Salivary duct carcinoma

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Salivary duct carcinoma, abbreviated SDC, is a rare salivary gland tumour that typically has an aggressive course.

Salivary duct carcinoma
Diagnosis in short

Salivary duct carcinoma. H&E stain.
LM varied arch. (sheets, nests, cords, cribriform, micropapillary), neoplastic cells line-up around cystic spaces "Roman bridges", nuclear atypia, apocrine snouts, decapitation secretions
LM DDx ductal carcinoma of the breast
Site salivary gland
Prognosis poor
Clin. DDx other salivary gland tumours

General

  • Malignant counterpart of salivary duct adenoma.
  • Male:female ~= 4:1.
  • Dismal prognosis.[1]
  • Typically >50 years old.
  • Mostly in the parotid.

Microscopic

Features - resembles ductal breast carcinoma:[1]

  • Architecture: sheets, nests, cords, cribriform, micropapillary.
  • Neoplastic cells line-up around cystic spaces "Roman bridges".
  • Nuclear atypia (variation in size, shape, staining).
  • Apocrine snouts - pseudopod-like/lollipop-like undulations of the cell membrane.
  • Decapitation secretions - apocrine snouts (membrane bound blobs of cytoplasm) that have separated from its mother cell.

Notes:

  • Similar to ductal breast carcinoma - key to remember.

DDx:

Images

  • SDC - very low mag. (WC/Nephron)

  • SDC - low mag. (WC/Nephron)

  • SDC - intermed. mag. (WC/Nephron)

  • SDC - high mag. (WC/Nephron)

  • SDC - very high mag. (WC/Nephron)

  • SDC - low mag. (WC/Nephron)

  • SDC - intermed. mag. (WC/Nephron)

www:

Subtypes

  • Conventional.
  • Mucinous - worse prognosis; opposite of what would one expect from the outcomes in breast cancer.
  • Micropapillary - assoc. with a poor prognosis.
  • Sarcomatoid/spindle cell.

IHC

  • LMWK, EMA, CK7, CK19 +ve.
  • p63 -ve.
  • Androgen receptor +ve.
  • BRST2 (GCDFP-15) +ve.
  • HER2 +ve ~21%; use of trastuzumab (Herceptin) not systematically studied.

Curiosity:

  • PSA +/-.
  • PSAP +/-.
  • ER-beta +ve.[2]
  • ER-alpha -ve (the common ER stain).

See also

References

  1. ↑ 1.0 1.1 Rajesh, NG.; Prayaga, AK.; Sundaram, C.. "Salivary duct carcinoma: correlation of morphologic features by fine needle aspiration cytology and histopathology.". Indian J Pathol Microbiol 54 (1): 37-41. doi:10.4103/0377-4929.77321. PMID 21393874. http://www.ijpmonline.org/text.asp?2011/54/1/37/77321.
  2. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf. Accessed on: 3 April 2012.
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