Undifferentiated Carcinoma of the Parotid Gland in a 10-Month-old Child

Malignant salivary gland tumors in children are very rare. This report describes the autopsy of a child with parotid gland cancer. The patient, a 10 month old girl, was admitted to the Nagoya First Red Cross Hospital with facial nerve palsy. lncisional biopsy of a post-auricular tumor was performed, and undifferentiated carcinoma was diagnosed. The patient died 6 months later of respiratory failure due to pulmonary lymphangitis carcinomatosis. Light and electron microscopic and immunohistochemical examinations of the tumor tissue were performed. The tumor cells were arranged in a medullary, sheet-like manner. Keratinization or mucus lakes were not observed. PAS-alcian blue staining demonstrated intracytoplasmic mucus as granules, and also small intercellular droplets of mucus that might otherwise have been unnoticed. Ultrastructurally, some of the tumor cells had tonofilament-like keratin filaments, and also small hollow spaces bounded by microvilli and containing secretory particles. These were stained by antisera against CEA and keratin. These findings are suggestive of differentiation to mucoepider-moid carcinoma. We also review and discuss malignant salivary tumors of epithelial origin in children. Acta Pathol Jpn 40: 149–152, 1990.     

Neuroendocrine Differentiation in a Case of Acinic Cell Carcinoma of the Parotid Gland

We report a case of acinic cell carcinoma of the parotid gland with neuroendocrine differentiation. Light microscopically, the tumor appeared as clear cell-type acinic cell carcinoma. In addition, the tumor showed neurosecretory features such as Grimelius positivity and the presence of neurosecretory granules by electron microscopy. We suggest that a tumor cell arising from a stem cell can show simultaneous differentiation to both neuroendocrine and acinic cells.     

Epithelial-myoepithelial carcinoma harboring p53 mutation

A case of epithelial-myoepithelial carcinoma of the parotid gland harboring p53 mutation is reported. The tumor removed from a 67-year-old Japanese female was composed of an organoid biphasic population of cells: inner dark epithelial cells were surrounded by clear myoepithelial cells. The cells were immunopositive for EMA and smooth muscle actin, respectively. Some of the epithelial cells formed solid nests. Immunostaining for proliferating cell nuclear antigen (PCNA) resulted in a higher percentage of labeled cells in the solid epithelial region than in the region with the more general biphasic pattern. Genetic analysis, including polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) and nucleotide sequencing, revealed a mutation in codon 207 (aspartic acid to glycine) of the p53 tumor-suppressor gene. To our knowledge, this is the first report of a mutation in the p53 gene in an epithelial-myoepithelial carcinoma of the salivary gland.     

鼻咽癌患者SPECT腮腺功能的测定

目的探讨ＳＰＥＣＴ腮腺功能测定评价鼻咽癌患者不同设野放射治疗后腮腺功能损伤情况的可行性．方法选取 ３１例鼻咽癌患者作研究对象,行单纯放射治疗,其中 ２０例行双耳前野放疗, １１例行双耳前野加鼻前野放疗．患者在放疗前和放疗后均用ＳＰＥＣＴ检测其腮腺功能．结果常规鼻咽双耳前野加鼻前野放射治疗和双耳前野放射治疗的腮腺摄取功能极度损伤率分别为４．５％（１／２２）和２７．５％（１１／４０）;排泌功能极度损伤率分别为３６．４％（８／２２）和６５．０％（２６／４０）,两对照组比较均有统计学差异（ｐ＜０．０５）．结论ＳＰＥＣＴ腮腺功能测定是评价鼻咽癌患者放射治疗后腮腺功能损伤程度的敏感、适用的方法;腮腺损伤以排泌功能损伤为主,放射剂量愈大,腮腺的摄取和排泌功能损伤愈严重．     

Helioid Inclusions in Dedifferentiated Acinic Cell Carcinoma of the Parotid Gland

Helioid bodies are exceedingly rare, intranuclear, rounded inclusions with peripheral radiating filaments. These structures, which were formerly observed in only three cases of proliferative breast epithelial lesions, appeared in 0.5–1% of the neoplastic cells of a case of dedifferentiated acinic cell carcinoma of the parotid gland. Helioid bodies are related to rough endoplasmic reticulum cisternae, which suggests that they are the result of the condensation and partial crystallization of their contents when sequestrated into the nuclear compartment of the cell. The presence of helioid bodies may be related to secretory dysfunction of the tumor cells associated with the process of neoplastic dedifferentiation.     

Helioid Inclusions in Dedifferentiated Acinic Cell Carcinoma of the Parotid Gland

Helioid bodies are exceedingly rare, intranuclear, rounded inclusions with peripheral radiating filaments. These structures, which were formerly observed in only three cases of proliferative breast epithelial lesions, appeared in 0.5-1% of the neoplastic cells of a case of dedifferentiated acinic cell carcinoma of the parotid gland. Helioid bodies are related to rough endoplasmic reticulum cisternae, which suggests that they are the result of the condensation and partial crystallization of their contents when sequestrated into the nuclear compartment of the cell. The presence of helioid bodies may be related to secretory dysfunction of the tumor cells associated with the process of neoplastic dedifferentiation.     

咽旁间隙腮腺入路的应用解剖学研究

目的 :为咽旁间隙肿瘤的外科手术提供解剖学基础。方法 :选用成人尸体头颈部 10例 2 0侧 ,模拟手术入路 ,按层次解剖方法解剖观察、测量其相关结构。结果 :咽旁间隙被茎突及茎突诸肌分为咽旁前、后间隙 ,咽旁前间隙内有腭帆提肌、腭帆张肌等 ,咽旁后间隙内有颈内动、静脉 ,第Ⅸ、Ⅹ、Ⅺ、Ⅻ脑神经等。茎突是达咽旁间隙的重要解剖标志 ,其外侧主要结构是腮腺及穿经腮腺的结构 ,间隙内容均位于茎突内侧 ,茎突与颈静脉孔相距 2 .98± 1.42mm。结论 :咽旁间隙的应用解剖对咽旁间隙肿瘤的外科手术具有重要的指导意义。     

Multifocal nodular oncocytic hyperplasia of bilateral parotid glands: A case report with a histological variant of clear cells

A case of multifocal nodular oncocytic hyperplasia (MNOH) of the bilateral parotid gland is presented. An 80-year-old woman was admitted to hospital because of painless swellings in bilateral parotid regions. Histologically, the nodular lesion had incomplete capsules and engulfed the surrounding parotid gland at the periphery. The lesions were mostly composed of clear cells, while the peripheries of the lesions had typical oncocytic cells with abundant fine granules. The histological existence of the clear cell component in the lesions led to misdiagnoses of other clear cell neoplasms. However, this case had multiple nodules in bilateral glands. No evidence of malignant histological findings was found. Moreover, the clear cells, as well as the oncocytic cells, were demonstrated to have mitochondria and glycogen in their cytoplasm using special staining. Based on these findings, the diagnosis of this case was MNOH in the parotid gland. We also discuss the differential diagnosis for clear cell lesions.     

Motor and Secretory Effects of Nerves on the Parotid Gland of the Rat

The influence of parasympathetic and sympathetic nerves on the parotid gland of the rat was investigated. It was found that both divisions of the autonomic nerves evoke secretion and probably also motor effects in this gland. Secretion elicited on sympathetic stimulation was mediated both via α- and β-adrenoceptors, while motor effects were mediated via α-adrenoceptors. On stimulation of the autonomic nerves a lower duct pressure was reached in the parotid than in the submaxillary gland, and on sympathetic nerve stimulation the flow of saliva always started later from the parotid than from the submaxillary gland. These findings are discussed in the view of the different arrangement of the myoepithelial cells in the 2 glands.     

Ultrastructural and Immunohistochemical Study of Salivary Duct Carcinoma of the Parotid Gland

A case of salivary duct carcinoma of the parotid gland found in an 81-year-old man was studied by light microscopy, immunohistochemistry, and electron microscopy. Histologically, the tumor was composed of elongated cords of cells and ductal structure with desmoplastic stromal reaction. Tumor cell nests sometimes showed central comedonecrosis. Immuno-histochemically, the tumor cells were positive for cytokeratin and epithelial membrane antigen, and they were negative for S-100 protein and muscle-specific actin. Electromicroscopi-cally, two cell types were identified. The first cell type showed electron-lucent cytoplasm with scant organelles. The second type cell contained numerous mitochondria. Neither acinar nor myoepithelial cell differentiation was observed. These findings suggest that salivary duct carcinoma originates from the interlobular or excretory ducts.     

Tubular-Trabecular Type Basal Cell Adenoma of the Parotid Gland: A Patient Report

Basal cell adenoma (BCA) is an uncommon benign salivary gland neoplasm that includes isomorphic basaloid cells. We report on a female patient with BCA that developed in the right parotid gland in her 50s. The present patient demonstrated a few tumor nests in the fibrous capsule, and her tumor was larger than usual. These facts made us suspect of malignancy. Histopathologically, the tumor was characterized by multiple duct-like structures and tubular-trabecular masses composed of small isomorphic cells with hyperchromatic, round nuclei and an eosinophilic cytoplasm. It was difficult to determine whether the ductal structures noted in the tumor capsule were invasive. By immunohistochemistry, tumor cells of the tubular nests were positive for cytokeratin 7 and that the outer cells of tubular nests were positive for alpha smooth muscle actin (αSMA) and calponin. Tumor cells were immuno-negative for S-100 protein and glial fibrillary acidic protein. The Ki-67 labeling scores of the cells were extremely low (< 1%). We could achieve an accurate diagnosis of BCA by immunohistochemistry with MIB-1 and other markers.     

Primary myoepithelial carcinoma of the lung: a case report and review of literature

Primary myoepithelial carcinoma of the lung is a very rare tumor arising from the salivary glands of the respiratory epithelium. Since it was first described by Higashiyama et al. in 1998, to the best of our knowledge, only eight actual cases reported in the English-language literature so far. The diagnosis is based entirely on histological and immunohistochemical evaluations. We report a primary myoepithelial carcinoma in a smoker 47-year-old Chinese man, who was referred to our institution for hemoptysis. Computed tomography revealed a 65 mm×78 mm solid mass in the left lower lobe of lung. The patient underwent the left lower lobe resection. The final histopathological diagnosis was primary myoepithelial carcinoma of the lung. Given the rare occurrences of this tumor, appropriate recommendations for treatment are difficult to formulate. Although classified as low-grade tumor, it has a significant rate of distant metastasis. Herein we report a case of a primary myoepithelial carcinoma of the lung and present a brief review of the literature.     

Altered Serous Granules in Acinar Cells of a Human Parotid Gland

A peculiar alteration of secretory granule morphology was observed in serous cells of the parotid gland from a patient undergoing radical neck surgery for oral cancer. The granules were half filled with a dense material that in early stages of formation appeared to consist of filaments or fine tubules. Growth of these apparently rigid fibrillar structures caused the formation of long pseudopo-dia on the granule surface. Granule alterations were not due to preoperative treatment because the patient had had none. It is postulated that the granule alterations were due to a perturbation in granule composition, possibly because of a genetic mutation that led to changes in one or more of the proline-rich proteins that normally reside in parotid serous granules.     

Clear cell malignant myoepithelioma of the salivary glands

Previous reports of monomorphic clear cell carcinoma of the salivary glands have shown inconsistent results with immunohistochemistry, especially for S-100 protein, and this has led to uncertainty about the nature of these tumours. We believe that much can be explained by considering this group as comprising not one but two separate neoplasms, one epithelial and the other myoepithelial. The former has been described as hyalinizing clear cell carcinoma—it generally occurs in the minor salivary glands, and strongly expresses cytokeratins but not S-100 protein or α smooth muscle actin. In contrast, this study presents five primary malignant tumours of the major salivary glands also composed largely of a single population of clear cells, but displaying histological and immunohistochemical features of myoepithelial differentiation, such as the formation of collagenous spherules and expression of S-100 protein and actin. A small number of similar tumours have been reported previously. We, therefore, believe that these neoplasms represent a clear cell variant of malignant myoepithelioma (myoepithelial carcinoma).     

Multiple Unrelated Translocations in a Metastatic Epimyoepithelial Carcinoma of the Parotid Gland

We report the cytogenetic, fluorescence in-situ hybridization (FISH) and DNA flow cytometric analysis of a rare metastatic epimyoepithelial carcinoma of the parotid gland to the lung with a clinical course of 29 years. DNA content and FISH analyses of tumor and short-term culture cells showed diploid DNA content and lack of numerical chromosomal abnormalities. Immunohistochemical analysis of the short-term culture cells showed predominantly keratin positive and sparse desmin staining supporting an epithelial rather than myoepithelial origin. Cytogenetic analysis showed 46,XY karyotype with clonal translocations of t(3;22)(q13.2;q13.1), t(1;7)(q21;q22), t(8;9)(p10;p10), and t(5;6) (q35;q21). Our findings indicate that these alterations developed in a diploid stemline during tumor progression and in the epithelial component of this tumor.     

The Action of Dibutyryl Adenosine-3‘:5’-Cyclic Monophosphoric Acid and Theophylline on the Isolated Cat Parotid Gland

In the isolated cat parotid gland intraarterially applied dibutyryl cyclic AMP (db-CAMP) (1.0 mM) produced a slow, but often maintained salivary flow. db-CAMP was also able to potentiate secretion evoked by supramaximal doses of intraarterially applied acetylcholine. Similar secretory effects were obtained also after intraarterial application of theophylline (1.0 mM). The secretory responses due to db-CAMP or theophylline were unaccompanied by measurable acinar membrane potential changes and stayed unchanged after cutting the parasympathetic innervation of the gland and after blocking both cholinergic and β-adrenergic receptors with atropine (10^--⁷ M), and with D-(-)-N-isopropyl-p-nitrophenol-ethanol-amine (INPEA) (10^--⁵ M), respectively. The possibility of the existence of an acinar adenylate cyclase system functionally linked to the β-adrenergic membrane receptor is discussed.     

Myoepithelial Carcinoma Arising in a Benign Myoepithelioma: Immunohistochemical, Ultrastructural, and Flow-Cytometrical Study

A case of myoepithelial carcinoma arising in a benign myoepithelioma of the minor salivary gland in a 71-year-old patient is reported. The tumor presented initially on the palate and had been diagnosed as “benign lesion” 40 years before. It recurred 22, 36, and 40 years after initial presentation, and a similar histopathological diagnosis was rendered. One year after the last recurrence, the tumor recurred showing typical changes of malignant transformation, and the diagnosis was malignant myoepithelioma. The light microscopy and ultra-structural features of the initial tumor were typical of plasmocytoid myoepithelioma. There were abundant round cells and rare spindle cells with uniform dispersed filaments, sometimes arranged in parallel streams without evidence of dense bodies. These cells showed micropinocytotic vesicles along the cell membrane with poorly developed intercellular junctions and were surrounded by a basal membrane. The malignant counterpart showed fewer plasmocytoid cells and a rather epithelial pattern with marked nuclear pleomorphism and formation of small, or rarely large, glandular lumina. The immunohistochemical features were similar for the benign and malignant tumors, with positivity for S-100 protein, vi-mentin, cytokeratins, and CAM 5.2, and were negative for GFAP, muscle-specific actin, CEA, and desmin. Flow cytometry showed a change in the DNA content profile. The benign myoepithelioma had a diploid DNA content with a low S-phase fraction of 3.9% and proliferative index of 9.1%, while the myoepithelial carcinoma had an evident aneuploid DNA stem line and an increased S-phase fraction of 8.3% with a proliferative index of 18.1%.     

Expression of Autophagy and Reactive Oxygen Species-Related Proteins in Lacrimal Gland Adenoid Cystic Carcinoma

PurposeTo investigate the difference of expression of autophagy and reactive oxygen species (ROS) related proteins in adenoid cystic carcinoma (ACC) of lacrimal gland in comparison with ACC of salivary gland.ResultsGSTpi in stromal cells was more highly expressed in lacrimal gland ACC (p=0.006), however, MnSOD in epithelial cells was expressed more in salivary gland ACC (p=0.046). LC3B positivity and BNIP3 positivity in epithelial component were associated with shorter disease-free survival (both p=0.002), and LC3A positivity in stromal component was the factor related to shorter OS (p=0.005).ConclusionThis is the first study to demonstrate the expression of autophagy and ROS related proteins in lacrimal gland ACC in comparison with the salivary gland ACC, which would provide a basis for further study of autophagy and ROS mechanism as novel therapeutic targets in lacrimal gland ACC.     

Renal Cell Carcinoma Metastatic to a Pituitary FSH/LH Adenoma: Case Report and Review of the Literature

Abstract

Metastases to the pituitary occur more frequently in patients with widespread cancer and mainly involve the posterior lobe. A few cases of metastatic carcinoma to a pituitary adenoma have been described so far. Here, the authors present an additional case of a clear cell renal cell carcinoma (CCRCC) metastatic to a FSH/LH/α-subunit pituitary adenoma and systematically review the literature. Immunohistochemistry and electron microscopy were performed to characterize both neoplastic components at the morphological level. Moreover, it was hypothesized that expression of VEGF and of the corresponding receptor VEGFR1 could be implicated in the development of the carcinomatous metastasis within the adenoma.