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Difference between revisions of "Salivary glands"
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| Line 122: | Line 122: | ||
| epithelioid | | epithelioid | ||
| clear | | clear | ||
| '''granular''' | | '''granular''' abundant | ||
| stippled, +/-occ. nucleoli | | stippled, +/-occ. nucleoli | ||
| ? | | ? | ||
| Line 360: | Line 360: | ||
=Malignant= | =Malignant= | ||
One approach: | |||
*Differentiate -- luminal vs. myoepithelial vs. basal. | *Differentiate -- luminal vs. myoepithelial vs. basal (mucoepideroid). | ||
==Mucoepidermoid carcinoma== | ==Mucoepidermoid carcinoma== | ||
*Abbreviated ''MEC''. | |||
===General=== | ===General=== | ||
*Most common malignant neoplasm of salivary gland. | *Most common malignant neoplasm of salivary gland in all age groups. | ||
*Female:male ~= 3:2. | |||
*Site: parotid > submandibular. | |||
===Gross=== | |||
*Cystic or solid, usu. a mix of both. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Architecture:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm]. Accessed on: 19 October 2010.</ref> | *Architecture:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm]. Accessed on: 19 October 2010.</ref> | ||
**Cystic | **Cystic (low grade). | ||
**Solid | **Solid (high grade). | ||
*Mucous cells with abundant fluffy cytoplasm and large mucin vacuoles - '''key feature'''. | |||
**Nucleus distorted by mucin vacuole. | |||
*Epidermoid cells: | |||
**Non-keratinized, polygonal squamoid cell with clear or oncocytic cytoplasm. | |||
***Clear cells contain glycogen ([[PAS]] +ve, [[PAS-D]] -ve). | |||
Notes: | Notes: | ||
*Mucin vacuoles may be rare; in a superficial glance -- it may mimic squamous cell carcinoma. | *Mucin vacuoles may be rare; in a superficial glance -- it may mimic squamous cell carcinoma. | ||
*"Intermediate cells" are described in textbooks. Weinreb thinks they are a pretty much a myth.<ref>IW. 10 January 2011.</ref> | |||
*The thought of high-grade MEC should prompt consideration of squamous cell carcinoma. | |||
Images: | Images: | ||
| Line 382: | Line 394: | ||
*[http://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%283%29_HE_stain.jpg Mucoepidermoid carcinoma 3 (WC)]. | *[http://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%283%29_HE_stain.jpg Mucoepidermoid carcinoma 3 (WC)]. | ||
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm Mucoepidermoid carcinoma (ouhsc.edu)]. | *[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm Mucoepidermoid carcinoma (ouhsc.edu)]. | ||
====Subtypes==== | |||
*Conventional. | |||
*Oncocytic. | |||
**Definition: composed of 50% oncocytes. | |||
**Good outcome.<ref name=pmid18971778>{{cite journal |author=Weinreb I, Seethala RR, Perez-Ordoñez B, Chetty R, Hoschar AP, Hunt JL |title=Oncocytic mucoepidermoid carcinoma: clinicopathologic description in a series of 12 cases |journal=Am. J. Surg. Pathol. |volume=33 |issue=3 |pages=409–16 |year=2009 |month=March |pmid=18971778 |doi=10.1097/PAS.0b013e318184b36d |url=}}</ref> | |||
*Clear cell. | |||
*Unicystic (cystadenocarcinoma). | |||
**Based on the gross. (???) | |||
*Sclerosing MEC +/- eosinophilia. | |||
**Rare. | |||
====Grading==== | |||
General: | |||
*Two competing system exist: | |||
**AFIP.<ref name=pmid9529011>{{cite journal |author=Goode RK, Auclair PL, Ellis GL |title=Mucoepidermoid carcinoma of the major salivary glands: clinical and histopathologic analysis of 234 cases with evaluation of grading criteria |journal=Cancer |volume=82 |issue=7 |pages=1217–24 |year=1998 |month=April |pmid=9529011 |doi= |url=}}</ref> | |||
**Brandwein.<ref name=pmid11420454>{{cite journal |author=Brandwein MS, Ivanov K, Wallace DI, ''et al.'' |title=Mucoepidermoid carcinoma: a clinicopathologic study of 80 patients with special reference to histological grading |journal=Am. J. Surg. Pathol. |volume=25 |issue=7 |pages=835–45 |year=2001 |month=July |pmid=11420454 |doi= |url=}}</ref> | |||
Notes: | |||
*Both systems have their pros and cons. | |||
*Weinreb uses the AFIP system with a slight modification. | |||
=====AFIP===== | |||
#Low cystic content <20%) - 2 points. | |||
#Perineural invasion - 2 points. | |||
#Necrosis - 3 points. | |||
#Mitoses > 4 per 10 HPFs (HPF not defined in paper - see [[HPFitis]]) - 3 points. | |||
#Anaplasia - 4 points. | |||
Scoring: | |||
*Low grade: 0-4 points. | |||
*Intermediate grade: 5 or 6 points. | |||
*High grade: 7+ points. | |||
===Stains=== | |||
Mucous cells: | |||
*Alcian blue +ve. | |||
*Mucicarcmine +ve. | |||
==Acinic cell adenocarcinoma== | ==Acinic cell adenocarcinoma== | ||
| Line 390: | Line 440: | ||
*The relative prevalence of the neoplasm in the various salivary gland reflects the abundance of acinic cells: parotid gland (~80%) > minor salivary glands (~17%) > submandibular glands (~3%). | *The relative prevalence of the neoplasm in the various salivary gland reflects the abundance of acinic cells: parotid gland (~80%) > minor salivary glands (~17%) > submandibular glands (~3%). | ||
*Affects wide age range -- including children. | *Affects wide age range -- including children. | ||
*Site affect prognosis (most aggressive to least aggressive): submandibular > parotid > minor salivary. | |||
===Gross=== | ===Gross=== | ||
*Tan or reddish. | *Tan or reddish. | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Sheets of cells | *Sheets of acinic cells with: | ||
*Abundant cytoplasm. | **Abundant cytoplasm. | ||
* | **Small nuclei stippled chromatin. | ||
*Scattered intercalcated duct type cells with: | |||
**Eosinophilic cytoplasm with moderate amount of cytoplasm. | |||
**Bland nuclei with slightly larger than seen in acinic cells. | |||
*+/-Peri-tumoural lymphocytes. | *+/-Peri-tumoural lymphocytes. | ||
Notes: | Notes: | ||
*Adipose tissue -- present in the salivary glands -- is absent in AcCC. | *Adipose tissue -- present in the salivary glands -- is absent in AcCC. | ||
*May focally resemble thyroid tissue. | |||
*Smaller (characteristic) microvacuoles (unreported in the literature) may be present that have a bubbly appearance and glassy basophilic inclusions.<ref>IW. 11 January 2011.</ref> | |||
Memory device: | Memory device: | ||
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*[http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/acinic.html AcCC (brown.edu)]. | *[http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/acinic.html AcCC (brown.edu)]. | ||
*[http://www.aciniccell.org/acc_images14.html AcCC (aciniccell.org)] - image collection. | *[http://www.aciniccell.org/acc_images14.html AcCC (aciniccell.org)] - image collection. | ||
====Grading==== | |||
General: | |||
*Not prognostic. | |||
*Done to avoid phone calls from clinician. | |||
Factors Weinreb uses:<ref>IW. 11 January 2011.</ref> | |||
*Necrosis. | |||
*Nuclear atypia. | |||
*Perineural invasion. | |||
*Mitoses. | |||
*Infiltrative margin. | |||
*Tumour sclerosis. | |||
====Subtypes==== | ====Subtypes==== | ||
*Oncocytic variant. | *Oncocytic variant - rare. | ||
*Clear cell variant. | *Clear cell variant - rare. | ||
*Papillary cystic variant. | *Papillary cystic variant. | ||
| Line 420: | Line 488: | ||
*PAS +ve. | *PAS +ve. | ||
*PAS-D +ve. | *PAS-D +ve. | ||
*S-100 -ve. | |||
*p63 -ve. | |||
**p63 +ve in mucoepidermoid carcinoma. | |||
There are a bunch of other stains that are touted to be useful (amylase, anti-chymotrypsin, lactoferrin); Weinreb thinks they are not helpful.<ref>IW. 11 January 2011.</ref> | |||
==Adenoid cystic carcinoma== | ==Adenoid cystic carcinoma== | ||