Adenoid cystic carcinoma of the maxillary sinus with gradual histologic transformation to high-grade adenocarcinoma: a comparative report with dedifferentiated carcinoma

Virchows Arch. 2006 Feb;448(2):204-8. doi: 10.1007/s00428-005-0054-8. Epub 2005 Aug 17.

Abstract

We report a unique case of adenoid cystic carcinoma (ACC) of the maxillary sinus, with gradual histologic transformation from lower-grade ACC (cribriform and tubular types) to high-grade adenocarcinoma (HGA) showing a sequential histologic spectrum via solid-type ACC. A 74-year-old man presented with swelling and mild pain of the right cheek. CT scan showed a mass measuring approximately 4 cm, with marked bone destruction in the right maxillary sinus. A surgically resected specimen revealed that the tumor was comprised of three different components: HGA and solid-type ACC in the central portion and lower-grade ACC in the periphery. The tumor was discriminated from a dedifferentiated carcinoma or hybrid tumor. Autopsy specimens also demonstrated both solid-type ACC and HGA components in the lung and spleen. Immunohistochemically, positive staining of p53 protein was detected on both solid-type ACC and HGA cells, but cyclin D1 and HER2/neu was only seen in HGA cells. Solid-type ACC cells were immunoreactive for CD117 (c-kit), but lower-grade ACC and HGA cells were negative. This case suggests that the overexpression of CD117, p53 protein, cyclin D1, and HER2/neu might be involved in the progression from lower-grade ACC to solid-type ACC and HGA.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Actins / analysis
  • Adenocarcinoma / metabolism
  • Adenocarcinoma / pathology*
  • Aged
  • Carcinoma / metabolism
  • Carcinoma / pathology
  • Carcinoma, Adenoid Cystic / metabolism
  • Carcinoma, Adenoid Cystic / pathology*
  • Disease Progression
  • Fatal Outcome
  • Humans
  • Immunohistochemistry
  • Keratins / analysis
  • Liver Neoplasms / secondary
  • Lung Neoplasms / secondary
  • Male
  • Maxillary Sinus Neoplasms / metabolism
  • Maxillary Sinus Neoplasms / pathology*
  • Muscle, Smooth / chemistry
  • S100 Proteins / analysis
  • Tumor Suppressor Protein p53 / analysis

Substances

  • Actins
  • S100 Proteins
  • Tumor Suppressor Protein p53
  • Keratins