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| The '''salivary glands''' help digest food. ENT surgeons take 'em out and want you to diagnose 'em. [[Cytopathology]] of the salivary glands is covered in the ''[[Head and neck cytopathology]]'' article. | | [[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. |
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| =Normal salivary glands= | | =Normal salivary glands= |
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| |[[Pleomorphic adenoma]] | | |[[Pleomorphic adenoma]] |
| | var. | | | var. |
| | '''mixed pop.'''; must include: (1) myoepithelium, (2) epithelium (ductal cells), (3) [[chondromyxoid stroma]] | | | '''mixed pop.'''; must include: (1) myoepithelium, (2) mesenchymal stroma, and (3) epithelium (ductal cells) ''or'' [[chondromyxoid stroma]] |
| | var. | | | var. |
| | var. | | | var. |
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| | [[basal cell adenoma]] | | | [[basal cell adenoma]] |
| | exclusively oral cavity, 80% in upper lip; IHC: p63- | | | exclusively oral cavity, 80% in upper lip; IHC: p63- |
| | [http://www.webpathology.com/image.asp?n=1&Case=116 (webpathology.com)], [http://www.webpathology.com/image.asp?n=2&Case=116 (webpathology.com)] | | | [[Image:Canalicular_adenoma_--_high_mag.jpg | thumb | center |150px| CA. (WC)]] |
| |- | | |- |
| |[[Sialoblastoma]] | | |[[Sialoblastoma]] |
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| |- | | |- |
| |[[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 |
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| |- | | |- |
| |[[Salivary duct carcinoma]] | | |[[Salivary duct carcinoma]] |
| | glandular, cribriform | | | glandular, [[cribriform]] |
| | columnar | | | columnar |
| | subtle/clear | | | subtle/clear |
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| | 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: S100+, CK+, vim.+, GFAP+/-, BCL2+/- | | | 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)]] |
| |- | | |- |
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| *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> |
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| ==IHC overview== | | ==IHC overview== |
| General: | | General: |
| *Usually has limited value. | | *Usually has limited value. <!--as per Ilan Weinreb--> |
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| Specifics:
| | 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. |
| *Myoepithelial markers: calponin, actin. | | *Myoepithelial markers: calponin, actin. |
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| 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> |
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| =Benign= | | =Benign= |
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| ==Chronic sialadenitis== | | ==Chronic sialadenitis== |
| ===General===
| | {{Main|Chronic sialadenitis}} |
| Etiology:<ref>URL: [http://emedicine.medscape.com/article/882358-overview http://emedicine.medscape.com/article/882358-overviewhttp://emedicine.medscape.com/article/882358-overview]. Accessed on: 10 January 2011.</ref>
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| *Infection.
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| *Autoimmune (e.g. [[Sjögren syndrome]], [[systemic lupus erythematosus]]).
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| *Other.
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| ===Microscopic===
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| Features:
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| *+/-Fibrosis.
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| *Non-neoplastic mononuclear inflammatory infiltrate (lymphocytes, [[plasma cell]]s).
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| Note:
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| *If the infiltrate is predominantly lymphocytes Sjögren's is a possibility, and reporting a ''[[Focus score]]'' should be considered.
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| DDx:
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| *[[Lymphoma]] - especially [[MALT lymphoma]].<ref name=pmid22475637>{{Cite journal | last1 = Beasley | first1 = MJ. | title = Lymphoma of the Thyroid and Head and Neck. | journal = Clin Oncol (R Coll Radiol) | volume = | issue = | pages = | month = Apr | year = 2012 | doi = 10.1016/j.clon.2012.02.010 | PMID = 22475637 }}</ref>
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|
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| ====Image====
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| <gallery>
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| Image:Chronic_sialadenitis.jpg | Chronic sialadenitis. (WC/Nephron)
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| </gallery>
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| ==Salivary gland mucocele== | | ==Salivary gland mucocele== |
| *[[AKA]] ''salivary mucocele''. | | *[[AKA]] ''salivary mucocele''. |
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| *[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=292590975 Mucocele (dermatlas.med.jhmi.edu)]. | | *[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=292590975 Mucocele (dermatlas.med.jhmi.edu)]. |
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| ==Pleomorphic adenoma== | | ===Sign out=== |
| *Abbreviated ''PA''.
| | <pre> |
| | | LESION, LEFT LOWER LIP, EXCISION: |
| ===General===
| | - BENIGN MUCOCELE. |
| Features:
| | </pre> |
| *Very common - approx. 60% of parotid gland tumours.<ref name=Ref_HaNP295>{{Ref HaNP|295}}</ref>
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| *May transform into a malignant tumour.
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| **Other benign salivary gland tumours do not do this.
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| *Only benign childhood salivary gland tumour of significance.
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| | |
| ====Weinreb's dictums====
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| #Most common salivary tumour in all age groups.
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| #Seen in all sites (unlike other benign tumours).
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| #Recurrence and malignancy risk (unlike other benign salivary gland tumours).
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| #Any part of a tumour that looks like PA makes it a PA.
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| ===Gross=== | | ====Micro==== |
| *May be cartilaginous appearing.
| | The sections show a stratified squamous epithelium with a thin layer of parakeratosis, |
| | minor salivary glands, and a well-circumscribed cystic lesion. |
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| Image:
| | The cystic lesion has a mildly fibrotic appearing wall, is lined by histiocytes intermixed with rare lymphocytes, and contains mucous and macrophages. No significant nuclear atypia is identified. Mitotic activity is not readily apparent. |
| *[http://screening.iarc.fr/atlasoral_detail.php?flag=1&lang=1&Id=C0100002&cat=C1 PA in situ (iarc.fr)].
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| ===Microscopic=== | | ==Pleomorphic adenoma== |
| Features:<ref name=Ref_HaNP295>{{Ref HaNP|295}}</ref>
| | {{Main|Pleomorphic adenoma}} |
| *Proliferation of myoepithelium and epithelium (ductal cells) in mesenchymal stroma.
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| **Cells in ducts = epithelial.
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| **Cells not in ducts = myoepithelial.<ref name=IW_10jan2011>IW. 10 January 2011.</ref>
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| *Mesenchymal stroma - '''important feature'''.
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| **May be any of following: [[myxoid stroma|myxoid]], mucochondroid, hyalinized, osseous, fatty.
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| ***[[chondromyxoid stroma|Chondroid]] = specific for PA; can diagnose PA without an epithelial (ductal) component if chondroid is present.
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| ***Myxoid = not specific for PA.
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| Notes:
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| *Mesenchymal stroma not required for diagnosis -- if >5% ducts.<ref name=IW_10jan2011>IW. 10 January 2011.</ref>
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| **No chondroid stroma ''and'' <5% ductal cells = '''[[myoepithelioma]]'''.
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| *Complete excision is often elusive; stating "completely excised" on a surgical pathology report is unwise.
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| *Look for, i.e. rule-out, poorly differentiated carcinoma: ''carcinoma ex pleomorphic adenoma''.
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| | |
| Memory device: '''MEC''' = '''m'''yoepithelium, '''e'''pithelium, '''c'''hondromyxoid stroma.
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| DDx:
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| *[[Myoepithelioma]].
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| *[[Carcinoma ex pleomorphic adenoma]].
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| *[[Epithelial-myoepithelial carcinoma]].
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| | |
| ====Images====
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| <gallery>
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| Image:Pleomorphic_adenoma_%281%29_parotid_gland.jpg | PA. (WC)
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| Image:Pleomorphic_adenoma_%282%29_parotid_gland.jpg | PA. (WC)
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| Image:Pleomorphic_adenoma_%283%29_parotid_gland.jpg | PA. (WC)
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| Image:Pleomorphic_adenoma_%284%29_parotid_gland.jpg | PA. (WC)
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| </gallery>
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| www:
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| *[http://www.webpathology.com/image.asp?n=7&Case=111 PA - myxoid stroma (webpathology.com)].
| |
| | |
| ===IHC===
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| *S-100 +ve, SMA +ve, GFAP +ve.
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| ==Myoepithelioma== | | ==Myoepithelioma== |
| ===General===
| | {{Main|Myoepithelioma}} |
| *Usually benign.
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| **May be malignant.
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| | |
| Location:<ref name=pmid2982059>{{Cite journal | last1 = Barnes | first1 = L. | last2 = Appel | first2 = BN. | last3 = Perez | first3 = H. | last4 = El-Attar | first4 = AM. | title = Myoepithelioma of the head and neck: case report and review. | journal = J Surg Oncol | volume = 28 | issue = 1 | pages = 21-8 | month = Jan | year = 1985 | doi = | PMID = 2982059 }}</ref>
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| *Parotid gland ~50%.
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| *Palate ~25%
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| *Submandibular gland ~12%.
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| | |
| Notes:
| |
| *First described in 1972.<ref name=pmid5075358>{{Cite journal | last1 = Saksela | first1 = E. | last2 = Tarkkanen | first2 = J. | last3 = Wartiovaara | first3 = J. | title = Parotid clear-cell adenoma of possible myoepithelial origin. | journal = Cancer | volume = 30 | issue = 3 | pages = 742-8 | month = Sep | year = 1972 | doi = | PMID = 5075358 }}</ref>
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| ===Microsopic===
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| Features:<ref name=Ref_DCHH130>{{Ref DCHH|130}}</ref>
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| *Myoepithelial cells - may be:
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| **Spindled.
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| **Plasmacytoid.
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| **Epithelioid.
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| **Clear (rare).
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| *Lack tubules, i.e. epithelial component.
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| **May be up to 10% (or 5%<ref>I. Weinreb. 24 October 2011.</ref>).
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| DDx:
| |
| *[[Pleomorphic adenoma]].
| |
| | |
| ====Images====
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| <gallery>
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| Image: Myoepithelioma - low mag.jpg | Myoepithelioma - low mag. (WC/Nephron)
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| Image: Myoepithelioma_-_intermed_mag.jpg | Myoepithelioma - intermed. mag. (WC/Nephron)
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| Image: Myoepithelioma - high mag.jpg | Myoepithelioma - high mag. (WC/Nephron)
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| Image: Myoepithelioma_-_very_high_mag.jpg | Myoepithelioma - very high mag. (WC/Nephron)
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| </gallery>
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| | |
| ===IHC===
| |
| Features:<ref name=Ref_DCHH130>{{Ref DCHH|130}}</ref>
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| *S100 +ve.
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| *GFAP +ve.
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| *CK14 +ve.
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| | |
| Others:<ref name=Ref_DCHH18>{{Ref DCHH|18}}</ref>
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| *SMA +ve.
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| *Calponin +ve.
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| ==Basal cell adenoma== | | ==Basal cell adenoma== |
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| *Luminal stains +ve: CK7 +ve, CAM5.2 +ve. | | *Luminal stains +ve: CK7 +ve, CAM5.2 +ve. |
| *p63 +ve -- basal component. | | *p63 +ve -- basal component. |
| *S100 +ve -- spindle cells in the stroma. | | *[[S-100]] +ve -- spindle cells in the stroma. |
|
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| ==Canalicular adenoma== | | ==Canalicular adenoma== |
| ===General===
| | {{Main|Canalicular adenoma}} |
| *Exclusively oral cavity.
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| **80% of lesions on upper lip.
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| | |
| ===Microscopic===
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| Features:
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| *Channels - "beading of cell".
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| *Mucoid/hemorrhagic stroma.
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| DDx:
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| *Basal cell adenoma.
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| Images:
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| *[http://www.webpathology.com/image.asp?n=1&Case=116 Canalicular adenoma - low mag. (webpathology.com)].
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| *[http://www.webpathology.com/image.asp?case=116&n=2 Canalicular adenoma - high mag. (webpathology.com)].
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| ===IHC===
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| *p63 -ve.
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| **Basal cell adenoma p63 +ve.
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| ==Warthin tumour== | | ==Warthin tumour== |
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| ==Sebaceous lymphadenoma== | | ==Sebaceous lymphadenoma== |
| ===General===
| | {{Main|Sebaceous lymphadenoma}} |
| *Rare salivary gland tumour.<ref name=pmid21393895/>
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| *Benign.
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| | |
| ===Microscopic===
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| Features:<ref name=pmid21393895>{{Cite journal | last1 = Mishra | first1 = A. | last2 = Tripathi | first2 = K. | last3 = Mohanty | first3 = L. | last4 = Nayak | first4 = M. | title = Sebaceous lymphadenoma of the parotid gland. | journal = Indian J Pathol Microbiol | volume = 54 | issue = 1 | pages = 131-2 | month = | year = | doi = 10.4103/0377-4929.77364 | PMID = 21393895 | url = http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2011;volume=54;issue=1;spage=131;epage=132;aulast=Mishra }}</ref>
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| *Sebaceous glands within lymphoid tissue - '''key feature'''.
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| | |
| DDx:<ref name=pmid20737364>{{Cite journal | last1 = While | first1 = B. | last2 = Whiteside | first2 = OJ. | last3 = Desai | first3 = V. | last4 = Gurr | first4 = P. | title = Sebaceous lymphadenoma: a case report and review of the literature. | journal = Ear Nose Throat J | volume = 89 | issue = 8 | pages = E22-3 | month = Aug | year = 2010 | doi = | PMID = 20737364 }}</ref>
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| *[[Warthin tumour]].
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| *Sebaceous lymphadenocarcinoma.
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| *[[Mucoepidermoid carcinoma]].
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| *Lymphoma.
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| ====Images====
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| <gallery>
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| Image:Sebaceous_lymphadenoma_-_low_mag.jpg| Sebaceous lymphadenoma - low mag. (WC/Nephron)
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| Image:Sebaceous_lymphadenoma_-_intermed_mag.jpg| Sebaceous lymphadenoma - intermed. mag. (WC/Nephron)
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| Image:Sebaceous_lymphadenoma_-_high_mag.jpg| Sebaceous lymphadenoma - high mag. (WC/Nephron)
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| Image:Sebaceous_lymphadenoma_-_very_high_mag.jpg| Sebaceous lymphadenoma - very high mag. (WC/Nephron)
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| </gallery>
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| www:
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| *[http://path.upmc.edu/cases/case281.html Sebaceous lymphadenoma (upmc.edu)].
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|
| ==Oncocytoma of the salivary gland== | | ==Oncocytoma of the salivary gland== |
| *[[AKA]] ''salivary gland oncocytoma''. | | *[[AKA]] ''salivary gland oncocytoma''. |
| ===General===
| | {{Main|Oncocytoma of the salivary gland}} |
| *No risk of malignant transformation.
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| *~1% of all salivary gland tumours.
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| *Typical age: 60s-80s.
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| *Associated with radiation exposure.
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| *Major salivary glands - usually parotid gland.<ref name=pmid19796983>{{Cite journal | last1 = Zhou | first1 = CX. | last2 = Gao | first2 = Y. | title = Oncocytoma of the salivary glands: a clinicopathologic and immunohistochemical study. | journal = Oral Oncol | volume = 45 | issue = 12 | pages = e232-8 | month = Dec | year = 2009 | doi = 10.1016/j.oraloncology.2009.08.004 | PMID = 19796983 }}</ref>
| |
| | |
| ===Gross===
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| *Golden brown appearance.
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| | |
| ====Image====
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| <gallery>
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| Image:Oncocytoma_of_the_Salivary_Gland.jpg | Salivary gland oncocytoma (WC/euthman)
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| </gallery>
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| ===Microscopic===
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| Features:
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| *Like [[oncocytoma]]s elsewhere.
| |
| **Eosinophilic cytoplasm (on [[H&E stain]]).
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| ***Due to increased number of mitochrondria.
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| **Fine capillaries.
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| *Architecture: solid sheets, trabeculae or duct-like structure.<ref name=pmid19796983/>
| |
| | |
| Notes:
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| *May have clear cell change.
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| *Multiple small incidental lesions = oncocytosis - ''not'' oncocytoma.
| |
| | |
| DDx:
| |
| *[[Acinic cell carcinoma]].
| |
| | |
| ====Images====
| |
| www:
| |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807526/figure/Fig1/ Salivary gland oncocytoma (nih.gov)].<ref name=pmid20614263/>
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| <gallery>
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| Image:Parotid_gland_oncocytoma_-_intermed_mag.jpg | Parotid gland oncocytoma - intermed. mag. (WC/Nephron)
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| Image: Parotid gland oncocytoma - high mag.jpg | Parotid gland oncocytoma - high mag. (WC/Nephron)
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| Image:Parotid_gland_oncocytoma_-_very_high_mag.jpg | Parotid gland oncocytoma - very high mag. (WC/Nephron)
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| </gallery>
| |
| | |
| ===IHC===
| |
| *p63 +ve<ref name=pmid20614263>{{Cite journal | last1 = McHugh | first1 = JB. | last2 = Hoschar | first2 = AP. | last3 = Dvorakova | first3 = M. | last4 = Parwani | first4 = AV. | last5 = Barnes | first5 = EL. | last6 = Seethala | first6 = RR. | title = p63 immunohistochemistry differentiates salivary gland oncocytoma and oncocytic carcinoma from metastatic renal cell carcinoma. | journal = Head Neck Pathol | volume = 1 | issue = 2 | pages = 123-31 | month = Dec | year = 2007 | doi = 10.1007/s12105-007-0031-4 | PMID = 20614263 | PMC = 2807526}}</ref> focally in nucleus.
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| =Malignant= | | =Malignant= |
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| ==Mucoepidermoid carcinoma== | | ==Mucoepidermoid carcinoma== |
| *Abbreviated ''MEC''.
| | {{Main|Mucoepidermoid carcinoma}} |
| | |
| ===General===
| |
| *Most common malignant neoplasm of salivary gland in all age groups.<ref>URL: [http://path.upmc.edu/cases/case715/dx.html http://path.upmc.edu/cases/case715/dx.html]. Accessed on: 2 February 2012.</ref>
| |
| *Female:male ~= 3:2.
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| *Site: parotid > submandibular.
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| | |
| ===Gross===
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| *Cystic or solid, usu. a mix of both.
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| | |
| ===Microscopic===
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| Features:
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| *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 (low grade).
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| **Solid (high grade).
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| *Mucous cells with abundant fluffy cytoplasm and large mucin vacuoles - '''key feature'''.
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| **Nucleus distorted by mucin vacuole.
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| **Mucous cell may be scarce - more difficult to diagnose.
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| *Epidermoid cells:
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| **Non-keratinized, polygonal squamoid cell with clear or oncocytic cytoplasm.
| |
| ***Clear cells contain glycogen ([[PAS]] +ve, [[PAS-D]] -ve).
| |
| | |
| Notes:
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| *The classic description - composed of 3 cell types: epidermoid, intermediate, and mucin producing.<ref>{{Cite journal | last1 = Lennerz | first1 = JK. | last2 = Perry | first2 = A. | last3 = Mills | first3 = JC. | last4 = Huettner | first4 = PC. | last5 = Pfeifer | first5 = JD. | title = Mucoepidermoid carcinoma of the cervix: another tumor with the t(11;19)-associated CRTC1-MAML2 gene fusion. | journal = Am J Surg Pathol | volume = 33 | issue = 6 | pages = 835-43 | month = Jun | year = 2009 | doi = 10.1097/PAS.0b013e318190cf5b | PMID = 19092631 }}</ref>
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| **"Intermediate cells" are described in textbooks. Weinreb thinks they are a pretty much a myth.<ref name=IW_10jan2011>IW. 10 January 2011.</ref>
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| *Mucin vacuoles may be rare; in a superficial glance -- it may mimic [[squamous cell carcinoma]].
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| *The thought of high-grade MEC should prompt consideration of squamous cell carcinoma.
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| | |
| ====Images====
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| <gallery>
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| Image:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg | Mucoepidermoid carcinoma 2. (WC)
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| Image:Mucoepidermoid_carcinoma_%283%29_HE_stain.jpg | Mucoepidermoid carcinoma 3. (WC)
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| Image:Mucoepidermoid_carcinoma_-_2_-_intermed_mag.jpg | Mucoepidermoid carcinoma - 2 - intermed. mag. (WC/Nephron)
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| Image:Mucoepidermoid_carcinoma_-_2_-_high_mag.jpg | Mucoepidermoid carcinoma - 2 - high mag. (WC/Nephron)
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| Image:Mucoepidermoid_carcinoma_-_2a_-_very_high_mag.jpg | Mucoepidermoid carcinoma - 2 - very high mag. (WC/Nephron)
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| </gallery>
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| www:
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| *[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm Mucoepidermoid carcinoma (ouhsc.edu)].
| |
| | |
| ====Subtypes====
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| *Conventional.
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| *Oncocytic.
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| **Definition: composed of 50% oncocytes.
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| **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>
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| *Clear cell.
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| *Unicystic (cystadenocarcinoma).
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| **Based on the gross. (???)
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| *Sclerosing MEC +/- eosinophilia.
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| **Rare.
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| | |
| ====Grading====
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| General:
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| *Two competing system exist:
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| **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:
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| *Both systems have their pros and cons.
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| *Weinreb uses the AFIP system with a slight modification.
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| | |
| =====AFIP=====
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| #Low cystic content (<20%) - 2 points.
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| #[[Perineural invasion]] - 2 points.
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| #[[Necrosis]] - 3 points.
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| #Mitoses > 4 per 10 HPFs (HPF not defined in paper - see [[HPFitis]]) - 3 points.
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| #Anaplasia - 4 points.
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| | |
| Scoring:
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| *Low grade = 0-4 points.
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| *Intermediate grade = 5-6 points.
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| *High grade = 7+ points.
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| | |
| ======Weinreb modification======
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| Weinreb looks for the following:
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| *Tumour invades in small nests/islands - 2 points.
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| **If applicable, the two points are added to the AFIP score.
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| **The tumour is graded using the AFIP (scoring) cut points -- see above.
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| | |
| Notes:
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| *It seems pointless to memorize this but it is occasionally asked on exams.
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| **How to remember: think of the Nottingham grading system (architecture, mitoses, nuclear grade) + necrosis + LVI.
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| | |
| ===Stains===
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| Mucous cells:
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| *Alcian blue +ve.
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| *Mucicarcmine +ve.
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| | |
| ===Molecular===
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| *t(11;19)(q21;p13) -- MECT1-MAML2 fusion.<ref name=pmid12539049>{{cite journal |author=Tonon G, Modi S, Wu L, ''et al.'' |title=t(11;19)(q21;p13) translocation in mucoepidermoid carcinoma creates a novel fusion product that disrupts a Notch signaling pathway |journal=Nat. Genet. |volume=33 |issue=2 |pages=208–13 |year=2003 |month=February |pmid=12539049 |doi=10.1038/ng1083 |url=}}</ref><ref name=pmid20588178>{{cite journal |author=Seethala RR, Dacic S, Cieply K, Kelly LM, Nikiforova MN |title=A reappraisal of the MECT1/MAML2 translocation in salivary mucoepidermoid carcinomas |journal=Am. J. Surg. Pathol. |volume=34 |issue=8 |pages=1106–21 |year=2010 |month=August |pmid=20588178 |doi=10.1097/PAS.0b013e3181de3021 |url=}}</ref>
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| **Present in ~65% of MECs.
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| **Presence assoc. with low-grade MEC (vs. high-grade MEC) & favourable prognosis.
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| **Not seen in tumours that are in the DDx of MEC.
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|
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|
| ==Acinic cell carcinoma== | | ==Acinic cell carcinoma== |
Line 637: |
Line 378: |
|
| |
|
| ==Adenoid cystic carcinoma== | | ==Adenoid cystic carcinoma== |
| :See: ''[[Adenoid cystic carcinoma of the breast]]'' for the [[breast]] tumour.
| |
| {{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}} |
| | |
| | ==Intraductal carcinoma of the salivary gland== |
| | {{Main|Intraductal carcinoma of the salivary gland}} |
|
| |
|
| ==Polymorphous low-grade adenocarcinoma== | | ==Polymorphous low-grade adenocarcinoma== |
| *Abbreviated ''PLGA''. | | *Abbreviated ''PLGA''. |
| | | {{Main|Polymorphous low-grade adenocarcinoma}} |
| ===General===
| |
| *Almost exclusively in the oral cavity.
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| **Classically found in the palate -- 60% of PLGAs in palate.
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| *Tumour of the minor salivary glands.
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| *Always a low-grade tumour - by definition.
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| *Female:male ~= 2:1.
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| *Older people ~50-70 years old.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_WMSP74>{{Ref WMSP|74}} <!-- Mike S. --></ref>
| |
| *Architecture: often small nests, may be targetoid.
| |
| **Classically has whorling with '''eye-of-storm''' & '''single file'''.
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| *Cytologically monotonous (uniform) with variable architecture - '''key feature'''.
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| **Nucleus: ovoid & small, small nucleoli, powdery chromatin.
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| ***'''[[Papillary thyroid carcinoma]]-like appearance'''.
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| **Cytoplasm: eosinophilic.
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| *Indistinct cell borders.
| |
| | |
| DDx:
| |
| *[[Adenoid cystic carcinoma]].
| |
| *[[Pleomorphic adenoma]].
| |
| *Cribriform adenocarcinoma of the minor salivary gland.<ref name=pmid21716087>{{Cite journal | last1 = Skalova | first1 = A. | last2 = Sima | first2 = R. | last3 = Kaspirkova-Nemcova | first3 = J. | last4 = Simpson | first4 = RH. | last5 = Elmberger | first5 = G. | last6 = Leivo | first6 = I. | last7 = Di Palma | first7 = S. | last8 = Jirasek | first8 = T. | last9 = Gnepp | first9 = DR. | title = Cribriform adenocarcinoma of minor salivary gland origin principally affecting the tongue: characterization of new entity. | journal = Am J Surg Pathol | volume = 35 | issue = 8 | pages = 1168-76 | month = Aug | year = 2011 | doi = 10.1097/PAS.0b013e31821e1f54 | PMID = 21716087 }}
| |
| </ref>
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Polymorphous_low-grade_adenocarcinoma_-_very_low_mag.jpg | PLGA - very low mag. (WC/Nephron)
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| Image:Polymorphous_low-grade_adenocarcinoma_high_mag.jpg | PLGA - high mag. (WC/Nephron)
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| </gallery>
| |
| ===IHC===
| |
| *S100 +ve, CK +ve, vimentin +ve.
| |
| *GFAP +ve/-ve.
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| *BCL2 +ve/-ve.
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| *Generally negative for myoepithelial markers (calponin, actin) - '''useful if negative'''.
| |
|
| |
|
| ==Carcinoma ex pleomorphic adenoma== | | ==Carcinoma ex pleomorphic adenoma== |
| *Abbreviated ''Ca ex PA''. | | *Abbreviated ''Ca ex PA''. |
| | | {{Main|Carcinoma ex pleomorphic adenoma}} |
| ===General===
| |
| Definition:
| |
| *Malignant transformation of a ''[[pleomorphic adenoma]]''.
| |
| | |
| Diagnosis (either 1 or 2):
| |
| #History of a pleomorphic adenoma at the same site.
| |
| #Features of a pleomorphic adenoma and a carcinoma.
| |
| | |
| Epidemiology:
| |
| *Rare.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Cells with cytologic features of malignancy.
| |
| *Architecture (any of the following):
| |
| **Glands.
| |
| **Nests.
| |
| **Single cells (may be subtle).
| |
| | |
| Architectural patterns:
| |
| *Ductal carcinoma NOS (arising from ductal cells) - most common pattern for Ca ex PA.
| |
| *Myoepithelial cacinoma NOS (arising from myoepithelial cells).
| |
| *"Named carcinoma":
| |
| **Salivary duct carcinoma - second most common pattern for Ca ex PA.
| |
| **Mucoepidermoid carcinoma.
| |
| **Adenoid cystic carcinoma.
| |
| | |
| Note:
| |
| *Often adenocarcinoma-like.
| |
| *Myoepithelial cells may be clear cells. (???)
| |
| | |
| ====Subclassification====
| |
| Extent of invasion:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf]. Accessed on: 2 April 2012.</ref>
| |
| #Non-invasive [[AKA]] ''intracapsular'' [[AKA]] ''in situ''.
| |
| #Minimally invasive <=1.5 mm beyond the capsule.
| |
| #Widely invasive >1.5 mm beyond the capsule.
| |
|
| |
|
| ==Epithelial-myoepithelial carcinoma== | | ==Epithelial-myoepithelial carcinoma== |