case_images: PMC11021063_01
case_images: (a-c) Microphotographs from fine-needle aspiration smears from the submandibular lymph node showing tumor cells in loose cohesive clusters having round-to-oval nuclei, coarse chromatin, and prominent nucleoli with a moderate amount of cytoplasm, (x40, x200, x400, May Grunwald Giemsa [MGG]). (d-f) Microphotograph from fine-needle aspiration smears from the sublingual swelling showing basaloid cells with oval to angulated hyperchromatic nuclei, indistinct nucleoli, and scant cytoplasm, (x40, x100, x200, MGG).
case_images: Cytojournal-21-10-g001.jpg
case_images: PMC11021063_01_Cytojournal-21-10-g001.jpg
case_images: F1
case_images: Few of these cells had vacuolated cytoplasm [Figure 1a-c]. The findings were characteristics of ADCC arising from the minor salivary gland [Figure 1d-f].
case_images: Microphotograph panel showing features of high-grade transformation (HGT) of adenoid cystic carcinoma (ADCC). (a and b) Sections from sublingual tumors showing classical cribriform pattern of ADCC. (c and d) Section showing areas of high-grade transformation; both basaloid cells disposed in the cribriform pattern with bands of hyalinization, and sheets of pleomorphic tumor cells with vesicular nuclei and prominent nucleoli are noted. (e and f) Section showing invasive sheets of poorly differentiated tumor cells. (g) Section showing perineural invasion by poorly differentiated tumor cells. (h) Section showing poorly differentiated tumor cells invading surrounding muscle tissue. (i) Lymph node metastases. (j and k) Immunohistochemical expression of tumor protein p53 (p53) in both basaloid tumor cells and poorly differentiated areas. (l) Tumor cells are immunonegative for human epidermal growth factor receptor 2. ((a-i): hematoxylin and eosin, (j-k): p53, l: Human epidermal growth factor receptor 2 (HER2), immunoperoxidase (IPOX), (a-c): 40x, d: 100x, e: 200x, (f-g): 400x, (h-i): 100x, (j-l): 100x).
case_images: Cytojournal-21-10-g002.jpg
case_images: PMC11021063_01_Cytojournal-21-10-g002.jpg
case_images: F2
case_images: Microscopy showed ADCC with the tumor disposed in cords, tubules, and cribriform pattern having hyperchromatic, angulated nuclei with scant cytoplasm, and the lumen showed the presence of pale mucoid secretions [Figure 2a and b]. However, the tumor showed a gradual transition to high grade and extended into the adjoining soft tissue arranged in cords, solid sheets, and focal glands present in the hyalinized stroma [Figure 2c and d]. The individual tumor cells were pleomorphic with vesicular nuclei, prominent nucleoli, and scant cytoplasm [Figure 2e and f]. Perineural invasion and large areas of tumor necrosis were seen, and dedifferentiated areas were present [Figure 2g and h]. The nodal metastases showed tumor cells with high-grade morphology [Figure 2i]. Immunohistochemistry (IHC), done on both well-differentiated and high-grade areas, revealed tumor cell immunopositivity for p53 [Figure 2j and k].