Diagnosis Of Salivary Duct Carcinoma Research Articles

A case of salivary duct carcinoma possibly arising from pleomorphic adenoma

Objective: We report a rare case of salivary duct carcinoma possibly arising from the malignant component of carcinoma ex pleomorphic adenoma.
 Methods: A 56-year-old Japanese male complained of swelling in the left side of jaw for 2 years which was painless until 2 days ago. On extraoral examination, the face was bilaterally asymmetrical. An ultrasonography revealed hypoechoic mass of size 1.5x2.5x2.5 cm on left parotid gland. Computed tomography (CT) revealed a slight irregular mass on left parotid gland with no infiltration to adjacent tissues. Based on these findings, a clinical diagnosis of left parotid benign tumor was made.
 Results: A surgical excision was performed under general anesthesia. On histopathological examination, the connective tissue was rich in fibrous components and was accompanied by hyaline. Epithelial cells with high atypia proliferating invasively as cords into connective tissue were observed. The intraductal component had Roman-bridge-like architecture with central portion undergoing comedonecrosis. Based on these findings, a final diagnosis of salivary duct carcinoma possibly arising from pleomorphic adenoma was made. p16 hypermethylation is a known phenomenon in oral malignancy. We also checked the methylation status of p16 gene and found high level of methylation in this tumor.
 Conclusion: We reported a rare case of salivary duct carcinoma possibly arising from pleomorphic adenoma and also demonstrated high methylation level of p16 gene in the tumor.

Salivary duct carcinoma- Role of accurate diagnosis for an accurate therapy

Salivary duct carcinoma is an aggressive subtype of primary salivary gland carcinoma with advanced stage at presentation, high rates of metastasis and recurrence. It is most commonly seen in parotid gland of older men with microscopic resemblance to high-grade breast ductal carcinoma. Salivary duct carcinoma mainly affects men over 50 years of age and accounts for 5% to 10% of all salivary gland malignancies. Characteristic histomorphology and immunohistochemical expression of Androgen Receptor (AR) aids the diagnosis of salivary duct carcinoma. Fine-needle aspiration typically reveals cytologic features of high-grade carcinoma. Heterologous alterations have been recognized in oncogenes and tumor suppressor genes such as TP53, HRAS, PIK3CA, PTEN, and BRAF as well as AR and HER2. Targeted therapy against these genes may help in broadening treatment options for salivary duct carcinoma. Salivary Duct Carcinoma is one of the most aggressive salivary malignancies with 33% local recurrence and 45% metastasis. We report a case of a 75 years old female patient, who presented with a swelling obliterating the retromandibular groove. FNAC & histopathology confirmed the diagnosis of salivary duct carcinoma.

Tumor-Infiltrating Lymphocytes and Programmed Death-Ligand 1 Expression in Salivary Duct Carcinoma

Abstract Objectives Salivary duct carcinoma is a rare high-grade salivary gland tumor, sharing common features with invasive ductal carcinoma of the breast—particularly apocrine type. Increased density of tumor-infiltrating lymphocytes (TILs) is a favorable prognostic factor in many solid tumors and has been correlated with elevated expression of programmed death-ligand 1 (PD-L1), a targetable molecule. We investigated the prognostic role of TILs and PD-L1 expression in salivary duct carcinoma. Methods Clinical records and archived surgical pathology material were evaluated from 28 patients with a diagnosis of salivary duct carcinoma at Mayo Clinic Rochester (between 1961 and 2007). TILs were evaluated on hematoxylin and eosin–stained slides and reported as continuous variables. Immunohistochemistry for PD-L1 (clone 22C3) was performed on unstained slides and evaluated using the Combined Positive Score (CPS). Fisher’s exact test was used to assess frequency distribution differences. Log-rank test and Cox proportional hazards model were used to assess the impact of the variables on survival. Results Twenty-eight patients had salivary duct carcinoma (age range 35-87, mean 61), and follow-up averaged 60 months (range 6-252 months). At the end of the follow-up period, 22 patients (79%) had died of salivary duct carcinoma, while remaining patients were alive (4.14%) or had died of other causes (2.7%). For the entire follow-up period, levels of TILs of 40% or more were associated with favorable overall survival (log-rank test, P = .01) and were predictors of better survival in univariate analysis (hazard ratio: 0.18, P = .02). PD-L1 expression was not significantly different between the high and low TIL groups (Fisher’s exact test, P = .67). Survival analysis regarding PD-L1 expression did not yield statistically significant results (log-rank test, P = .74; hazard ratio: 0.87, P = .74). Conclusion High TIL levels, but not PD-L1 expression as determined using the CPS, predict better survival in patients with salivary duct carcinoma.

SALIVARY DUCT CARCINOMA, A CASE REPORT

Objective We report a case of salivary duct carcinoma outside age of presentation and with a rare location. Case report A 31-year-old male patient who arrived to Hospital Juarez de Mexico, complaining of an 8 month tissue increase in the submental region, right neck and right face paresthesia. CT scan showed a submandibular tumor that infiltrated the floor of the mouth and base of the ipsilateral tongue with multiple right neck adenopathies levels IB, II, III and IV. Histologically, the lesion displayed cellular and nuclear pleomorfic epitelial cells, with abundant eosinofilic citoplasm, focal central necrosis, cribriform architectural pattern reminiscent of the image of “Roman bridges”. An inmunohistochemical profile was performed: androgen receptors (+), GATA-3 (+), cytokeratin 7 (+) and p-63 (-). A diagnosis of salivary duct carcinoma was emited. Discussion Salivary duct carcinoma is an aggressive malignant epithelial neoplasm, which may occur de novo or as a component of a carcinoma ex-pleomorphic adenoma. It constitutes only 3-6% of all salivary gland neoplasms. With a male predilection, affecting individuals between the 6th and 7th decades of life. Microscopically, it is characterized by celular and nuclear pleomorphism, atypical mitoses, and a cribiform pattern with dilated ducts. Conclusion Salivary duct carcinoma is an aggressive and rare salivary gland neoplasm, we present this case which differs in age and location usually reported.

Salivary Duct Carcinoma of Sublingual Salivary Gland: A Rare Case Report

The salivary duct carcinoma represents a rare variant of the group of adenocarcinomas originated from the salivary glands, especially extremely rare from sublingual salivary gland origin. We report a case of a salivary duct carcinoma of the sublingual salivary gland in a 61-year-old man. Incisional biopsy was done and the diagnosis of salivary duct carcinoma of sublingual salivary gland was given by histopathological report.

Salivary Duct Carcinoma of the Deep Lobe of the Parotid Gland: A Rare Clinical Finding.

Salivary Duct Carcinoma of the Deep Lobe of the Parotid Gland: A Rare Clinical Finding.

Salivary duct carcinoma: Clinicopathologic features, morphologic spectrum, and somatic mutations.

Accurate diagnosis of salivary duct carcinoma requires a high index of suspicion and clinicopathologic correlation. Hallmark genetic changes that may provide novel therapeutic options are being explored. One hundred ninety salivary gland malignancies at Royal Prince Alfred Hospital (from 1989-2014) were reviewed. Human epidermal growth factor receptor 2 (HER2) and androgen receptor status were determined along with multigene profiling. Twenty-three salivary duct carcinomas were identified, predominantly in men in their fifth to ninth decades of life. Facial nerve palsy (12%) and cervical lymph node metastases (82%) were present, and 96% received postoperative adjuvant therapy. Histologically, the tumors resembled high-grade invasive and in situ ductal carcinoma of the breast. Micropapillary, papillary, sarcomatoid, oncocytic, and mucinous variants were seen. The tumors showed androgen receptor (70%), HER2 amplification (30%), and HRAS, AKT1, PIK3CA, and NRAS mutations (22%; cumulative). The 5-year disease-free survival was 36%. Salivary duct carcinoma demonstrates a wide histopathologic spectrum. Treatment strategies need to take androgen receptor, HER2 amplification, and PIK3CA mutation into account. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1838-E1847, 2016.

Salivary duct carcinoma: the predominance of apocrine morphology, prevalence of histologic variants, and androgen receptor expression.

Salivary duct carcinoma (SDC) is a prototypic aggressive salivary gland carcinoma. Our aim is to determine the prevalence of histologic variants (micropapillary, basal-like) and androgen receptor (AR) expression in a large multi-institutional series of SDC. AR status was determined by immunohistochemistry (IHC). Most SDCs were characterized by an apocrine phenotype and AR expression. Cases with a nonapocrine phenotype and AR-negative status were studied by additional IHC and fluorescence in situ hybridization for ETV6 or MYB/NFIB. The diagnosis of SDC was confirmed in 187 of 199 (94%) cases. Variant morphologies were identified in 12 cases: micropapillary (n=6), sarcomatoid (n=3), mucinous (n=2), and basal-like (n=1). AR IHC was performed in 183 cases, of which 179 (97.8%) showed AR expression. On the basis of morphologic appearance and results of additional studies, 12 cases were reclassified as squamous cell carcinoma (SCC) (n=4), epithelial-myoepithelial carcinoma with high-grade transformation (HGT) (n=2), myoepithelial carcinoma (n=2), mammary analogue secretory carcinoma, high grade (ETV6 translocated; n=1), adenoid cystic carcinoma with HGT (n=1), acinic cell carcinoma with HGT (n=1), and adenosquamous carcinoma (n=1). AR-negative SDC is extremely rare, and the majority of such cases are more accurately classified as other entities. HGTs of other salivary carcinomas and squamous cell carcinoma are the most common mimics of SDC. SDCs with variant morphologies still show at least a minor component of conventional apocrine appearance. Thus, apocrine morphology defines SDC.

Predictors of cervical lymph node metastasis in salivary gland cancer

This study compares clinicopathological parameters with novel molecular markers for predicting cervical lymph node metastasis in salivary gland cancer. Three hundred sixteen salivary gland carcinomas were included in this study. Genomic epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), phosphatase and tensin homolog (PTEN), and hepatocyte growth factor receptor (MET) was determined by fluorescence in situ hybridization (FISH). Chi-square tests, multivariate regression, and Kaplan-Meier survival analysis were used for statistics. Nodal staging determines long-term survival. Clinicopathological parameters associated with positive neck nodes are advanced age (p = .006), T3/T4 classification, histological high-grade malignancy, and diagnosis of salivary duct carcinoma (p < .001 each). Neck node metastases also correlate with copy number gain of EGFR (p = .004) and HER2, aberration of MET, and deletion of PTEN (p < .001 each). Multivariate analysis showed SDC (p = .002) to be the strongest predictor of lymph node metastasis, followed by MET aberration (p = .009), T3/T4 classification (p = .017), PTEN deletion (p = .042), and adenocarcinoma not otherwise specified (NOS; p = .047). The histological subtype is crucial for decisions regarding neck dissection. New molecular parameters may also indicate elective treatment of the neck.

Salivary Duct Carcinoma

A case of salivary duct carcinoma of the parotid gland is reported in a 58-year-old man who presented with an enlarged lymph node in the right upper neck and whose only risk factor for malignancy was a history of occupational radiation exposure. Fine needle aspiration biopsy yielded a carcinoma with cytologic features reminiscent of apocrine-type breast carcinoma. Immunohistochemical stains for keratin, androgen receptor, and gross cystic disease fluid protein-15 were all positive. Imaging studies identified an infiltrative mass in the deep lobe of the right parotid gland and multiple pathologically enlarged right cervical lymph nodes. The combination of the clinical presentation, cytologic features, and the results of immunostains was consistent with a diagnosis of salivary duct carcinoma. Total parotidectomy and modified radical neck dissection were subsequently performed and microscopic evaluation confirmed the diagnosis. Salivary duct carcinoma is a clinically aggressive carcinoma with pathological features that resemble high-grade ductal adenocarcinoma of the breast. Most tumors are positive for androgen receptor. Although uncommon, the histologic appearance of salivary duct carcinoma is distinctive. Awareness of this entity is important for accurate diagnosis. Appropriate adjunctive testing may inform clinical management in advanced cases.

Salivary Duct Carcinoma of the Submandibular Gland Mimicking Deep Neck Infection-A Case Report

Background: Salivary duct carcinoma (SDC) is a rare highly malignant tumor, characterized by early distant metastasis and dismal prognosis. It often derives from the excretory duct reserve cell of the major salivary glands and is histologically similar to ductal carcinoma of the breast. The parotid gland is affected in most of the cases. Aim and Objectives: We report a 47-year-old man with diabetes mellitus and SDC of the submandibular gland mimicking deep neck infection. Materials and Methods: The patient underwent surgical drainage for his rapidly swollen right neck accompanied by erythema and tenderness. Results: A solid tumor of the right submandibular gland was found instead. Pathological examination confirmed the diagnosis of salivary duct carcinoma. Distant metastasis had evolved at the time of diagnosis and the patient died within two months. Conclusion: The presentation of SDC can mimic a deep neck infection. In this article, the clinical characteristics of SDC and the treatment strategies are discussed.

Salivary duct carcinoma with comedonecrosis in the mobile portion of the tongue

We present a patient suffering from salivary duct carcinoma in the mobile portion of the tongue, arising from a minor salivary gland; this condition is extremely rare. The patient was a 64-year-old woman who presented with a nonpainful, hard mass in her tongue. An aspiration smear showed cells with very scant cytoplasm and pale oval nuclei containing small, single nucleoli. Scattered clusters of small cells had darkly stained nuclei. Neither necrosis nor cribriform areas were seen. The smears suggested a salivary gland neoplasm; however, definitive diagnosis of salivary duct carcinoma remained difficult. Partial glossectomy was performed with a wide margin. Macroscopic examination revealed an unencapsulated, submucosal tumour infiltrating underlying muscle. Microscopic examination revealed a salivary duct carcinoma with comedonecrosis and relatively few cribriform and papillary areas. This case suggests that it may not be easy to establish a definitive diagnosis of salivary duct carcinoma from an aspiration smear if the salivary duct carcinoma is composed of comedonecrosis surrounded by solid tissue in a noncribriform pattern.

Speichelgangkarzinome

This tutorial focuses on salivary duct carcinoma (SDC), a rare, high grade neoplasm mainly of major salivary glands. The clinical course of these tumors is characterised by extended local disease, early distant metastasis, and poor outcome. The morphology of SDC is reminiscent of breast ductal carcinomas and may occasionally cause diagnostic problems. In spite of mimicry with ductal carcinoma in situ of the breast and an in situ component, that is evident in most tumors by immunohistology with antibodies directed against high molecular weight cytokeratins (Ck), SDC is always an invasive carcinoma. By immunohistology, most tumors show reactivity with antibodies directed against Ck 7, Ck 8/18 and Ck 19 whereas a morphologically indistinguishable subgroup expresses Ck 5/6 in tumor cells in addition to residual basal epithelia. Carcinoembryonic antigen, GCDFP-15 and androgen receptor are other helpful markers in routine diagnosis of SDC. Prostate-specific antigen is detectable in some cases. Abnormal p53 expression seems to indicate an adverse prognosis. Expression of c-erbB2, the over-expression of which is associated with a poor prognosis, may form the basis for a targeted therapeutic approach for selected cases of SDC.

Cytologic Diagnosis of Salivary Duct Carcinoma

Cytologic Diagnosis of Salivary Duct Carcinoma

顎下腺原発唾液腺導管癌の２例

Salivary duct carcinoma is an uncommon tumor, and mainly originates in the parotid gland. We treated two patients with salivary duct carcinoma in the submandibular gland. One patient was a 60-year-old male who complained of right submandibular swelling. Submandibular sialoadenectomy, right neck dissection and postoperative radiation were performed. Four months later, multiple bone metastase were found. The other patient was a 40-year-old male who complained of right submandibular and bilateral cervical swelling. Submandibular sialoadenectomy, bilateral neck dissection, and postoperative radiation and chemotherapy were performed. Six months later, skin metastasis was found. Histologically, both were diagnosed as salivary duct carcinoma based on the presence of cribriform pattern and comedo necrosis. Preoperative diagnosis of salivary duct carcinoma is difficult. This carcinoma resists combined therapy and has a poor prognosis.

副耳下腺に発生した唾液腺導管癌例

Salivary duct carcinoma is an uncommon, relatively unknown, and clinically aggressive carcinoma of salivary origin. Recently, we treated a rare case of salivary duct carcinoma arising from the accessory parotid gland. The patient was a 68-year-old male who complained of left cheek swelling. The mass was located in left mid-cheek. Fine needle aspiration biopsy and open biopsy of the mid-cheek mass revealed malignant cells, but the pathological diagnosis was not settled. The mass in the mid-cheek was resected en-block including the buccal branches of the facial nerve, the superficial parotid gland, a part of the masseter muscle, and the skin right above the tumor. A pathological examination identified comedo necrosis and a final diagnosis of salivary duct carcinoma was made. The patient was treated with postoperative radiation therapy and has been free of tumors for 10 months.

Cytologic diagnosis of salivary duct carcinoma: a review of seven cases.

The cytomorphologic findings in fine-needle aspirates from 7 cases of salivary duct carcinoma (SDC) are reviewed and correlated with the histologic features. Malignant cytologic characteristics are clear in this tumor, and no false-negative results were obtained. But the absence of cribriform or papillary groups suggests an inconclusive diagnosis and sometimes the need to establish a differential diagnosis with other salivary tumors, and in particular with adenocarcinoma not otherwise specified (ADC-NOS) and high-grade mucoepidermoid carcinoma (h-g MEC). The pitfalls in the cytologic diagnosis of this tumor are discussed. In addition, the literature on the subject is reviewed.