Difference between revisions of "Salivary glands"

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Salivary glands (view source)

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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.  


==Normal==
The [[cytopathology]] of the salivary glands is covered in the ''[[Head and neck cytopathology]]'' article.
===Types of salivary glands===
 
=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===
==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:
Line 25: Line 38:
*Sub'''m'''andibular = glands are '''m'''ixed.
*Sub'''m'''andibular = glands are '''m'''ixed.


==Overview==
=Overview=
===Benign tumours===
==Benign tumours==
'''Tabular form - adapted from Thompson<ref>{{Ref HaNP|295-319}}</ref>'''
'''Tabular form - adapted from Thompson<ref>{{Ref HaNP|295-319}}</ref>'''
{| class="wikitable"
{| class="wikitable sortable"
|
! Entity
| '''Architecture'''
! Architecture
| '''Morphology'''
! Morphology
| '''Cell borders'''
! Cell borders
| '''Cytoplasm'''
! Cytoplasm
| '''Nucleus'''
! Nucleus  
| '''DDx'''
! DDx
| '''Other'''
! Other
! Image
|-
|-
|Pleomorphic adenoma || var. || '''mixed pop.'''; must include: (1) myoepithelium, (2) epithelium, (3) chondromyxoid stroma  || var. || var. || (1) plasmacytoid || adenoid cystic c. || occ. encapsulated, <br>mixed pop. of glandular, <br>myoepithelial and mesenchymal cells
|[[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 || papillary, <br>'''bilayer''' || cuboid (basal), columnar (apical) || clearly seen || '''eosinophilic, abundant''' || unremarkable || sebaceous lymphadenoma || AKA ''papillary cystadenoma lymphomatosum''
|[[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 || var., '''islands surrounded'''<br>'''by hyaline bands''' || basaloid || subtle || scant,<br>hyperchromatic || granular || basal cell adenoca || -
|[[Basal cell adenoma]]
| var., '''islands surrounded'''<br>'''by hyaline bands''', lesion encapsulated
| basaloid
| subtle
| scant,<br>hyperchromatic
| granular
| [[basal cell adenocarcinoma]]
| -
| -  
|-
|-
|Canalicular adenoma || '''chains of cells''' || cuboid or columnar || subtle || scant,<br>hyperchromatic || granular || basal cell 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 || var., '''islands surrounded'''<br>'''by loose fibrous stroma''' || basaloid || subtle || scant, hyperch. || granular || basal cell adenoca || -
|[[Sialoblastoma]]
| var., '''islands surrounded'''<br>'''by loose fibrous stroma'''
| basaloid
| subtle
| scant, hyperch.
| granular
| [[basal cell adenocarcinoma]]
| -
| -
|-
|-
|}
|}


===Malignant tumours===
==Malignant tumours==
'''Tabular form - adapted from Thompson<ref>{{Ref HaNP|325-357}}</ref>'''
'''Tabular form - adapted from Thompson<ref>{{Ref HaNP|325-357}}</ref>'''
{| class="wikitable"
{| class="wikitable sortable"
|
! Entity
| '''Architecture'''
! Architecture
| '''Morphology'''
! Morphology
| '''Cell borders'''
! Cell borders
| '''Cytoplasm'''
! Cytoplasm
| '''Nucleus'''
! Nucleus  
| '''DDx'''
! DDx
| '''Other'''
! Other
! Image
|-
|-
|Mucoepidermoid carcinoma  
|[[Mucoepidermoid carcinoma]]
| cystic & solid
| cystic & solid
| epithelioid
| epithelioid
Line 68: Line 123:
| '''fuffy, clear,<br>abundant'''  
| '''fuffy, clear,<br>abundant'''  
| nuclei sm.
| 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 adenocarcinoma (AcCC)  
|[[Acinic cell carcinoma]] (AcCC)  
| acinar (islands)
| sheets, acinar (islands)
| epithelioid
| epithelioid
| clear
| clear
| '''granular''', generous
| '''granular abundant'''
| stippled, +/-occ. nucleoli
| '''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)]]
|Adenoid cystic carcinoma (AdCC)
| pseudocysts,<br>cribriform, solid,<br>hyaline stroma
| epithelioid
| subtle
| scant,<br>hyperchromatic
| '''small<br>"carrot-shaped"'''
| ?
| ?
|-
|-
|Salivary duct carcinoma  
|[[Salivary duct carcinoma]]
| glandular, cribriform  
| glandular, [[cribriform]]
| columnar  
| columnar  
| subtle/clear  
| subtle/clear  
| hyperchromatic  
| hyperchromatic  
| columnar  
| columnar  
| metastatic breast ca
| metastatic breast carcinoma
| similar to ductal<br>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 low-grade adenocarcinoma  
|[[Polymorphous low-grade adenocarcinoma]]
| variable, often small<br>nests, may be targetoid  
| variable, often small<br>nests, may be targetoid  
| epithelioid  
| epithelioid  
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| '''eosinophilic'''  
| '''eosinophilic'''  
| ovoid & small with<br>small nucleoli  
| ovoid & small with<br>small nucleoli  
| ?
| AdCC
| minor salivary gland tumour,<br>often in palate,<br> cytologically monotonous
| 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 by site===
==DDx==
Palate:
===Palate===
*Polymorphous low-grade adenocarcinoma.
*[[Polymorphous low-grade adenocarcinoma]].
*Adenoid cystic carcinoma.
*[[Adenoid cystic carcinoma]].
*Pleomorphic adenoma.
*[[Pleomorphic adenoma]].


=Benign=
===Benign parotid tumours===
General DDx:
*[[Pleomorphic adenoma]].
*Inflammation.
*[[Warthin tumour]].
*Neoplasm.
*Ductal obstrution.


==Chronic Sialadenitis==
===Oncocytic tumours===
===General===
*Benign:
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>
**Oncocytoma.
*Infection.
**[[Warthin tumour]].
*Autoimmune (e.g. Sjögren syndrome, [[systemic lupus erythematosus]]).
*Malignant:
*Other.
**[[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.


===Microscopic===
===Clear cell tumours===
Features:
*[[Mucoepidermoid carcinoma]], clear cell variant.
*Fibrosis.
*[[Acinic cell carcinoma]], clear cell variant.
*Non-neoplastic mononuclear inflammatory infiltrate.
*[[Hyalinizing clear cell carcinoma]].
*[[Epithelial-myoepithelial carcinoma]].
*Metastatic [[clear cell carcinoma]].
**Metastatic [[clear cell renal cell carcinoma]].


Image:
===Basaloid neoplasms===
*[http://commons.wikimedia.org/wiki/File:Chronic_sialadenitis.jpg Chronic sialadenitis (WC)].
*[[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>


==Mucocele==
==IHC overview==
===Microscopic===
General:
Features:
*Usually has limited value. <!--as per Ilan Weinreb-->
*Mucous.


==Pleomorphic adenoma==
Overview:
===Epidemiology===
*Luminal markers: [[CK7]], [[CK19]], CAM5.2 (LMWK).
Features:<ref name=Ref_HaNP295>{{Ref HaNP|295}}</ref>
*Basal markers: p63, HMWK, CK14.
*Very common - approx. 60% of parotid gland tumours
*Myoepithelial markers: calponin, actin.
*Uncommitted: S-100.


===Histology===
Notes:
Features:<ref name=Ref_HaNP295>{{Ref HaNP|295}}</ref>
*p63 and S-100 are sometimes call myoepithelial.
*Proliferation of myoepithelium and epithelium in mesenchymal stroma.
*Mesenchymal stroma - key feature.
**May be any of following: myxoid, mucochondroid, hyalinized, osseous, fatty.
*Look for, i.e. rule-out, poorly differentiated carcinoma: ''carcinoma ex pleomorphic adenoma''.


IHC: S-100 +ve, SMA +ve, GFAP +ve.
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>


==Basal cell adenoma==
=Benign=
===Microscopic===
General DDx:
Features:
*Inflammation.
*Basophilic cells.
*Neoplasm.
*Nests.
*Ductal obstrution.


==Canalicular adenoma==
==Chronic sialadenitis==
===Microscopic===
{{Main|Chronic sialadenitis}}
Features:
*Channels.


==Papillary cystadeoma lymphomatosum==
==Salivary gland mucocele==
*AKA ''Warthin tumour''.
{{Main|Salivary gland mucocele}}
*Papillae.


===Microscopy===
==Pleomorphic adenoma==
* Papillae (nipple-shaped structures) with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells) -- '''key feature'''.
{{Main|Pleomorphic adenoma}}
* Fibrous capsule - pink & homogenous on H&E.
* Cystic space.
* Lymphoid stroma.


===DDx===
==Myoepithelioma==
*Lymphoepithelial cyst.
{{Main|Myoepithelioma}}
**Cyst within a lymph node.


==Sebaceous adenoma==
==Basal cell adenoma==
Features:
*Benign counterpart of ''sebaceous carcinoma''.
 
==Oncocytoma==
Features:
*Like [[oncocytoma]]s elsewhere.
**Eosinophilic cytoplasm (H&E) - due to increased number of mitochrondria.
 
=Malignant=
Approach:
*Differentiate -- luminal vs. myoepithelial vs. basal.
 
==Mucoepidermoid carcinoma==
===General===
===General===
*Most common malignant neoplasm of salivary gland.
*~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===
===Microscopic===
Features:
Features:
*Abundant fluffy cytoplasm - with large mucin vacuoles - '''key feature'''.
#Basal component.
*Nucleus distorted by mucin vacuole.
#*Basophilic cells - '''key feature'''.
*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>
#*Usu. in nests.
**Cystic - low grade.
#**May be bilayered tubules ''or'' [[trabeculae]].
**Solid - high grade.
#*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:
Notes:
*Mucin vacuoles may be rare; in a superficial glance -- it may mimic squamous cell carcinoma.
*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://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg Mucoepidermoid carcinoma 2 (WC)].
*[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://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%283%29_HE_stain.jpg Mucoepidermoid carcinoma 3 (WC)].
*[http://www.webpathology.com/image.asp?n=1&Case=115 BCA (webpathology.com)].
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm Mucoepidermoid carcinoma (ouhsc.edu)].
*[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)].


==Acinic cell adenocarcinoma==
===IHC===
*Abbreviated ''AcCC''.
*Luminal stains +ve: CK7 +ve, CAM5.2 +ve.
*Common malignant neoplasm of salivary gland.
*p63 +ve -- basal component.
*[[S-100]] +ve -- spindle cells in the stroma.


Features:
==Canalicular adenoma==
*Psammoma bodies(?).
{{Main|Canalicular adenoma}}
*Abundant cytoplasm.
*Stipled chromatin.
*Acinar architecture (islands of cells).


Memory device:
==Warthin tumour==
*AcCC - lots of "C"s - '''c'''hromatin stipled, '''c'''ytoplasm generous.
{{Main|Warthin tumour}}


==Adenoid cystic carcinoma==
==Sebaceous adenoma==
===General===
{{Main|Sebaceous adenoma}}
*Common malignant neoplasm of salivary gland.
*Benign counterpart of ''[[sebaceous carcinoma]]''.
*AKA ''cylindroma''.<ref>Chest. May 1957. Vol. 31. No. 5. PP. 493-511. [http://www.chestjournal.org/content/31/5/493.abstract http://www.chestjournal.org/content/31/5/493.abstract]</ref>
**Should ''not'' be confused with ''dermal cylindroma'' (a benign skin tumour).


===Microscopic===
==Sebaceous lymphadenoma==
Features:
{{Main|Sebaceous lymphadenoma}}
*Cribriform architecture.
*Scant cytoplasm.
*Carrot-shaped nucleus.
*Hyaline stroma.


Images: [http://www.nature.com/modpathol/journal/v16/n12/fig_tab/3880915f2.html Adenoid cystic carcinoma - Mod. Pathol.]
==Oncocytoma of the salivary gland==
*[[AKA]] ''salivary gland oncocytoma''.
{{Main|Oncocytoma of the salivary gland}}


Memory device:  
=Malignant=
*A'''d'''CC - mostly '''D'''NA (scant cytoplasm), distinct nucleus (carrot-shaped).
One approach:
*Differentiate -- luminal vs. myoepithelial vs. basal (mucoepideroid).


===IHC===
==Mucoepidermoid carcinoma==
Features:<ref name=pmid19360297>{{Cite journal  | last1 = Sequeiros-Santiago | first1 = G. | last2 = García-Carracedo | first2 = D. | last3 = Fresno | first3 = MF. | last4 = Suarez | first4 = C. | last5 = Rodrigo | first5 = JP. | last6 = Gonzalez | first6 = MV. | title = Oncogene amplification pattern in adenoid cystic carcinoma of the salivary glands. | journal = Oncol Rep | volume = 21 | issue = 5 | pages = 1215-22 | month = May | year = 2009 | doi =  | PMID = 19360297 }}</ref>
{{Main|Mucoepidermoid carcinoma}}
*CD117 +ve.
*Cyclin D1 +ve.


==Salivary duct carcinoma==
==Acinic cell carcinoma==
Needs work.
{{Main|Acinic cell carcinoma}}


*Malignant counterpart of ''salivary duct adenoma''.
==Adenoid cystic carcinoma==
{{Main|Adenoid cystic carcinoma}}
Note: The [[breast]] tumour is dealt with in ''[[adenoid cystic carcinoma of the breast]]''.


==Polymorphous low-grade adenocarcinoma==
==Salivary duct carcinoma==
*Classically found in the palate.
{{Main|Salivary duct carcinoma}}
*Tumour of the minor salivary glands.


===Microscopy===
==Intraductal carcinoma of the salivary gland==
*Cytologically monotonous (uniform) with variable architecture - '''key feature'''.
{{Main|Intraductal carcinoma of the salivary gland}}
**Architecture: often small nests, may be targetoid.
*Nucleus: ovoid & small with small nucleoli.
*Indistinct cell borders.
*Eosinophilic cytoplasm.


===DDx===  
==Polymorphous adenocarcinoma==
*Pleomorphic adenoma.
*Abbreviated ''PAC''.
*Adenoid cystic carcinoma.
*Previously known as ''polymorphous low-grade adenocarcinoma'', abbreviated ''PLGA''.
{{Main|Polymorphous adenocarcinoma}}


==Carcinoma ex pleomorphic adenoma==
==Carcinoma ex pleomorphic adenoma==
*Malignant transformation of ''pleomorphic adenoma''.
*Abbreviated ''Ca ex PA''.
*Rare.
{{Main|Carcinoma ex pleomorphic adenoma}}
*May be subtle.


===Microscopy===
==Epithelial-myoepithelial carcinoma==
*Nests of cells, may from glands, single cells. (???)
{{Main|Epithelial-myoepithelial carcinoma}}


Note:
==Basal cell adenocarcinoma==
*Adenocarcinoma-like.
{{Main|Basal cell adenocarcinoma}}


==Sebaceous carcinoma==
==Sebaceous carcinoma==
*Arises from ''sebaceous glands''
{{Main|Sebaceous carcinoma}}
*Sebaceous glands are serous glands and clear on H&E.
It is similar to the tumour found in the skin.
 
==Hyalinizing clear cell carcinoma==
{{Main|Hyalinizing clear cell carcinoma}}


==See also==
=See also=
*[[Head and neck pathology]].
*[[Head and neck pathology]].
*[[Thyroid gland]].
*[[Thyroid gland]].
*[[Breast]].
*[[Breast]].
*[[Head and neck cytopathology]].
*[[Head and neck cytopathology]].
*[[Lacrimal gland]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Head and neck pathology]]
[[Category:Head and neck pathology]]
[[Category:Salivary gland|Salivary gland]]
Michael
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