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The '''salivary glands''' help digest food. ENT surgeons | [[Image:Blausen_0780_SalivaryGlands.png|thumb|300px|Schematic showing the major salivary glands. (WC)]] | ||
The '''salivary glands''' help digest food. ENT surgeons excise them if a malignancy is suspected. | |||
The [[cytopathology]] of the salivary glands is covered in the ''[[Head and neck cytopathology]]'' article. | |||
=Normal salivary glands= | |||
==Types of salivary glands== | |||
Types of glands:<ref>[http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/oral.htm#LABSALIVA http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/oral.htm#LABSALIVA]</ref> | Types of glands:<ref>[http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/oral.htm#LABSALIVA http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/oral.htm#LABSALIVA]</ref> | ||
#Serrous - eosinophilic cytoplasmic granules, acinar arrangement - vaguely resembles the acinar morphology of the [[pancreas]]. | #Serrous - eosinophilic cytoplasmic granules, acinar arrangement - vaguely resembles the acinar morphology of the [[pancreas]]. | ||
#Mucinous - light eosinophilic staining. | #Mucinous - light eosinophilic staining. | ||
==Identifying the glands== | |||
The three main glands: | The three main glands: | ||
# Parotid: | # Parotid: | ||
Line 14: | Line 17: | ||
# Submandibular: | # Submandibular: | ||
#*Serous and mucinous glands. | #*Serous and mucinous glands. | ||
#**Serous ~90% of gland. | |||
#**Mucinous ~10% of gland. | |||
#*Serous demilunes = mucinous gland with "cap" consisting of a serous glandular component. | |||
#**Demilune = crescent.<ref>URL: [http://dictionary.reference.com/browse/demilune http://dictionary.reference.com/browse/demilune]. Accessed on: 19 August 2011.</ref> | |||
#**Image: [http://pathology.mc.duke.edu/research/histo_course/demilunes.jpg Serous demilunes (duke.edu)].<ref>URL: [http://pathology.mc.duke.edu/research/pth225.html http://pathology.mc.duke.edu/research/pth225.html]. Accessed on: 19 August 2011.</ref> | |||
# Sublingual: | # Sublingual: | ||
#*Mucinous glands. | #*Mucinous glands. | ||
Other: | |||
*Adipose tissue is found between the glands. | |||
**It increases with age. | |||
Images: | Images: | ||
*[http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/oral.htm#LABSALIVA Salivary glands ( | *[http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/oral.htm#LABSALIVA Salivary glands - normal (uwa.edu.au)]. | ||
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/PQ-Images/E1N002-2b.gif Submandibular gland (ouhsc.edu)] - from a [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/E1N002-PQ01-M.htm Pathology Quiz]. | |||
Memory | Memory devices: | ||
*The '''''p'''arotid gland'' vaguely resembles the '''''p'''ancreas''. | *The '''''p'''arotid gland'' vaguely resembles the '''''p'''ancreas''. | ||
*Sub'''m'''andibular = glands are '''m'''ixed. | |||
=Overview= | |||
==Benign tumours== | |||
'''Tabular form - adapted from Thompson<ref> | '''Tabular form - adapted from Thompson<ref>{{Ref HaNP|295-319}}</ref>''' | ||
{| class="wikitable" | {| class="wikitable sortable" | ||
! Entity | |||
! Architecture | |||
! Morphology | |||
! Cell borders | |||
! Cytoplasm | |||
! Nucleus | |||
! DDx | |||
! Other | |||
! Image | |||
|- | |- | ||
|Pleomorphic adenoma | |[[Pleomorphic adenoma]] | ||
| var. | |||
| '''mixed pop.'''; must include: (1) myoepithelium, (2) mesenchymal stroma, and (3) epithelium (ductal cells) ''or'' [[chondromyxoid stroma]] | |||
| var. | |||
| var. | |||
| (1) plasmacytoid | |||
| [[adenoid cystic carcinoma]] | |||
| occ. encapsulated, <br>mixed pop. of glandular, <br>myoepithelial and mesenchymal cells | |||
| [[Image:Pleomorphic_adenoma_(1)_parotid_gland.jpg | thumb | center |150px| PA. (WP)]] | |||
|- | |- | ||
|Warthin tumour | |[[Warthin tumour]] | ||
| papillary, <br>'''bilayer''' | |||
| cuboid (basal), columnar (apical) | |||
| clearly seen | |||
| '''eosinophilic, abundant''' | |||
| unremarkable | |||
| [[sebaceous lymphadenoma]] | |||
| AKA ''papillary cystadenoma lymphomatosum'' | |||
| [[Image:Papillary_cystadenoma_lymphomatosum2.jpg| thumb| center | 150px| PCL. (WP/Nephron)]] | |||
|- | |- | ||
|Basal cell adenoma | |[[Basal cell adenoma]] | ||
| var., '''islands surrounded'''<br>'''by hyaline bands''', lesion encapsulated | |||
| basaloid | |||
| subtle | |||
| scant,<br>hyperchromatic | |||
| granular | |||
| [[basal cell adenocarcinoma]] | |||
| - | |||
| - | |||
|- | |- | ||
|Canalicular adenoma | |[[Canalicular adenoma]] | ||
| '''chains of cells''' | |||
| cuboid or columnar | |||
| subtle | |||
| scant,<br>hyperchromatic | |||
| granular | |||
| [[basal cell adenoma]] | |||
| exclusively oral cavity, 80% in upper lip; IHC: p63- | |||
| [[Image:Canalicular_adenoma_--_high_mag.jpg | thumb | center |150px| CA. (WC)]] | |||
|- | |- | ||
|Sialoblastoma | |[[Sialoblastoma]] | ||
| var., '''islands surrounded'''<br>'''by loose fibrous stroma''' | |||
| basaloid | |||
| subtle | |||
| scant, hyperch. | |||
| granular | |||
| [[basal cell adenocarcinoma]] | |||
| - | |||
| - | |||
|- | |- | ||
|} | |} | ||
==Malignant tumours== | |||
'''Tabular form - adapted from Thompson<ref> | '''Tabular form - adapted from Thompson<ref>{{Ref HaNP|325-357}}</ref>''' | ||
{| class="wikitable" | {| class="wikitable sortable" | ||
! Entity | |||
! Architecture | |||
! Morphology | |||
! Cell borders | |||
! Cytoplasm | |||
! Nucleus | |||
! DDx | |||
! Other | |||
! Image | |||
|- | |||
|[[Mucoepidermoid carcinoma]] | |||
| cystic & solid | |||
| epithelioid | |||
| distinct | |||
| '''fuffy, clear,<br>abundant''' | |||
| nuclei sm. | |||
| SCC (?) | |||
| IHC: p63+ | |||
| [[Image:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg |thumb| center| 150px | MEC. (WC)]] | |||
|- | |- | ||
| | |[[Adenoid cystic carcinoma]] (AdCC) | ||
| pseudocysts,<br>'''[[cribriform]]''', solid,<br>hyaline stroma | |||
| epithelioid | |||
| subtle | |||
| '''scant''',<br>hyperchromatic | |||
| '''small'''<br>+/-"carrot-shaped" | |||
| [[pleomorphic adenoma]], [[PLGA]] | |||
| Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+ | |||
| [[Image:Adenoid_cystic_carcinoma_-_high_mag.jpg|thumb|center|150px| AdCC. (WC/Nephron)]] | |||
|- | |- | ||
|Acinic cell | |[[Acinic cell carcinoma]] (AcCC) | ||
| sheets, acinar (islands) | |||
| epithelioid | |||
| clear | |||
| '''granular abundant''' | |||
| '''stippled''', +/-occ. nucleoli | |||
| adenocarcinoma not otherwise specified, [[oncocytoma of salivary gland]] | |||
| Stains: PAS +ve, PAS-D +ve; [[IHC]]: S-100 -ve, p63 -ve | |||
| [[Image:Acinic_cell_carcinoma_-_high_mag.jpg | thumb| center|150px| AcCC. (WC/Nephron)]] | |||
|- | |- | ||
| | |[[Salivary duct carcinoma]] | ||
| glandular, [[cribriform]] | |||
| columnar | |||
| subtle/clear | |||
| hyperchromatic | |||
| columnar | |||
| metastatic breast carcinoma | |||
| similar to ductal<br>breast carcinoma; male>female | |||
| [[Image:Salivary_duct_carcinoma_-a-_low_mag.jpg | thumb| center|150px | SDC. (WC/Nephron)]] | |||
|- | |- | ||
| | |[[Polymorphous adenocarcinoma]] (previously polymorphous low-grade adenocarcinoma) | ||
| variable, often small<br>nests, may be targetoid | |||
| epithelioid | |||
| indistinct | |||
| '''eosinophilic''' | |||
| ovoid & small with<br>small nucleoli | |||
| AdCC | |||
| minor salivary gland tumour,<br>often in palate,<br> cytologically monotonous; IHC: [[S-100]]+, CK+, vim.+, GFAP+/-, BCL2+/- | |||
| [[Image:Polymorphous_low-grade_adenocarcinoma_-_very_low_mag.jpg|thumb|center|150px|PLGA. (WC/Nephron)]] | |||
|- | |- | ||
| | | [[Epithelial-myoepithelial carcinoma]] | ||
| '''nests (myoepithelial) with tubules (epithelial)''' | |||
| epithelioid | |||
| not distinct | |||
| eosinophilic cytoplasm; epithelial: scant; myoepithelial: moderate | |||
| focal clearing | |||
| [[AdCC]], [[pleomorphic adenoma]] | |||
| rare | |||
| [[Image:Epithelial-myoepithelial_carcinoma_-_high_mag.jpg |thumb|center|150px|EMCa. (WC/Nephron)]] | |||
|- | |- | ||
| [[Basal cell adenocarcinoma]] | |||
| var., '''islands surrounded'''<br>'''by hyaline bands''', lesion '''not''' encapsulated | |||
| basaloid | |||
| subtle | |||
| scant,<br>hyperchromatic | |||
| granular | |||
| [[basal cell adenoma]] | |||
| rare, usu. parotid gland, may arise from a basal cell adenoma | |||
| [[Image:Basal_cell_adenocarcinoma_-_parotid_gland_-_high_mag.jpg|thumb|center|150px|BCA. (WC/Nephron)]] | |||
|} | |} | ||
=== | ==DDx== | ||
Palate | ===Palate=== | ||
*Polymorphous | *[[Polymorphous adenocarcinoma]]. | ||
*Adenoid cystic carcinoma. | *[[Adenoid cystic carcinoma]]. | ||
*Pleomorphic adenoma. | *[[Pleomorphic adenoma]]. | ||
===Benign parotid tumours=== | |||
*[[Pleomorphic adenoma]]. | |||
*[[Warthin tumour]]. | |||
= | ===Oncocytic tumours=== | ||
== | *Benign: | ||
* | **Oncocytoma. | ||
**[[Warthin tumour]]. | |||
*Malignant: | |||
**[[Mucoepidermoid carcinoma]], oncocytic variant. | |||
**[[Salivary duct carcinoma]]. | |||
**[[Carcinoma ex pleomorphic carcinoma]] with a salivary duct carcinoma component. | |||
**[[Apocrine carcinoma]]. | |||
**Oncocytic carcinoma. | |||
**[[Acinic cell carcinoma]], oncocytic variant. | |||
== | ===Clear cell tumours=== | ||
*[[Mucoepidermoid carcinoma]], clear cell variant. | |||
*[[Acinic cell carcinoma]], clear cell variant. | |||
* | *[[Hyalinizing clear cell carcinoma]]. | ||
*[[Epithelial-myoepithelial carcinoma]]. | |||
*Metastatic [[clear cell carcinoma]]. | |||
**Metastatic [[clear cell renal cell carcinoma]]. | |||
=== | ===Basaloid neoplasms=== | ||
*[[Basal cell adenoma]]. | |||
* | *[[Basal cell adenocarcinoma]] | ||
*[[Pleomorphic adenoma]].<ref name=pmi12478487/> | |||
*[[Adenoid cystic carcinoma]].<ref name=pmi12478487/> | |||
*[[Small cell carcinoma]].<ref name=pmi12478487>{{Cite journal | last1 = Chhieng | first1 = DC. | last2 = Paulino | first2 = AF. | title = Basaloid tumors of the salivary glands. | journal = Ann Diagn Pathol | volume = 6 | issue = 6 | pages = 364-72 | month = Dec | year = 2002 | doi = 10.1053/adpa.2002.37013 | PMID = 12478487 }}</ref> | |||
IHC: | ==IHC overview== | ||
General: | |||
*Usually has limited value. <!--as per Ilan Weinreb--> | |||
Overview: | |||
* | *Luminal markers: [[CK7]], [[CK19]], CAM5.2 (LMWK). | ||
* | *Basal markers: p63, HMWK, CK14. | ||
*Myoepithelial markers: calponin, actin. | |||
*Uncommitted: S-100. | |||
Notes: | |||
* | *p63 and S-100 are sometimes call myoepithelial. | ||
Specifics: | |||
* | *Calponin, S-100, Ki-67 may be useful as per Nagao ''et al.''<ref>{{Cite journal | last1 = Nagao | first1 = T. | last2 = Sato | first2 = E. | last3 = Inoue | first3 = R. | last4 = Oshiro | first4 = H. | last5 = H Takahashi | first5 = R. | last6 = Nagai | first6 = T. | last7 = Yoshida | first7 = M. | last8 = Suzuki | first8 = F. | last9 = Obikane | first9 = H. | title = Immunohistochemical analysis of salivary gland tumors: application for surgical pathology practice. | journal = Acta Histochem Cytochem | volume = 45 | issue = 5 | pages = 269-82 | month = Oct | year = 2012 | doi = 10.1267/ahc.12019 | PMID = 23209336 }}</ref> | ||
* | *Most salivary gland tumours are p40 positive and p63 positive; [[polymorphous adenocarcinoma]] is p63 positive and p40 negative.<ref name=pmid34518135>{{cite journal |authors=Sivakumar N, Narwal A, Pandiar D, Devi A, Anand R, Bansal D, Kamboj M |title=Diagnostic utility of p63/p40 in the histologic differentiation of salivary gland tumors: A systematic review |journal=Oral Surg Oral Med Oral Pathol Oral Radiol |volume=133 |issue=2 |pages=189–198 |date=February 2022 |pmid=34518135 |doi=10.1016/j.oooo.2021.07.010 |url=}}</ref> | ||
= | =Benign= | ||
General DDx: | |||
* | *Inflammation. | ||
* | *Neoplasm. | ||
* | *Ductal obstrution. | ||
=== | ==Chronic sialadenitis== | ||
{{Main|Chronic sialadenitis}} | |||
== | ==Salivary gland mucocele== | ||
{{Main|Salivary gland mucocele}} | |||
== | ==Pleomorphic adenoma== | ||
{{Main|Pleomorphic adenoma}} | |||
= | ==Myoepithelioma== | ||
{{Main|Myoepithelioma}} | |||
== | ==Basal cell adenoma== | ||
General: | ===General=== | ||
* | *~2% of salivary gland tumours. | ||
*May be multifocal. | |||
*Usually parotid gland, occasionally submandibular gland. | |||
*Female:male = ~2:1. | |||
*May be seen in association with [[dermal cylindroma]]s in the context of a genetic mutation.<ref name=pmid12023583>{{Cite journal | last1 = Choi | first1 = HR. | last2 = Batsakis | first2 = JG. | last3 = Callender | first3 = DL. | last4 = Prieto | first4 = VG. | last5 = Luna | first5 = MA. | last6 = El-Naggar | first6 = AK. | title = Molecular analysis of chromosome 16q regions in dermal analogue tumors of salivary glands: a genetic link to dermal cylindroma? | journal = Am J Surg Pathol | volume = 26 | issue = 6 | pages = 778-83 | month = Jun | year = 2002 | doi = | PMID = 12023583 }}</ref> | |||
*Malignant transformation - rarely. | |||
===Microscopic=== | |||
Features: | Features: | ||
* | #Basal component. | ||
* | #*Basophilic cells - '''key feature'''. | ||
#*Usu. in nests. | |||
#**May be bilayered tubules ''or'' [[trabeculae]]. | |||
#*Large basophilic nucleus. | |||
#*Minimal-to-moderate eosinophilic cytoplasm. | |||
#Stromal cells. | |||
#*Plump spindle cells without significant nuclear atypia - '''distinguishing feature'''. | |||
#**Stromal cell nuclei width ~= diameter [[RBC]]. | |||
#*Dense hyaline stroma. | |||
#Tubular component. | |||
#*Within basal component, may be minimal. | |||
#Lesion is encapsulated - '''key feature'''. | |||
Notes: | |||
*No chondromyxoid stroma. | |||
**Chondromyxoid stroma present -> [[pleomorphic adenoma]]. | |||
*Neoplastic cells embedded in stroma ("stromal invasion") = basal cell adenocarcinoma. | |||
**Basal cell adenocarcinoma may be cytologically indistinguishable from basal cell adenoma, i.e. "bad" architecture makes it a basal cell adenocarcinoma. | |||
DDx: | |||
*[[Adenoid cystic carcinoma]] - not encapsulated. | |||
*[[Basal cell adenocarcinoma]] - not encapsulated. | |||
*[[Canalicular adenoma]] - different site; canalicular adenoma is the in oral cavity, usually upper lip. | |||
Images: | Images: | ||
*[http:// | *[http://moon.ouhsc.edu/kfung/jty1/Com/ComImage/Com304-3-LM1.gif BCA (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/Com/Com304-3-Diss.htm http://moon.ouhsc.edu/kfung/jty1/Com/Com304-3-Diss.htm]. Accessed on: 25 October 2011.</ref> | ||
*[http:// | *[http://www.webpathology.com/image.asp?n=1&Case=115 BCA (webpathology.com)]. | ||
*[http://www.webpathology.com/image.asp?n=4&Case=115 BCA (webpathology.com)]. | |||
*[http://www.flickr.com/photos/euthman/5691555734/in/set-72057594114099781/ BCA (flickr.com/euthman)]. | |||
===IHC=== | |||
*Luminal stains +ve: CK7 +ve, CAM5.2 +ve. | |||
*p63 +ve -- basal component. | |||
*[[S-100]] +ve -- spindle cells in the stroma. | |||
== | ==Canalicular adenoma== | ||
{{Main|Canalicular adenoma}} | |||
==Warthin tumour== | |||
{{Main|Warthin tumour}} | |||
==Sebaceous adenoma== | |||
* | {{Main|Sebaceous adenoma}} | ||
*Benign counterpart of ''[[sebaceous carcinoma]]''. | |||
== | ==Sebaceous lymphadenoma== | ||
{{Main|Sebaceous lymphadenoma}} | |||
==Oncocytoma of the salivary gland== | |||
* | *[[AKA]] ''salivary gland oncocytoma''. | ||
{{Main|Oncocytoma of the salivary gland}} | |||
=Malignant= | |||
One approach: | |||
*Differentiate -- luminal vs. myoepithelial vs. basal (mucoepideroid). | |||
==Mucoepidermoid carcinoma== | |||
{{Main|Mucoepidermoid carcinoma}} | |||
== | ==Acinic cell carcinoma== | ||
{{Main|Acinic cell carcinoma}} | |||
==Adenoid cystic carcinoma== | |||
{{Main|Adenoid cystic carcinoma}} | |||
Note: The [[breast]] tumour is dealt with in ''[[adenoid cystic carcinoma of the breast]]''. | |||
== | ==Salivary duct carcinoma== | ||
{{Main|Salivary duct carcinoma}} | |||
=== | ==Intraductal carcinoma of the salivary gland== | ||
{{Main|Intraductal carcinoma of the salivary gland}} | |||
== | ==Polymorphous adenocarcinoma== | ||
* | *Abbreviated ''PAC''. | ||
* | *Previously known as ''polymorphous low-grade adenocarcinoma'', abbreviated ''PLGA''. | ||
{{Main|Polymorphous adenocarcinoma}} | |||
==Carcinoma ex pleomorphic adenoma== | ==Carcinoma ex pleomorphic adenoma== | ||
* | *Abbreviated ''Ca ex PA''. | ||
{{Main|Carcinoma ex pleomorphic adenoma}} | |||
== | ==Epithelial-myoepithelial carcinoma== | ||
{{Main|Epithelial-myoepithelial carcinoma}} | |||
==Basal cell adenocarcinoma== | |||
{{Main|Basal cell adenocarcinoma}} | |||
==Sebaceous carcinoma== | ==Sebaceous carcinoma== | ||
{{Main|Sebaceous carcinoma}} | |||
It is similar to the tumour found in the skin. | |||
==Hyalinizing clear cell carcinoma== | |||
{{Main|Hyalinizing clear cell carcinoma}} | |||
=See also= | |||
*[[Head and neck pathology]]. | *[[Head and neck pathology]]. | ||
*[[Thyroid gland]]. | *[[Thyroid gland]]. | ||
*[[Breast]]. | *[[Breast]]. | ||
*[[Head and neck cytopathology]]. | |||
*[[Lacrimal gland]]. | |||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Head and neck pathology]] | [[Category:Head and neck pathology]] | ||
[[Category:Salivary gland|Salivary gland]] |
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