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Time to Rethink Pathology Reporting in Adenoid Cystic Carcinoma
Luigi Lorini1, Emily Governini1,2, Armando Di Bello3
1Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
Purpose:
To propose a practical, biologically informed pathology reporting framework for adenoid cystic carcinoma (AdCC) that integrates conventional morphology with selective biomarker assessment.
Methods:
A narrative review of current pathological reporting standards, emerging proteogenomic evidence, and clinically relevant biomarkers was performed. Based on available evidence, a stepwise reporting strategy was developed in which routine histopathological evaluation remains the foundation, while additional immunohistochemical and molecular analyses are selectively recommended for high-risk or clinically relevant cases.
Findings:
Conventional morphology accurately establishes the diagnosis but does not fully capture the biological heterogeneity and complexity of AdCC. A selective biological addendum including MYC, p63, B7-H4, TROP2, Nectin-4, and selected molecular analyses may improve biological stratification, optimize tissue stewardship, and identify patients eligible for biomarker-driven therapeutic trials.
Conclusion:
Morphology should remain the cornerstone of AdCC pathology reporting while guiding selective biological characterization to support precision oncology and future clinical trial enrollment.