High-Grade Transformation (“Dedifferentiation”)—Malignant Progression of Salivary Gland Neoplasms, Including Carcinoma ex Pleomorphic Adenoma

Petersson, Fredrik

doi:10.1097/pcr.0000000000000076

Cited by 13 publications

(10 citation statements)

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“…The concept of carcinomas progressing into more poorly differentiated versions of themselves, whereby the original line of differentiation is no longer evident, is universally acknowledged in SG pathology, where most experts prefer the term high-grade transformation (HGT). 36,37 HGT in ACC confers more aggressive behavior leading to higher local recurrence rates, increased regional or distant metastasis, and poorer clinical outcomes. 1,38,39 A retrospective review of the cytomorphology from our ACC-HGT cases showed nonspecific features of large nuclei, higher nuclear to cytoplasmic ratios, and nondescript cytoplasm resembling an adenocarcinoma of no special type in all but 1 case (13%) in which the features of both conventional Cancer Cytopathology December 2021 ACC and ACC-HGT were present.…”

Section: Discussionmentioning

confidence: 99%

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

Wakely

Lott-Limbach

2021

Cancer Cytopathology

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BACKGROUND:Although largely readily recognizable in tissue sections, acinic cell carcinoma (ACC) remains diagnostically problematic in fine-needle aspiration (FNA) cytopathology. The authors undertook an analysis of a large series of ACC aspirates, including acinic cell carcinoma with high-grade transformation (ACC-HGT). METHODS: The authors searched their cytopathology files for ACC cases with histopathologic confirmation. FNA biopsy was performed according to standard techniques. RESULTS: Fifty FNA biopsy cases of ACC (including 36 of parotid origin [72%]) from 41 patients (female to male ratio, 1.4:1; age range, 23-84 years; average, 54 years) met the study inclusion requirements. Primary neoplasm aspirates were most common (72%), and they were followed by recurrent tumors (16%) and metastases (12%). A precise cytologic diagnosis was made for 64%. Three of 9 ACC-HGT cases (33%) were correctly interpreted as such; 98% of conventional ACC cases were correctly graded as low-grade. With the Milan classification system, 74% fit into the malignant category.Ancillary testing was performed for only 36%. Conventional ACC had moderately to highly cellular smears; monotonous cells in aggregates and single forms; rounded nuclei; and microvacuolated, finely granular, oncocyte-like, or nonspecific cytoplasm. ACC-HGT smears contained larger nuclei, high nuclear to cytoplasmic ratios, coarse nuclear chromatin, and a loss of cytoplasmic granules/vacuoles. CONCLUSIONS: A correct diagnosis of ACC via FNA biopsy was made in almost two-thirds of the cases. With the Milan classification, 84% of the cases would have been classified as malignant or suspicious for malignancy. An absence of conventional serous acinar cell morphology in some cases as well as an absence of ancillary immunohistochemistry testing in almost two-thirds of the cases prevented even better diagnostic performance. Cancer

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Section: Discussionmentioning

confidence: 99%

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

Wakely

Lott-Limbach

2021

Cancer Cytopathology

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“…Dedifferentiation/HGT is an unusual phenomenon that has been described in a variety of salivary gland carcinomas, including acinic cell carcinoma, epithelial-myoepithelial carcinoma, polymorphous low-grade adenocarcinoma, myoepithelial carcinoma, mucoepidermoid carcinoma, hyalinising clear cell carcinoma, mammary analogue secretory carcinoma, low grade cribriform cystadenocarcinoma and AdCC [1]. The term "dedifferentiation" has been applied traditionally to sarcomas and was first coined by Dahlin and Beabout in reference to the abrupt transition of low-grade chondrosarcoma to a histologically different high-grade sarcoma [2].…”

Section: Introductionmentioning

confidence: 99%

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

Dutta

Arun

2020

Head and Neck Pathol

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Adenoid cystic carcinoma (AdCC) comprises of less than 1% of all head and neck cancers and less than 10% of all salivary gland neoplasms. Dedifferentiation/high-grade transformation (HGT) in AdCC is a rare but well known phenomenon which is associated with aggressive clinical behaviour and poor prognosis. We herein report the clinical, cytologic, histologic and immunohistochemical findings of a left submandibular gland AdCC with transformation to high grade carcinomatous and probable dedifferentiation to sarcomatoid component, occurring in a 64 year old male patient. To the author's best knowledge, this is the first case report of such dual transformation occurring in adenoid cystic carcinoma.

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“…From a clinical perspective, HGT is known to impart more aggressive biologic behavior and a worse prognosis than conventional low‐ to intermediate‐grade SGC 4,6‐8 . 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 .…”

Section: Introductionmentioning

confidence: 99%

“…4,5,7 From a clinical perspective, HGT is known to impart more aggressive biologic behavior and a worse prognosis than conventional low-to intermediate-grade SGC. 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.…”

Section: Introductionmentioning

confidence: 99%

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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High-Grade Transformation (“Dedifferentiation”)—Malignant Progression of Salivary Gland Neoplasms, Including Carcinoma ex Pleomorphic Adenoma

Cited by 13 publications

References 138 publications

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

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

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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