tumors of salivary gland
TRANSCRIPT
![Page 1: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/1.jpg)
AZFAR NEYAZ, JUNIOR RESIDENT
SGPGIMS, LUCKNOW
![Page 2: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/2.jpg)
![Page 3: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/3.jpg)
![Page 4: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/4.jpg)
![Page 5: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/5.jpg)
![Page 6: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/6.jpg)
![Page 7: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/7.jpg)
Serous-type acini of a parotid gland
with dense secretory granules
Histologic section of a submaxillary
gland.
![Page 8: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/8.jpg)
Portion of a parotid gland demonstrating multiple foci of sebaceous
differentiation.
![Page 9: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/9.jpg)
The intercalated ducts (arrows)
(sectioned longitudinally) lie in
contact with the acinus.
The striated ducts (sectioned
transversely) are lined with a
oncocytic columnar cells.
![Page 10: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/10.jpg)
Malignant epithelial tumors
![Page 11: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/11.jpg)
Malignant epithelial tumors
![Page 12: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/12.jpg)
Benign epithelial tumors
![Page 13: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/13.jpg)
Soft tissue tumors
Hemangioma
Haematolymphoid tumors
Secondary tumors
![Page 14: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/14.jpg)
General features of salivary gland tumors in adults and children
![Page 15: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/15.jpg)
![Page 16: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/16.jpg)
Major salivary gland Minor salivary gland
Warthin tumor Polymorphous low grade
adenocarcinoma (palate)
Acinic cell carcinoma Canalicular adenoma (lip, buccal
mucosa)
Oncocytoma/oncocytic carcinoma Cystadenoma/cystadenocarcinoma
Epithelial-myoepithelial carcinoma Inverted papilloma
Basal cell adenoma/adenocarcinoma Intraductal papilloma
Salivary duct carcinoma
Lymphoepithelial carcinoma
Sialadenoma papilliferum (palate)
![Page 17: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/17.jpg)
architecturalpleomorphism
![Page 18: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/18.jpg)
![Page 19: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/19.jpg)
Benign mixed tumor of the
submandibular gland demonstrating
a firm, whitish tan, well-encapsulated
mass
Gross specimen of pleomorphic
adenoma. The external surfaces have
been marked with blue dye.
The cut surface of the tumor is tan-
colored and interspersed with brown
areas. Note the glistening quality of the
tumor.
![Page 20: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/20.jpg)
![Page 21: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/21.jpg)
![Page 22: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/22.jpg)
• Plasmacytoid hyaline cells :
Chondromyxoid stroma
![Page 23: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/23.jpg)
There is a small satellite nodule
immediately outside the thin capsule
of the tumor. This represents a tumor
protuberance . This finding is still
compatible with a diagnosis of benign
pleomorphic adenoma.
Double-layered duct-like structures
with a conspicuous abluminal layer
of clear myoepithelial cells.
![Page 24: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/24.jpg)
An intimate mixture of epithelial and
stromal elements is seen in this mixed
tumor.
The stroma exhibits cartilaginous
differentiation.
Plasmacytoid cells
![Page 25: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/25.jpg)
Cellular mixed tumor :
Because of its extreme cellularity, this
tumor may be mistaken for a malignant
tumor
Pleomorphic adenoma with a focus
resembling adenoid cystic carcinoma.
There are some cribriform structures and
tubules sharply demarcated from the
stroma.
![Page 26: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/26.jpg)
Pleomorphic adenoma showing a
focus of mucous metaplasia.
Focal squamous differentiation with
keratinization is seen amidst complex glandular structures.
![Page 27: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/27.jpg)
Lipomatous pleomorphic adenoma.
Pleomorphic adenoma showing bone
forming by osseous metaplasia in
stroma.
![Page 28: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/28.jpg)
Spindly and stellate cells are disposed in a lattice-like fashion within the
myxoid matrix. A myoepithelioma can show a similar appearance.
![Page 29: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/29.jpg)
![Page 30: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/30.jpg)
![Page 31: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/31.jpg)
Recurrent pleomorphic adenoma
Typical multinodular growth
pattern.
![Page 32: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/32.jpg)
![Page 33: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/33.jpg)
Metastasizing pleomorphic adenoma
![Page 34: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/34.jpg)
Signs of malignant transformation:
Rapid growth,
Malignant mixed tumor
![Page 35: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/35.jpg)
![Page 36: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/36.jpg)
Noninvasive carcinoma ex pleomorphic
adenoma showing more extensive
dysplastic change
Noninvasive carcinoma ex pleomorphic
adenoma showing dysplastic cells
replacing the inner duct layer leaving a
benign myoepithelial layer.
![Page 37: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/37.jpg)
Perineural invasion next to remnant of
scarred pleomorphic adenoma.
Note the benign component with
numerous small irregular ducts in a
hyalinized stroma (upper left) and a
focus of adenocarcinoma with
associated necrosis (lower right).
![Page 38: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/38.jpg)
![Page 39: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/39.jpg)
Carcinosarcoma showing mixture of adenocarcinomatous and osteosarcomatous
differentiation
![Page 40: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/40.jpg)
basaloid
![Page 41: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/41.jpg)
Cut surface of the parotid gland
tumor shows well-circumscribed,
grayish-white, solid mass.
![Page 42: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/42.jpg)
Histologically subclassified according to their cellular growth
pattern.
Solid
Trabecular
Tubular,
Membranous (dermal analogue) types
![Page 43: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/43.jpg)
Trabecular type :
Narrow epithelial islands forming an
interconnecting cord-like architecture.
Solid type :
Large sheets & broad bands of basaloid
cells with peripheral palisading.
Detail of a squamous diff. frequently
found in the solid variant (inset).
![Page 44: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/44.jpg)
Tubular type.
Prominent duct-like structures with
intraluminal eosinophilic secretion.
Membranous type.
Thick, hyaline, basement membrane
like material surrounds large lobules.
This material is also present within the
epithelial nests forming coalescing,
hyaline droplets.
![Page 45: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/45.jpg)
![Page 46: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/46.jpg)
![Page 47: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/47.jpg)
Basal cell adenocarcinoma. Islands of basaloid cells infiltrate a fibrous stroma.
Distinction from basal cell adenoma is based on the presence of unequivocally infiltrative growth.As is typical of basal cell adenocarcinoma, some cells have darker nuclei and some have larger paler nuclei.
A focus of perineural invasion is seen
(right of center).
![Page 48: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/48.jpg)
Basal cell adenocarcinoma.
Solid nests of mildly atypical basaloid cells
with peripheral palisading
Basal cell adenocarcinoma.
Focal squamous differentiation with
keratin pearl formations.
![Page 49: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/49.jpg)
![Page 50: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/50.jpg)
![Page 51: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/51.jpg)
Myoepithelioma.
The cut surface of a tumor presents as a well-circumscribed, yellow-tan
colored, solid mass in the parotid gland.
![Page 52: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/52.jpg)
![Page 53: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/53.jpg)
Spindle cell type.
The spindle cells are arranged in an
interlacing fascicular pattern.
Plasmacytoid cell type.
The plasmacytoid cells exhibiting
eccentrically located nuclei and abundant
eosinophilic cytoplasm are surrounded by
a myxoid matrix.
![Page 54: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/54.jpg)
Epithelioid cell type :
Solid and trabecular growth patterns of
polygonal epithelial cells with central nuclei
and eosinophilic cytoplasm
Clear cell type :
Solid growth of polygonal shaped clear
cells with intercellular hyaline depositions.
![Page 55: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/55.jpg)
Spindle-shaped myoepithelial cell forming
a neurilemmoma-like pattern.
Myoepithelial cells forming a reticular
pattern.
![Page 56: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/56.jpg)
![Page 57: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/57.jpg)
![Page 58: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/58.jpg)
![Page 59: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/59.jpg)
• Reactivity for cytokeratin and at least one of the other myoepithelialmarkers, including SMA , GFAP, CD10, calponin and smooth muscleactin is required for diagnosis.
![Page 60: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/60.jpg)
Myoepithelial carcinoma.
Low-power view showing multinodular
architecture.
Spindle cell type.
The spindle cells arranged in a vaguely
interlacing fascicular pattern.
![Page 61: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/61.jpg)
![Page 62: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/62.jpg)
Gross appearance of oxyphilic adenoma.The tumor is well circumscribed, solid, and light brown.
![Page 63: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/63.jpg)
Oncocytoma consisting of
characteristic light and dark cells.
Oncocytoma with clear cell change.
![Page 64: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/64.jpg)
![Page 65: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/65.jpg)
Oncocytic carcinoma.
This is a destructive infiltrating tumor.
Oncocytic carcinoma showing neural
invasion.
![Page 66: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/66.jpg)
![Page 67: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/67.jpg)
![Page 68: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/68.jpg)
![Page 69: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/69.jpg)
Canalicular adenoma is made up of double
rows of interconnecting & branching cords
of tumor composed of bland, basaloid,
cuboidal to columnar cells.
The surrounding stroma is acellular with
very sparse collagen production
![Page 70: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/70.jpg)
![Page 71: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/71.jpg)
• 2nd mc tumor
M>F
Radiation smoking.
![Page 72: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/72.jpg)
Gross appearance of Warthin tumor of
parotid gland.
The presence of multiple large cystic
spaces is characteristic of this lesion.
Warthin tumor is typically tannish
brown, often with cystic spaces.
In addition, this tumor demonstrates
areas of degeneration and necrosis
(yellowish foci).
![Page 73: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/73.jpg)
Warthin’s tumor showing papillary
cystic tumor with dense lymphoid
stroma
The papillae and glands are typically lined
by columnar oncocytic luminal cells in
which the nuclei are often polarized
towards the lumen. Beneath the luminal
cells is a layer of basal cells, which are
sharply demarcated from the underlying
lymphoid stroma.
![Page 74: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/74.jpg)
![Page 75: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/75.jpg)
![Page 76: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/76.jpg)
![Page 77: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/77.jpg)
Sebaceous adenoma showing nests of
sebaceous cells with peripheral squamous
differentiation.
Sebaceous adenoma consisting solely of
sebaceous cells of varying sizes.
![Page 78: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/78.jpg)
Well-differentiated sebaceous carcinoma consisting of non-specific glandular
cells and cells showing conspicuous sebaceous differentiation.
![Page 79: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/79.jpg)
within a background of lymphocytes andlymphoid follicles
![Page 80: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/80.jpg)
Sebaceous lymphadenoma :
Variably shaped epithelial nests with multiple
cystic formations, containing sebaceous cells
,in a lymphoid stroma.
Sebaceous glands in a diffuse lymphoid
background
![Page 81: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/81.jpg)
Lymphadenoma.
A well-circumscribed tumor in the parotid
gland.
Lymphadenoma, nonsebaceous type.
There are multiple nests of basaloid tumor
cells with focal ductal differentiation in a
lymphoid background.
![Page 82: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/82.jpg)
![Page 83: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/83.jpg)
Cystadenoma.
Well-circumscribed tumor composed of
variably sized, multiple cysts with focal
papillary configurations.
The cyst lining epithelium consists of
columnar or cuboidal cells.
The cysts contain eosinophilic,
proteinaceous material
![Page 84: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/84.jpg)
Oncocytic cystadenoma.
Papillary-cystic proliferation of oncocytic
epithelium in the parotid gland.
Note the absence of lymphoid infiltration in
fibrous stroma separating cystic spaces.
The cysts are lined by a double-layered
oncocytic epithelium, resembling that
seen in Warthin tumor.
![Page 85: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/85.jpg)
![Page 86: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/86.jpg)
Cystadenocarcinoma.
Tumor with multiple papillary-cystic
structures invades into the surrounding
salivary gland parenchyma.
Cyst formations accompanied by
prominent intracystic papillary projections
of columnar cells.
![Page 87: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/87.jpg)
arising at the junction
endophytic growth
![Page 88: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/88.jpg)
Inverted ductal papilloma.
This tumor is continuous with the overlying
surface epithelium and grows in an inverting
pattern, forming a smooth-edged, broad-
based mass.
It is composed of immature squamous or
basaloid epithelium
In addition, numerous mucinous goblet
cells are often intermixed with the
basaloid and squamous cells.
![Page 89: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/89.jpg)
Intraductal papilloma
![Page 90: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/90.jpg)
Intraductal papilloma.
A cystically dilated duct with papillary
epithelial projections into the cystic space.
Extending into the lumen of the cystic
space are fronds of columnar epithelium
supported by a central fibrovasacular
core.
![Page 91: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/91.jpg)
![Page 92: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/92.jpg)
Sialadenoma papilliferum demonstrating
the typical exophytic papillary surface and
deeper ductal components.
The bland surface squamous epithelium
communicates with the underlying columnar
epithelium lining the ductal structures.
![Page 93: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/93.jpg)
• Salivary gland anlage tumor manifests in newborns or within the first
few weeks of life with respiratory distress.
• The tumor is postulated to be a hamartoma because the histologic
features are reminiscent of developing salivary gland in embryo.
• Although some investigators favor a teratomatous interpretation.
Salivary gland anlage tumor
The surface is covered by nonkeratinizing
squamous epithelium which extends
downwards into the submucosal tissue,
giving rise to squamous nests, branching
ducts and cystic structures.
![Page 94: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/94.jpg)
• Commonest childhood.
![Page 95: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/95.jpg)
Cut surface of the intermediate-grade
tumor shows gray white, solid mass
accompanied by multiple small cystic
structures and infiltrative borders.
Low-grade mucoepidermoid
carcinomas may have a distinctly
cystic gross appearance.
![Page 96: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/96.jpg)
Low-grade mucoepidermoid
carcinoma: with a prominent cystic
component. The tumor contains
goblet, intermediate and squamous
cells.
![Page 97: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/97.jpg)
Intermediate grade mucoepidermoid
carcinoma.
Solid nests with focal cystic structures
consisting of intermediate cells as well
as epidermoid cells & a few mucous
cells
Low-grade mucoepidermoid carcinoma
![Page 98: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/98.jpg)
Tumor is composed primarily of
markedly pleomorphic epidermoid
cells and a small proportion of
mucous cells.
Periodic acid–Schiff (PAS) stain
showing scattered positive mucous
cells in the solid nests.
![Page 99: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/99.jpg)
Mucoepidermoid carcinoma.
Clear cell variant
Oncocytic variant.
![Page 100: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/100.jpg)
Mucoepidermoid carcinoma.
Abundant hyalinized stroma is evident.
Extensive secondary lymphoid cell
infiltration, referred to as tumor-
associated lymphoid proliferation.
![Page 101: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/101.jpg)
![Page 102: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/102.jpg)
![Page 103: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/103.jpg)
Differential diagnosis
![Page 104: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/104.jpg)
perineural invasion.
![Page 105: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/105.jpg)
Adenoid cystic carcinoma of the
parotid gland has deceptively well-
delineated outlines. Microscopically,
the tumor extends well beyond the
grossly apparent edges of the tumor.
Tan, fleshy, firm, invasive tumor
![Page 106: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/106.jpg)
The classic cribriform pattern of
adenoid cystic carcinoma.
At higher magnification, the cells are
haphazardly arranged around the
extracellular spaces
![Page 107: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/107.jpg)
Adenoid cystic carcinoma.
Tubular variant (20-30%) showing
morphologically similar luminal and
abluminal cells.
Adenoid cystic carcinoma.
Tubular variant showing morphologically
clear abluminal cells.
![Page 108: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/108.jpg)
Adenoid cystic carcinoma.
Solid variant higher power showing
scattered duct-like structures within
the tumor sheet.
Adenoid cystic carcinoma.
Solid variant showing extensive
comedo necrosis.
![Page 109: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/109.jpg)
Adenoid cystic carcinoma with
prominent perineurial invasion
Adenoid cystic carcinoma showing
bone invasion
![Page 110: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/110.jpg)
Adenoid cystic carcinoma with
hyalinization or myxoid change, mimicking
pleomorphic adenoma.
The cribriform island shows deposits of
abundant hyaline material with
strangulation" of the tumor cells.
This pattern differs from the hyalinization
seen in pleomorphic adenomq in that the
process is confined to the cellular island,
which itself is sharply delineated from the
fibrous stroma.
![Page 111: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/111.jpg)
![Page 112: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/112.jpg)
Adenoid cystic carcinoma. P63 staining of myoepithelial component.
![Page 113: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/113.jpg)
The left field depicts the pre-existing
adenoid cystic carcinoma, comprising
Basaloid cells with interspersed
pseudocystics paces.
The right field shows the poorly
differentiated (dedifferentiated) solid tumor
composed of much larger, pleomorphic and
mitotically active cells, associated with
coagulative necrosis
![Page 114: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/114.jpg)
DIFFERENTIAL DIAGNOSIS:
PLG adenocarcinoma
Basaloid sq. cell carcinoma
Pleomorphic adenoma
BC adenocarcinoma
![Page 115: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/115.jpg)
serous acinar celldifferentiation
![Page 116: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/116.jpg)
![Page 117: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/117.jpg)
Sections through a superficial parotidectomy for an acinic cell carcinoma
reveal a sharply demarcated tumor with a partially cystic appearance.
![Page 118: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/118.jpg)
Acinic cell carcinoma.
The cells have an abundant cytoplasm
filled with basophilic zymogen granules
Acinic cell carcinoma.
Periodic acid Schiff stain highlighting
zymogen granules on the luminal aspect
![Page 119: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/119.jpg)
Some tumor cells contain basophilic
granules (left lower field).
Most cells are polygonal and many
resemble intercalated duct cells. Note
the bland appearances of the nuclei.
Acinic cell carcinoma with extensive
psammoma body formation
![Page 120: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/120.jpg)
Microcystic variant.
Follicular variant
![Page 121: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/121.jpg)
Acinic cell carcinoma showing focalclear cell change.
Papillary cystic variant.
There are many hobnail cells and
some vacuolated cell
![Page 122: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/122.jpg)
Well-differentiated acinic cell carcinoma
with abundant lymphoid stroma.
favorable prognosis
This otherwise typical acinic cell carcinoma
shows an area (upper) of higher grade
carcinoma with small-cell features.
This phenomenon has been referred to as
“dedifferentiation.”
![Page 123: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/123.jpg)
![Page 124: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/124.jpg)
![Page 125: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/125.jpg)
Tumor invades into the minor
salivary gland parenchyma.
A malignant infiltrative tumor characterized by diverse architectural
patterns but unified by bland-looking tumor cells.
![Page 126: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/126.jpg)
Sheet-like solid growth of the tumor cells
exhibiting uniform oval nuclei without any
pleomorphism.
Polymorphous low-grade adenocarcinoma.
Low power view showing histologic
diversity within the tumor. Mainly solid and
tubular growth patterns with focal cribriform
and papillary areas.
![Page 127: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/127.jpg)
Tubular structures are predominantly lined
by a single layer of small cuboidal cells.
Multiple pseudocystic spaces with pale
staining amphophilic mucoid contents
resulting in a cribriform appearance
![Page 128: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/128.jpg)
Papillary configurations of columnar or
cuboidal cells
Polymorphous low-grade adenocarcinoma
‘‘Indian-file’’ growth pattern.
![Page 129: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/129.jpg)
Perineural invasion with concentric
targetoid appearance.
Fascicular growth pattern
![Page 130: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/130.jpg)
• So variability of growth pattern is the most consistent architectural
feature of the tumor.
![Page 131: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/131.jpg)
![Page 132: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/132.jpg)
The myoepithelial component is
represented by the cells with clear
cytoplasm
The tumor characteristically invades in
broad fronts (normal salivary gland tissue
seen in right field)
![Page 133: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/133.jpg)
Epithelial-myoepithelial carcinoma with
trabecular arrangement & predominantly
non-canalized ducts.
Epithelial-myoepithelial carcinoma.
Not uncommonly some glandular
structures have dilated lumens or are
thrown into papillary folds.
This feature is practically never seen in
adenoid cystic carcinoma.
![Page 134: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/134.jpg)
A) Cytokeratin stain highlighting the luminal
cells.
(B) Calponin staining highlighting abluminal
myoepithelial cells.
Epithelial-myoepithelial carcinoma
showing neural invasion
![Page 135: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/135.jpg)
![Page 136: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/136.jpg)
Cut surface of the tumor shows gray-white, solid mass with foci of necrosis
![Page 137: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/137.jpg)
Intraductal component comprised of
cribriform structures.
Note that the central portion of the ductal
cell nests undergoes comedo-like necrosis
The invasive component consists of
irregular glands and cords of cells that
elicit a prominent desmoplastic reaction.
![Page 138: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/138.jpg)
Carcinoma cells exhibiting large
pleomorphic nuclei with coarse chromatin
and prominent nucleoli. The cytoplasm is
abundant and granularly eosinophilic
Sarcomatoid salivary duct carcinoma.
There are several nests of typical salivary
duct carcinoma with a prominent
cribriform pattern surrounded by a
markedly pleomorphic, atypical spindle
cell population of tumor cells
![Page 139: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/139.jpg)
Mucin-rich variant.
Mucin lakes containing islands of
carcinoma cells (right) in addition to the
typical salivary duct carcinoma
component.
Invasive micropapillary variant.
Morula-like small cell clusters without
fibrovascular cores, surrounded by a clear
space.
![Page 140: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/140.jpg)
Salivary duct carcinoma.
Immunohistochemistry.
Carcinoma cells are diffusely positive
for androgen receptor in their nuclei.
Diffuse and strong membranous staining
for HER-2/neu.
![Page 141: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/141.jpg)
![Page 142: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/142.jpg)
![Page 143: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/143.jpg)
• The majority of tumors with a predominant population of clear cells
have been diagnosed as epithelial-myoepithelial carcinomas.
• Other differentials:
• clear cell oncocytoma
• mucoepidermoid carcinoma
• acinic cell carcinoma
• sebaceous carcinoma
• metastatic renal cell carcinoma are needed to be excluded.
• It is a diagnosis by exclusion.
![Page 144: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/144.jpg)
Hyalinizing clear cell carcinoma.
Uniform population of cells with clear
cytoplasm forming discrete nests in a
dense fibrous stroma.
![Page 145: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/145.jpg)
undifferentiated carcinoma non-neoplastic lymphoplasmacytic
![Page 146: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/146.jpg)
![Page 147: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/147.jpg)
Undifferentiated lymphoepithelioma-like carcinoma of the parotid gland.
The tumor has sharply demarcated margins and grossly resembles a lymphoma.
![Page 148: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/148.jpg)
Undifferentiated, lymphoepithelioma-like
carcinoma. A large component of tumor
(left) is surrounded by a brisk
lymphoplasmacytic reaction (right).
The neoplastic cells have large, vesicular,
but relatively uniform nuclei. Mitotic figures
are typically easily identified. Cell borders
are indistinct. The epithelial cells are mixed
in a complex fashion with the reactive
lymphoplasmacytic elements
![Page 149: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/149.jpg)
In situ hybridization for EBV-encoded small RNA (EBER). Almost all of the carcinoma cells express strong nuclear EBER hybridization
signals. Note complete absence of signal in the surrounding lymphoid stroma.
![Page 150: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/150.jpg)
![Page 151: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/151.jpg)
Undifferentiated carcinoma
• Rare tumors composed of primitive/anaplastic cells which exhibit no
obvious line of differentiation.
• Focal isolated glandular formation or squamous differentiation does
not exclude this diagnosis.
• Undifferentiated carcinoma can be further subclassified into:
• small cell carcinoma
• large cell undifferentiated carcinoma
• lymphoepithelioma-like carcinoma
![Page 152: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/152.jpg)
![Page 153: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/153.jpg)
Small cell carcinoma.
High-power view showing the tumor cells
with scant cytoplasm and inconspicuous
nucleoli. Mitotic figures are readily
identified.
Small cell carcinoma.
Tumor cells are diffusely immunopositive
for chromograninA.
![Page 154: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/154.jpg)
Paranuclear dot-like pattern of
immunoreactivity for cytokeratin 20.
The tumor cell nuclei are round to oval,
with pale, dispersed chromatin and a well-
defined nuclear membrane
![Page 155: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/155.jpg)
![Page 156: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/156.jpg)
![Page 157: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/157.jpg)
Large cell carcinoma. Sheet-like growth
pattern of large pleomorphic cells with
abundant eosinophilic cytoplasm
and prominent nucleoli
Solid growth with peripheral palisading and
several rosette-like structures.
The tumor cells have large and polygonal
nuclei with vesicular chromatin and
prominent nucleoli
![Page 158: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/158.jpg)
![Page 159: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/159.jpg)
![Page 160: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/160.jpg)
Adenocarcinoma NOS: Low grade tumor.
Prominent well-formed glandular
formations.
Intermediate-grade tumor.
Fused glandular formations with focal solid
areas.
![Page 161: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/161.jpg)
High-grade tumor.Irregularly shaped islands and strands of anaplastic carcinoma cells. Glandular formations are inconspicuous.
![Page 162: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/162.jpg)
![Page 163: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/163.jpg)
Colloid carcinoma
Composed of multiple pools of mucin in a
delicate fibrous stroma that surrounds
atypical pleomorphic carcinoma cells.
Detail of carcinoma nests demonstrating
prominent nucleoli and moderate amounts
of eosinophilic cytoplasm
![Page 164: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/164.jpg)
![Page 165: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/165.jpg)
Low-power view showing multilocular
cystic lesions filled with lamellar keratin
material.
Portion of the cyst wall consists of
stratified squamous epithelium with
keratinization through parakeratotic cells.
![Page 166: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/166.jpg)
![Page 167: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/167.jpg)
The tumor forms sheets of basaloid cells with focal ductal differentiation separated
by fibromyxomatous stroma.. The tumor cells are uniform without mitotic figures or
pleomorphism.
![Page 168: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/168.jpg)
![Page 169: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/169.jpg)
![Page 170: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/170.jpg)
Tumor diffusely and uniformly involves the parotid gland lobules, leaving scattered striated ducts.
Proliferation of the plump endothelial cells with mild nuclear atypia.
![Page 171: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/171.jpg)
![Page 172: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/172.jpg)
![Page 173: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/173.jpg)
well-developed stage of MALT lymphoma
showing scattered lymphoepithelial lesions
in diffuse sheets of monocytoid cells
Lymphoepithelial lesion formed by the
infiltration of monocytoid cells in the
proliferation of duct epithelial cells.
![Page 174: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/174.jpg)
MALT lymphoma.Immunohistochemistry.
(A) The lymphoid tumor cells at both
inside and outside of the
lymphoepithelial lesion diffusely\ express
CD20 (left) but are negative for CD3
(right).
Immunoglobulin light chain restriction.
Many kappa light chain-positive cells are
seen in the left, whereas only scattered
lambda positive cells are identified in the
right
![Page 175: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/175.jpg)
![Page 176: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/176.jpg)
Most important features taken into consideration before making a
diagnosis are :
• Tumor borders
• Cellular composition
• Architectural arrangement
• Cytologic features
• Stromal components
Analytic approach to diagnosis of epithelial tumors of
salivary glands
![Page 177: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/177.jpg)
• Some acinic cell ca and ca-ex-PA have circumscribed borders.
• Pushing type of infiltration – Epithelial myoepithelial carcinoma,
Basal cell adenocarcinoma, acinic cell carcinoma.
• Morphologically bland looking myoepithelial, basal cell, oncocytic
neoplasm if having invasive borders : malignant.
• Warthin's tumor complicated by infarction or inflammation can result
in adhesions to the surrounding tissues, mimicking a -malignant
neoplasm clinically or grossly.
Invasive or not?
![Page 178: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/178.jpg)
Cellular differentiation in various salivary gland neoplasms
![Page 179: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/179.jpg)
![Page 180: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/180.jpg)
![Page 181: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/181.jpg)
![Page 182: Tumors of salivary gland](https://reader033.vdocuments.net/reader033/viewer/2022061511/55a516731a28abd77f8b4648/html5/thumbnails/182.jpg)