Avtor/Urednik		Ihrler, Stephan; Stiefel, David; Jurmeister, Philipp; Sandison, Ann; Chaston, Nicola; Laco, Jan; Zidar, Nina; Brčić, Luka; Stoehr, Robert; Agaimy, Abbas
Naslov		Salivary carcinosarcoma
Tip		članek
Leto izdaje		2022
Obseg		str. str.
ISSN		0309-0167 - Histopathology
Jezik		eng
Abstrakt		Aims The formal pathogenesis of salivary carcinosarcoma (SCS) remained unclear, both with respect to the hypothetical development from either preexisting pleomorphic adenoma (PA) or de novo and the clonal relationship between highly heterogeneous carcinomatous and sarcomatous components. Methods and results We performed clinicopathological and molecular (targeted RNA sequencing) analyses on a large series of 16 cases and combined this with a comprehensive literature search (111 cases). Extensive sampling (average 11.6 blocks), combined with immunohistochemistry and molecular studies (PA-specific translocations including PLAG1 or HMGA2 proven in 6/16 cases), enabled the morphogenetic identification of PA in 15/16 cases (93.8%), by far surpassing a reported rate of 49.6%. Furthermore, we demonstrated a multistep (intraductal/intracapsular/extracapsular) adenoma-carcinoma-sarcoma-progression, based on two alternative histogenetic pathways (intraductal, 56.3%, versus myoepithelial pathway, 37.5%). Thereby, early intracapsular stages are identical to conventional carcinoma ex PA, while later extracapsular stages are dominated by secondary, frequently heterologous sarcomatous transformation with often large tumour size (>60 mm). Conclusion Our findings strongly indicate that SCS (almost) always develops from PA, with a complex multistep adenoma-carcinoma-sarcoma-sequence, based on two alternative histogenetic pathways. The findings from this novel approach strongly suggest that SCS pathogenetically is a rare (3‐6%), unique, and aggressive variant of carcinoma ex PA with secondary sarcomatous overgrowth. In analogy to changes of terminology in other organs, the term “sarcomatoid carcinoma ex PA with/without heterologous elements” might be more appropriate.
Proste vsebinske oznake		karcinosarkom žleza slinavka večstopenjska patogeneza carcinosarcoma salivary multistep pathogenesis