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Detection of MYB Alterations and Other Immunohistochemical Markers in Primary Cutaneous Adenoid Cystic Carcinoma

Journal article
Authors J. P. North
T. H. McCalmont
Andre Fehr
A. van Zante
Göran Stenman
P. E. LeBoit
Published in American Journal of Surgical Pathology
Volume 39
Issue 10
Pages 1347-1356
ISSN 0147-5185
Publication year 2015
Published at Institute of Biomedicine, Department of Pathology
Pages 1347-1356
Language en
Links dx.doi.org/10.1097/pas.000000000000...
Keywords adenoid cystic carcinoma, cutaneous adenoid cystic carcinoma, MYB, c-kit, salivary-glands, diagnostic utility, adnexal carcinomas, primary, skin, expression, breast, neoplasms, nfib, adenocarcinoma, Pathology, Surgery
Subject categories Cancer and Oncology

Abstract

Adenoid cystic carcinoma (ACC) can arise in several organs, and prognosis is highly dependent on the primary tumor site. Primary cutaneous ACC has an excellent prognosis compared with salivary or lacrimal ACC. Activation of MYB by gene fusion or other mechanisms has been found in salivary, breast, and lacrimal ACCs but has not been described in cutaneous ACC. We analyzed the histopathologic and immunohistochemical features of 19 primary cutaneous ACCs, 2 periorbital ACCs, and 12 salivary gland ACCs and assessed for MYB activation in primary cutaneous ACC by immunohistochemistry and molecular methods. The presence of perineural invasion differed significantly among ACCs of various sites (83% salivary, 50% eyelid, 11% skin, P=0.0002). Over 90% of all ACCs were grade 1 or 2 and exhibited diffuse (>50%) positivity with CD117, SOX-10, and smooth muscle actin immunostains. CK15 and vimentin showed diffuse positivity in 36% and 57% of cutaneous ACCs, respectively, and were negative or only focally positive in all salivary ACCs (P=0.04 and 0.002). Six of the 11 cutaneous and periorbital ACCs tested with reverse transcriptase polymerase chain reaction and/or fluorescence in situ hybridization had MYB rearrangements including 2 cases that expressed MYB-NFIB fusion transcripts. Diffuse expression of MYB protein assessed by immunostaining was present in 8 of 9 cutaneous ACCs, including cases both with and without MYB rearrangements. These results indicate that cutaneous ACCs possess the same types of MYB alterations as ACCs of other anatomic sites. Vimentin and CK15 appear to have some discriminatory value in differentiating between primary cutaneous and salivary gland ACCs.

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