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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 193-195
Histopathological and immunohistochemical analysis of oncocytic pleomorphic adenoma


1 Department of Oral Pathology, Dental School, University of Campinas, Piracicaba-UNICAMP, Av. Limeira 901, Caixa Postal 52, CEP: 13414-903, Piracicaba-SP, Brazil
2 DDS, Centro Clínico e Cabeza y Cuello, 6 ave. 7-39 zona 10, ed. Las Brisas of. 501, Ciudad de Guatemala, 01010, Guatemala
3 Facultad de Odontología, Universidad Juárez del Estado de Durango, Durango, Mexico

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Mariano FV, Vidaurre EC, Bologna-Molina RE, Carlos-Bregni R, Paes de Almeida O. Histopathological and immunohistochemical analysis of oncocytic pleomorphic adenoma. Indian J Pathol Microbiol 2011;54:193-5

How to cite this URL:
Mariano FV, Vidaurre EC, Bologna-Molina RE, Carlos-Bregni R, Paes de Almeida O. Histopathological and immunohistochemical analysis of oncocytic pleomorphic adenoma. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Nov 19];54:193-5. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/193/77403


Pleomorphic adenoma (PA) is the most common salivary gland tumor. Microscopically, PA presents a myriad of histological patterns, and typically the stroma is fibrous, myxoid and/or chondroid. [1]

Oncocytic metaplasia is very common in endocrine and exocrine glands, particularly in elderly patients. [1],[2] Although eventual oncocytic cells are common in PA, extensive oncocytic differentiation is rare. We herein describe the histopathological and immunohistochemical features of one case of oncocytic PA of the parotid gland.

A 60-year-old female presented with a slow-growing asymptomatic nodule in the right parotid region. Physical examination disclosed a non-tender, nodular mass overlying the posterior aspect of the right mandibular ramus. After the examination and diagnosis, the tumor was completely removed by superficial parotidectomy.

Microscopically, an evident capsule surrounded a homogenous eosinophilic cellular mass, showing epithelial components disposed in tubular and solid patterns, resembling PA [Figure 1]a. At high-power examination, most of the cells were polygonal or spindle-shaped, showing abundant eosinophilic light granular cytoplasm characteristic of oncocytic differentiation. The cell borders were distinct, nuclei were central with prominent small nucleoli [Figure 1]b. The tumor was very cellular, devoid of chondromyxoid stroma, showing only a few areas of hyalinization.
Figure 1: (a) PA showing cells with central nuclei and lightly granular eosinophilic cytoplasm characterized as oncocytic cells (H and E, ×200). (b) Higher magnification of PA rich in polygonal and spindle-shaped oncocytic cells. Nuclei are central showing evident small nucleoli. Scarce small ductal structures can be observed (H and E, ×400). (c) Oncocytic PA stained with phosphotungstic acid-hematoxylin confirming that the granular cytoplasmic structures are mitochondria (PTAH, ×400). (d) Oncocytic PA showing most of the cells strongly positive for anti-mitochondrial human antibody (IHC, ×400)

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The cytoplasmic granules of most of the tumor cells stained deeply blue with phosphotungstic acid-hematoxylin stain [Figure 1]c. The cells were also strongly positive for anti-human mitochondria antibody, confirming the oncocytic nature [Figure 1]d. A large panel of antibodies was used to illustrate the benign nature of the tumor and also the epithelial luminal and myoepithelial characteristics of the oncocytic cells [Table 1]. Cytokeratins (CKs) 7, 8, 18 and 19 stained mainly the luminal cells of the ductal structures [Figure 2]a, b, while the myoepithelial components were deeply stained with CK5 and 14, actin-1A4, and S-100 [Figure 3]a-d. Ki-67 and p53 were negative [Table 1].
Figure 2: (a) Oncocytic cells expressing CK7 particularly in the epithelial luminal cells surrounding the ductal lumen (×40). (b) Oncocytic cells expressing CK18 mainly in the epithelial luminal cells (×40)

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Figure 3: PA showing myoepithelial oncocytic cells in solid areas and surrounding the epithelial luminal cells, strongly positive for CK5 (a), CK14 (b), S-100 (c) and actin 1A4 (d), (IHC, ×400)

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Table 1: Antibodies used in the present study and summary of the immunohistochemical findings on epithelial luminal and myoepithelial cells

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In 1931, Hamperl [3] coined the term "oncocyte" to describe cells with abundant eosinophilic granular cytoplasm and central hyperchromatic nuclei. Ultrastructural studies have shown that the cytoplasm of these cells is packed with numerous large and bizarre mitochondria. It is believed that the mitochondrial hyperplasia is a form of compensatory adaptation, resulting from an acquired mitochondriopathy due to mtDNA error. [4] Oncocytic cells are easily recognized in H&E preparations, but anti-mitochondrial antibody and phosphotungstic haematoxylin are helpful to confirm the mitochondrial hyperplasia. [5]

Oncocytes are commonly found as metaplastic cells in normal and tumoral tissues of salivary glands, lacrimal glands, thyroid, parathyroid, pituitary, adrenal cortex, pancreas, lungs, testicles,  Fallopian tube More Detailss, liver, and gastrointestinal tract of elderly people. [4],[5] Tumors of the salivary glands formed by oncocytic cells include oncocytoma, oncocytic carcinoma and Warthin tumor. Rarely, non-oncocytic tumors present a predominance of oncocytes, and this has been reported in myoepithelioma, acinic cell carcinoma, mucoepidermoid carcinoma, basal cell adenoma, polymorphous low-grade adenocarcinoma and sebaceous adenoma. [1] In PA, eventual oncocytes are common, but extensive oncocytic changes are unusual.

PA characteristically shows abundant myxoid, chondroid and hyaline material, and most oncocytic PA described in the literature also showed this typical stroma. [1] Nevertheless, the case described here was very cellular, most of them oncocytic, forming sheets and discreet ductal structures, showing only scarce regions of hyalinization. As for PA, in general, treatment of oncocytic PA is surgical, and does not seem to be relevant in terms of recurrences. Similar to what is found in PA in general, Ki-67 was expressed only in a few cells and p53 was negative.

It is well established that in the salivary glands, epithelial luminal cells are highlighted by immunohistochemistry expression of low-molecular-weight cytokeratins, carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA), while myoepithelial cells express high-molecular-weight CKs, vimentine, S-100 and myoid proteins (HHF-35, actin 1A4, calponin). Luminal and myoepithelial oncocytic cells of the present case, although oncocytic, continued to express their respective typical markers. The origin of oncocytic cells in PA is unknown, but this case illustrates that the mitochondrial phenotype can be seen in both epithelial luminal and myoepithelial cells, suggesting that the mutation occurs in more undifferentiated cells during the tumor formation.

According to Di Palma et al., [5] the oncocytic cells of PA are derived from the neoplastic cells and not from eventual normal entrapped cells in the tumor. In metaplastic oncocytic cells seen in elderly patients, both luminal and abluminal cells also show similar oncocytic morphology, indicating that the molecular mechanisms involved in metaplastic and neoplastic oncocytes in general are similar.

In summary, we have described here the histopathological and IHC findings of an oncocytic PA affecting the parotid gland. Results indicate that the oncocytic differentiation occurred on either epithelial and/or myoepithelial cells. The recognition of massive oncocytic cells in PA and in other glandular neoplasias is important to avoid misclassification of these lesions.

 
   References Top

1.Eveson JW, Auclair P, Gnepp DR. Tumors of the Salivary Glands. In: Barnes L, Eveson JW, Reichart P, Sidransky D, editors. Pathology and genetics of head and neck tumors. World Health Organization Classification of Tumors. Lyon: IARC Press; 2005. p. 209-81.   Back to cited text no. 1
    
2. Di Palma S, Lambros MB, Savage K, Jones C, Mackay A, Dexter T, et al. Oncocytic change in pleomorphic adenoma: Molecular evidence in support of an origin in neoplastic cells. J Clin Pathol 2007;60:492-9.  Back to cited text no. 2
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3.Hamperl H. Beitrage zur normalen und pathologischen histology menschilicher speicheldrusen. Zeitschrift duer Mikroskopish-Anatomische Forschung 1931;27:1-25.   Back to cited text no. 3
    
4.Chang A, Harawi S. Oncocytes, oncocytosis, and oncocytic tumors. Pathol Annu 1992;27:263-304.  Back to cited text no. 4
    
5.Shintaku M, Honda T. Identification of oncocytic lesions of salivary glands by anti-mitochondrial immunohistochemistry. Histopathology 1997;31:408-11.  Back to cited text no. 5
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Correspondence Address:
Fernanda Viviane Mariano
Department of Oral Pathology, Dental School, University of Campinas, Piracicaba-UNICAMP, Av. Limeira 901, Caixa Postal 52, CEP: 13414-903, Piracicaba-SP, Brazil

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77403

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This article has been cited by
1 Differential diagnosis of oncocytic pleomorphic adenoma
Yang, S.
Indian Journal of Pathology and Microbiology. 2011; 54(4): 853-854
[Pubmed]
2 Authorsæ reply
# Mariano, F.V., Vidaurre, E.C., Bologna-Molina, R.E., Carlos-Bregni, R., Paes De Almeida, O.
Indian Journal of Pathology and Microbiology. 2011; 54(4): 854
[Pubmed]



 

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