Difference between revisions of "Salivary glands"
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[[Image:Blausen_0780_SalivaryGlands.png|thumb|300px|Schematic showing the major salivary glands. (WC)]] | [[Image:Blausen_0780_SalivaryGlands.png|thumb|300px|Schematic showing the major salivary glands. (WC)]] | ||
The '''salivary glands''' help digest food. ENT surgeons | 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= | =Normal salivary glands= | ||
| Line 88: | Line 90: | ||
| [[basal cell adenoma]] | | [[basal cell adenoma]] | ||
| exclusively oral cavity, 80% in upper lip; IHC: p63- | | exclusively oral cavity, 80% in upper lip; IHC: p63- | ||
| [ | | [[Image:Canalicular_adenoma_--_high_mag.jpg | thumb | center |150px| CA. (WC)]] | ||
|- | |- | ||
|[[Sialoblastoma]] | |[[Sialoblastoma]] | ||
| Line 126: | Line 128: | ||
|- | |- | ||
|[[Adenoid cystic carcinoma]] (AdCC) | |[[Adenoid cystic carcinoma]] (AdCC) | ||
| pseudocysts,<br>'''cribriform''', solid,<br>hyaline stroma | | pseudocysts,<br>'''[[cribriform]]''', solid,<br>hyaline stroma | ||
| epithelioid | | epithelioid | ||
| subtle | | subtle | ||
| Line 146: | Line 148: | ||
|- | |- | ||
|[[Salivary duct carcinoma]] | |[[Salivary duct carcinoma]] | ||
| glandular, cribriform | | glandular, [[cribriform]] | ||
| columnar | | columnar | ||
| subtle/clear | | subtle/clear | ||
| Line 155: | Line 157: | ||
| [[Image:Salivary_duct_carcinoma_-a-_low_mag.jpg | thumb| center|150px | SDC. (WC/Nephron)]] | | [[Image:Salivary_duct_carcinoma_-a-_low_mag.jpg | thumb| center|150px | SDC. (WC/Nephron)]] | ||
|- | |- | ||
|[[Polymorphous low-grade adenocarcinoma | |[[Polymorphous adenocarcinoma]] (previously polymorphous low-grade adenocarcinoma) | ||
| variable, often small<br>nests, may be targetoid | | variable, often small<br>nests, may be targetoid | ||
| epithelioid | | epithelioid | ||
| Line 162: | Line 164: | ||
| ovoid & small with<br>small nucleoli | | ovoid & small with<br>small nucleoli | ||
| AdCC | | AdCC | ||
| minor salivary gland tumour,<br>often in palate,<br> cytologically monotonous; IHC: | | 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)]] | | [[Image:Polymorphous_low-grade_adenocarcinoma_-_very_low_mag.jpg|thumb|center|150px|PLGA. (WC/Nephron)]] | ||
|- | |- | ||
| Line 188: | Line 190: | ||
==DDx== | ==DDx== | ||
===Palate=== | ===Palate=== | ||
*[[Polymorphous | *[[Polymorphous adenocarcinoma]]. | ||
*[[Adenoid cystic carcinoma]]. | *[[Adenoid cystic carcinoma]]. | ||
*[[Pleomorphic adenoma]]. | *[[Pleomorphic adenoma]]. | ||
| Line 215: | Line 217: | ||
*Metastatic [[clear cell carcinoma]]. | *Metastatic [[clear cell carcinoma]]. | ||
**Metastatic [[clear cell renal 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 overview== | ==IHC overview== | ||
General: | General: | ||
*Usually has limited value. | *Usually has limited value. <!--as per Ilan Weinreb--> | ||
Overview: | |||
*Luminal markers: [[CK7]], [[CK19]], CAM5.2 (LMWK). | *Luminal markers: [[CK7]], [[CK19]], CAM5.2 (LMWK). | ||
*Basal markers: p63, HMWK, CK14. | *Basal markers: p63, HMWK, CK14. | ||
| Line 228: | Line 237: | ||
Notes: | Notes: | ||
*p63 and S-100 are sometimes call myoepithelial. | *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= | =Benign= | ||
| Line 239: | Line 252: | ||
==Salivary gland mucocele== | ==Salivary gland mucocele== | ||
{{Main|Salivary gland mucocele}} | |||
==Pleomorphic adenoma== | ==Pleomorphic adenoma== | ||
| Line 336: | Line 305: | ||
*Luminal stains +ve: CK7 +ve, CAM5.2 +ve. | *Luminal stains +ve: CK7 +ve, CAM5.2 +ve. | ||
*p63 +ve -- basal component. | *p63 +ve -- basal component. | ||
* | *[[S-100]] +ve -- spindle cells in the stroma. | ||
==Canalicular adenoma== | ==Canalicular adenoma== | ||
{{Main|Canalicular adenoma}} | |||
==Warthin tumour== | ==Warthin tumour== | ||
| Line 367: | Line 318: | ||
==Sebaceous lymphadenoma== | ==Sebaceous lymphadenoma== | ||
{{Main|Sebaceous lymphadenoma}} | |||
==Oncocytoma of the salivary gland== | ==Oncocytoma of the salivary gland== | ||
*[[AKA]] ''salivary gland oncocytoma''. | *[[AKA]] ''salivary gland oncocytoma''. | ||
{{Main|Oncocytoma of the salivary gland}} | |||
=Malignant= | =Malignant= | ||
| Line 446: | Line 335: | ||
==Adenoid cystic carcinoma== | ==Adenoid cystic carcinoma== | ||
{{Main|Adenoid cystic carcinoma}} | {{Main|Adenoid cystic carcinoma}} | ||
Note: The [[breast]] tumour is dealt with in ''[[adenoid cystic carcinoma of the breast]]''. | |||
==Salivary duct carcinoma== | ==Salivary duct carcinoma== | ||
{{Main|Salivary duct carcinoma}} | {{Main|Salivary duct carcinoma}} | ||
==Polymorphous | ==Intraductal carcinoma of the salivary gland== | ||
*Abbreviated ''PLGA''. | {{Main|Intraductal carcinoma of the salivary gland}} | ||
{{Main|Polymorphous | |||
==Polymorphous adenocarcinoma== | |||
*Abbreviated ''PAC''. | |||
*Previously known as ''polymorphous low-grade adenocarcinoma'', abbreviated ''PLGA''. | |||
{{Main|Polymorphous adenocarcinoma}} | |||
==Carcinoma ex pleomorphic adenoma== | ==Carcinoma ex pleomorphic adenoma== | ||
Latest revision as of 20:36, 2 June 2024
The salivary glands help digest food. ENT surgeons excise them if a malignancy is suspected.
File:Blausen 0780 SalivaryGlands.png
Schematic showing the major salivary glands. (WC)
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:[1]
- Serrous - eosinophilic cytoplasmic granules, acinar arrangement - vaguely resembles the acinar morphology of the pancreas.
- Mucinous - light eosinophilic staining.
Identifying the glands
The three main glands:
- Parotid:
- Serous glands - lower viscosity, acini (lobules).[2]
- Most tumours in this gland are benign.
- Submandibular:
- 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.[3]
- Image: Serous demilunes (duke.edu).[4]
- Serous and mucinous glands.
- Sublingual:
- Mucinous glands.
Other:
- Adipose tissue is found between the glands.
- It increases with age.
Images:
Memory devices:
- The parotid gland vaguely resembles the pancreas.
- Submandibular = glands are mixed.
Overview
Benign tumours
Tabular form - adapted from Thompson[5]
| Entity | Architecture | Morphology | Cell borders | Cytoplasm | Nucleus | DDx | Other | Image |
|---|---|---|---|---|---|---|---|---|
| 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, mixed pop. of glandular, myoepithelial and mesenchymal cells |
|
| Warthin tumour | papillary, bilayer |
cuboid (basal), columnar (apical) | clearly seen | eosinophilic, abundant | unremarkable | sebaceous lymphadenoma | AKA papillary cystadenoma lymphomatosum | |
| Basal cell adenoma | var., islands surrounded by hyaline bands, lesion encapsulated |
basaloid | subtle | scant, hyperchromatic |
granular | basal cell adenocarcinoma | - | - |
| Canalicular adenoma | chains of cells | cuboid or columnar | subtle | scant, hyperchromatic |
granular | basal cell adenoma | exclusively oral cavity, 80% in upper lip; IHC: p63- | |
| Sialoblastoma | var., islands surrounded by loose fibrous stroma |
basaloid | subtle | scant, hyperch. | granular | basal cell adenocarcinoma | - | - |
Malignant tumours
Tabular form - adapted from Thompson[6]
| Entity | Architecture | Morphology | Cell borders | Cytoplasm | Nucleus | DDx | Other | Image |
|---|---|---|---|---|---|---|---|---|
| Mucoepidermoid carcinoma | cystic & solid | epithelioid | distinct | fuffy, clear, abundant |
nuclei sm. | SCC (?) | IHC: p63+ | |
| Adenoid cystic carcinoma (AdCC) | pseudocysts, cribriform, solid, hyaline stroma |
epithelioid | subtle | scant, hyperchromatic |
small +/-"carrot-shaped" |
pleomorphic adenoma, PLGA | Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+ | |
| 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 | |
| Salivary duct carcinoma | glandular, cribriform | columnar | subtle/clear | hyperchromatic | columnar | metastatic breast carcinoma | similar to ductal breast carcinoma; male>female |
|
| Polymorphous adenocarcinoma (previously polymorphous low-grade adenocarcinoma) | variable, often small nests, may be targetoid |
epithelioid | indistinct | eosinophilic | ovoid & small with small nucleoli |
AdCC | minor salivary gland tumour, often in palate, cytologically monotonous; IHC: S-100+, CK+, vim.+, GFAP+/-, BCL2+/- |
Error creating thumbnail: 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 | |
| Basal cell adenocarcinoma | var., islands surrounded by hyaline bands, lesion not encapsulated |
basaloid | subtle | scant, hyperchromatic |
granular | basal cell adenoma | rare, usu. parotid gland, may arise from a basal cell adenoma | Error creating thumbnail: BCA. (WC/Nephron) |
DDx
Palate
Benign parotid tumours
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.[7]
- Adenoid cystic carcinoma.[7]
- Small cell carcinoma.[7]
IHC overview
General:
- Usually has limited value.
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.[8]
- Most salivary gland tumours are p40 positive and p63 positive; polymorphous adenocarcinoma is p63 positive and p40 negative.[9]
Benign
General DDx:
- Inflammation.
- Neoplasm.
- Ductal obstrution.
Chronic sialadenitis
Main article: Chronic sialadenitis
Salivary gland mucocele
Main article: Salivary gland mucocele
Pleomorphic adenoma
Main article: Pleomorphic adenoma
Myoepithelioma
Main article: Myoepithelioma
Basal cell adenoma
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 cylindromas in the context of a genetic mutation.[10]
- Malignant transformation - rarely.
Microscopic
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.
- Plump spindle cells without significant nuclear atypia - distinguishing feature.
- 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:
IHC
- Luminal stains +ve: CK7 +ve, CAM5.2 +ve.
- p63 +ve -- basal component.
- S-100 +ve -- spindle cells in the stroma.
Canalicular adenoma
Main article: Canalicular adenoma
Warthin tumour
Main article: Warthin tumour
Sebaceous adenoma
Main article: Sebaceous adenoma
- Benign counterpart of sebaceous carcinoma.
Sebaceous lymphadenoma
Main article: Sebaceous lymphadenoma
Oncocytoma of the salivary gland
- AKA salivary gland oncocytoma.
Main article: Oncocytoma of the salivary gland
Malignant
One approach:
- Differentiate -- luminal vs. myoepithelial vs. basal (mucoepideroid).
Mucoepidermoid carcinoma
Main article: Mucoepidermoid carcinoma
Acinic cell carcinoma
Main article: Acinic cell carcinoma
Adenoid cystic carcinoma
Main article: Adenoid cystic carcinoma
Note: The breast tumour is dealt with in adenoid cystic carcinoma of the breast.
Salivary duct carcinoma
Main article: Salivary duct carcinoma
Intraductal carcinoma of the salivary gland
Main article: Intraductal carcinoma of the salivary gland
Polymorphous adenocarcinoma
- Abbreviated PAC.
- Previously known as polymorphous low-grade adenocarcinoma, abbreviated PLGA.
Main article: Polymorphous adenocarcinoma
Carcinoma ex pleomorphic adenoma
- Abbreviated Ca ex PA.
Main article: Carcinoma ex pleomorphic adenoma
Epithelial-myoepithelial carcinoma
Main article: Epithelial-myoepithelial carcinoma
Basal cell adenocarcinoma
Main article: Basal cell adenocarcinoma
Sebaceous carcinoma
Main article: Sebaceous carcinoma
It is similar to the tumour found in the skin.
Hyalinizing clear cell carcinoma
Main article: Hyalinizing clear cell carcinoma
See also
References
- ↑ http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Oral/oral.htm#LABSALIVA
- ↑ http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Epithelia/Epithel.htm
- ↑ URL: http://dictionary.reference.com/browse/demilune. Accessed on: 19 August 2011.
- ↑ URL: http://pathology.mc.duke.edu/research/pth225.html. Accessed on: 19 August 2011.
- ↑ Thompson, Lester D. R. (2006). Head and Neck Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 295-319. ISBN 978-0443069604.
- ↑ Thompson, Lester D. R. (2006). Head and Neck Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 325-357. ISBN 978-0443069604.
- ↑ 7.0 7.1 7.2 Chhieng, DC.; Paulino, AF. (Dec 2002). "Basaloid tumors of the salivary glands.". Ann Diagn Pathol 6 (6): 364-72. doi:10.1053/adpa.2002.37013. PMID 12478487.
- ↑ Nagao, T.; Sato, E.; Inoue, R.; Oshiro, H.; H Takahashi, R.; Nagai, T.; Yoshida, M.; Suzuki, F. et al. (Oct 2012). "Immunohistochemical analysis of salivary gland tumors: application for surgical pathology practice.". Acta Histochem Cytochem 45 (5): 269-82. doi:10.1267/ahc.12019. PMID 23209336.
- ↑ Sivakumar N, Narwal A, Pandiar D, Devi A, Anand R, Bansal D, Kamboj M (February 2022). "Diagnostic utility of p63/p40 in the histologic differentiation of salivary gland tumors: A systematic review". Oral Surg Oral Med Oral Pathol Oral Radiol 133 (2): 189–198. doi:10.1016/j.oooo.2021.07.010. PMID 34518135.
- ↑ Choi, HR.; Batsakis, JG.; Callender, DL.; Prieto, VG.; Luna, MA.; El-Naggar, AK. (Jun 2002). "Molecular analysis of chromosome 16q regions in dermal analogue tumors of salivary glands: a genetic link to dermal cylindroma?". Am J Surg Pathol 26 (6): 778-83. PMID 12023583.
- ↑ URL: http://moon.ouhsc.edu/kfung/jty1/Com/Com304-3-Diss.htm. Accessed on: 25 October 2011.