Adenoid Cystic Carcinoma with Transformation to High Grade Carcinomatous and Sarcomatoid Components: A Rare Case Report with Review of Literature

Dutta, Anupurva; Arun, Pattatheyil; Arun, Indu

doi:10.1007/s12105-019-01120-3

Cited by 10 publications

(9 citation statements)

References 35 publications

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“…However, in view of the complexity of diagnostic criteria emphasized by the subjective descriptive features, very few cases are likely to satisfy the diagnosis of HGT. Indeed, most previous studies have been case reports or small series (24). In a large series with 135 cases of salivary gland ACC, there were only 16 cases with HGT (22).…”

Section: Discussionmentioning

confidence: 99%

Exploration of High-Grade Transformation and Postoperative Radiotherapy on Prognostic Analysis for Primary Adenoid Cystic Carcinoma of the Head and Neck

Zhu

Xue

et al. 2021

Front. Oncol.

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BackgroundDespite Adenoid cystic carcinoma (ACC) with cribriform or tubular components being recognized as a potentially indolent malignancy, ACC displaying solid or, more rarely, high-grade transformation (HGT) components is considered a more aggressive variant of the disease. As it is difficult to measure the proportion of the solid component objectively, and the role of HGT in the current grading system remains unclear, the prognostic influence of tumor grading remains controversial. In addition, postoperative radiotherapy (PORT) has been proven to be effective in local control of ACC of the head and neck (ACCHN) with a high rate of nerve invasion and close surgical margin. However it remains to be explored that whether PORT could improve the survival of patients with ACC, particularly those with HGT.MethodsA series of 73 surgically treated primary ACCHN cases were retrospectively accessed. Immunohistochemical staining was performed to observe the biphasic ductal-myoepithelial differentiation and to identify the HGT components of ACC for tumor grading. The correlation between tumor grading and clinicopathological characteristics was analyzed. Univariate and multivariate prognostic analysis were performed for progression-free survival (PFS) and overall survival (OS).ResultsOf the 73 included cases, 47 were grade I-II ACC and 26 were grade III ACC. Among the grade III cases, 14 with loss of biphasic ductal-myoepithelial differentiation identified by immunostaining were classified as HGT, and could be distinguished from conventional grade III cases. These HGT cases were correlated with a high propensity of lymph node metastases and more advanced stage. Univariate analysis demonstrated that tumor grading, perineural invasion, T stage, stage groups, and PORT were predictors for PFS, whereas tumor grading, margin status, and PORT were predictors for OS. However, only tumor grading and PORT were independent predictors for PFS and OS. The patients with HGT had significantly worse prognosis than those with conventional ACC. Moreover, disease progression tended to occur more frequently in younger patients. Among the patients with HGT, those who received PORT had a longer median survival time than those who did not.ConclusionHGT ACC identified by loss of biphasic differentiation should be considered in tumor grading. Tumor grading and PORT were independent predictors for disease progression and OS in surgically treated ACCHN patients.

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Section: Discussionmentioning

confidence: 99%

Exploration of High-Grade Transformation and Postoperative Radiotherapy on Prognostic Analysis for Primary Adenoid Cystic Carcinoma of the Head and Neck

Zhu

Xue

et al. 2021

Front. Oncol.

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“…In our data, the only patient who died of PCACC was the case with ACC with HGT. The median survival time for patients with ACC–HGT is estimated to be 12 months, 15,18,20,21,34–43,45,48–51,54–62 while median survival time for grade III ACC is approximately 3 years 14,21,28,63–68 …”

Section: Discussionmentioning

confidence: 99%

Primary cutaneous adenoid cystic carcinoma: a clinicopathologic, immunohistochemical, and fluorescence in‐situ hybridisation study of 13 cases

Ren

Cai

et al. 2021

Histopathology

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Aims This study aimed to investigate the clinical, histological, immunohistochemical and chromosomal features of primary cutaneous adenoid cystic carcinoma (PCACC). Methods and results We retrospectively analysed 13 cases identified on their clinicopathological features and performed fluorescence in‐situ hybridisation (FISH) on six available cases. Head and neck (46.2%) were most commonly involved. The median age was 53 years, with a male predilection. Histologically, tumours were classified as grades 1 (eight), 2 (four) and 3 with high‐grade transformation (HGT) (one). The HGT component was demonstrated as poorly differentiated carcinoma with multifocal necrosis and myoepithelial differentiation. Patients with one of the following factors: longest diameter of the lesion (≥ 1 cm), involvement of subcutaneous fat tissue and widely infiltrative border had a relatively higher rate of local recurrence, distant metastasis and death. Five of six cases were confirmed to have MYB translocation, while nuclear staining for MYB proto‐oncogene, transcription factor (MYB) protein was found in four cases. During the follow‐up (median = 64 months), two patients experienced local recurrences. One patient, who was classified as grade III PCACC with HGT, developed multiple metastases and died of disease. Another patient was alive with multiple metastases. Conclusions This is the largest single‐institution study, to our knowledge, of PCACC in an Asian population. We describe the first case of scalp PCACC with HGT, which is the only death case in our series. PCACC tends to recur locally and has metastatic potential. PCACC with HGT has a poor prognosis.

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“…The cytomorphologic findings of HGT from previous reports are summarized in Table 3. [10][11][12][13][14][15][16][17] Among 8 single case reports, all FNA specimens, except for 1 report of metastatic SGC with HGT in pleural effusion cytology, 17 were from primary salivary gland tumors. [10][11][12][13][14][15][16] All reported FNA specimens were diagnosed as malignant.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15][16][17] Among 8 single case reports, all FNA specimens, except for 1 report of metastatic SGC with HGT in pleural effusion cytology, 17 were from primary salivary gland tumors. [10][11][12][13][14][15][16] All reported FNA specimens were diagnosed as malignant. A retrospective analysis of the reported cases revealed 2 morphological components-a lower-grade conventional carcinoma and a component with HGT-in 6 cases, solely cells from the HGT component in 1 case, and solely cells from the conventional component in 1 case.…”

Section: Discussionmentioning

confidence: 99%

“…4,[6][7][8] Preoperative recognition of a high-grade component by fine needle aspiration (FNA) would therefore be useful for patient prognostication as well as for influencing patient management, including presurgical planning. 9 Despite wide recognition of this disease concept, only a few case reports describing the cytological features of SGC with HGT have been published, [10][11][12][13][14][15][16][17] and comprehensive FNA case series are lacking. Using a multi-institutional approach, we describe the clinical and cytomorphologic features of the largest FNA series of SGC with HGT and provide a comprehensive review of the literature.…”

Section: Introductionmentioning

confidence: 99%

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Fine needle aspiration of salivary gland carcinomas with high‐grade transformation: A multi‐institutional study of 22 cases and review of the literature

Nakaguro

Faquin

Baloch

et al. 2020

Cancer Cytopathology

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Background High‐grade transformation (HGT) is a rare process whereby conventional low‐ to intermediate‐grade salivary gland carcinomas (SGC) transform into high‐grade, poorly or undifferentiated malignancies with focal or complete loss of their conventional histomorphologic features. Because tumors with HGT are associated with a worse prognosis than their conventional counterparts, preoperative recognition of HGT may be of benefit for optimal patient management. Using a multi‐institutional approach, we describe the largest fine needle aspiration (FNA) cohort of salivary gland carcinomas with HGT. Methods The archives of 9 large academic medical centers were searched, and 22 cases of SGC with HGT were identified by surgical excision accompanied by preoperative FNA. Clinical and cytomorphologic features were retrospectively reviewed. Results The male‐to‐female ratio was 14:8, and the mean patient age was 60.2 years. The average tumor size was 3.6 cm, and 19 cases were from the parotid gland. Acinic cell carcinoma with HGT was the most common tumor subtype, comprising 12 cases with HGT, followed by adenoid cystic carcinoma, secretory carcinoma, and other subtypes. Eighteen cases were classified as malignant; however, a specific diagnosis of HGT was not made. Sixteen cases contained a high‐grade cytologic component, and 7 cases had a mixture of both conventional and high‐grade components retrospectively. Conclusions SGC with HGT should be considered in the differential diagnosis of a salivary gland aspirate exhibiting high‐grade cytomorphologic features. The presence of distinct tumor populations, conventional and high‐grade, should prompt consideration of HGT, especially when the conventional component is acinic cell carcinoma or adenoid cystic carcinoma.

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Adenoid Cystic Carcinoma with Transformation to High Grade Carcinomatous and Sarcomatoid Components: A Rare Case Report with Review of Literature

Cited by 10 publications

References 35 publications

Exploration of High-Grade Transformation and Postoperative Radiotherapy on Prognostic Analysis for Primary Adenoid Cystic Carcinoma of the Head and Neck

Exploration of High-Grade Transformation and Postoperative Radiotherapy on Prognostic Analysis for Primary Adenoid Cystic Carcinoma of the Head and Neck

Primary cutaneous adenoid cystic carcinoma: a clinicopathologic, immunohistochemical, and fluorescence in‐situ hybridisation study of 13 cases

Fine needle aspiration of salivary gland carcinomas with high‐grade transformation: A multi‐institutional study of 22 cases and review of the literature

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