Salivary adenocarcinoma, not otherwise specified: A collection of orphans

Department of Oral Pathology, School of Stomatology and Affiliated Shanghai Ninth People's Hospital, Shanghai Second Medical University, Shanghai, People's Republic of China.
Archives of pathology & laboratory medicine (Impact Factor: 2.84). 01/2005; 128(12):1385-94. DOI: 10.1043/1543-2165(2004)128<1385:SANOSA>2.0.CO;2
Source: PubMed


Salivary adenocarcinoma, not otherwise specified, refers to gland-forming malignancies that do not satisfy the diagnostic requirements of other "named" malignancies.
To review the features of 11 patients with salivary adenocarcinoma, not otherwise specified. To also compare the diagnostic frequencies of 2 databases, one from the Mount Sinai Medical Center (New York, NY), the other from the Shanghai Ninth People's Hospital (Shanghai, People's Republic of China).
Pathology files were searched to establish a database of salivary tumors. All available hematoxylin-eosin- stained slides from the resection specimens diagnosed as either adenocarcinoma, not otherwise specified, or with vague or unusual diagnoses (eg, probable carcinoma-ex-pleomorphic adenoma) were pulled from our files and reexamined. Dates of death were confirmed with the Social Security Death Index.
We identified 11 patients with salivary adenocarcinoma, not otherwise specified, ranging in age from 49 to 80 years (median, 67 years), with a male preponderance. The parotid gland was the most common site of tumor origin. Ten of these tumors were high grade, and 1 was intermediate grade. Two patients were diagnosed at stage II, while the remaining patients were diagnosed at stage III or IV. Histologically, all tumors were invasive, with variable glandular differentiation and diverse architectural patterns. The diverse cytologic tumor cell types included cuboidal, columnar, epithelioid, polygonal, oncocytoid, clear, melanoma-like, mucinous, sebaceous, and plasmacytoid. Four patients died after 4 to 27 months (mean, 15 months), 1 patient is alive with disease at 12 months, 1 patient is disease-free at 14 years, and 3 patients remain disease-free after short follow-ups (10, 12, and 12 months). One patient had surgery just recently, and the remaining patient had no follow-up.
Salivary adenocarcinoma, not otherwise specified, is an aggressive, high-grade malignancy, with a predisposition for the parotid gland. It is characterized by cytologic and architectural diversity and an invasive growth pattern.

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    • "Data concerning the relative frequency of adenocarcinoma (NOS) vary from 1.2% to 17.8% of all salivary gland carcinomas [6,8], since in previous classifications tumours, which are currently established as more specific histologies like salivary duct carcinoma, epithelial-myoepithelial carcinoma or polymorphous low-grade adenocarcinoma, were often categorized as adenocarcinoma (NOS) [6,8]. About 40% of adenocarcinomas (NOS) are located in the minor salivary glands [7], with a relative frequency of 4.3%–10.3% of all minor gland carcinomas [3-5]. "
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    ABSTRACT: With the 2005 WHO classification of salivary gland tumours and its increasingly recognized diagnostic entities, the frequency of adenocarcinoma (NOS) has decreased significantly. This paper describes a fast growing adenocarcinoma (NOS), originating from the minor salivary glands of the left buccal mucosa with a rapid onset of multiple local and distant metastases, especially in the lung. A lung primary was unlikely as the tumour was characterized by positivity for cytokeratin 20 and negativity for the thyroid transcription factor-1 protein (TTF-1) in immunohistochemistry. A rare case of an adenocarcinoma (NOS) of the minor salivary glands with a rapid development and an unfavourable clinical course is reported. It shows that additional immunohistochemical analysis can decisively contribute to determine the site of the primary tumour in cases with unknown primary.
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