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Neoplastic Salivary Pathology (Polymorphous low-grade adenocarcinoma…
Neoplastic Salivary Pathology
Adenomas
Pleomorphic Adenomas
Most common benign salivary gland tumor
Female predominance
80% rise in parotid(superf. Lobe), 10% submandibular and salivary gland
Tendency to recur (3-6%) after 5 years
Clinical Presentations
Slow growing painless mass
Smooth, mobile lump in smaller lesion but larger become bossellated
Usually not ulcerated
Histology
Morphological diversity
Epithelial and myoepithelial cells
Clear cytoplasm
Plasmacytoid Spindle shape
Mesenchymal stroma (behave like stem cells)
myxoid or chondroid spindle-shaped cells
Capsule (variable thickness)
Canalicuar Adenomas
Monomorphic adenoma
Ovoid mass with thin capsule
Prognosis is excellent and recurrence is rare
Ductal Papillomas
Group of benign papillary salivary gland neoplasm w/ consistent morphology
Inverted ductal papilloma
Intraductal papilloma
Sialedinoma papilliferum
Features of luminal/ductal epithelium forming papillary endophytic growth pattern
Prognosis is good
Acini Cell Carcinoma
Neoplasm demonstrating some differentiation towards (serous) acinar cells
90% Parotid
other sites: upper lip, buccal mucosa, palate
Histology
Encapsulated/lobulated mass
Cells with serous acinar differentiation
Arrange in lobule or strands
Area of microcystic formation
Tx
Surgical excision
w/ 5 year survival rate is 91%
10 years 88%
Mucoepidermoid Carcinoma (MEC)
Most common salivary gland malignancy
(5year survival rate 50-60%)
Minor Salivary Gland
40% of patients are symptomatic, suffering from pain, numbness of teeth, dysphagia, ulceration, and hemorrhage.
Palate most common
Major Salivary Gland
Presents as a solitary painless lesion,
Parotid(88%), submandibular(10%), sublingual(2%)
Histology
Poorly differentiated epithelium
Intermediate cells, which can form solid sheets
Multicystic with a solid component
Adenoid cystic carcinoma
Salivary malignancies w/ Basaloid Cells (intercalated cells)
F>M
Marked infiltrative tendency –
aggressive behavior
Perineural and perivascular invasion
Histology
= Three presentations
Cribriform Pattern
Most common type
. Epithelial nests permeated by “Swiss cheese” spaces.
GRADE II
Cells with serous acinar differentiation showing basophilic granular cytoplasm, arrange in lobule or strands
Area of microcystic formation
Tubular Pattern
Two-layered ductal structure composed of inner ductal and outer myopeithelial cells
GRADE I
Solid Pattern
Least common but most aggressive
GRADE III
Solid nests or strands of basaloid myoepithelial cells
Peripheral, palisading columnar basaloid cells
Dx
Limited biopsy – can be confused with Pleomorphic adenoma due to bland pattern
89% at 5 years, 40% at 10 years
(esp. poor w/ GRADE III - perineural invasion)
Polymorphous low-grade adenocarcinoma (PLGA)
Terminal Duct Carcinoma
Limited to the intraoral area, esp.
Hard palate 60%
Occurs in Females 2:1
Clinical
swelling,
+/- ulceration,
assoc. Pains,
clinically often benign
Histology
Cellular uniformity and blandness
Architectural diversity
Solid/lobular, Tubular, Cribriform, Targetoid
No fibrous capsule
Invasive tumor periphery
Perineural spread
Foci of infiltrative growth around nerve
Behavior
Low metastatic potential (limited to regional LN)
Low recurrence rate
Excellent prognosis