Salivary gland tumor pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

The pathophysiology of salivary gland tumors depends on the histological subtype.[1]

Pathophysiology

Pathogenesis

The parotid gland is the most frequent site of salivary gland tumors which accounts for approximately 80 to 85 percent of these tumors.[2][3] About 75 percent of parotid lesions are benign and approximately 25 percent are malignant.[4] Less frequently, salivary gland tumors originate in the sublingual, submandibular, and minor salivary glands, which are located throughout the submucosa of the upper aerodigestive tract and mouth.[5]

  • In comparison to tumors arising in the parotid, 70 to 90 percent of sublingual gland tumors, 50 to 75 percent of minor salivary gland tumors, and 40 to 45 percent of submandibular gland tumors are malignant. Approximately 85% of salivary gland tumors occur in the parotid glands, followed by the minor salivary glands and submandibular, and approximately 1% occur in the sublingual glands. Overall approximately 80% of all parotid masses are benign.[6]

Microscopic Pathology

Histological features of benign tumors

Tabular form - adapted from Libre Pathology[1]

Entity Architecture Morphology Cell borders Cytoplasm Nucleus Other
Pleomorphic adenoma Variable Mixed proportion; must include:
  • Myoepithelium
  • Mesenchymal stroma
  • Epithelium (ductal cells) or
  • Chondromyxoid stroma
Variable Variable Plasmacytoid Occasionally encapsulated, mixed proportion of glandular, myoepithelial and mesenchymal cells
Warthin tumor Papillary, bilayer Cuboid (basal), columnar (apical) Clearly seen Eosinophilic, abundant Unremarkable AKA papillary cystadenoma lymphomatosum
Basal cell adenoma Variable, islands surrounded by hyaline bands, lesion encapsulated Basaloid Subtle Scant, hyperchromatic Granular
Canalicular adenoma Chains of cells Cuboid or columnar Subtle Scant, hyperchromatic Granular Exclusively oral cavity, 80% in upper lip; immunohistochemistry: p63-
Sialoblastoma Variable, islands surrounded by loose fibrous stroma Basaloid Subtle Scant, hyperchromatic Granular Basal cell adenocarcinoma

Histological features of malignant tumors

Entity Architecture Morphology Cell borders Cytoplasm Nucleus Differential Diagnosis Other
Mucoepidermoid carcinoma Cystic and solid Epitheloid Distinct Fuffy, clear, abundant Nuclei small SCC (?) Immunohistochemistry: p63+
Adenoid cystic carcinoma (AdCC) Pseudocysts, cribriform, solid, hyaline stroma Epitheloid Subtle Scant, hyperchromatic Small+/-"carrot-shaped" Pleomorphic adenoma, Polymorphous low grade adenocarcinoma (PLGA) Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+
Acinic cell carcinoma (AcCC) Sheets, acinar (islands) Epithelioid Clear Granular abundant Stippled, +/-occasional nucleoli Adenocarcinoma not otherwise specified, oncocytoma of salivary gland Stains: PAS +ve, PAS-D +ve; Immunohistochemistry: S-100 -ve, p63 -ve
Salivary duct carcinoma Glandular, cribriform Columnar Subtle/clear Hyperchromatic Columnar Metastatic breast carcinoma Similar to ductal breast carcinoma; male>female
Polymorphous low-grade adenocarcinoma Variable, often small nests, may be targetoid Epithelioid Indistinct Eosinophilic Ovoid & small with small nucleoli Adenoid cystic carcinoma (AdCC) Minor salivary gland tumour, often in palate, cytologically monotonous; IHC: S-100+, CK+, vim.+, GFAP+/-, BCL2+/-
Epithelial-myoepithelial carcinoma Nests (myoepithelial) with tubules (epithelial) Epithelioid Not distinct Eosinophilic cytoplasm; epithelial: scant; myoepithelial: moderate Focal clearing Adenoid cystic carcinoma (AdCC), pleomorphic adenoma Rare
Basal cell adenocarcinoma Variable, islands surrounded by hyaline bands, lesion not encapsulated Basaloid Subtle Scant, hyperchromatic Granular Basal cell adenoma Rare, usually parotid gland, may arise from a basal cell adenoma

References

  1. 1.0 1.1 Salivary glands. Libre pathology(2015) http://librepathology.org/wiki/index.php/Salivary_glands Accessed on November 11, 2015
  2. Barnes, Leon. Pathology and genetics of head and neck tumours. Lyon: IARC Press, 2005. Print.
  3. Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter |month= ignored (help)
  4. R. H. Spiro (1986). "Salivary neoplasms: overview of a 35-year experience with 2,807 patients". Head & neck surgery. 8 (3): 177–184. PMID 03744850. Unknown parameter |month= ignored (help)
  5. Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter |month= ignored (help)
  6. Salivary gland tumors. Radiopedia(2015) http://radiopaedia.org/articles/salivary-gland-tumours Accessed on November 8, 2015

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