Difference between revisions of "Salivary glands"

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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.
 
=Normal salivary glands=
==Types of 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>
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#**Serous ~90% of gland.
#**Serous ~90% of gland.
#**Mucinous ~10% 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.
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==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'''
! Image
|-
|-
|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.
| (1) plasmacytoid
| (1) plasmacytoid
| adenoid cystic c.
| [[adenoid cystic carcinoma]]
| occ. encapsulated, <br>mixed pop. of glandular, <br>myoepithelial and mesenchymal cells
| occ. encapsulated, <br>mixed pop. of glandular, <br>myoepithelial and mesenchymal cells
| [http://en.wikipedia.org/wiki/File:Pleomorphic_adenoma_(1)_parotid_gland.jpg]
| [[Image:Pleomorphic_adenoma_(1)_parotid_gland.jpg | thumb | center |150px| PA. (WP)]]
|-
|-
|Warthin tumour
|[[Warthin tumour]]
| papillary, <br>'''bilayer'''  
| papillary, <br>'''bilayer'''  
| cuboid (basal), columnar (apical)  
| cuboid (basal), columnar (apical)  
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| '''eosinophilic, abundant'''  
| '''eosinophilic, abundant'''  
| unremarkable  
| unremarkable  
| sebaceous lymphadenoma  
| [[sebaceous lymphadenoma]]
| AKA ''papillary cystadenoma lymphomatosum''
| AKA ''papillary cystadenoma lymphomatosum''
| [http://en.wikipedia.org/wiki/File:Papillary_cystadenoma_lymphomatosum2.jpg], [http://commons.wikimedia.org/wiki/File:Papillary_cystadenoma_lymphomatosum3.jpg]  
| [[Image:Papillary_cystadenoma_lymphomatosum2.jpg| thumb| center | 150px| PCL. (WP/Nephron)]]
|-
|-
|Basal cell adenoma
|[[Basal cell adenoma]]
| var., '''islands surrounded'''<br>'''by hyaline bands'''
| var., '''islands surrounded'''<br>'''by hyaline bands''', lesion encapsulated
| basaloid
| basaloid
| subtle
| subtle
| scant,<br>hyperchromatic
| scant,<br>hyperchromatic
| granular
| granular
| basal cell adenoca
| [[basal cell adenocarcinoma]]
| -
| -
| -  
| -  
|-
|-
|Canalicular adenoma
|[[Canalicular adenoma]]
| '''chains of cells'''
| '''chains of cells'''
| cuboid or columnar
| cuboid or columnar
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| scant,<br>hyperchromatic  
| scant,<br>hyperchromatic  
| granular
| granular
| 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]]
| var., '''islands surrounded'''<br>'''by loose fibrous stroma'''
| var., '''islands surrounded'''<br>'''by loose fibrous stroma'''
| basaloid
| basaloid
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| scant, hyperch.
| scant, hyperch.
| granular
| granular
| basal cell adenoca
| [[basal cell adenocarcinoma]]
| -
| -
| -
| -
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==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
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| '''fuffy, clear,<br>abundant'''  
| '''fuffy, clear,<br>abundant'''  
| nuclei sm.
| nuclei sm.
| ?
| SCC (?)
| IHC: p63+
| IHC: p63+
| [[Image:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg |thumb| center| 150px | MEC. (WC)]]
|-
|-
|Acinic cell adenocarcinoma (AcCC)  
|[[Adenoid cystic carcinoma]] (AdCC)
| acinar (islands)
| 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 carcinoma]] (AcCC)  
| 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)
|[[Salivary duct carcinoma]]
| pseudocysts,<br>cribriform, solid,<br>hyaline stroma
| glandular, [[cribriform]]
| epithelioid
| subtle
| scant,<br>hyperchromatic
| '''small<br>"carrot-shaped"'''
| ?
| ?
|-
|Salivary duct carcinoma  
| 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; 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)]]
|-
| [[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==
==DDx==
Palate:
===Palate===
*Polymorphous low-grade adenocarcinoma.
*[[Polymorphous low-grade adenocarcinoma]].
*Adenoid cystic carcinoma.
*[[Adenoid cystic carcinoma]].
*Pleomorphic adenoma.
*[[Pleomorphic adenoma]].
 
===Benign parotid tumours===
*[[Pleomorphic adenoma]].
*[[Warthin tumour]].


Parotid (benign):
===Oncocytic tumours===
*Pleomorphic adenoma.
*Benign:
*Warthin tumour.
**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 overview==
==IHC overview==
General:
General:
*Usually has limited value.
*Usually has limited value. <!--as per Ilan Weinreb-->


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>


=Benign=
=Benign=
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*Ductal obstrution.
*Ductal obstrution.


==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>
*Infection.
*Autoimmune (e.g. Sjögren syndrome, [[systemic lupus erythematosus]]).
*Other.
 
===Microscopic===
Features:
*Fibrosis.
*Non-neoplastic mononuclear inflammatory infiltrate.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Chronic_sialadenitis.jpg Chronic sialadenitis (WC)].
 
==Mucocele==
===General===
*Benign.


===Microscopic===
==Salivary gland mucocele==
Features:
{{Main|Salivary gland mucocele}}
*Ball of mucous.


==Pleomorphic adenoma==
==Pleomorphic adenoma==
*Abbreviated ''PA''.
{{Main|Pleomorphic adenoma}}
 
===General===
Features:
*Very common - approx. 60% of parotid gland tumours.<ref name=Ref_HaNP295>{{Ref HaNP|295}}</ref>
*May transform into a malignant tumour.
**Other benign salivary gland tumours do not do this.
*Only benign childhood salivary gland tumour of significance.
 
====Weinreb's dictums====
#Most common salivary tumour in all age groups.
#Seen in all sites (unlike other benign tumours).
#Recurrence and malignancy risk (unlike other benign salivary gland tumours).
#Any part of a tumour that looks like PA makes it a PA.
 
===Gross===
*May be cartilaginous appearing.
 
===Microscopic===
Features:<ref name=Ref_HaNP295>{{Ref HaNP|295}}</ref>
*Proliferation of myoepithelium and epithelium (ductal cells) in mesenchymal stroma.
**Cells in ducts = epithelial.
**Cells not in ducts = myoepithelial.<ref>IW. 10 January 2011.</ref>
*Mesenchymal stroma - '''important feature'''.
**May be any of following: myxoid, mucochondroid, hyalinized, osseous, fatty.
***Chondroid = specific for PA; can diagnose PA without an epithelial (ductal) component if chondroid is present.
***Myxoid = not specific for PA.
 
Notes:
*Mesenchymal stroma not required for diagnosis -- if >5% ducts.<ref>IW. 10 January 2011.</ref>
**No chondroid stroma ''and'' <5% ductal cells = '''myoepithelioma'''.
*Complete excision is often elusive; stating "completely excised" on a surgical pathology report is unwise.
*Look for, i.e. rule-out, poorly differentiated carcinoma: ''carcinoma ex pleomorphic adenoma''.
 
Memory device: '''MEC''' = '''m'''yoepithelium, '''e'''pithelium, '''c'''hondromyxoid stroma.


===IHC===  
==Myoepithelioma==
*S-100 +ve, SMA +ve, GFAP +ve.
{{Main|Myoepithelioma}}


==Basal cell adenoma==
==Basal cell adenoma==
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*~2% of salivary gland tumours.
*~2% of salivary gland tumours.
*May be multifocal.
*May be multifocal.
*Usu. parotid gland, occasionally submandibular gland.
*Usually parotid gland, occasionally submandibular gland.
*Female:male = ~2:1.
*Female:male = ~2:1.
*May be seen in association with dermal cylindromas in the context of a genetic mutation.
*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.
*Malignant transformation - rarely.


===Microscopic===
===Microscopic===
Features:
Features:
*Basophilic cells.
#Basal component.
*Usu. nests; may be bilayered tubules ''or'' [[trabeculae]].
#*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:
Notes:
*No chondromyxoid stroma.
*No chondromyxoid stroma.
**Chondromyxoid stroma present -> pleomorphic adenoma.
**Chondromyxoid stroma present -> [[pleomorphic adenoma]].
*Neoplastic cells embeded in stroma ("stromal invasion") = basal cell adenocarcinoma.
*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.
**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:
*[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://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===
===IHC===
*Luminal stains +ve: CK7 +ve, CAM5.2 +ve.
*Luminal stains +ve: CK7 +ve, CAM5.2 +ve.
*p63 +ve -- basal component.
*[[S-100]] +ve -- spindle cells in the stroma.


==Canalicular adenoma==
==Canalicular adenoma==
===General===
{{Main|Canalicular adenoma}}
*Exclusively oral cavity.
**80% of lesions on upper lip.
 
===Microscopic===
Features:
*Channels - "beading of cell".
*Mucoid/hemorrhagic stroma.
 
DDx:
*Basal cell adenoma.
 
===IHC===
*p63 -ve.
**Basal cell adenoma p63 +ve.
 
==Papillary cystadeoma lymphomatosum==
*[[AKA]] '''Warthin tumour'''.
 
===General===
Epidemiology:
*May be multicentric ~ 15% of the time.
*May be bilateral ~10% of the time.
*Classically: male > female -- changing with more women smokers.
*Smokers.
*Old - usu. 60s, very rarely < 40 years old.


Notes:
==Warthin tumour==
*No malignant transformation.
{{Main|Warthin tumour}}
*Not in submandibular gland.
*Not in sublingual gland.
*Not in children.
 
===Gross===
*Motor-oil like fluid.
*Cystic component larger in larger lesions.
**Small lesions may be solid.
 
===Microscopy===
Features:
* Papillae (nipple-shaped structures) with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells) -- '''key feature'''.
* Fibrous capsule - pink & homogenous on [[H&E stain]].
* Cystic space filled with debris ''in situ'' (not necrosis).
* Lymphoid stroma.
 
Notes:
*+/-Squamous differentiation.
*+/-Goblet cell differentiation.
 
DDx:
*Lymphoepithelial cyst.
**Cyst within a lymph node.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Papillary_cystadenoma_lymphomatosum3.jpg Warthin tumour - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Papillary_cystadenoma_lymphomatosum2.jpg Warthin tumour - intermed. mag. (WC)].


==Sebaceous adenoma==
==Sebaceous adenoma==
===Microscopic===
{{Main|Sebaceous adenoma}}
Features:
*Benign counterpart of ''[[sebaceous carcinoma]]''.
*Benign counterpart of ''sebaceous carcinoma''.


==Oncocytoma==
==Sebaceous lymphadenoma==
===General===
{{Main|Sebaceous lymphadenoma}}
*No risk of malignant transformation.
*~1% of all salivary gland tumours.
*Typical age: 60s-80s.
*Associated with radiation exposure.
*Major salivary glands - usu. parotid gland.


===Gross===
==Oncocytoma of the salivary gland==
*Golden brown appearance.
*[[AKA]] ''salivary gland oncocytoma''.
 
{{Main|Oncocytoma of the salivary gland}}
===Microscopic===
Features:
*Like [[oncocytoma]]s elsewhere.
**Eosinophilic cytoplasm (on [[H&E stain]]).
***Due to increased number of mitochrondria.
**Fine capillaries.
 
Notes:
*May have clear cell change.
*Multiple small incidental lesions = oncocytosis - ''not'' oncocytoma.
 
===IHC===
*p63 +ve focally in nucleus.


=Malignant=
=Malignant=
Approach:
One approach:
*Differentiate -- luminal vs. myoepithelial vs. basal.
*Differentiate -- luminal vs. myoepithelial vs. basal (mucoepideroid).


==Mucoepidermoid carcinoma==
==Mucoepidermoid carcinoma==
===General===
{{Main|Mucoepidermoid carcinoma}}
*Most common malignant neoplasm of salivary gland.
 
===Microscopic===
Features:
*Abundant fluffy cytoplasm - with large mucin vacuoles - '''key feature'''.
*Nucleus distorted by mucin vacuole.
*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.
**Solid - high grade.
 
Notes:
*Mucin vacuoles may be rare; in a superficial glance -- it may mimic squamous cell carcinoma.


Images:
==Acinic cell carcinoma==
*[http://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg Mucoepidermoid carcinoma 2 (WC)].
{{Main|Acinic cell carcinoma}}
*[http://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%283%29_HE_stain.jpg Mucoepidermoid carcinoma 3 (WC)].
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/D2A001-PQ01-M.htm Mucoepidermoid carcinoma (ouhsc.edu)].
 
==Acinic cell adenocarcinoma==
*Abbreviated ''AcCC''.
*Common malignant neoplasm of salivary gland.
 
Features:
*Psammoma bodies(?).
*Abundant cytoplasm.
*Stipled chromatin.
*Acinar architecture (islands of cells).
 
Memory device:
*AcCC - lots of "C"s - '''c'''hromatin stipled, '''c'''ytoplasm generous.


==Adenoid cystic carcinoma==
==Adenoid cystic carcinoma==
===General===
{{Main|Adenoid cystic carcinoma}}
*Common malignant neoplasm of salivary gland.
Note: The [[breast]] tumour is dealt with in ''[[adenoid cystic carcinoma of the breast]]''.
*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===
Features:
*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.]
 
Memory device:
*A'''d'''CC - mostly '''D'''NA (scant cytoplasm), distinct nucleus (carrot-shaped).
 
===IHC===
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>
*CD117 +ve.
*Cyclin D1 +ve.


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


*Malignant counterpart of ''salivary duct adenoma''.
==Intraductal carcinoma of the salivary gland==
{{Main|Intraductal carcinoma of the salivary gland}}


==Polymorphous low-grade adenocarcinoma==
==Polymorphous adenocarcinoma==
*Classically found in the palate.
*Abbreviated ''PAC''.
*Tumour of the minor salivary glands.
*Previously known as ''polymorphous low-grade adenocarcinoma'', abbreviated ''PLGA''.
 
{{Main|Polymorphous adenocarcinoma}}
===Microscopy===
*Cytologically monotonous (uniform) with variable architecture - '''key feature'''.
**Architecture: often small nests, may be targetoid.
*Nucleus: ovoid & small with small nucleoli.
*Indistinct cell borders.
*Eosinophilic cytoplasm.
 
===DDx===
*Pleomorphic adenoma.
*Adenoid cystic carcinoma.


==Carcinoma ex pleomorphic adenoma==
==Carcinoma ex pleomorphic adenoma==
*Abbreviated ''Ca ex PA''.
*Abbreviated ''Ca ex PA''.
{{Main|Carcinoma ex pleomorphic adenoma}}


===General===
==Epithelial-myoepithelial carcinoma==
Definition:
{{Main|Epithelial-myoepithelial carcinoma}}
*Malignant transformation of a ''pleomorphic adenoma''.


Diagnosis (either 1 or 2):
==Basal cell adenocarcinoma==
#History of a pleomorphic adenoma at the same site.
{{Main|Basal cell adenocarcinoma}}
#Features of a pleomorphic adenoma and a carcinoma.


Epidemiology:
==Sebaceous carcinoma==
*Rare.
{{Main|Sebaceous carcinoma}}
It is similar to the tumour found in the skin.


===Microscopy===
==Hyalinizing clear cell carcinoma==
Features:
{{Main|Hyalinizing clear cell carcinoma}}
*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====
#Non-invasive [[AKA]] ''intracapsular'' [[AKA]] ''in situ''.
#Minimally invasive <1.5 mm beyond the capsule.
#Widely invasive >=1.5 mm beyond the capsule.
 
==Sebaceous carcinoma==
*Arises from ''sebaceous glands''
*Sebaceous glands are serous glands and clear on H&E.


=See also=
=See also=
Line 487: Line 370:
*[[Breast]].
*[[Breast]].
*[[Head and neck cytopathology]].
*[[Head and neck cytopathology]].
*[[Lacrimal gland]].


=References=
=References=
Line 492: Line 376:


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