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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. |
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| =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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| ==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. |
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| | [[adenoid cystic carcinoma]] | | | [[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 (WP)] | | | [[Image:Pleomorphic_adenoma_(1)_parotid_gland.jpg | thumb | center |150px| PA. (WP)]] |
| |- | | |- |
| |[[Warthin tumour]] | | |[[Warthin tumour]] |
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| | [[sebaceous lymphadenoma]] | | | [[sebaceous lymphadenoma]] |
| | AKA ''papillary cystadenoma lymphomatosum'' | | | AKA ''papillary cystadenoma lymphomatosum'' |
| | [http://en.wikipedia.org/wiki/File:Papillary_cystadenoma_lymphomatosum2.jpg (WP)], [http://commons.wikimedia.org/wiki/File:Papillary_cystadenoma_lymphomatosum3.jpg (WP)] | | | [[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 adenocarcinoma | | | [[basal cell adenocarcinoma]] |
| | - | | | - |
| | - | | | - |
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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- |
| | [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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| | 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'''
| | ! Entity |
| | '''Architecture'''
| | ! Architecture |
| | '''Morphology'''
| | ! Morphology |
| | '''Cell borders'''
| | ! Cell borders |
| | '''Cytoplasm'''
| | ! Cytoplasm |
| | '''Nucleus'''
| | ! Nucleus |
| | '''DDx'''
| | ! DDx |
| | '''Other'''
| | ! Other |
| | '''Image'''
| | ! Image |
| |- | | |- |
| |[[Mucoepidermoid carcinoma]] | | |[[Mucoepidermoid carcinoma]] |
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| | SCC (?) | | | SCC (?) |
| | IHC: p63+ | | | IHC: p63+ |
| | [http://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg (WC)] | | | [[Image:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg |thumb| center| 150px | MEC. (WC)]] |
| |- | | |- |
| |[[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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| | [[pleomorphic adenoma]], [[PLGA]] | | | [[pleomorphic adenoma]], [[PLGA]] |
| | Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+ | | | Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+ |
| | [http://commons.wikimedia.org/wiki/File:Adenoid_cystic_carcinoma_-_high_mag.jpg (WC)] | | | [[Image:Adenoid_cystic_carcinoma_-_high_mag.jpg|thumb|center|150px| AdCC. (WC/Nephron)]] |
| |- | | |- |
| |[[Acinic cell carcinoma]] (AcCC) | | |[[Acinic cell carcinoma]] (AcCC) |
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| | '''granular abundant''' | | | '''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 | | | Stains: PAS +ve, PAS-D +ve; [[IHC]]: S-100 -ve, p63 -ve |
| | [http://commons.wikimedia.org/wiki/File:Acinic_cell_carcinoma_-_high_mag.jpg (WC)] | | | [[Image:Acinic_cell_carcinoma_-_high_mag.jpg | thumb| center|150px| AcCC. (WC/Nephron)]] |
| |- | | |- |
| |[[Salivary duct carcinoma]] | | |[[Salivary duct carcinoma]] |
| | glandular, cribriform | | | glandular, [[cribriform]] |
| | columnar | | | columnar |
| | subtle/clear | | | subtle/clear |
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| | metastatic breast carcinoma | | | metastatic breast carcinoma |
| | similar to ductal<br>breast carcinoma; male>female | | | similar to ductal<br>breast carcinoma; male>female |
| | [http://commons.wikimedia.org/wiki/File:Salivary_duct_carcinoma_-a-_low_mag.jpg (WC)] | | | [[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 |
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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+/- |
| | [http://commons.wikimedia.org/wiki/File:Polymorphous_low-grade_adenocarcinoma_-_very_low_mag.jpg (WC)] | | | [[Image:Polymorphous_low-grade_adenocarcinoma_-_very_low_mag.jpg|thumb|center|150px|PLGA. (WC/Nephron)]] |
| |- | | |- |
| | [[Epithelial-myoepithelial carcinoma]] | | | [[Epithelial-myoepithelial carcinoma]] |
| | nests (myoepithelial) with tubules (epithelial) | | | '''nests (myoepithelial) with tubules (epithelial)''' |
| | epithelioid | | | epithelioid |
| | not distinct | | | not distinct |
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| | [[AdCC]], [[pleomorphic adenoma]] | | | [[AdCC]], [[pleomorphic adenoma]] |
| | rare | | | rare |
| | [http://commons.wikimedia.org/wiki/File:Epithelial-myoepithelial_carcinoma_-_high_mag.jpg (WC)] | | | [[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)]] |
| |} | | |} |
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| ==DDx== | | ==DDx== |
| ===Palate=== | | ===Palate=== |
| *[[Polymorphous low-grade adenocarcinoma]]. | | *[[Polymorphous adenocarcinoma]]. |
| *[[Adenoid cystic carcinoma]]. | | *[[Adenoid cystic carcinoma]]. |
| *[[Pleomorphic adenoma]]. | | *[[Pleomorphic adenoma]]. |
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| *[[Hyalinizing clear cell carcinoma]]. | | *[[Hyalinizing clear cell carcinoma]]. |
| *[[Epithelial-myoepithelial carcinoma]]. | | *[[Epithelial-myoepithelial carcinoma]]. |
| *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--> |
|
| |
|
| 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> |
| | *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> |
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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=== | | ==Salivary gland mucocele== |
| Features:
| | {{Main|Salivary gland mucocele}} |
| *Fibrosis.
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| *Non-neoplastic mononuclear inflammatory infiltrate.
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| | |
| Image:
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| *[http://commons.wikimedia.org/wiki/File:Chronic_sialadenitis.jpg Chronic sialadenitis (WC)].
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| ==Mucocele==
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| ===General===
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| *Benign.
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| *Infected mucocele = mucopyocele.
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| | |
| ===Microscopic=== | |
| Features:<ref>URL: [http://emedicine.medscape.com/article/1076717-workup http://emedicine.medscape.com/article/1076717-workup]. Accessed on: 6 March 2012.</ref>
| |
| *Granulation tissue-like and pseudocyst-like.
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| **Granulation tissue-like:
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| ***Fibroblasts.
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| ***Small caliber blood vessels.
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| ***Histocytes.
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| ***Neutrophils.
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| **Pseudocyst:
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| ***No epithelial lining.
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| ***Poorly circumscribed.
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| *Pale pink extracellular material (mucous) - '''key feature'''.
| |
| *+/-[[Granuloma]]s.<ref name=pmid7251405>{{Cite journal | last1 = Seifert | first1 = G. | last2 = Donath | first2 = K. | last3 = von Gumberz | first3 = C. | title = [Mucoceles of the minor salivary glands. Extravasation mucoceles (mucus granulomas) and retention mucoceles (mucus retention cysts) (author's transl)]. | journal = HNO | volume = 29 | issue = 6 | pages = 179-91 | month = Jun | year = 1981 | doi = | PMID = 7251405 }}</ref>
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| DDx:
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| *[[Granulation tissue]].
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| *[[Signet ring cell carcinoma]] - muciphages may mimic signet ring cells.
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Mucocele_of_lower_lip_%281%29.JPG Mucocele - low mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Mucocele_of_lower_lip_%282%29.JPG Mucocele - high mag. (WC)].
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| *[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=292590975 Mucocele (dermatlas.med.jhmi.edu)].
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| ==Pleomorphic adenoma== | | ==Pleomorphic adenoma== |
| *Abbreviated ''PA''.
| | {{Main|Pleomorphic adenoma}} |
| | |
| ===General===
| |
| Features:
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| *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===
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| *May be cartilaginous appearing.
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| ===Microscopic===
| |
| Features:<ref name=Ref_HaNP295>{{Ref HaNP|295}}</ref>
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| *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.
| |
| | |
| ===IHC===
| |
| *S-100 +ve, SMA +ve, GFAP +ve.
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|
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| ==Myoepithelioma== | | ==Myoepithelioma== |
| ===General===
| | {{Main|Myoepithelioma}} |
| *Usually benign.
| |
| **May be malignant.
| |
| | |
| 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>
| |
| *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>
| |
| ===Microsopic===
| |
| 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]].
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| | |
| Images:
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| *[http://commons.wikimedia.org/wiki/File:Myoepithelioma_-_intermed_mag.jpg Myoepithelioma - intermed. mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Myoepithelioma_-_very_high_mag.jpg Myoepithelioma - very high mag. (WC)].
| |
| | |
| ===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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|
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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.
| |
| **80% of lesions on upper lip.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *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)].
| |
| | |
| ===IHC===
| |
| *p63 -ve.
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| **Basal cell adenoma p63 +ve.
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|
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|
| ==Warthin tumour== | | ==Warthin tumour== |
| *[[AKA]] ''papillary cystadenoma lymphomatosum''.
| | {{Main|Warthin tumour}} |
| | |
| ===General===
| |
| Epidemiology:
| |
| *May be multicentric ~ 15% of the time.
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| *May be bilateral ~10% of the time.
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| *Classically: male > female -- changing with more women smokers.
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| *Smokers.
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| *Old - usu. 60s, very rarely < 40 years old.
| |
| | |
| Notes:
| |
| *No malignant transformation.
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| *Not in submandibular gland.
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| *Not in sublingual gland.
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| *Not in children.
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| | |
| ===Gross===
| |
| *Motor-oil like fluid.
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| *Cystic component larger in larger lesions.
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| **Small lesions may be solid.
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| | |
| Image:
| |
| *[http://www.flickr.com/photos/bc_the_path/2510239905/in/photostream/ Warthin tumour (flickr.com)].
| |
| | |
| ===Microscopic===
| |
| 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== |
Line 463: |
Line 318: |
|
| |
|
| ==Sebaceous lymphadenoma== | | ==Sebaceous lymphadenoma== |
| ===General===
| | {{Main|Sebaceous lymphadenoma}} |
| *Rare salivary gland tumour.<ref name=pmid21393895/>
| |
| *Benign.
| |
| | |
| ===Microscopic===
| |
| 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>
| |
| *Sebaceous glands within lymphoid tissue - '''key feature'''.
| |
| | |
| 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>
| |
| *[[Warthin tumour]].
| |
| *Sebaceous lymphadenocarcinoma.
| |
| *[[Mucoepidermoid carcinoma]].
| |
| *Lymphoma.
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Sebaceous_lymphadenoma_-_low_mag.jpg Sebaceous lymphadenoma - low mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Sebaceous_lymphadenoma_-_high_mag.jpg Sebaceous lymphadenoma - high mag. (WC)].
| |
| *www:
| |
| **[http://path.upmc.edu/cases/case281.html Sebaceous lymphadenoma (upmc.edu)].
| |
|
| |
|
| ==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.
| |
| *~1% of all salivary gland tumours.
| |
| *Typical age: 60s-80s.
| |
| *Associated with radiation exposure.
| |
| *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===
| |
| *Golden brown appearance.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Like [[oncocytoma]]s elsewhere.
| |
| **Eosinophilic cytoplasm (on [[H&E stain]]).
| |
| ***Due to increased number of mitochrondria.
| |
| **Fine capillaries.
| |
| *Architecture: solid sheets, trabeculae or duct-like structure.<ref name=pmid19796983/>
| |
| | |
| Notes:
| |
| *May have clear cell change.
| |
| *Multiple small incidental lesions = oncocytosis - ''not'' oncocytoma.
| |
| | |
| DDx:
| |
| *[[Acinic cell carcinoma]].
| |
| | |
| Image:
| |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807526/figure/Fig1/ Salivary gland oncocytoma (nih.gov)].<ref name=pmid20614263/>
| |
| | |
| ===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.
| |
|
| |
|
| =Malignant= | | =Malignant= |
Line 522: |
Line 329: |
|
| |
|
| ==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.
| |
| *Site: parotid > submandibular.
| |
| | |
| ===Gross===
| |
| *Cystic or solid, usu. a mix of both.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *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).
| |
| *Mucous cells with abundant fluffy cytoplasm and large mucin vacuoles - '''key feature'''.
| |
| **Nucleus distorted by mucin vacuole.
| |
| **Mucous cell may be scarce - more difficult to diagnose.
| |
| *Epidermoid cells:
| |
| **Non-keratinized, polygonal squamoid cell with clear or oncocytic cytoplasm.
| |
| ***Clear cells contain glycogen ([[PAS]] +ve, [[PAS-D]] -ve).
| |
| | |
| Notes:
| |
| *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>
| |
| **"Intermediate cells" are described in textbooks. Weinreb thinks they are a pretty much a myth.<ref name=IW_10jan2011>IW. 10 January 2011.</ref>
| |
| *Mucin vacuoles may be rare; in a superficial glance -- it may mimic [[squamous cell carcinoma]].
| |
| *The thought of high-grade MEC should prompt consideration of squamous cell carcinoma.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Mucoepidermoid_carcinoma_%282%29_HE_stain.jpg Mucoepidermoid carcinoma 2 (WC)].
| |
| *[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)].
| |
| | |
| ====Subtypes====
| |
| *Conventional.
| |
| *Oncocytic.
| |
| **Definition: composed of 50% oncocytes.
| |
| **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>
| |
| *Clear cell.
| |
| *Unicystic (cystadenocarcinoma).
| |
| **Based on the gross. (???)
| |
| *Sclerosing MEC +/- eosinophilia.
| |
| **Rare.
| |
| | |
| ====Grading====
| |
| General:
| |
| *Two competing system exist:
| |
| **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:
| |
| *Both systems have their pros and cons.
| |
| *Weinreb uses the AFIP system with a slight modification.
| |
| | |
| =====AFIP=====
| |
| #Low cystic content <20%) - 2 points.
| |
| #Perineural invasion - 2 points.
| |
| #Necrosis - 3 points.
| |
| #Mitoses > 4 per 10 HPFs (HPF not defined in paper - see [[HPFitis]]) - 3 points.
| |
| #Anaplasia - 4 points.
| |
| | |
| Scoring:
| |
| *Low grade = 0-4 points.
| |
| *Intermediate grade = 5-6 points.
| |
| *High grade = 7+ points.
| |
| | |
| ======Weinreb modification======
| |
| Weinreb looks for the following:
| |
| *Tumour invades in small nests/islands - 2 points.
| |
| **If applicable, the two points are added to the AFIP score.
| |
| **The tumour is graded using the AFIP (scoring) cut points -- see above.
| |
| | |
| ===Stains===
| |
| Mucous cells:
| |
| *Alcian blue +ve.
| |
| *Mucicarcmine +ve.
| |
| | |
| ===Molecular===
| |
| *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>
| |
| **Present in ~65% of MECs.
| |
| **Presence assoc. with low-grade MEC (vs. high-grade MEC) & favourable prognosis.
| |
| **Not seen in tumours that are in the DDx of MEC.
| |
|
| |
|
| ==Acinic cell carcinoma== | | ==Acinic cell carcinoma== |
| *Abbreviated ''AcCC''.
| | {{Main|Acinic cell carcinoma}} |
| *[[AKA]] ''acinic cell adenocarcinoma''.
| |
| | |
| ===General===
| |
| *Malignant neoplasm of salivary gland arising from acinic cells.
| |
| *The relative prevalence of the neoplasm in the various salivary gland reflects the abundance of acinic cells: parotid gland (~80%) > minor salivary glands (~17%) > submandibular glands (~3%).
| |
| *Affects wide age range -- including children.
| |
| *Site affect prognosis (most aggressive to least aggressive): submandibular > parotid > minor salivary.
| |
| ===Gross===
| |
| *Tan or reddish.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Sheets of acinic cells with:
| |
| **Abundant finely vacuolated cytoplasm with basophilic granules - '''key feature'''.
| |
| ***Granules may be focal.
| |
| **Small nuclei stippled chromatin.
| |
| *Scattered intercalcated duct type cells with:
| |
| **Eosinophilic cytoplasm with moderate amount of cytoplasm.
| |
| **Bland nuclei with slightly larger than seen in acinic cells.
| |
| *+/-Peri-tumoural lymphocytes.
| |
| *+/-Glassy extracellular bluish/purple blobs.
| |
| | |
| Notes:
| |
| *Adipose tissue -- present in the salivary glands -- is absent in AcCC.
| |
| *May focally resemble thyroid tissue.
| |
| *Smaller (characteristic) microvacuoles (unreported in the literature) may be present that have a bubbly appearance and glassy basophilic inclusions.<ref name=IW_10jan2011>IW. 11 January 2011.</ref>
| |
| | |
| Memory device:
| |
| *AcCC - lots of "C"s - '''c'''hromatin stipled, '''c'''ytoplasm generous.
| |
| | |
| DDx:
| |
| *[[Oncocytoma of the salivary gland]].
| |
| | |
| Images:
| |
| *www:
| |
| **[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170246445 AcCC (surgicalpathologyatlas.com)].
| |
| **[http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/acinic.html AcCC (brown.edu)].
| |
| **[http://www.aciniccell.org/acc_images14.html AcCC (aciniccell.org)] - image collection.
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Acinic_cell_carcinoma_-_intermed_mag.jpg AcCC - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Acinic_cell_carcinoma_-_very_high_mag.jpg AcCC - very high mag. (WC)].
| |
| | |
| ====Grading====
| |
| General:
| |
| *Not prognostic.
| |
| *Done to avoid phone calls from clinician.
| |
| | |
| Factors Weinreb uses:<ref name=IW_10jan2011>IW. 11 January 2011.</ref>
| |
| *Necrosis.
| |
| *Nuclear atypia.
| |
| *Perineural invasion.
| |
| *Mitoses.
| |
| *Infiltrative margin.
| |
| *Tumour sclerosis.
| |
| | |
| ====Subtypes====
| |
| *Oncocytic variant - rare.
| |
| *Clear cell variant - rare.
| |
| *Papillary cystic variant.
| |
| | |
| ===Stains/IHC===
| |
| *PAS +ve.
| |
| *PAS-D +ve.
| |
| | |
| *S-100 -ve.
| |
| *p63 -ve.
| |
| **p63 +ve in mucoepidermoid carcinoma.
| |
| | |
| There are a bunch of other stains that are touted to be useful (amylase, anti-chymotrypsin, lactoferrin); Weinreb thinks they are not helpful.<ref name=IW_10jan2011>IW. 11 January 2011.</ref>
| |
|
| |
|
| ==Adenoid cystic carcinoma== | | ==Adenoid cystic carcinoma== |
| :See: ''[[Adenoid cystic carcinoma of the breast]]'' for the [[breast]] tumour.
| | {{Main|Adenoid cystic carcinoma}} |
| ===General===
| | Note: The [[breast]] tumour is dealt with in ''[[adenoid cystic carcinoma of the breast]]''. |
| *Common malignant neoplasm of salivary gland.
| |
| *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).
| |
| *Composed of ductal cells and myoepithelial cells; '''myoepithelial cells''' > ductal cells.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Cribriform architecture ''or'' pseudoglandular spaces (classic pattern) - '''important feature'''.
| |
| **Other patterns: solid, cords, (bilayered) tubules.
| |
| **Cystic spaces filled with basophilic material (that is PAS +ve) - '''key feature'''.
| |
| *Scant cytoplasm in most cells (myoepithelial cells) - clear/eosinophilic.
| |
| **Moderate eosinophilic cytoplasm in the (rare) ductal cells.
| |
| *Nucleus - small.
| |
| **May be angulated (carrot-shaped) - myoepithelial cells; round/ovoid in ductal cells.
| |
| *Hyaline stroma.
| |
| | |
| Memory device:
| |
| *A'''d'''CC - mostly '''D'''NA (scant cytoplasm), distinct nucleus (carrot-shaped).
| |
| | |
| Notes:
| |
| *'''Squamous differentiation is extremely rare'''. It presence should prompt consideration of:
| |
| **Basaloid [[squamous cell carcinoma]], [[basal cell carcinoma]] (BCC).
| |
| | |
| DDx:
| |
| *[[Pleomorphic adenoma]], esp. if encapsulated.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Adenoid_cystic_carcinoma_-_intermed_mag.jpg AdCC - intermed. mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Adenoid_cystic_carcinoma_-a-_very_high_mag.jpg AdCC - very high mag. (WC)].
| |
| *[http://www.nature.com/modpathol/journal/v16/n12/fig_tab/3880915f2.html Adenoid cystic carcinoma (nature.com)].
| |
| | |
| ====Grading====
| |
| Based on solid component:
| |
| *Low grade = tubules and cribriform structures only; no solid component.
| |
| *Intermediate grade = solid component <30%.
| |
| *High grade = solid component >=30%
| |
| | |
| ===Stains===
| |
| Special stains:
| |
| *PAS +ve material - cystic spaces.<ref name=pc_add>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970070-5 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970070-5]. Accessed on: 12 May 2011.</ref>
| |
| | |
| IHC:<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.
| |
| *Myoepithelial markers (e.g. calponin, actin) +ve.
| |
| **Typically -ve in PLGA.
| |
| | |
| ===Molecular===
| |
| Features:<ref>{{Cite journal | last1 = Mitani | first1 = Y. | last2 = Rao | first2 = PH. | last3 = Futreal | first3 = PA. | last4 = Roberts | first4 = D. | last5 = Stephens | first5 = P. | last6 = Zhao | first6 = YJ. | last7 = Zhang | first7 = L. | last8 = Mitani | first8 = M. | last9 = Weber | first9 = RS. | title = Novel Chromosomal Rearrangements and breakpoints at the t(6;9) in Salivary Adenoid Cystic Carcinoma: association with MYB-NFIB chimeric fusion, MYB expression, and clinical outcome. | journal = Clin Cancer Res | volume = | issue = | pages = | month = Oct | year = 2011 | doi = 10.1158/1078-0432.CCR-11-1870 | PMID = 21976542 }}</ref>
| |
| *t(6;9) MYB-NFIB.
| |
| **Seen in ~50% of cases.
| |
| **Worse prognosis if present, esp. if fusion assoc. with transcription.
| |
|
| |
|
| ==Salivary duct carcinoma== | | ==Salivary duct carcinoma== |
| ===General===
| | {{Main|Salivary duct carcinoma}} |
| *Malignant counterpart of ''salivary duct adenoma''.
| |
| *Male:female ~= 4:1.
| |
| *Dismal prognosis.<ref name=pmid21393874>{{Cite journal | last1 = Rajesh | first1 = NG. | last2 = Prayaga | first2 = AK. | last3 = Sundaram | first3 = C. | title = Salivary duct carcinoma: correlation of morphologic features by fine needle aspiration cytology and histopathology. | journal = Indian J Pathol Microbiol | volume = 54 | issue = 1 | pages = 37-41 | month = | year = | doi = 10.4103/0377-4929.77321 | PMID = 21393874 | url = http://www.ijpmonline.org/text.asp?2011/54/1/37/77321 }}</ref>
| |
| *Typically >50 years old.
| |
| *Mostly in the parotid.
| |
| | |
| ===Microscopic===
| |
| Features - resembles ductal breast carcinoma:<ref name=pmid21393874/>
| |
| *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.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Salivary_duct_carcinoma_-a-_low_mag.jpg SDC - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Salivary_duct_carcinoma_-_low_mag.jpg SDC - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Salivary_duct_carcinoma_-_high_mag.jpg SDC - high mag. (WC)].
| |
| *[http://www.webpathology.com/image.asp?case=122&n=2 Salivary duct carcinoma (webpathology.com)].
| |
| | |
| Notes:
| |
| *Similar to ductal breast carcinoma - '''key to remember'''.
| |
| | |
| DDx:
| |
| *[[Carcinoma ex pleomorphic adenoma]] with SDC component.
| |
| | |
| ====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.<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: 3 April 2012.</ref>
| |
| *ER-alpha -ve (the common ''ER'' stain).
| |
| | |
| ==Polymorphous low-grade adenocarcinoma==
| |
| *Abbreviated ''PLGA''.
| |
| | |
| ===General===
| |
| *Almost exclusively in the oral cavity.
| |
| **Classically found in the palate -- 60% of PLGAs in palate.
| |
| *Tumour of the minor salivary glands.
| |
| *Always a low-grade tumour - by definition.
| |
| *Female:male ~= 2:1.
| |
| *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'''.
| |
| *Cytologically monotonous (uniform) with variable architecture - '''key feature'''.
| |
| **Nucleus: ovoid & small, small nucleoli, powdery chromatin.
| |
| ***'''[[Papillary thyroid carcinoma]]-like appearance'''.
| |
| **Cytoplasm: eosinophilic.
| |
| *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:
| | ==Intraductal carcinoma of the salivary gland== |
| *[http://commons.wikimedia.org/wiki/File:Polymorphous_low-grade_adenocarcinoma_-_very_low_mag.jpg PLGA - very low mag. (WC)].
| | {{Main|Intraductal carcinoma of the salivary gland}} |
| *[http://commons.wikimedia.org/wiki/File:Polymorphous_low-grade_adenocarcinoma_high_mag.jpg PLGA - high mag. (WC)].
| |
|
| |
|
| ===IHC=== | | ==Polymorphous adenocarcinoma== |
| *S100 +ve, CK +ve, vimentin +ve. | | *Abbreviated ''PAC''. |
| *GFAP +ve/-ve. | | *Previously known as ''polymorphous low-grade adenocarcinoma'', abbreviated ''PLGA''. |
| *BCL2 +ve/-ve.
| | {{Main|Polymorphous adenocarcinoma}} |
| *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== |
| *Abbreviated ''EMCa''.
| | {{Main|Epithelial-myoepithelial carcinoma}} |
| | |
| ===General===
| |
| *Rare ~1% of salivary gland tumours.<ref name=pmid9568184>{{Cite journal | last1 = Tralongo | first1 = V. | last2 = Daniele | first2 = E. | title = Epithelial-myoepithelial carcinoma of the salivary glands: a review of literature. | journal = Anticancer Res | volume = 18 | issue = 1B | pages = 603-8 | month = | year = | doi = | PMID = 9568184 }}</ref>
| |
| *Female:male = 1.5:1.<ref name=pmid17197918>{{Cite journal | last1 = Seethala | first1 = RR. | last2 = Barnes | first2 = EL. | last3 = Hunt | first3 = JL. | title = Epithelial-myoepithelial carcinoma: a review of the clinicopathologic spectrum and immunophenotypic characteristics in 61 tumors of the salivary glands and upper aerodigestive tract. | journal = Am J Surg Pathol | volume = 31 | issue = 1 | pages = 44-57 | month = Jan | year = 2007 | doi = 10.1097/01.pas.0000213314.74423.d8 | PMID = 17197918 }}</ref>
| |
| *Usu. older people - 50s or 60s.
| |
| *Usu. parotid gland ~ 60% of cases.<ref name=pmid17197918/>
| |
| *Prognosis: usually good; 5-year and 10-year survival over 90% and 80% respectively.<ref name=pmid17197918/>
| |
| | |
| Notes:
| |
| *Most common malignant component in ''[[carcinoma ex pleomorphic adenoma]]''.
| |
| *May be the same tumour as ''[[adenomyoepithelioma]] of the breast''.<ref name=pmid9769134>{{Cite journal | last1 = Seifert | first1 = G. | title = Are adenomyoepithelioma of the breast and epithelial-myoepithelial carcinoma of the salivary glands identical tumours? | journal = Virchows Arch | volume = 433 | issue = 3 | pages = 285-8 | month = Sep | year = 1998 | doi = | PMID = 9769134 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Biphasic tumour:<ref name=pmid17197918/>
| |
| *#Epithelial layer.
| |
| *#Myoepithelial layer - '''key feature'''.
| |
| *Architecture: variable (solid, cystic, tubular, papillary).
| |
| *+/-Spindle cells.
| |
| *Basement membrane-like material; may mimic adenoid cystic carcinoma.
| |
| | |
| Notes:
| |
| *Usually few mitoses.
| |
| | |
| DDx:
| |
| *[[Adenoid cystic carcinoma]] (tubular variant).
| |
| *[[Pleomorphic adenoma]], tubular variant.
| |
| **Has focal epithelial-myoepithelial carcinoma-like areas.
| |
| | |
| Images:
| |
| *www:
| |
| **[http://www.pathologyimagesinc.com/sgt-cytopath/epith-myoepith-ca/cytopathology/images-features/emc-rev-cyto1-18.jpg EMCa (pathologyimagesinc.com)].<ref>{{cite web |url=http://www.pathologyimagesinc.com/sgt-cytopath/epith-myoepith-ca/cytopathology/fs-emc-cytopath-feat.html |title=Cytopathologic Features of
| |
| Epithelial-myoepithelial Carcinoma |last1= |first1= |last2= |first2= |date= |work= |publisher= |accessdate=January 18, 2011}}</ref>
| |
| **[http://www.headandneckoncology.org/content/2/1/4 EMCa (headandneckoncology.org)].
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Epithelial-myoepithelial_carcinoma_-_intermed_mag.jpg EMCa - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Epithelial-myoepithelial_carcinoma_-_high_mag.jpg EMCa - high mag. (WC)].
| |
| | |
| ===IHC===
| |
| *CAM5.2 +ve -- epithelial component.
| |
| *p63 +ve -- myoepithelial component.
| |
|
| |
|
| ==Basal cell adenocarcinoma== | | ==Basal cell adenocarcinoma== |
| ===General===
| | {{Main|Basal cell adenocarcinoma}} |
| *Malignant.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| #Lesion is '''not''' encapsulated - '''key feature'''.
| |
| #Basal-like cells:
| |
| #*Basophilic cells - '''key feature'''.
| |
| #*Usually 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.
| |
| #**Stromal cell nuclei width ~= diameter [[RBC]].
| |
| #*Dense hyaline stroma.
| |
| #Tubular component.
| |
| #*Within basal component, may be minimal.
| |
| | |
| DDx:
| |
| *[[Adenoid cystic carcinoma]].
| |
| *[[Basal cell adenoma]] - encapsulated.
| |
| | |
| Images:
| |
| *[http://www.webpathology.com/image.asp?n=5&Case=115 Basal cell adenocarcinoma - intermed. mag. (webpathology.com)].
| |
| *[http://www.webpathology.com/image.asp?n=6&Case=115 Basal cell adenocarcinoma - high mag. (webpathology.com)].
| |
|
| |
|
| ==Sebaceous carcinoma== | | ==Sebaceous carcinoma== |
Line 934: |
Line 364: |
|
| |
|
| ==Hyalinizing clear cell carcinoma== | | ==Hyalinizing clear cell carcinoma== |
| *Abbreviated ''HCCC''.
| | {{Main|Hyalinizing clear cell carcinoma}} |
| | |
| ===General===
| |
| *Rare.
| |
| *Good prognosis.<ref name=pmid21393908>{{Cite journal | last1 = Masilamani | first1 = S. | last2 = Rao | first2 = S. | last3 = Chirakkal | first3 = P. | last4 = Kumar | first4 = AR. | title = Hyalinizing clear cell carcinoma of the base of tongue: a distinct and rare entity. | journal = Indian J Pathol Microbiol | volume = 54 | issue = 1 | pages = 167-9 | month = | year = | doi = 10.4103/0377-4929.77393 | PMID = 21393908 }}</ref>
| |
| *Typically palate or tongue.<ref name=pmid21669357>{{Cite journal | last1 = Kauzman | first1 = A. | last2 = Tabet | first2 = JC. | last3 = Stiharu | first3 = TI. | title = Hyalinizing clear cell carcinoma: a case report and review of the literature. | journal = Oral Surg Oral Med Oral Pathol Oral Radiol Endod | volume = 112 | issue = 1 | pages = e26-34 | month = Jul | year = 2011 | doi = 10.1016/j.tripleo.2011.02.041 | PMID = 21669357 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=pmid20596970>{{Cite journal | last1 = O'Sullivan-Mejia | first1 = ED. | last2 = Massey | first2 = HD. | last3 = Faquin | first3 = WC. | last4 = Powers | first4 = CN. | title = Hyalinizing clear cell carcinoma: report of eight cases and a review of literature. | journal = Head Neck Pathol | volume = 3 | issue = 3 | pages = 179-85 | month = Sep | year = 2009 | doi = 10.1007/s12105-009-0124-3 | PMID = 20596970 }}</ref>
| |
| *Groups of cells with abundant clear cytoplasm.
| |
| **Arranged in cords, trabeculae or clusters.
| |
| **Minimal [[nuclear pleomorphism]].<ref name=pmid7506496/>
| |
| *Hyalinized stroma.
| |
| | |
| Notes:
| |
| *Clear cytoplasm due to glycogen.<ref name=pmid7506496>{{Cite journal | last1 = Milchgrub | first1 = S. | last2 = Gnepp | first2 = DR. | last3 = Vuitch | first3 = F. | last4 = Delgado | first4 = R. | last5 = Albores-Saavedra | first5 = J. | title = Hyalinizing clear cell carcinoma of salivary gland. | journal = Am J Surg Pathol | volume = 18 | issue = 1 | pages = 74-82 | month = Jan | year = 1994 | doi = | PMID = 7506496 }}</ref>
| |
| *Low mitotic rate.
| |
| | |
| DDx:
| |
| *[[Mucoepidermoid carcinoma]], clear cell variant.
| |
| *[[Acinic cell carcinoma]], clear cell variant.
| |
| *Metastatic [[clear cell renal cell carcinoma]].
| |
| **Classically have hemorrhage & [[necrosis]].
| |
| *[[Epithelial-myoepithelial carcinoma]].
| |
| | |
| Images:
| |
| *www:
| |
| **[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811632/figure/Fig2/ HCCC (nlm.nih.gov)].
| |
| **[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811632/figure/Fig5/ HCCC (nlm.nih.gov)].<ref name=pmid20596970/>
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Hyalinizing_clear_cell_carcinoma_-_intermed_mag.jpg HCCC - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Hyalinizing_clear_cell_carcinoma_-_very_high_mag.jpg HCCC - very high mag. (WC)].
| |
| | |
| ===Stains/IHC===
| |
| *PAS +ve.
| |
| *AE1/AE3 +ve.
| |
| *EMA +ve.<ref name=pmid7506496/>
| |
| | |
| Others:
| |
| *Desmin -ve.
| |
| *SMA -ve.<ref name=pmid7506496/>
| |
| *S-100 -ve.<ref name=pmid7506496>{{Cite journal | last1 = Milchgrub | first1 = S. | last2 = Gnepp | first2 = DR. | last3 = Vuitch | first3 = F. | last4 = Delgado | first4 = R. | last5 = Albores-Saavedra | first5 = J. | title = Hyalinizing clear cell carcinoma of salivary gland. | journal = Am J Surg Pathol | volume = 18 | issue = 1 | pages = 74-82 | month = Jan | year = 1994 | doi = | PMID = 7506496 }}</ref>
| |
| | |
| ===Molecular===
| |
| Recurrent [[translocation]]:<ref name=pmid21484932>{{Cite journal | last1 = Antonescu | first1 = CR. | last2 = Katabi | first2 = N. | last3 = Zhang | first3 = L. | last4 = Sung | first4 = YS. | last5 = Seethala | first5 = RR. | last6 = Jordan | first6 = RC. | last7 = Perez-Ordoñez | first7 = B. | last8 = Have | first8 = C. | last9 = Asa | first9 = SL. | title = EWSR1-ATF1 fusion is a novel and consistent finding in hyalinizing clear-cell carcinoma of salivary gland. | journal = Genes Chromosomes Cancer | volume = 50 | issue = 7 | pages = 559-70 | month = Jul | year = 2011 | doi = 10.1002/gcc.20881 | PMID = 21484932 }}</ref>
| |
| *t(12;22) -- EWSR1/ATF1.
| |
| **Same translocation as in ''[[clear cell sarcoma]]''.
| |
|
| |
|
| =See also= | | =See also= |
Line 993: |
Line 377: |
|
| |
|
| [[Category:Head and neck pathology]] | | [[Category:Head and neck pathology]] |
| | [[Category:Salivary gland|Salivary gland]] |