Archives of Otol

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American Head & Neck Society
July 21-25, 2012
Metro Toronto Convention Centre
Toronto, ON, Canada

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Presentation: P089
Topic: Larynx/Oral Cavity
Type: Poster
Date: Sunday - Tuesday, July 22 - 24, 2012
Session: Designated Poster viewing times
Authors: Chad L McDonald, DO
Institution(s): Department of Pathology, Penn State Milton S. Hershey Medical Center

Hyalinizing clear cell adenocarcinoma (HCCA) of the soft palate is a somewhat rare subtype of clear cell adenocarcinoma which features a slow growing, typically painless submucosal mass. In this case presentation, a review of the clinical and histological features of HCCA is offered, along with keys to identifying the entity and differentiating it from other clear cell malignancies.

A 60-year-old male with a soft palate mass for 7 years presented for fine-needle aspiration and subsequent histological analysis. A diagnosis of HCCA was made after imaging studies revealed no renal lesions and immunohistochemistry was employed to eliminate other clear cell entities in the differential. Aside from a wide local excision, no further therapy was given to the patient. The patient remains symptom and recurrence free after one year.

Since HCCA has a better prognosis (and wide excision is a sufficient form of treatment), it is essential that a differentiation from other clear cell carcinomas of the soft palate is made. A variety of entities need to be considered in the differential diagnosis in such cases including pleomorphic adenoma, myoepithelioma, low grade mucoepidermoid carcinoma, and metastatic renal cell carcinoma.
The histopathological picture of clear cell carcinomas of the soft palate features a monomorphic population of round cells in sheets, nests, cords, and/or ducts, all of which contain clear cytoplasm. HCCA differs in that thick bands of collagen separate clusters of tumor cells into discrete solid lobules.
Clinician familiarity with this lesion will enable improved diagnosis of HCCA entity, and histopathological evaluation along with immunohistochemistry can assist physicians in making the correct diagnosis. Since HCCA has a good prognosis with only rare metastasis, it is important to distinguish the entity from more malignant conditions (e.g. metastatic renal cell carcinoma) to prevent unnecessary suffering of patients.

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