Hiroyuki Mihashi

Nuclear β‐catenin expression in basal cell adenomas of salivary gland

BACKGROUND Nuclear localization of β-catenin is known in a wide variety of human neoplasms; however, there are few reports in basal cell adenoma of the salivary gland. Our objective was to confirm the nuclear localization of β-catenin in basal cell adenoma and to examine whether nuclear β-catenin expression could be a useful marker in the diagnosis of basal cell adenoma. METHODS To evaluate the nuclear localization of β-catenin in basal cell adenomas, immunohistochemistry (IHC) and mutation analysis of CTNNB1 were performed in 22 and 21 cases, respectively. Mutation analysis of CTNNB1 in exon 3 was performed by DNA direct sequencing. In a comparative study, IHC for β-catenin was also performed in 157 other salivary gland tumors. RESULTS Nuclear β-catenin expression was examined in 22 basal cell adenomas; scores were 2+ in 18 cases (81.8%), 1+ in three cases (13.6%), and 0 in one case (4.5%). Expression was localized in the basaloid myoepithelial cells. CTNNB1 mutation analysis was performed in 21 basal cell adenomas; mutations, including I35T and T41P, were detected in 11/21 (52%) cases. In comparison with other salivary gland tumors, one of three basal cell adenocarcinomas showed nuclear β-catenin expression, whereas there was no nuclear β-catenin expression in 154 other salivary gland tumors. CONCLUSIONS We demonstrated nuclear β-catenin expression and activation of the CTNNB1 gene in basal cell adenoma. Although nuclear β-catenin expression may be unable to distinguish basal cell adenoma from basal cell adenocarcinoma, it should be a helpful marker in the diagnosis of basal cell adenoma.

Relationship between clinicopathological factors and fluorine-18-fluorodeoxyglucose uptake in patients with papillary thyroid cancer

ObjectiveTo examine the relationship between clinicopathological factors and fluorine-18-fluorodeoxyglucose (18F-FDG) uptake in patients with papillary thyroid cancer (PTC). Materials and methodsFifty-four patients were included in this study.18F-FDG positron emission tomography was performed before surgery. Immunohistochemistry of glucose transporter (GLUT) was performed using postoperative histopathological specimens. We investigated the relationship between maximum standardized uptake value (SUVmax) and GLUT-1, GLUT-3, and GLUT-4 expression/SUVmax and prognostic risk factors {tumor size, age, sex, extrathyroidal extension, and lymph node metastasis [ly (+)]}. ResultsGLUT-3 and GLUT-4 expressions significantly correlated with SUVmax (GLUT-3: r=0.38, P=0.008; GLUT-4: r=0.46, P=0.001), but GLUT-1 did not (r=0.21, P=0.147). The tumor size correlated with SUVmax (r=0.5, P<0.001), but GLUT-1, GLUT-3, and GLUT-4 did not (GLUT-1: r=0.006, P=0.681; GLUT-3: r=0.05, P=0.705; GLUT-4: r=−0.17, P=0.217). Both SUVmax and GLUT-4 expressions were statistically significant with ly (+) (SUVmax: P=0.012; GLUT-4: P=0.018), but GLUT-1 and GLUT-3 expressions were not (GLUT-1: P=0.165; GLUT-3: P=0.499). There was no significant difference between other clinicopathological factors and SUVmax or any GLUT expressions. Conclusion 18F-FDG uptake in PTC may be determined by GLUT-3 and GLUT-4 expressions and may be related to tumor size and lymph node metastasis of PTC. 18F-FDG uptake may reflect tumor progression of PTC.

Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature review

Cystadenocarcinoma is a rare malignant tumor, with an estimated incidence of 2% of malignant salivary gland tumors. Cytological diagnosis of cystadenocarcinoma is important for differential diagnosis between benign lesions and malignant tumors with cystic growth. We report a case of cystadenocarcinoma causing difficulty in cytological diagnosis. A 23‐year‐old man presented with an asymptomatic mass in the left parotid gland that had been present for 2 years. The mass was elastic hard, measuring 30 × 35 mm in diameter. Preoperative fine‐needle aspiration cytology (FNAC) showed a small number of tumor cell clusters in the cystic fluid. The cluster was arranged in a ball‐like structure and was cohesive with overlapping. Tumor cells had a small vacuolated, soap‐bubble appearance in the cytoplasm. The papillary‐cystic variant of acinic cell carcinoma (ACC‐PCV) was suggested from these findings on FNAC. Histologically, the tumor was not encapsulated, but formed large cystic spaces against a background of fibrous connective tissue. The tumor cells in the cystic dilated duct showed papillary structures, which were continuous with the lining cuboidal cells. There was neither a definite double‐layered arrangement in cystic ducts and solid islands nor histological findings characteristic of the papillary‐cystic or follicular pattern of ACC‐PCV. As tumor cells with a small vacuolated, soap‐bubble appearance of the cytoplasm are common findings of both cystadenocarcinoma and ACC‐PCV, they are of little use for differentiation; however, they are so characteristic that the majority of benign salivary gland lesions with cystic structures can be excluded, if enough attention is paid. Diagn. Cytopathol. 2010.

Histiocytic sarcoma of the parotid gland region

Histiocytic sarcoma (HS) is a malignant neoplasm showing the morphological and immunophenotypic features of mature histiocytes. Reported herein is a case of HS of the parotid gland region. A 53‐year‐old woman noticed a swelling of the right preauricular area. Preoperative fine needle aspiration cytology showed an admixture of pleomorphic atypical cells and mature lymphocytes. She underwent total parotidectomy. Grossly, the tumor was located at the parotid gland to subcutaneous tissue, and showed infiltrative growth with massive necrosis and hemorrhage. Microscopically, the tumor was composed of marked pleomorphic cells with eosinophilic cytoplasm. Bizarre multinuclear giant cells were scattered and intermingled. Tumor cells were positive for CD68 (KP‐1 and PG‐M1), CD163, S‐100 protein, CD1a, CD4 and CD31, but negative for CD3, CD20, CD21, CD79a, DEC205 and langerin, immunohistochemically. Monoclonal proliferation of B cells was not confirmed on polymerase chain reaction for IgH. The patient had recurrent lesions in the pelvis and stomach 5 months after parotidectomy and died of the disease 10 months after the operation.

New silicone tube placement therapy for patients with an anterior glottic web.

An anterior glottic web in adults comprises a bridge of scar tissue commonly formed as a result of iatrogenic laryngeal injury. Traditionally, procedures such as transcervical midline thyrotomy and keel placement have been used to repair this condition. However, we recently repaired an anterior glottic web using a new surgical procedure involving a silicone tube instead of a keel. We herein report this case, in which we placed a silicone tube at the anterior commissure after resection of an anterior glottic web, under endolaryngeal microsurgery, without performing a tracheostomy.

Immunological responses against human papilloma virus and human papilloma virus induced laryngeal cancer.

OBJECTIVE This study aimed to clarify the local immune status in the larynx in the presence of infection or carcinogenesis associated with human papilloma virus. METHODS Cytological samples (for human papilloma virus detection) and laryngeal secretions (for immunoglobulin assessment) were obtained from 31 patients with laryngeal disease, during microscopic laryngeal surgery. On histological examination, 12 patients had squamous cell carcinoma, four had laryngeal papilloma and 15 had other benign laryngeal disease. Cytological samples were tested for human papilloma virus DNA using the Hybrid Capture 2 assay. RESULTS High risk human papilloma virus DNA was detected in 25 per cent of patients (three of 12) with laryngeal cancer. Low risk human papilloma virus DNA was detected only in three laryngeal papilloma patients. The mean laryngeal secretion concentrations of immunoglobulins M, G and A and secretory immunoglobulin A in human papilloma virus DNA positive patients were more than twice those in human papilloma virus DNA negative patients. A statistically significant difference was observed between the secretory immunoglobulin A concentrations in the two groups. Patients with laryngeal cancer had higher laryngeal secretion concentrations of each immunoglobulin type, compared with patients with benign laryngeal disease. The study assessed the mean laryngeal secretion concentrations of each immunoglobulin type in the 12 laryngeal cancer patients, comparing human papilloma virus DNA positive patients (n = 3) and human papilloma virus DNA negative patients (n = 9); the mean concentrations of immunoglobulins M, G and A and secretory immunoglobulin A tended to be greater in human papilloma virus DNA positive cancer patients, compared with human papilloma virus DNA negative cancer patients. CONCLUSION These results suggest that the local laryngeal immune response is activated by infection or carcinogenesis due to human papilloma virus. The findings strongly suggest that secretory IgA has inhibitory activity against infection or carcinogenesis associated with human papilloma virus in the larynx.

Fine needle aspiration cytology of metastatic polymorphous low-grade adenocarcinoma of the palate in a cervical lymph node

Dear Editor, Polymorphous low-grade adenocarcinoma (PLGA) is well recognized as a major type of minor salivary gland neoplasm, almost 60% occurring in the palate. Although PLGA is described as the commonest intraoral malignant salivary gland tumour, comprising 26% of all carcinomas, it is especially rare in the Japanese population. PLGA has a distinct natural history characterized by slow and indolent growth, with late development of cervical lymph node metastasis and often distant recurrence. Cervical lymph node metastasis of PLGA is present in nearly 5% of cases at diagnosis and occurs in 10% during long follow-up after the initial surgery. Different cytological features in two lymph node metastases are reported with their differential diagnosis. A 70-year-old Japanese man with a history of PLGA of the palate underwent resection of the tumour and partial removal of the upper jawbone in 2000. We have previously reported the primary cytomorphological features of PLGA in this patient. The patient was followed after surgery: a cervical palpable mass was noted after 6 years and again 8 years later. Clinical examination revealed a firm rubbery mass in the cervical lymph node. Fine needle aspiration cytology (FNAC) was performed on each occasion, and subsequent resection of cervical lymph nodes. There has been no recurrence during the following 3 years. The first FNAC smear of the cervical lymph node metastasis showed high cellularity, with a moderate to large number of papillary clusters (Figure 1a). The clusters contained overlapping metachromatic hyaline globules on May-Grünwald–Giemsa staining, as seen in adenoid cystic carcinoma, with similar material in the background (Figure 1b). The tumour cells had a light green cytoplasm on Papanicolaou staining with slightly irregular nuclei and small nucleoli. No mitotic figures were observed. On the FNAC of a second cervical lymph node matastasis, serous fluid was (a)

Supraglottic carcinoma treatment results analysed by therapeutic approach

This study reviewed 161 patients with supraglottic squamous cell carcinoma who underwent radical therapy at Kurume University Hospital between 1989 and 2003. The five-year survival rate was 89 per cent in patients with stage III disease and 75 per cent in stage IV patients, thus demonstrating favourable results even for patients with advanced cancer. The five-year local control rate and the laryngeal preservation rate were poor in patients with T3 tumours (being 75 per cent for both), but the overall five-year local control rate for all patients was 86 per cent. Laser surgery plus chemo-radiotherapy was the most frequently used treatment. The local control rates and laryngeal preservation rates were poor in patients with tumour infiltration to the glottis and the laryngeal ventricle. In conclusion, the indications for combination laser therapy for supraglottic carcinoma should in future be extended, and the type and number of chemotherapy courses for this cancer should be further clarified.