J Korean Assoc Oral Maxillofac Surg.  2013 Dec;39(6):283-288. 10.5125/jkaoms.2013.39.6.283.

An atypical case of rare salivary malignancy, hyalinizing clear cell carcinoma

• Kim DW
• Park HJ
• Cha IH
• Yang DH
• Kim HS
• Nam W

• KMID: 1960978
• DOI: http://doi.org/10.5125/jkaoms.2013.39.6.283

Abstract

As an uncommon, malignant salivary gland tumor with female predominance, hyalinizing clear cell carcinoma (HCCC) is regarded as an indolent tumor. The diagnosis of this rare tumor is challenging, and it depends on microscopic and immunohistochemical (IHC) studies. Although it is regarded as an indolent tumor, there are reports of unconventional forms with aggressive clinical courses. We report an atypical case of this rare tumor, HCCC, in a male patient who had a relatively large-sized mass (3.8x3.0 cm) on the right mouth floor with ipsilateral neck node metastasis. The clinical, radiological, pathological, and IHC features together with the clinical course are described.

Keyword

Adenocarcinoma; Clear cell; Sublingual gland; Head and neck neoplasms

MeSH Terms

Adenocarcinoma
Diagnosis
Female
Head and Neck Neoplasms
Humans
Hyalin*
Male
Mouth Floor
Neck
Neoplasm Metastasis
Salivary Glands
Sublingual Gland

Figure

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  Fig. 1 Initial intraoral photograph.

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  Fig. 2 Gadolinium-enhanced magnetic resonance imaging, coronal view. A. Main mass (arrow). B. Nodal metastasis on level II, ipsilateral side (arrow). C. Positron emission tomography-computed tomography, coronal view. Main mass (arrow). D. Nodal metastasis on level II, ipsilateral side (arrow).

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  Fig. 3 A. Histopathological examination of incisional biopsy. Poorly differentiated epithelial cells with multiple clear cells were noted (H&E staining, ×100). B. Specimen from incisional biopsy in higher magnification. The specimen was mostly composed of malignant cells with clear cytoplasm, and there were some portions of cells with glandular differentiation (H&E staining, ×400). C. The specimen from incisional biopsy showing clear cells stained negatively to mucicarmine (×200). D. Immunohistochemical (IHC) staining for S-100 showing negative reactivity of clear cells (×200). E. IHC staining for cytokeratin (CK) 7 showing positive reactivity of clear cells (×200). F. IHC staining for CK20 showing negative reactivity of clear cells (×200). G. Histopathologic examination of final specimen. Epithelial cells and clear cells arranged in cords or nests (H&E staining, ×100). H. Final specimen in higher magnification. Areas of hyalinization are seen (marked in asterisks) (H&E staining, ×400).

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  Fig. 4 Intraoperative photographs. A. Palpable node on level II was revealed. B. The main lesion was shown. C. Surgical specimen of the main mass. D. Operation site after the excision and neck dissection.

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