Yarman Yanki, Post Robert, Breslin Zachary, Solomides Charalambos C, Gargano Stacey M
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Diagn Cytopathol. 2025 May;53(5):238-245. doi: 10.1002/dc.25453. Epub 2025 Feb 25.
Basaloid salivary gland neoplasms (BSNs) are notoriously difficult to classify in fine needle aspiration (FNA) specimens due to the morphologic overlap of benign and malignant entities. Adenoid cystic carcinoma (AdCC) represents a particular diagnostic challenge, as it typically shows low-grade cytologic features despite its aggressive clinical behavior. We examined whether the proliferation markers Ki-67 and PHH3 could help predict malignancy in BSNs.
A retrospective search was conducted to identify FNA cases of BSNs that had adequate tumor cellularity in the cell block and a subsequent excision specimen. Ki-67 and PHH3 immunohistochemical stains were performed. Aperio (Leica Biosystems) was used to calculate the percentage of tumor cell nuclear expression. Proliferation scores and final histopathologic diagnoses were correlated using a two-sided p-value test.
Ten benign and 14 malignant basaloid neoplasms were analyzed. Benign cases showed low mean percentages of tumor cell staining for Ki-67 (1.14%) and PHH3 (0.84%), while malignant cases showed significantly higher mean percentages, especially with Ki-67 (19% for low-grade malignancies and 25.5% for high-grade malignancies). The difference in proliferation marker scores between the benign and low-grade malignant cases showed statistical significance for both Ki-67 (p = 0.0041) and PHH3 (p = 0.00397). The difference between benign entities and AdCC was also statistically significant for Ki-67 (p = 0.0013) and PHH3 (p = 0.002).
Ki-67 and PHH3 analysis in cell block material may help predict malignancy in a cytologic specimen from a BSN, offering a valuable ancillary tool for cases with cytomorphologic ambiguity. In particular, the ability to suggest a sample is more likely to be AdCC rather than another morphologically similar low-grade BSN would be helpful for surgical planning.
由于良性和恶性实体在形态学上存在重叠，基底样唾液腺肿瘤（BSNs）在细针穿刺（FNA）标本中极难分类。腺样囊性癌（AdCC）是一个特殊的诊断挑战，因为尽管其临床行为具有侵袭性，但通常表现出低级别细胞学特征。我们研究了增殖标志物Ki-67和PHH3是否有助于预测BSNs的恶性程度。
进行回顾性检索，以确定在细胞块中有足够肿瘤细胞量且随后有切除标本的BSNs的FNA病例。进行Ki-67和PHH3免疫组织化学染色。使用Aperio（徕卡生物系统公司）计算肿瘤细胞核表达的百分比。使用双侧p值检验将增殖评分与最终组织病理学诊断进行关联。
分析了10例良性和14例恶性基底样肿瘤。良性病例中Ki-67（1.14%）和PHH3（0.84%）的肿瘤细胞染色平均百分比很低，而恶性病例的平均百分比显著更高，尤其是Ki-67（低级别恶性肿瘤为19%，高级别恶性肿瘤为25.5%）。良性和低级别恶性病例之间增殖标志物评分的差异在Ki-67（p = 0.0041）和PHH3（p = 0.00397）方面均具有统计学意义。良性实体与AdCC之间在Ki-67（p = 0.0013）和PHH3（p = 0.002）方面的差异也具有统计学意义。
对细胞块材料进行Ki-67和PHH3分析可能有助于预测BSN细胞学标本的恶性程度，为细胞形态学不明确的病例提供有价值的辅助工具。特别是，能够提示一个样本更可能是AdCC而不是另一种形态学上相似的低级别BSN，将有助于手术规划。
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