Clear cell carcinoma of the major salivary gland: time for a different approach to management?

We read with interest the article of L opez -Q uiles et al. regarding clear cell carcinoma (CCC) of major salivary glands in a HIV-infected patient treated with wide excision, suprahyoid lymph node dissection and radiotherapy. CCC appears in the World Health Organization classification of salivary gland tumours in 2005, under the name of ‘clear cell carcinoma, not otherwise specified’ with one variant being the hyalinizing type .

This case report is of particular interest to our group, as we have recently treated a patient with a similar tumour. In 2007, a 37-year-old man was referred to our service for the evaluation of a painless lesion on the floor of month. His past medical history was unremarkable. A biopsy showed a hyalinizing CCC presenting as infiltrating islands and small nests of clear cells with pleomorphic nuclei, small nucleoli, insignificant mitotic activity and hyalinized stroma ( Fig. 1 a and b) ; tumour cells were negative for S100 protein and smooth muscle actin, and contained glycogen, being periodic acid Schiff stain positive and diastase labile ( Fig. 2 ). No local or regional metastasis and no other primary tumour was demonstrated on imaging studies. Our patient underwent a wide local excision without neck dissection. The specimen resection margins were negative for tumour and the patient did not receive post-operative radiotherapy He has no evidence of recurrence at a follow-up of 4 years.

Fig. 1
(a) Tumour infiltrates the stroma extensively (H and E; magnification 40×). (b) Tumour consists of nests of cells with moderately pleomorphic nuclei, inconspicuous nucleoli, clear cytoplasm and hyalinized stroma (H and E; magnification 400×).

Jan 26, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Clear cell carcinoma of the major salivary gland: time for a different approach to management?
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