16 September 2010 were 10 males and 2 females with an age range of 41 to 86 years (median age: 61.3 years). Most occurred in the parotid gland (10/12) with one in the palate and one in the retromolar gland. The tumors were Keywords: unencapsulated and often invaded into the nearby gland, lymphatic tissues and nerves. The neoplastic Oncocytic carcinoma cells had eosinophilic granular cytoplasm and round vesicular nuclei with prominent red nucleoli. Ultra- Salivary gland Clinicopathologic structural study, PTAH, and immunohistochemistry staining confirmed the presence of numerous mito- Immunohistochemistry chondria in the cytoplasm of oncocytes.
    [Show full text]
  • Heterogeneity of PD-L1 Expression and CD8 Tumor-Infiltrating
    Cancer Immunology, Immunotherapy (2019) 68:951–960 https://doi.org/10.1007/s00262-019-02334-8 ORIGINAL ARTICLE Heterogeneity of PD‑L1 expression and CD8 tumor‑infltrating lymphocytes among subtypes of cutaneous adnexal carcinomas Lucie Duverger1 · Amélie Osio1 · Bernard Cribier2 · Laurent Mortier3 · Adèle De Masson4,5 · Nicole Basset‑Seguin4,5 · Céleste Lebbé4,5 · Maxime Battistella1,6 Received: 15 September 2018 / Accepted: 28 March 2019 / Published online: 5 April 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Background Adnexal carcinomas are rare and heterogeneous skin tumors, for which no standard treatments exist for locally advanced or metastatic tumors. Aim of the study To evaluate the expression of PD-L1 and CD8 in adnexal carcinomas, and to study the association between PD-L1 expression, intra-tumoral T cell CD8+ infltrate, and metastatic evolution. Materials and methods Eighty-three adnexal carcinomas were included. Immunohistochemistry using anti-PD-L1 mono- clonal antibodies (E1L3N and 22C3) and CD8 was performed. PD-L1 expression in tumor and immune cells, and CD8 + tumor-infltrating lymphocyte (TIL) density were analyzed semi-quantitatively. Results Among the 60 sweat gland, 18 sebaceous and 5 trichoblastic carcinomas, 11% expressed PD-L1 in ≥ 1% tumor cells, more frequently sweat gland carcinomas (13%, 8/60) including apocrine carcinoma (40%, 2/5) and invasive extramam- mary Paget disease (57%, 4/7). Immune cells expressed signifcantly more PD-L1 than tumor cells (p < 0.01). Dense CD8+ TILs were present in 60% trichoblastic, 43% sweat gland, and 39% sebaceous carcinomas. CD8+ TILs were associated with PD-L1 expression by tumor cells (p < 0.01).
    [Show full text]
  • Detection and Genomic Characterization of a Mammary-Like Adenocarcinoma
    Downloaded from molecularcasestudies.cshlp.org on October 3, 2021 - Published by Cold Spring Harbor Laboratory Press COLD SPRING HARBOR Molecular Case Studies | RESEARCH REPORT Detection and genomic characterization of a mammary-like adenocarcinoma Jasleen K. Grewal,1 Peter Eirew,2 Martin Jones,1 Kenrry Chiu,3 Basile Tessier-Cloutier,2,3 Anthony N. Karnezis,3 Aly Karsan,4 Andy Mungall,1 Chen Zhou,3 Stephen Yip,3 Anna V. Tinker,5 Janessa Laskin,5 Marco Marra,1 and Steven J.M. Jones1 1Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia V5Z 1L3, Canada; 2Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, British Columbia V5Z 1L3, Canada; 3Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 2B5, Canada; 4Genome Sciences Centre and Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia V5Z 1L3, Canada; 5Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia V5Z 4E6, Canada Abstract Whole-genome and transcriptome sequencing were performed to identify potential therapeutic strategies in the absence of viable treatment options for a patient initially diagnosed with vulvar adenocarcinoma. Genomic events were prioritized by com- parison against variant distributions in the TCGA pan-cancer data set and complemented with detailed transcriptome sequencing and copy-number analysis. These findings were considered against published scientific literature in order to evaluate the functional effects of potentially relevant genomic events. Analysis of the transcriptome against a background of 27 TCGA cancer types led to reclassification of the tumor as a primary HER2+ mammary- like adenocarcinoma of the vulva.
    [Show full text]
  • Iodine-. 13 1 Therapy for Parotid Oncocytoma
    Iodine-. 13 1 Therapy for Parotid Oncocytoma Shigeru Kosuda, Masazumi Ishikawa, Kohei Tamura, Miwako Mukai, Atsushi Kubo, and Shozo Hashimoto Department ofRadiology, Okura National Hospital and Keio University Hospital, Tokyo, Japan We presenta rarecaseofa patientwithcoexistingparotidoncocytomaandchronic thyroiditis who received two therapeutic doses of [131ljiodidefor a recurrent oncocytoma (oxyphilic granular cell adenoma), resulting in a definite reduction in tumor volume. We suggest thatradiolodinetherapyfora recurrentoncocytomais an effectiveformof tumor therapy. J Nucl Med 29: 1126—1129,1988 oxic thyroid adenomas represent the only benign SecondAdmission(February2, 1985) lesions ofthe thyroid which have been reported to have From3 mo priorto thesecondadmission,thepatienthad been treated with radioactive iodine therapy (1—4). complained of pain and swelling at the same site due to Parotid oncocytoma, or oxyphilic granular cell ade recurrence. Iodine-l23 (1231)scintigraphy revealed extrathy noma, is an uncommon and benign tumor. It is known roidal accumulation in the recurrent left parotid mass. No activity was seen in the region of the thyroid gland. The that the parotid oncocytomas, as well as Warthin's recurrent tumor did not discharge 1231on washout by lemon. tumors, take up both radioiodine and pertechnetate The patient refuseda second surgicalprocedure. because they originate from salivary duct epithelium (5—9). Iodine-131 Therapy We have encountered an unprecedented case of a Before we tried a new approach of radioiodine
    [Show full text]
  • Parotid Adenoid Cystic Carcinoma: a Case Report and Review of The
    ancer C C as & e y Ilson et al., Oncol Cancer Case Rep 2015,1:1 g R o e l p o o c r t n Oncology and Cancer Case O ISSN: 2471-8556 Reports ResearchCase Report Article OpenOpen Access Access Parotid Adenoid Cystic Carcinoma: A Case Report and Review of the Literature Sepúlveda Ilson1*, Frelinghuysen Michael2, Platín Enrique3, Ortega Pablo4 and Delgado Carolina5 1Maxillofacial-Head and Neck Radiologist, ENT-Head and Neck Surgery Service, General Hospital of Concepcion, Chile 2Physician, Radiation Oncologist, Oncology Service, General Hospital of Concepcion, Chile 3Professor of Oral and Maxillofacial Radiology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA 4Physician, Otolaryngologist, ENT-Head and Neck Surgery Service, General Hospital of Concepcion, Chile 5Physician Pathologist, Pathology Department, General Hospital of Concepción, University of Concepcion School of Medicine, Concepcion, Chile Abstract We report on a patient who presented to the ENT service with swelling of the right side of the parotid gland. The swelling had been present for four years. Imaging studies revealed an expansive process confined to the superficial right parotid lobule. The affected area was well delineated with irregular enhancement post intravenous contrast media administration. Surgical biopsy concluded the presence of Adenoid Cystic Carcinoma. The patient was treated with adjuvant radiation therapy and follow up exams confirm there is no evidence of recurrence. Introduction Adenoid cystic carcinoma (ACC) is malignant epithelial tumors that most commonly occur between the 5th and 6th decades of life. It is a slowly growing but highly invasive cancer with a high recurrence rate. This tumor has the propensity for perineural invasion.
    [Show full text]
  • Adenoid Cystic Carcinoma of the Head and Neck– Literature Review 311
    Quality in Primary Care (2015) 23 (5): 309-314 2015 Insight Medical Publishing Group Research Article AdenoidResearch Article Cystic Carcinoma of the Head and Open Access Neck– literature review Pinakapani R, MDS Department of Oral Medicine and Radiology, Genesis Institute of Dental Science and Research, Ferozepur, Punjab. Nallan CSK Chaitanya, MDS, Ph.D Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences & Research Centre, Hyderabad Reddy Lavanya Senior Lecturer, Department of Oral Medicine and Radiology Panineeya Institute of Dental Sciences & Research Centre, Hyderabad Srujana Yarram Senior Lecturer, Department of Oral Medicine and Radiology Panineeya Institute of Dental Sciences & Research Centre, Hyderabad Mamatha Boringi Senior Lecturer, Department of Oral Medicine and Radiology Panineeya Institute of Dental Sciences & Research Centre, Hyderabad Shefali Waghray Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences & Research Centre, Hyderabad AbStRACt Adenoid cystic carcinoma (ACC) is a rare salivary gland ACCs have a good five year survival rate. Nevertheless, overall malignant neoplasm. Clinically it represents as an indolent survival rate drops after 5-year followup period. yet a persistent lesion, which shows propensity for late distant This review paper attempts understanding ACC – it’s clinical metastases, involving vital tissues often leading to the death presentation, management and factors affecting prognosis. of the patient. Its innoceous clinical presentation remains a diagnostic challenge. Keywords: Adenoid cystic carcinoma; Malignant salivary gland neoplasm; Perineural invasion. Till date surgery and radiotherapy still remain the main course of treatment. Despite advanced successful therapies these tumors Key Messages : This review deals with recent concepts are notoriously associated with loco regional recurrences.
    [Show full text]
  • Acinic Cell Carcinoma of the Salivary Gland: a Continuing Medical Education Case Diane A
    CME/MOC Section Editor: Daniel F. I. Kurtycz, M.D. Jointly sponsored by the University of Wisconsin School Authors: Robert T. Pu, M.D., Ph.D., Assistant Professor, of Medicine and Public Health, Office of Continuing Pro- Co-Director, UM Cancer Center Tissue Core, Department of fessional Development in Medicine and Public Health and Pathology, The University of Michigan Medical School, the Wisconsin State Laboratory of Hygiene. Ann Arbor, Michigan; Diane A. Hall, M.D., Ph.D., Surgical Statement of Need: To reinforce the diagnostic features Pathology Fellow, Department of Pathology, The University of medullary carcinoma and to reacquaint the reader with of Michigan, Ann Arbor, Michingan. the clinical laboratory tests needed to support this diagnosis. Educational Reviewer: Daniel F. I. Kurtycz, M.D., Pro- Target Audience: Cytopathologists, cytopathology fel- fessor, Department of Pathology and Laboratory Medicine, lows, and other healthcare professionals. Wisconsin School of Medicine and Public Health, Medical Learning Objectives: After completing this exercise, Director, Wisconsin State Laboratory of Hygiene. participants should be able to: Disclosure of Faculty Relationships: As a sponsor accredited by the ACCME, it is the policy of the University 1. Identify the general features of medullary carcinoma of Wisconsin School of Medicine and Public Health to of the thyroid. require the disclosure of the existence of any significant fi- 2. Describe the cytologic morphology of medullary nancial interest or any other relationship a faculty member carcinoma of the thyroid derived from Fine Needle or a sponsor has with either the commercial supporter(s) of Aspiration samples. this activity or the manufacturer(s) of any commercial 3.
    [Show full text]
  • S1609 Faq Upcoming Dart Cohort Closures As of 28
    S1609 FAQ 1 UPCOMING DART COHORT CLOSURES AS OF 24-SEP-2021 6:10 AM Up-coming Closure Closure # COHORT Name Date Type 40 Peritoneal mesothelioma 10/06/2021 Temporary CLOSED DART COHORTS AS OF 24-SEP-2021 6:10 AM 2 REGS. REGS. REGS. REGS. REGS. LAST LAST LAST LAST LAST # of # of TOTAL 12 6 3 30 7 ACT. CURR Closure Type # COHORT NAME REGS. Month Month Month DAYS DAYS INSTs IRBs Permanent 1 Epithelial tumors of nasal cavity, sinuses, nasopharynx 7 0 0 0 0 0 337 150 Close Permanent 2 Epithelial tumors of major salivary glands 30 0 0 0 0 0 Close Permanent 3 Salivary gland type tumors of head and neck, lip, esophagus, stomach, trachea and lung, breast and other location 6 0 0 0 0 0 Close Permanent 4 Undifferentiated carcinoma of gastrointestinal (GI) tract 6 1 0 0 0 0 Close Permanent 5 Adenocarcinoma with variants of small intestine 26 0 0 0 0 0 Close Permanent 6 Squamous cell carcinoma with variants of GI tract (stomach small intestine, colon, rectum, pancreas) 6 0 0 0 0 0 Close Permanent 7 Fibromixoma and low grade mucinous adenocarcinoma (pseudomixoma peritonei) of the appendix and ovary 10 0 0 0 0 0 Close Permanent 8 Rare Pancreatic tumors including acinar cell carcinoma, mucinous cystadenocarcinoma or serous 11 0 0 0 0 0 Close cystadenocarcinoma Permanent 9 Intrahepatic cholangiocarcinoma 9 0 0 0 0 0 Close Permanent 10 Extrahepatic cholangiocarcinoma and bile duct tumors 10 0 0 0 0 0 Close Permanent 13 Non-epithelial tumors of the ovary 25 0 0 0 0 0 Close Permanent 14 Trophoblastic tumor 3 0 0 0 0 0 Close Permanent 15 Transitional cell
    [Show full text]
  • Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: a Clinicopathologic and Immunophenotypic Study of 86 Cases
    Head and Neck Pathol DOI 10.1007/s12105-013-0487-3 ORIGINAL RESEARCH Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases Lester D. R. Thompson • Carla Penner • Ngoc J. Ho • Robert D. Foss • Markku Miettinen • Jacqueline A. Wieneke • Christopher A. Moskaluk • Edward B. Stelow Received: 14 July 2013 / Accepted: 23 August 2013 Ó Springer Science+Business Media New York (outside the USA) 2013 Abstract ‘Primary sinonasal tract and nasopharyngeal (n = 44), with a mean size of 3.7 cm. Patients presented adenoid cystic carcinomas (STACC) are uncommon equally between low and high stage disease: stage I and II tumors that are frequently misclassified, resulting in inap- (n = 42) or stage III and IV (n = 44) disease. Histologi- propriate clinical management. Eighty-six cases of STACC cally, the tumors were invasive (bone: n = 66; neural: included 45 females and 41 males, aged 12–91 years (mean n = 47; lymphovascular: n = 33), composed of a variety 54.4 years). Patients presented most frequently with of growth patterns, including cribriform (n = 33), tubular obstructive symptoms (n = 54), followed by epistaxis (n = 16), and solid (n = 9), although frequently a com- (n = 23), auditory symptoms (n = 12), nerve symptoms bination of these patterns was seen within a single tumor. (n = 11), nasal discharge (n = 11), and/or visual symp- Pleomorphism was mild with an intermediate N:C ratio in toms (n = 10), present for a mean of 18.2 months. The cells containing hyperchromatic nuclei. Reduplicated tumors involved the nasal cavity alone (n = 25), naso- basement membrane and glycosaminoglycan material was pharynx alone (n = 13), maxillary sinus alone (n = 4), or commonly seen.
    [Show full text]
  • FNA of Tumors of Unknown Primary in the Head and Neck Jeffrey F
    FNA of Basaloid Neoplasms of the Head and Neck Jeffrey F. Krane, MD PhD Professor of Pathology David Geffen School of Medicine at UCLA Overview • Case based approach • Basaloid tumors and closely related entities • Review – Common clinical presentations – Cytologic features – Adjunctive techniques as appropriate Basaloid Tumors • Sparse cytoplasm confers an immature appearance • Need to rely on other clues to classify – Chromatin – Matrix – Architecture/Smear pattern – Non-basaloid areas Two Main Scenarios • Basaloid salivary gland tumors • Basaloid metastases in neck lymph nodes Salivary Gland Tumors Salivary gland neoplasms Clinical Management • Superficial parotid gland is most common site • Benign tumor/Low-grade carcinoma Excision of the mass (partial parotidectomy) • High-grade carcinoma Radical surgery (complete parotidectomy) Neck dissection? Radiation therapy Challenging Salivary Gland Patterns Benign/LG Malignant HG Malignant • Oncocytic/Clear cell • High-grade • Spindle cell • Cystic/Mucinous Basaloid neoplasms Basaloid pattern is most problematic Differential diagnosis spans benign, low-grade and high-grade carcinomas Case 1: History • A 79 year-old woman with a 5 month history of a firm, mobile 2 cm non-tender parotid mass. Case 1 Case 1 Case 1 Case 1 Case 1 Case 1 Case 1: Diagnosis? A. Adenoid cystic carcinoma B. Basal cell adenoma C. Skin adnexal neoplasm D. Basaloid squamous cell carcinoma Case 1 Case 1: Diagnosis? Basal cell adenoma, membranous type Basaloid neoplasms: Differential Diagnosis • Benign: Basal cell adenoma,
    [Show full text]
  • Molecular and Cellular Modelling of Salivary Gland Tumors Open New Landscapes in Diagnosis and Treatment
    cancers Review Molecular and Cellular Modelling of Salivary Gland Tumors Open New Landscapes in Diagnosis and Treatment Cristina Porcheri * , Christian T. Meisel and Thimios A. Mitsiadis Orofacial Development and Regeneration, Institute of Oral Biology, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; [email protected] (C.T.M.); [email protected] (T.A.M.) * Correspondence: [email protected] Received: 4 October 2020; Accepted: 20 October 2020; Published: 24 October 2020 Simple Summary: This review elaborates the current knowledge on salivary gland tumors, with a specific focus on classical histological classification, cellular mechanisms and molecular pattern at the origin of the most common glandular malignancies. We dive into novel approaches for modeling, diagnosis and therapy, giving an overview of the biomedical advances for the study of salivary cancers. Thereby this review helps to understand the complexity of these malignancies and paves the way for novel and efficient treatments. Abstract: Salivary gland tumors are neoplasms affecting the major and minor salivary glands of the oral cavity. Their complex pathological appearance and overlapping morphological features between subtypes, pose major challenges in the identification, classification, and staging of the tumor. Recently developed techniques of three-dimensional culture and organotypic modelling provide useful platforms for the clinical and biological characterization of these malignancies. Additionally, new advances in genetic and molecular screenings allow precise diagnosis and monitoring of tumor progression. Finally, novel therapeutic tools with increased efficiency and accuracy are emerging. In this review, we summarize the most common salivary gland neoplasms and provide an overview of the state-of-the-art tools to model, diagnose, and treat salivary gland tumors.
    [Show full text]