Intraoral Pigmented Low-Grade Adenocarcinoma, Not Otherwise Specified: Case Report and Immunohistochemical Study

Author(s)

dos Santos, Jessica Luana ^[1] ; de Almeida Milani Altemani, Albina Messias ^[2] ; Trivellato, Alexandre Elias ^[3] ; Sverzut, Cassio Edvard ^[3] ; Almeida, Luciana Yamamoto ^[1] ; Teixeira, Lucas Ribeiro ^[1] ; Ribeiro-Silva, Alfredo ^[1] ; Leon, Jorge Esquiche ^[4]

Affiliation

^[1] Univ Sao Paulo, Ribeirao Preto Med Sch FMRP, Dept Pathol & Forens Med, Oral Pathol, Ave Cafe S-N, BR-14040904 Sao Paulo - Brazil

^[2] Univ Estadual Campinas, Fac Med Sci, Dept Pathol, Div Pathol, Rua Tessalia Vieira de Camargo 126, BR-13083887 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Ribeirao Preto Dent Sch FORP, Dept Oral & Maxillofacial Surg & Periodontol, Oral & Maxillofacial Surg, Ave Cafe S-N, BR-14040904 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Ribeirao Preto Dent Sch FORP, Dept Stomatol Publ Oral Hlth & Forens Dent, Oral Pathol, Ave Cafe S-N, BR-14040904 Sao Paulo - Brazil

• Document type: Journal article
• Source: Head and Neck Pathology; v. 12, n. 4, p. 610-618, DEC 2018.
• Web of Science Citations: 0

Abstract

Salivary adenocarcinoma, not otherwise specified (AdCaNOS) is a rare malignant tumor with potential diagnostic challenge, which mainly affects the parotid glands; however, the minor salivary glands can also be involved by AdCaNOS. This paper reports a case of a 45-year-old Afro-descendant woman complaining of a slow-growing mass with 6 months of evolution in the left superior vestibular fornix. Microscopic examination revealed an infiltrative epithelial neoplasm composed of predominantly solid growth pattern, arranged in a lobular configuration, admixed with glandular or ductal structures. Perineural invasion was evident. The tumor cells were polygonal or oval showing focally mild nuclear pleomorphism, and eosinophilic or clear cytoplasm. Notably, some areas exhibited intracytoplasmic pigment granules mainly in non-luminal cells, as well as sebaceous-like cells, discrete hyaline material deposition and foci of infiltration of residual salivary gland parenchyma. Tumor cells were negative for PAS, mucicarmine and Alcian blue stains. By immunohistochemistry, the tumor cells were diffuse and strongly positive for pan-cytokeratin (CK) AE1/AE3, 34betaE12 CK, vimentin, p63 and S100. CK7 and EMA strongly highlighted the ductal structures. Solid areas also showed diffuse and moderate expression of CD56. Podoplanin (D2-40), GFAP and Calponin, followed by DOG-1, were focally positive; whereas CK20, a-SMA, h-Caldesmon, CD57, ERBB2/HER2 and p53 were negative. Ki-67 was <2%. Consecutive serial tissue sections using CD57 confirmed the perineural invasion. Positivity for HMB-45 and MART-1/Melan-A, as well as Fontana-Masson stain (and potassium permanganate bleaching-sensitive), identified the pigment granules as melanin. To the best of our knowledge, this is the first case of intraoral low-grade AdCaNOS with intracytoplasmic melanin granules. (AU)

• FAPESP's process: 16/11419-0 - Clinicopathological correlation of the degree of differentiation, tetraspanin expression, viral agents and cell proliferation in a large sample of squamous cell carcinoma of the head and neck region.
• Grantee: Jorge Esquiche León
• Support Opportunities: Regular Research Grants
• FAPESP's process: 11/52090-8 - Comparative immunohistochemical analysis of dendritic cells, cytotoxic lymphocytes, and indolamine 2,3-dioxigenase expression in potentially malignant disorders and squamous cells carcinoma of the oral cavity and lower lip
• Grantee: Jorge Esquiche León
• Support Opportunities: Regular Research Grants