Mammary analogue secretory carcinoma of the parotid: An arduous maze to solve

Mammary analogue secretory carcinoma (MASC) is an unusual and rare salivary gland malignancy that recapitulates the genetic and microscopic features of secretory carcinoma of the breast (SCB) which is an equally rare entity. MASC and SCB express S-100 protein, vimentin, mammaglobin, and harbor a t (12; 15) (p13; q25) translocation which leads to ETV6-NTRK3 fusion product. The morphology of MASC is not specific and can overlap with many salivary gland tumors. S100 and mammaglobin抯 strong positivity confirm the diagnosis of MASC. The morphology along with immunohistochemical findings provides important clues for diagnosis. Recent advances in molecular pathology help in investigating both differential diagnosis and prognosis in salivary gland oncology. Molecular testing is recommended to arrive at a diagnosis of MASC. We report a case of MASC of the parotid gland in a 47-year-old male patient with his immunohistochemical profile.

Mammary analogue secretory carcinoma in minor salivary gland

ABSTRACT Mammary analogue secretory carcinoma is a rare neoplasm usually confused with other neoplasms in the salivary glands region. It has great similarity with the breast carcinoma. We report a case of a patient who presented with gingival submucosal bleeding and lesion, with the initial histopathological examination revealing salivary gland neoplasm of low crane. Computed tomography revealed the lesion near the tooth 27, with extension to the floor of the left maxillary sinus and to the palate mucosa. Resection of the infra-structure was performed, with a diagnosis of breast cancer secretory carcinoma in the minor salivary gland.

Mandibular secretory carcinoma: a case report / 华西口腔医学杂志

Secretory carcinoma, a low-grade malignant tumor, occurs mainly in parotid, submandibular gland, and small salivary glands in the mouth. It has not yet been reported in the mandible. Now we report a case occurred in the right mandibular angle of secretory carcinoma, accompanying with its diagnosis, treatment and prognosis.

Mammary analogue secretory carcinoma: An Indian experience of a novel entity

Aims: To explore clinical, histopathological and immunohistochemistry (IHC) features of mammary analogue secretory carcinoma (MASC) with systematic literature review. Settings and Design: Hospital based cross-sectional study. Subjects and Methods: The data of all cases of MASC diagnosed over a period of 1 year i.e., from July 2017 to July 2018 were retrieved. The haematoxylin and eosin (H and E) sections, and IHC sections were studied. A strict histological and recently updated criteria were applied and patients with a confirmed diagnosis of MASC were included in the study. A systematic literature review was conducted by searching the PubMed and National Centre for Biotechnology Information database. Statistical Analysis Used: Microsoft Excel 2010. Results: The present case series is 27th in the English literature and 1stcase series describing its histopathology in the Indian literature. The mean age of presentation is 43 years. Female preponderance was found i.e., M:F ratio of 0.5. Conclusion: Histopathology and if necessary, followed by IHC is required for the confirmation of diagnosis of MASC. We should be aware about this recently described entity which is usually mistaken for other low grade salivary gland carcinomas like Acinic cell carcinoma (AciCC) and Mucoepidermoid carcinoma (MEC). The knowledge about its typical morphology, high degree of suspicion and IHC confirmation with both S-100 and Mammaglobin help in precise diagnosis.

Cytopathologic Features of Secretory Carcinoma of Salivary Gland: Report of Two Cases

Secretory carcinoma of the salivary gland (SC) is a newly introduced rare salivary gland tumor that shares histological, immunohistochemical, and genetic characteristics with secretory carcinoma of the breast. Here, we report the cytologic features of two cases of SC confirmed by surgical resection. In these two cases, SC was incidentally detected in a 64-year-old female and a 56-yearold male. Fine needle aspiration cytology revealed nests of tumor cells with a papillary or glandular structure floating in mucinous secretions. The tumor cells demonstrated uniform, round, smooth nuclear contours and distinct nucleoli. Multiple characteristic cytoplasmic vacuoles were revealed. Singly scattered tumor cells frequently showed variable sized cytoplasmic vacuoles. The cytopathologic diagnosis of SC should be considered when characteristic cytological findings are revealed. Further immunohistochemistry and gene analyses are helpful to diagnose SC.

Clinicopathologic features of secretory breast carcinoma / 中华肿瘤杂志

Objective@#Investigate the clinicopathological features for secretory carcinoma of breast (SCB).@*Methods@#The clinical data of 3 SCB cases were collected, immunohistochemical staining was performed by the streptavidin-peroxidase (SP) method to test the expression of the antibodies: ER, PR, HER-2, Ki-67, S100, CK5/6, p63, SMA, calponin, GCDFP-15, and EGFR. Fluorescence in situ hybridization (FISH) was used to detect the ETV6-NTRK3 gene fusion.@*Results@#ER was focal weakly positive in case 1 and case 2 (about 5%) , and negative in case 3. PR was focal weakly positive in case 1 (about 5%) and completely negative in case 2 and case 3. Three cases showed that HER-2, SMA, calponin, GCDFP-15 were negative, while S100, CK5/6, EGFR were diffuse strongly positive. The proliferation index was nearly 15% in case 1 and case 2, and 10% in case 3. p63 was negative in mostly tumor cells of case 1, and focal positive expression in the nucleus and cytoplasm. In case 2, p63 was completely negative. However, p63 was observed positive in the cytoplasm as well as some secretory material in case 3. ETV6-NTRK3 gene fusion detection by FISH was positive in all cases.@*Conclusions@#SCB is a rare low grade triple-negative breast cancer with the unique pathomorphologic features, while its recurrent t (12; 15) (p13; q25) translocation resulting in ETV6 -NTRK3 gene fusion. It has the indolent clinical behavior and good prognosis.

Granular cell tumor of breast: clinicopathological and biological behavior / 中华内分泌外科杂志

Objective To investigate the clinicopathological and immunohistochemical features,diagnosis and prognosis of granular cell tumor of breast (GCT)and to improve the awareness of the disease.Methods Three cases of GCT were collected;Specimens were fully drawn,microscopic pathologic examinations and immunohistochemistry (SP method)were performed.Results Three cases were female patients aged from 39 to 56 years old (average 46 years).In clinical,a single indolent or indolent mass with a hard texture was located in the breast parenchyma.In pathological,the lump was mainly solid or hard tumor with clear boundary or infiltration,with a mean diameter of 2.1 (1.2-3.0)cm,and grey to yellow sections.Histologically,large cells were round or polygonal in shape.The cytoplasm was abundant and eosinophilic.The boundary of the tumor was clear in one case,and in the other two cases,the boundary was unclear.The nucleus was small and located in the center or ectopic.The cytoplasm was coarse-grained with s-100 staining positive microparticles and PAS reaction positive (anti-digestive enzymes).Immunohistochemistrically,the tumor cells were strongly positive for S-100,CD56,NSE and Vimentin,and negative for CK and SMA.None of the patients had present malignant transformation or metastasis.Conclusions GCT can occur in any part of the body,but is not common in breast.GCT is similar to breast cancer in clinical manifestations,imaging and macroscopic observation,etc.The correct diagnosis of this lesion depends on HE morphology,immunohistochemistry and special dyeing.The close postoperative follow-up should be performed.

Secretory breast carcinoma: a clinicopathological study of 6 cases / 临床与实验病理学杂志

Purpose To describe the clinicopathologic features, diagnosis and differential diagnosis, and prognosis of secretory breast carcinoma (SBC). Methods Clinicopathological and follow-up data of six SBC patients were collected. Histopathologic analysis was performed on hematoxylin and eosinstained (HE) section. Immunohistochemical staining was performed by En Vision two-step method and ETV6 gene detected by fluorescence in situ hybridization (FISH), then relevant literatures were reviewed. Results The ages of the patients ranged from 6 to 76 years with a mean age of 38.7 years, including one male and five female patients. The right breast was involved in 4 cases, and the left, in 2 cases. Five cases showed painless breast mass while one presented with a nipple discharge. The tumor size ranged from 1.0 to 3.1 cm with a mean size of 2.0 cm. Most of the tumors were circumscribed, solid gray white to light brown. Histologically, tumor showed solid nested microcystic, glandular or papillary pattern separating by hyaline fibrous tissue and growed in multiple nodular from. The cytoplasm contains abundant eosinophilic secretions or secretory vesicles. Immunhistochemistry, all cases were positive for CK7, S-100 and CEA, but negative for estrogen and progesterone receptors (ER and PR) and HER-2, and the proliferation index Ki-67 ranged from 10％ to 40％. Molecular testing confirmed the presence of the EVT6 gene translocation in one case. Lumpectomy was performed in 2 cases and modified radical mastectomy in 4 cases, two of them had lymph node metastasis (3/15, 1/16). Five cases were followed up for 6 months to 20 years, 1 case had lung metastasis. Conclusion SBC is a rare breast tumor with relatively indolent clinical and good prognosis. It can be diagnosed according to typical pathological morphology and immunohistochemical characteristics. The characteristic EVT6 gene translocation also has important differential diagnostic value.

Primary cutaneous cribriform apocrine carcinoma: Case report and literature review

Primary cutaneous cribriform apocrine carcinoma is a rare but distinct variant of primary cutaneous apocrine carcinoma and it is considered a low grade malignancy. We herein present a case of primary cutaneous cribriform apocrine carcinoma at the neck of a 26-year-old female. The tumor features a relatively well-circumscribed border and multiple aggregations of mildly pleomorphic epithelial cells with large ovoid nuclei, small nucleoli and abundant eosinophilic cytoplasms. Cribriform and tubular structures are the major architectural patterns. The primary differential diagnosis is cutaneous metastasis from a cribriform visceral carcinoma; others include primary secretory carcinoma of the skin, adenoid cystic basal cell carcinoma and primary cutaneous adenoid cystic carcinoma.

Clinicopathologic and molecular genetic analysis of secretory carcinoma of salivary gland / 中华口腔医学杂志

Objective@#To investigate the clinicopathologic and molecular genetic features of secretory carcinoma of salivary gland (SCSG).@*Methods@#Six cases of SCSG were collected from Zhejiang Provincial People's Hospital from January 2011 to March 2018. The clinical, histopathological and immunohistochemical features were analyzed and fluorescence in situ hybridization (FISH) was used to detect ETV6 gene rearrangement.@*Results@#Four out of 6 tumors originated in the parotid gland and one of each in the minor salivary glands of soft palate and the buccal mucosa. Grossly, 4 cases were solid and 2 were partially cystic with maximum diameter ranging from 1.0 to 4.0 cm. Microscopically, 5 tumors showed typical features of low grade SCSG with tumor divided by thin fibrous septa into lobules composed of solid acinar, microcystic, follicular and papillary structures with abundant extracellular mucinous secretions. The tumor cells had cuolated or hobnail cytoplasm with low-grade nuclei and scarce mitoses. Perineural invasion was present in 1 case. The remaining tumor showed about 30% of the tumor areas with high-grade transformation characterized by proliferation of a distinct population of anaplastic cells arranged in irregular glandular, small nested and single cell patterns that were surrounded by desmoplastic stroma and invaded into surface mucosa with ulceration. Immunohistochemistry showed that all 6 tumors had diffuse and strong reactivities to S100 protein and cytokeratin 7, and 4 cases showed focal reactivity to gross cystic disease fluid protein 15 (GCDFP15), all were negative for discovered on gist 1 (DOG1), cytokeratin 20, p63 and calponin. High grade transformation cases were analysed, the high grade SCSG components showed a significantly increased Ki-67 index and cyclin D1 positive tumor cells compared to the conventional SCSG components. FISH analyses showed that 4 cases had ETV6 gene rearrangement. Eleven to seventy one months' follow-up showed no evidence of tumor recurrence nor metastasis.@*Conclusions@#SCSG harbors characteristic genetic abnormalities with ETV6 gene rearrangement and typically shows a low grade morphology with occasionally, high grade transformation can be present.

Clinicopathologic features of mammary analogue secretory carcinoma of salivary glands / 临床与实验病理学杂志

Purpose To summarize the clinicopathological features, immunophenotype, diagnosis and differential diagnosis of mammary analogue secretory carcinoma of salivary glands(MASC). Methods Four cases of MASC were included. The clinical, histological, and immunohistochemical features and follow-up data were evaluated. Results The patients aged between 20 to 72 years. Two cases were male and two were female. The average age was 52.2 years. All cases showed infiltrative growth and diverse cytology and histology, including lobular, cystic papillary, solid, cribriform or glandular structures, and microcystic honeycombed pattern composed of small cysts merged into larger cysts resembling thyroid follicles. There were no necrosis, nerve or vascular invasion in 4 cases. S-100 protein, Mammaglobin or SOX10 were strongly positive in all MASC cases.3 cases were insignificant positivity for GATA-3. Both p63 and DOG-1 were negative. Conclusion MASC is a lowgrade malignant epithelial tumor of salivary glands. Combined immunohistochemical positivity of S-100 protein, Mammaglobin and SOXIO, or negative for DOG-1, are useful in the diagnosis and differential diagnosis of MASC.

Sinonasal mammary analogue secretory carcinoma: a clinicopathological analysis of 2 cases / 临床与实验病理学杂志

Purpose To investigate the clinicopathological features of sinonasal primary secretory carcinoma (SC) and its diagnosis, differential diagnosis. Methods Two cases of sin-nasal SC were analyzed by light microscopy with immunohisto-chemical staining (EnVision) for CK, vimentin, S-100 protein, SOX10, PAS, DPAS, Mamaglobin, Calponin, DOG1, p63 and molecular detection of ETV6 gene break. Results Morphologically, SC revealed varying proportions of solid, tubular, acinar, microcystic, tubular growth patterns. All SC cases were cytological low grade with uniform cells, small-to medium-sizes nuclei, occasional small nucleoli, and abundant pink, bubbly cytoplasm. Mitotic figures were rarely encountered. Tumor cells secreted eosinophilic, colloid-like secretions that were PAS positive. There were no DPAS positive zymogen granules in cyto-plasm. This tumor cells were CK, vimentin, S-100, SOX10, PAS positive and Mamaglobin, Calponin and p63 negative. The ETV6 gene rearrangement was confirmed in all cases by fluorescence in situ hybridization (FISH). After excision, all two patients were survival without tumor recurrence for 41 months and53 months. Conclusion Sinonasal primary SC is a low grade malignant tumor. The histological features of SC are overlap with other salivary gland tumors. Immunohistochemical analysis and FISH are useful for the diagnosis and differential diagnosis.

Clinicopathological characteristics and prognosis of salivary gland secretory carcinoma / 临床与实验病理学杂志

Purpose To investigate the clinicopathological features and prognosis of salivary gland secretory carcinoma(SC). Methods A retrospective study was performed including reviewing the clinical documents and pathological sections of 10 cases of SC. Immunohistochemical EnVision study and histochemical staining were performed in the 10 cases. Fluorescence in situ hybridization (FISH) was used to detect the ETV6-NTRK3 fusion gene. Results There were 8 men and 2 women included in this study. The mean age was 45 years(ranged from 22 to 62 years).9 cases occurred in the parotid and 1 case in submandibular gland. Local painless masses were common first symptoms. Tumor size ranged from 1 cm to 3.5 cm in maximum diameter (average 1.8 cm) and the cut surface of most tumors was solid with dusty red or grayish yellow color, of which 1 case showed cystic degeneration. Histologically, the tumors usually pushed and were invasive to the adjacent tissues. Sometimes, the tumors showed expansive growth pattern. Tumor cells demonstrated microcystic, cystic papillary and alveolar patterns. Eosinophilic secretions could be observed in both microcysts and lumen of alveolus. Immunohistochemically, 10 cases revealed diffuse positivity of cytokeratin, and 9 cases were diffusely and strongly positive for S-100, Mammaglobin, vimentin and CK7, whereas all cases were negative for CD117, Dog-1, p53, p63, SMA, and GATA3. The tumor cells were positive for PAS staining and negative for mucicarmine staining. The detection ETV6-NTRK3 fusion gene was carried out in 4 cases by FISH analysis, among which 3 cases were positive. Follow-up data were available in the 10 patients (ranged from 2 months to35 years), among which 9 patients were alive, except for 1 patient died of tumor recurrence and metastasis 16 years after surgery. Conclusion SC is a newly recognized rare malignant tumor of salivary gland with a lowgrade malignancy, slow growth pattern and favorable prognosis. The histological structures of microcysts and eosinophilic secretions are (he crucial histological characteristics of SC. Diffusely strong positive expression of S-100 and mammaglobin is helpful for the diagnosis and differential diagnosis of the tumor. The diagnosis of SC could be confirmed when ETV6-NTRK3 fusion gene could be identified.

Mammary analogue secretory carcinoma of salivary gland A case report of new entity

Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland tumor. Few cases are reported in the literature. We have reported here this case for its rarity.

Large lipid-rich mammary analogue secretory carcinoma of parotid gland: An unusual case.

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a malignant tumor which bears morphologic, immunohistochemical and molecular features similar to those of mammary secretory carcinoma. The tumor is considered as a low-grade malignancy perhaps slightly more aggressive than acinic cell carcinoma. High-grade transformation with recurrences, regional nodal involvement, metastases, and cancer-related death has been reported in a few cases. We report an unusual case of large MASC of the parotid gland in a young patient without regional lymph node involvement. To the best of our knowledge till date such a large MASC of the salivary gland has not been reported in the English literature.

A Case of Mammary Analogue Secretory Carcinoma Arising from Parotid Gland / 대한이비인후과학회지

Mammary analogue secretory carcinoma is a recently described salivary gland tumor. Histopathologically, mammary analogue secretory carcinoma resembles both acinic cell carcinoma and secretory breast carcinoma but also exhibit some differences. We present a case of mammary analogue secretory carcinoma of the parotid gland to help further characterize this rare tumor.

Carcinoma mamário secretório em criança de sete anosde idade: relato de caso e revisão da literatura / Carcinoma mamário secretório em criança de sete anos de idade: relato de caso e revisão da literatura

O carcinoma secretório da mama é uma entidade extremamente rara, inicialmente descrita em crianças e adolescentes, mas um número relativamente frequente de casos foi relatado em adultos. É usualmente associado ao bom prognóstico. O presente caso refere-se a uma menina de sete anos de idade com crescimento tumoral progressivo na mama esquerda. O exame clínico identificou um nódulos ubareolar duro, móvel, indolor e margens regulares; macroscopicamente, o espécime cirúrgico mostrou nódulo com 1,3 cm de diâmetro e superfície lisa. O diagnóstico final de neoplasia maligna levou à mastectomia, e a avaliação intraoperatória do linfonodo sentinela foi negativa. O perfil imunoistoquímico incluiu coloração fortemente positiva para citoqueratinas (AE1/AE3) e TP53, expressão negativa para receptores de estrógeno e progesterona e proteína Her-2/neu; o antígeno de proliferação celualar Ki-67 (MIB-1) mostrou índice de marcação de 10%. Exames adicionais de acompanhamento não mostraram nenhuma evidência de metástases à distância, com desenvolvimento normal das características sexuais secundárias (pubarca, telarca direita e menarca, que ocorreu em julho de 2009). Sete anos mais tarde, a adolescente ainda está livre da doença e aguarda cirurgia plástica reconstrutiva da mama esquerda.

Secretory breast carcinoma is an extremely rare entity initially described in children and in adolescents, but a relatively frequent number of cases has been reported in adults. It is often associated with good prognosis. The present case refers to a seven-year-old girl with a progressively growing tumor in the left breast. Clinical examination identified a hard, mobile, non-painful,subareolar nodule with regular margins; further macroscopy of surgical specimen showed a smooth surface and 1.3 cm in diameter. The final diagnosis of malignancy led to mastectomy and intra-operatively negative sentinel lymph node assessment. Immunohistochemical profile included a strong positive stain for cytokeratins (AE1/AE3) and TP53, and estrogen-receptor and progesterone-receptor and Her-2/neu protein expression negative; and MIB-1 (Ki-67) labeling index was 10%. Further follow-up examinations have shown no evidence of distant metastases, with normal development of secondary sexual characteristics (pubarche, right thelarche, and menarche occurring in July, 2009). Seven years later, the teenager still does not have the disease and waits reconstructive plastic surgery of the left breast.

Fine Needle Aspiration Cytology for Secretory Carcinoma of the Breast in a Female Adult: A Case Report / 대한세포병리학회지

Secretory carcinoma of the breast is a rare tumor of the ductal origin with a more favorable prognosis than the conventional ductal carcinoma. To the best of our knowledge, there are a few reports on fine needle aspiration cytology (FNAC) of secretory carcinoma in the English literature and one in the Korean literature. Recently, we experienced a case of secretory carcinoma of the breast performed by FNAC. The cytologic smears revealed several clusters and sheets of cohesive neoplastic cells in eosinophilic secretory background. Individually scattered cells were rarely found. Intracytoplasmic vacuolization and occasional signet ring cells with lacy cytoplasm were detected. To make the diagnosis and differentiation of this rare tumor, an identification of the secretory background and microcystic spaces filled with bluish mucin and occasional nuclear atypism of tumor cells is crucial.

Secretory Carcinoma of the Breast in Three Year-old Girl: A Case report / 대한암학회지

Secretory carcinoma is one of the least common forms of breast cancer and demonstrates distinctive clinical and pathological characteristics. We herein report a case of secretory carcinoma of the breast in 3 year and 1 month-old girl. At presentation, the patient had a 2.5cm sized mass on her left breast which was firmly attached to the overlying nipple. The aspiration cytologic findings of the tumor were consistent with a secretory carcinoma. After confirming malignancy by frozen section diagnosis, a modified radical mastectomy was performed and secretory carcinoma was finally diagnosed. To our knowledge, secretory breast carcinoma in children has not been reported previously in Korea and this seems to be the youngest case of secretory carcinoma of the breast which had been reported in English literature.