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Modern Pathology : An Official Journal... Mar 2024Cutaneous mixed tumors exhibit a wide morphologic diversity and are currently classified into apocrine and eccrine types based on their morphologic differentiation. Some...
Cutaneous mixed tumors exhibit a wide morphologic diversity and are currently classified into apocrine and eccrine types based on their morphologic differentiation. Some cases of apocrine-type cutaneous mixed tumors (ACMT), namely, hyaline cell-rich apocrine cutaneous mixed tumors (HCR-ACMT) show a prominent or exclusive plasmacytoid myoepithelial component. Although recurrent fusions of PLAG1 have been observed in ACMT, the oncogenic driver of eccrine-type cutaneous mixed tumors (ECMT) is still unknown. The aim of the study was to provide a comprehensive morphologic, immunohistochemical, and molecular characterization of these tumors. Forty-one cases were included in this study: 28 cases of ACMT/HCR-ACMT and 13 cases of ECMT. After morphologic and immunohistochemical characterization, all specimens were analyzed by RNA sequencing. By immunohistochemistry, all cases showed expression of SOX10, but only ACMT/HCR-ACMT showed expression of PLAG1 and HMGA2. RNA sequencing confirmed the presence of recurrent fusion of PLAG1 or HMGA2 in all cases of ACMT/HCR-ACMT, with a perfect correlation with PLAG1/HMGA2 immunohistochemical status, and revealed internal tandem duplications of SOX10 (SOX10-ITD) in all cases of ECMT. Although TRPS1::PLAG1 was the most frequent fusion, HMGA2::WIF1 and HMGA2::NFIB were detected in ACMT cases. Clustering analysis based on gene expression profiling of 110 tumors, including numerous histotypes, showed that ECMT formed a distinct group compared with all other tumors. ACMT, HCR-ACMT, and salivary gland pleomorphic adenoma clustered together, whereas myoepithelioma with fusions of EWSR1, FUS, PBX1, PBX3, POU5F1, and KLF17 formed another cluster. Follow-up showed no evidence of disease in 23 cases across all 3 tumor types. In conclusion, our study demonstrated for the first time SOX10-ITD in ECMT and HMGA2 fusions in ACMT and further refined the prevalence of PLAG1 fusions in ACMT. Clustering analyses revealed the transcriptomic distance between these different tumors, especially in the heterogenous group of myoepitheliomas.
Topics: Humans; Adenoma, Pleomorphic; DNA-Binding Proteins; Myoepithelioma; Repressor Proteins; Salivary Gland Neoplasms; Skin Neoplasms; SOXE Transcription Factors; Sweat Gland Neoplasms; Transcription Factors
PubMed: 38266920
DOI: 10.1016/j.modpat.2024.100430 -
American Journal of Ophthalmology Apr 2024
Topics: Humans; Hyperplasia; Meibomian Glands; Eyelid Neoplasms; Adenoma; HIV Infections; Tears; Dry Eye Syndromes; Eyelid Diseases
PubMed: 38266800
DOI: 10.1016/j.ajo.2024.01.017 -
Journal of Medical Case Reports Jan 2024Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic... (Review)
Review
BACKGROUND
Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic carcinoma with chondrosarcoma to the best of our knowledge. They consist of distinct carcinomatous and sarcomatous components and may arise de novo or from a preexisting pleomorphic adenoma.
CASE PRESENTATION
Herein we present a case of an 80-year-old white female who presented with progressively increasing left facial swelling over 6 weeks. Magnetic Resonance Imagining revealed a mass (3.4 cm) in the parotid gland with a predominant cystic/necrotic component. The cytology was atypical (Milan3) and a total parotidectomy and selective lymph node dissection was done. The resection showed extensive necrosis with high grade sarcomatous (chondrosarcoma) areas. The epithelial component was adenoid cystic carcinoma with perineural invasion. The patient is currently undergoing radiotherapy of the tumor bed and skull base due to propensity of perineural invasion of the adenoid cystic component. The most common carcinomas in carcinosarcomas of salivary glands are adenocarcinoma and squamous cell carcinoma.
CONCLUSION
Carcinosarcoma is a high-grade aggressive lesion with a poor prognosis and should be treated aggressively. More studies are needed to understand the origin of these tumors.
Topics: Humans; Female; Aged, 80 and over; Parotid Gland; Parotid Neoplasms; Carcinoma, Adenoid Cystic; Carcinosarcoma; Chondrosarcoma; Bone Neoplasms
PubMed: 38243328
DOI: 10.1186/s13256-023-04280-7 -
Journal of Histotechnology Jun 2024Sclerosing polycystic adenoma (SPA) is a rare neoplastic salivary gland lesion with only about 100 cases reported worldwide so far. The lesion is confused with several... (Review)
Review
Sclerosing polycystic adenoma (SPA) is a rare neoplastic salivary gland lesion with only about 100 cases reported worldwide so far. The lesion is confused with several malignant and other benign tumors such as apocrine intraductal carcinoma (IC), salivary duct carcinoma (SDC), chronic sclerosing sialadenitis, polycystic dysgenetic disease (PDD), pleomorphic adenoma (PA), acinic cell carcinoma (ACC), and mucoepidermoid carcinoma (MEC). We present a case of SPA for a 23-year-old male patient presenting with a slowly growing parotid mass. Fine needle aspiration (FNA) followed by total excision of the tumor was performed and the picture was consistent with SPA. We discuss the findings of the case and briefly review the literature on SPA.
Topics: Humans; Male; Young Adult; Adenoma; Biopsy, Fine-Needle; Parotid Gland; Parotid Neoplasms; Sclerosis
PubMed: 38224047
DOI: 10.1080/01478885.2023.2299911 -
Oral Surgery, Oral Medicine, Oral... Mar 2024To investigate the value of magnetic resonance imaging (MRI) signal intensity ratios (SIRs) based on fat-suppressed T2-weighted imaging (FS-T2WI), together with...
OBJECTIVE
To investigate the value of magnetic resonance imaging (MRI) signal intensity ratios (SIRs) based on fat-suppressed T2-weighted imaging (FS-T2WI), together with demographic features, MRI anatomical characteristics, and SIRs of histopathological patterns of the tumors, in the differentiation of parotid pleomorphic adenoma (PA) from Warthin tumor (WT).
STUDY DESIGN
In total, 90 patients with PA and 56 patients with WT were enrolled in the study. SIRs of tumor to normal parotid gland (SIR-T/P), spinal cord (SIR-T/S), and muscle (SIR-T/M) were calculated. Demographic and radiological features of the 2-patient groups were compared with univariate analysis and multivariate logistic regression analysis. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were analyzed to evaluate the utility of SIRs in distinguishing between PA and WT.
RESULTS
SIR-T/P exhibited outstanding discriminating ability (AUC = 0.934), SIR-T/S had excellent discrimination (AUC = 0.839), and SIR-T/M showed acceptable discrimination (AUC = 0.728). When SIR-T/P of 1.96 was selected as the cutoff value, sensitivity and specificity were 0.756 and 0.982, respectively. SIR-T/P, age, sex, and number of lesions were identified as independent predictors by multivariate logistic regression analysis. Differences in SIRs between histopathological patterns were significant.
CONCLUSION
SIR-T/P based on FS-T2WI is an effective discriminator in the differential diagnosis between PA and WT. Age, sex, and number of lesions provided additional value in differentiation.
Topics: Humans; Adenoma, Pleomorphic; Adenolymphoma; Magnetic Resonance Imaging; Parotid Gland; Salivary Gland Neoplasms
PubMed: 38195353
DOI: 10.1016/j.oooo.2023.12.786 -
Archivio Italiano Di Urologia,... Nov 2023Transurethral resection of the prostate (TURP) is the gold-standard for the treatment of benign prostate enlargement (BPE) associated with lower urinary tract symptoms...
INTRODUCTION
Transurethral resection of the prostate (TURP) is the gold-standard for the treatment of benign prostate enlargement (BPE) associated with lower urinary tract symptoms (LUTS), after failure of conservative therapy. At present, only resection-rate (grams of prostate resected over time) is regarded as an efficiency parameter to evaluate the skill of the operator and to assess the outcome of the procedure.
MATERIALS AND METHODS
Five surgeons performed TURP using a Gyrus-type bipolar system in 123 patients with BPE/LUTS who came to our observation from June 2016 to December 2019. The amount of irrigation fluid used during the procedure was registered and correlated to the operating time, resection-rate, prostate adenoma weight, post-operative bladder irrigation time, intraoperative bleeding and days of catheterization.
RESULTS
We found an inverse correlation between the amount of irrigation fluid used during TURP and the resection-rate recorded for all operators, according to Spearman's Correlation (r = -0.78, p = 0.002); a direct correlation was also found between the amount of irrigation fluid and the adenoma weight. Finally, we also found a direct correlation with intraoperative bleeding and the duration and amount of bladder irrigation during and after TURP.
CONCLUSIONS
The amount of irrigation fluid used is proposed as a reliable parameter to estimate the efficiency of the endoscopic procedure as well to assess the skill of the operator and shortterm results. The observed data encourage the possibility of applying this new efficiency indicator to all endoscopic maneuvers.
Topics: Male; Humans; Prostate; Transurethral Resection of Prostate; Urologic Surgical Procedures; Surgeons; Prostatic Hyperplasia; Lower Urinary Tract Symptoms; Adenoma
PubMed: 38193228
DOI: 10.4081/aiua.2023.11868 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Dec 2023To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid. From January 2017 to January 2022, 19...
To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid. From January 2017 to January 2022, 19 patients (11 males and 8 females, age ranged from 17 to 69 years, with a median age of 48) with benign tumor in the deep lobe of parotid gland underwent parotidectomy through retroauricular sulcus incision in Linyi People's Hospital. Among them, 17 cases with tumor diameter≤4.0 cm underwent simple retroauricular groove incision, and 2 cases were dumbbell type with tumor diameter>4.0 cm on the medial side of mandible protruding into the parapharyngeal space, in which the deep lobe and tumor of parotid gland were resected through retroauricular sulcus incision combined with intraoral incision. Tumors were completely removed through retroauricular sulcus incision in 17 cases, and dumbbell type tumors were removed through retroauricular sulcus incision combined with intraoral incision in 2 cases. Postoperative pathological examinations showed pleomorphic adenoma in 13 cases, basal cell adenoma in 4 cases and Warthin's tumor in 2 cases. Temporary mandibular marginal branch paralysis occurred in 2 patients and returned to normal 3 weeks after operation. All incisions healed in Phase I. By following-up of 1-5 years with a median follow-up time of 3.1 years, none of the patients had Frey syndrome, salivary fistula, other complications and tumor recurrence. The patients and their families were satisfied with the postoperative facial appearances. The retroauricular groove approach can not only preserve the function of parotid superficial lobe and facial nerve, but also has less trauma, less tissue defect and hidden scar. As the advantages of less complication, low recurrence rate and good cosmetic effect, the incision is worthy of clinical application.
Topics: Female; Male; Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Parotid Gland; Surgical Wound; Neoplasms; Postoperative Care; Cicatrix
PubMed: 38186099
DOI: 10.3760/cma.j.cn115330-20231008-00126 -
Clinical Oral Investigations Dec 2023Surgical management of parotid pleomorphic adenoma ranges from total parotidectomy to extracapsular dissection (ECD). Minimalistic techniques aim to preserve function...
OBJECTIVES
Surgical management of parotid pleomorphic adenoma ranges from total parotidectomy to extracapsular dissection (ECD). Minimalistic techniques aim to preserve function and minimize the rate of recurrence. This study assesses functional, aesthetic, and disease control outcomes post-ECD through a sole transverse cervical incision for parotid pleomorphic adenoma.
MATERIALS AND METHODS
This longitudinal analysis enrolled 36 consecutive patients with pleomorphic adenoma who underwent ECD via a single cervical incision. Complications, satisfaction, salivary function, and tumor recurrence were evaluated. Salivary gland function was assessed using scintigraphy at 6 months post-surgery.
RESULTS
Tumors occurred in superficial (83%) or deep (17%) parotid inferior parts according to the European Salivary Gland Society level classification. The median tumor size was 2.8 cm (1.8-6.0 cm); the median operation time was 42 min (30-65 min). No tumor spillage or facial nerve injuries occurred. Facial nerve paralysis was only temporary in two (6%) patients, with minimal other complications. Operated parotid gland function matched the unoperated side. No recurrence was found during the median follow-up of 44 months (24-60 months).
CONCLUSIONS
ECD via a single transverse cervical incision is a safe approach for benign parotid tumors, yielding excellent functional and disease control outcomes.
CLINICAL RELEVANCE
These findings can provide clinically meaningful minimally invasive recommendations to treat pleomorphic adenoma with minimal complications.
Topics: Humans; Adenoma, Pleomorphic; Postoperative Complications; Neoplasm Recurrence, Local; Retrospective Studies; Esthetics, Dental; Parotid Neoplasms; Parotid Gland
PubMed: 38151592
DOI: 10.1007/s00784-023-05420-5 -
American Journal of Otolaryngology 2024There has been historical controversy regarding the extent of resection in the management of pleomorphic adenomas. This study aims to evaluate the extent of surgery and...
INTRODUCTION
There has been historical controversy regarding the extent of resection in the management of pleomorphic adenomas. This study aims to evaluate the extent of surgery and short-term postoperative outcomes of partial superficial parotidectomy (PSP) for the management of pleomorphic adenomas at a tertiary, high-volume center.
METHODS
A retrospective chart review of patients who underwent PSP was performed. Variables included demographics, pre-operative facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence.
RESULTS
151 adults who underwent PSP for pleomorphic adenoma from January 1st, 2000 to December 31st, 2022 were identified. Median age was 55 (IQR 40-66) years with females representing 74 % of the cohort. Median tumor size at presentation was 1.8 (IQR 1.3-2.3) cm. Baseline facial nerve function was excellent for most patients (House-Brackmann I, 99 %). Most patients underwent a superficial inferior parotidectomy (88 %). Modified Blair incision (70 %) was the most common incision. Intraoperatively, the facial nerve was identified in 149 (99 %) patients. The main trunk was identified in 126 (85 %) patients. No patient had tumor spillage. Only two patients required parotid bed reconstruction. The most common complication was ear numbness (60 %). Postoperatively, 114 patients were House-Brackmann grade I at both preoperative and postoperative assessment, 8 went from grade I to II, and 1 went from grade VI to II (Bell's palsy that resolved to grade II following surgery). Median follow-up was 1(IQR 1-5) month.
CONCLUSION
PSP is efficacious in the management of pleomorphic adenomas with preservation of facial nerve function, and minimal post-operative complications. Future study is needed to assess long term recurrence risk.
Topics: Adult; Female; Humans; Middle Aged; Parotid Gland; Adenoma, Pleomorphic; Parotid Neoplasms; Retrospective Studies; Postoperative Complications; Neoplasm Recurrence, Local
PubMed: 38104469
DOI: 10.1016/j.amjoto.2023.104185 -
Journal of Cutaneous Pathology Mar 2024Apocrine cystadenoma is a rare, benign adenomatous cystic neoplasm, the pathogenesis of which is not fully understood. We sought to characterize the clinical,...
BACKGROUND
Apocrine cystadenoma is a rare, benign adenomatous cystic neoplasm, the pathogenesis of which is not fully understood. We sought to characterize the clinical, dermatoscopic, and histopathologic features of apocrine cystadenoma and its relationship to hidrocystoma.
METHODS
We retrospectively analyzed cases of apocrine cystadenoma and hidrocystoma retrieved from the dermatopathology laboratory information system.
RESULTS
Of the 350 cases apocrine cystic lesions, 13 cases of apocrine cystadenomas met the inclusion criteria. The age ranged from 20 to 84 years with an average of 64 years. They were long-standing (duration 3-15 years), slow-growing, large tumors usually found on the scalp. Dermatoscopy accentuated translucent light to dark blue color and prominent vessels that were present more at the periphery. All lesions were multilocular with columnar to cuboidal lining and decapitation secretion. A large portion of the lesion consisted of a simple nonproliferative epithelial lining, identical to that observed in apocrine hidrocystomas, while the proliferative adenomatous component made up a smaller portion with two patterns: (1) tubular proliferation, which either protruded into the cystic cavity or expanded outward peripherally, or (2) papillary projections, which were multiple layers thick with fibrovascular core, sometimes accompanied by tubular proliferation. Immunohistochemical stains showed strong staining for p40 and a sparse number of cells stained for Ki-67 and p53.
CONCLUSIONS
The long duration of the lesion and the large areas of simple apocrine epithelial lining suggest that apocrine cystadenomas arise from long-standing apocrine hidrocystomas. However, the retrospective nature of the study from a single institution is a limitation.
Topics: Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Hidrocystoma; Retrospective Studies; Sweat Gland Neoplasms; Apocrine Glands; Cystadenoma; Cell Proliferation
PubMed: 38084825
DOI: 10.1111/cup.14573