Metastatic salivary duct carcinoma in cardiac and pleural effusions: A case report with immunocytochemical analysis for androgen receptor and HER2.

Salivary duct carcinoma (SDC) is a relatively rare highly aggressive salivary gland tumor. Although SDC shows frequent lymph node and distant metastases, the presence of neoplastic cells in the pleural effusion is extremely rare. In this report, we describe the first documented cytological case of metastatic SDC in cardiac and pleural effusions with immunocytochemical analyses for androgen receptor (AR) and human epidermal growth factor receptor (HER)2. A 52-year-old Japanese male developed cardiac tamponade and respiratory discomfort after surgery and chemo-radiation therapy for SDC of the right submandibular gland. Aspiration of the cardiac and pleural effusions was performed. The Papanicolaou-stained cytological specimens of cardiac and pleural effusions showed that numerous small ball-like or papillary structures were present in an inflammatory background. The neoplastic cells had rich granular cytoplasm and large round to oval nuclei containing conspicuous nucleoli. Immunocytochemical analyses clearly demonstrated positivity for AR and strong membranous expression of HER2 in the neoplastic cells. Accordingly, a cytodiagnosis of metastatic SDC was made. Recently, HER2-targeted or AR deprivation therapy have been introduced for patients with SDC, therefore, determination of expression profiles of AR and HER2 may be crucial for developing a treatment strategy for patients with metastatic SDC. According to the results of the present report, immunocytochemical analyses for AR and HER2 in the effusion specimens may be useful for determination of a treatment strategy for patients with metastatic SDC.