Top 10 Clear Cell Head and Neck Lesions to Contemplate

Kakkar, Aanchal

doi:10.1007/s12105-022-01518-6

Cited by 2 publications

(1 citation statement)

References 85 publications

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“…The underlying cause of the clear-cell phenotype is believed to stem from intracytoplasmic deposits of glycogen or lipids. While the histologic manifestation of clear-cell change appears to have limited prognostic significance, it poses a significant challenge in terms of differential diagnoses, as follicular thyroid tumors, PTC, MTC, metastatic renal cell carcinoma, and parathyroid tumors all may present with these rare features [30][31][32][33][34].…”

Section: Other Forms Of Cellular Atypiamentioning

confidence: 99%

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Juhlin,

Baloch

2023

Acta Cytologica

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Background: Thyroid nodules are prevalent among the general population, thus imposing substantial demands upon healthcare providers to establish effective management paradigms when investigating these lesions. A pivotal component in the diagnostic process involves the cytomorphologic evaluation of fine needle aspiration (FNA) specimens extracted from the nodule under scrutiny. This examination serves the critical purpose of enabling a comprehensive assessment for the risk of either a neoplasm or malignancy, thereby providing the clinical team with the requisite information to render decisions regarding potential surgical intervention and/or a structured clinical follow-up. A subset of FNA specimens obtained from the thyroid gland present a vexing challenge for interpretation and cannot be classified based on cytomorphology as either benign or malignant and are classified as “indeterminate” for neoplasm or malignancy. The indeterminate thyroid FNA diagnosis in the third iteration of the Bethesda classification are termed as "atypia of undetermined significance" (AUS). Summary: The thyroid FNA specimens classified as “atypical” constitutes a perplexing category, necessitating considerations such as repeated cytological evaluations, supplementary molecular analyses, diagnostic lobectomy, or vigilant surveillance. This review article draws upon the most recent Bethesda classification guidelines and delineates various potential pitfalls encountered during the interpretation of atypia observed in thyroid fine needle aspiration and histopathologic counterparts. Additionally, it proffers strategic algorithms devised to effectively navigate these diagnostic challenges.

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Section: Other Forms Of Cellular Atypiamentioning

confidence: 99%

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Juhlin,

Baloch

2023

Acta Cytologica

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Clear Cell Squamous Cell Carcinoma of the Maxillary Gingiva Associated with PIK3CA and HRAS Mutations: Report of a Case and Literature Review

Hirose,

Shibahara,

Teramoto

et al. 2023

Head and Neck Pathol

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Background Squamous cell carcinoma (SCC) is the most common oral malignancy, and somatic mutations in some driver genes have been implicated in SCC development. Clear cell SCC (CCSCC) is a rare histological variant of SCC, and various clear cell neoplasms must be considered in the differential diagnosis of CCSCC in the oral cavity. Based on a limited number of CCSCC cases reported in the oral cavity, CCSCC is considered an aggressive variant of SCC with a poor prognosis; however, its genetic characteristics remain unknown. Methods A maxillary gingival tumor in an 89-year-old female was described and investigated using immunohistochemical staining, special staining, fluorescence in situ hybridization, and next-generation sequencing (NGS) with a custom panel of driver genes, including those associated with SCC and clear cell neoplasm development. Results Histopathological examination revealed a proliferation of atypical epithelial cells with abundant clear cytoplasm and enlarged and centrally placed round nuclei. The tumor was exophytic with deep, penetrating proliferation. The atypical clear cells were continuous with the conventional SCC cells. Immunohistochemical analysis showed that the clear cells were positive for CK AE1/AE3 and CK5/6 and nuclear-positive for p63. In contrast, the clear cells were negative for αSMA, S100, HMB45, Melan-A, CD10, and p16. p53 immunoreactivity exhibited a wild-type expression pattern. Additionally, the clear cells were positive for periodic acid-Schiff (PAS) and negative for diastase-PAS, mucicarmine, and Alcian blue. Based on these results, the diagnosis of CCSCC was confirmed. Molecular analysis of the clear cells identified PIK3CA p.E542K (c.1624G>A) and HRAS p.G12A (c.35 G>C) somatic mutations classified as oncogenic. No pathogenic variants were identified in TP53, EWSR1, AKT1, PTEN, BRAF, KRAS, NRAS, RASA1, or MAML2. Conclusions We report a case of CCSCC of the oral cavity with PIK3CA and HRAS mutations. The identification of PIK3CA and/or HRAS mutations is rare in SCC; however, both mutations are important potential targets for antitumor therapy. A detailed analysis of gene mutations in CCSCC may lead to a better understanding of its biological behavior and an improved prognosis, as well as a differential diagnosis from other clear cell neoplasms.

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Top 10 Clear Cell Head and Neck Lesions to Contemplate

Cited by 2 publications

References 85 publications

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Clear Cell Squamous Cell Carcinoma of the Maxillary Gingiva Associated with PIK3CA and HRAS Mutations: Report of a Case and Literature Review

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