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Presented by William Westra, M.D. and prepared by Doreen Nguyen, M.D.
Case 1: 50 year-old male with mass in the base of tongue.
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1. Question
Week 607: Case 1
50 year-old male with mass in the base of tongue.
Correct
Answer: Cribriform adenocarcinoma of the tongue (CAT)
Histology: The tumor is covered by an intact squamous epithelium without dysplasia. It is unencapsulated. The tumor demonstrates a predominant cribriform to solid pattern of growth. Irregular solid tumor nodules are divided by fibrous septa. There is also an intermingled tubular pattern, and papillary/pseudopapillary structures are also encountered. The nuclei of the tumor cells are uniformly round to oval without significant pleomorphism. In areas, the nuclei overlap and demonstrate chromatin clearing.
Discussion: Cribriform adenocarcinoma of the tongue (CAT) is a tumor occurring mostly, but not exclusively, in the base of the tongue. In light of reports noting their location in other non-lingual sites of the oral cavity, the designation has been modified to cribriform adenocarcinoma of the tongue and minor salivary glands (CATMS). Histopathologically, CATMSG is sometimes confused with papillary carcinoma of the thyroid based on areas of papillary growth, nuclear overlapping and chromatin clearing, and (less commonly) the presence of psammomatous calcifications. Unlike papillary thyroid carcinomas, the tumor is negative for TTF-1 and thyroglobulin by immunohistochemistry. The tumor cells actually show differentiation along salivary gland secretory and myoepithelial lines. They tend to be positive for cytokeratin, cKit, p63, CK5/6 and S100. CATMSG differs from polymorphous low grade adenocarcinoma in terms of location (base of tongue vs palate) and architectural makeup.
CATMSG are often metastatic to regional lymph nodes at the time of presentation. Nonetheless, early metastatic disease seen in most cases of CATMSG is not associated with aggressive behavior as patients consistently follow an indolent course. Accordingly, CATMSG is regarded as a low grade salivary gland carcinoma.
Incorrect
Answer: Cribriform adenocarcinoma of the tongue (CAT)
Histology: The tumor is covered by an intact squamous epithelium without dysplasia. It is unencapsulated. The tumor demonstrates a predominant cribriform to solid pattern of growth. Irregular solid tumor nodules are divided by fibrous septa. There is also an intermingled tubular pattern, and papillary/pseudopapillary structures are also encountered. The nuclei of the tumor cells are uniformly round to oval without significant pleomorphism. In areas, the nuclei overlap and demonstrate chromatin clearing.
Discussion: Cribriform adenocarcinoma of the tongue (CAT) is a tumor occurring mostly, but not exclusively, in the base of the tongue. In light of reports noting their location in other non-lingual sites of the oral cavity, the designation has been modified to cribriform adenocarcinoma of the tongue and minor salivary glands (CATMS). Histopathologically, CATMSG is sometimes confused with papillary carcinoma of the thyroid based on areas of papillary growth, nuclear overlapping and chromatin clearing, and (less commonly) the presence of psammomatous calcifications. Unlike papillary thyroid carcinomas, the tumor is negative for TTF-1 and thyroglobulin by immunohistochemistry. The tumor cells actually show differentiation along salivary gland secretory and myoepithelial lines. They tend to be positive for cytokeratin, cKit, p63, CK5/6 and S100. CATMSG differs from polymorphous low grade adenocarcinoma in terms of location (base of tongue vs palate) and architectural makeup.
CATMSG are often metastatic to regional lymph nodes at the time of presentation. Nonetheless, early metastatic disease seen in most cases of CATMSG is not associated with aggressive behavior as patients consistently follow an indolent course. Accordingly, CATMSG is regarded as a low grade salivary gland carcinoma.
