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MRI: cystic lesion of the upper lip
CT and US: right parotid nodule
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1.2 cm upper lip nodule
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Well circumscribed multilobulated mass
Contributed by Rema A. Rao, M.D. and Arash H. Lahouti, M.D.
Well circumscribed tumor
Finely vacuolated cytoplasm
Tumor associated lymphoid proliferation
Cystic pattern and hemorrhage
NR4A3 nuclear stain
Contributed by Rema A. Rao, M.D. and Arash H. Lahouti, M.D.
Loosely cohesive groups
Cellular smears
Finely vacuolated to granular cytoplasm
Round eccentric nuclei
Loosely cohesive clusters
PASD
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FISH, NR4A3 break apart probe
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MRI: cystic lesion of the upper lip
CT and US: right parotid nodule
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1.2 cm upper lip nodule
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Well circumscribed multilobulated mass
Contributed by Rema A. Rao, M.D. and Arash H. Lahouti, M.D.
Well circumscribed tumor
Finely vacuolated cytoplasm
Tumor associated lymphoid proliferation
Cystic pattern and hemorrhage
NR4A3 nuclear stain
Contributed by Rema A. Rao, M.D. and Arash H. Lahouti, M.D.
Loosely cohesive groups
Cellular smears
Finely vacuolated to granular cytoplasm
Round eccentric nuclei
Loosely cohesive clusters
PASD
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FISH, NR4A3 break apart probe
Contributed by Marino Leon, M.D.
Oncocytic carcinoma, H&E and p63
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Histologic impact on survival
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MRI parotid mass
Lung metastases
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Vocal cord mass
Contributed by Bin Xu, M.D., Ph.D. and Kelly Magliocca, D.D.S., M.P.H.
Parotid mass
Cut section turbinate to palate
Contributed by Bin Xu, M.D., Ph.D. and Kelly Magliocca, D.D.S., M.P.H.
Tubular pattern
Cribriform pattern
Solid pattern
High grade transformation
Perineural invasion
Squamous metaplasia
Clear myoepithelial cells
p40
SMA
CAM5.2
MYB
H&E of turbinate to palate
Contributed by Bin Xu, M.D., Ph.D. and Jen-Fan Hang, M.D.
Smear, Diff-Quik
Smear, Papanicolaou
Basaloid cells
Microcystic pattern
Branching pattern
Contributed by Theoni Haralabopoulos, M.D. and AFIP
3 major salivary glands (left side)
Schematic representation of acinus and ductal system
Embryological development of oral cavity
Parotid gland lymph nodes
Horizontal section through parotid gland
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Overview of major salivary gland anatomy
Contributed by Ruta Gupta, M.B.B.S., M.D. and Theoni Haralabopoulos, M.D.
Parotid gland
Cut surface of parotid gland
Submandibular gland
Cut surface of submandibular gland
Sublingual gland
Cut surface of sublingual gland
Contributed by Ruta Gupta, M.B.B.S., M.D. and Theoni Haralabopoulos, M.D.
Major salivary glands:
Parotid gland
Serous acini of Parotid gland
Striated ducts of parotid gland
Interlobular duct of parotid gland
Intraparotid lymph node
Intraparotid lymph node with glandular inclusions
Sebaceous cells in parotid gland
Submandibular gland
Mucous acinar cells of submandibular gland
Sublingual gland
Seromucous acini of sublingual gland
Minor salivary glands:
Minor salivary glands
Minor salivary glands are unencapsulated
Special stains and immunohistochemistry:
Mucicarmine stain of sublingual gland
PAS stain of sublingual gland
SMA positivity of myoepithelial cells
EMA positivity of ductal cells
AE1 / AE3 positivity of all cell types
p63 positivity of myoepithelial cells
Shotgun histology parotid gland
Shotgun histology submandibular gland
Shotgun histology sublingual gland
Contributed by Umamaheshwari Golconda, M.D.
Rare atypical cells
Lymphoid rich aspirate
Abundant extracellular mucin
Contributed by Natasha Prosser, B.Sc., M.B.B.S.
Parotid gland tumor
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Bisected specimen with focal hemorrhage
Contributed by Natasha Prosser, B.Sc., M.B.B.S. and Ruta Gupta, M.D.
Peripheral palisading
Biphasic tumor composition
Solid pattern
Tubular and trabecular growth patterns
Membranous pattern
Glandular elements
Squamous morules
Invasion
Perineural invasion
DPAS special stain
Beta catenin IHC
Cytokeratin 7 IHC
p63 IHC
Ki67 IHC
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Basal cell adenoma in left parotid gland
Basal cell adenoma versus pleomorphic adenoma of the parotid gland
Contributed by Shuanzeng Wei, M.D., Ph.D.
Solid pattern
Trabecular pattern
Tubular pattern
Membranous type
Contributed by Shuanzeng Wei, M.D., Ph.D.
Diff-Quik stain
Pap stain
Membranous type Pap stain
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Ultrasound examination (1B) and MRI (1C)
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Oral nodule
Oral swelling / tumefaction / lesion
Oral lesion after resection, postresection zone
Oral nodule
Nodules (lip)
Oral nodules / lesions
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2 resected nodules
Resected specimen
Resected specimen / nodule
Resected lesion
Resected nodule
Contributed by Adriana Handra-Luca, M.D., Ph.D. (slides courtesy of Emmanuelle Vaz, M.D.)
Cystic tumor zone
Solid tumor zone
Microscopy
Canalicular pattern
Alcian blue stain
BCL2 expression
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Cytology of parotid case
Slides with cytology material
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Apical zone of columnar cells
Basal zone of canalicular cells
Zone of 2 parallel rows of tumor cells
Basal zone of tumor cells
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Axial T2 weighted and ADC mapping
Salivary duct carcinoma ex PA, axial T2 weighted
Contributed by Ruta Gupta, M.B.B.S., M.D.
Parotid mass
2 distinct tumor components
Parotid mass involving skin
Contributed by Ruta Gupta, M.B.B.S., M.D.
2 distinct microscopic components
Interface of distinct components
Infiltrative component
DCIS-like morphology
HER2 IHC
Androgen receptor IHC
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CT of head and neck
CT showing cystic necrotic areas
MRI of parotid lesion
MRI of heterogeneous mass lesion
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Swelling of right parotid
Contributed by Alexander Tang, M.B.B.S.
Cut section of tan, fleshy carcinosarcoma
Contributed by Manish Mahadeorao Bundele, M.B.B.S., M.D.
Carcinomatous and intervening sarcomatous components
Carcinosarcoma with residual PA
Sarcomatoid component with storiform pattern
Undifferentiated carcinoma with necrosis
Undifferentiated carcinoma / pleomorphic sarcoma
Focal squamoid component
Focal squamoid component
p40+ / SOX10- squamoid component
p40+ squamoid component
Focal SOX10 staining
Nonspecific CD117 staining
High proliferative index
Diffuse positive p53
AE1 / AE3 + sarcomatoid component
Calponin weak positive
Variably increased p53 staining
Myoepithelial cells in PA
Contributed by Manish Mahadeorao Bundele, M.B.B.S., M.D.
Cell block showing sheets of carcinoma cells
Cell block
Parotid FNA (high grade carcinoma)
Parotid FNA (high grade carcinoma)
Pleural fluid metastasis
Cytokeratin positive
CK7
Nonspecific CD117 positive
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Hypoechoic mass
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Smooth mass
Sialolith
Contributed by James S. Lewis, M.D.
Preservation of lobular architecture
Intense chronic inflammation
Acinar destruction
Contributed by Tony Ng, M.D., Ph.D.
CT scan
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Echo, CT, MRI
Contributed by Pallavi Parashar, D.D.S.
Submucosal mass
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Buccal mass
Contributed by Erin Chapman, M.D
Well demarcated mass
Contributed by Pooja Navale, M.D. (Case #483), Tony Ng, M.D., Ph.D. and Erin Chapman, M.D
Circumscribed lesion
Cord-like to trabecular architecture
Hyalinzied stroma
Anastomosing nests
Monotonous cells
Clear to eosinophilic cytoplasm
Bland nuclei
Centrally placed nuclei
Inconspicuous nucleoli
Soft palate mass
Clear cell proliferation
Base of tongue mass
Clear cell and columnar phenotype
Buccal mass
Nests and cords of clear cells
Submucosal tissue
Posterior maxilla submucosal tumor
Islands and cords of tumor cells
p40
PASD
Contributed by Aditya Talwar, M.D.
Palpable mass, left neck
Left parotid lesion
Contributed by Jalal B. Jalaly, M.B.B.S., M.S.
Parotid gland
Contributed by Aditya Talwar, M.D.
Parotid gland cyst
Epithelial lining
Oncocytic variant
Contributed by Aditya Talwar, M.D.
Salivary gland lesion, Diff-Quik
Salivary gland lesion, Pap stain
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Upper lip tumor has papillary
proliferation of epithelial
cells with branching fronds
in cystically dilated duct lumen
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A: secretary granules, rough endoplasmic reticulum, golgi apparatus
and mitochondria; B: microvilli on luminal surface of epithelial cells
appear to be secretory; C: annulate lamellae composed of parallel
arrays of cisternae have small annuli or fenestrae
Contributed by Ruta Gupta, M.B.B.S., M.D.
Solid tumor
Contributed by Ruta Gupta, M.B.B.S., M.D.
Nodular growth pattern
Biphasic morphology
Biphasic pattern
Spindled myoepithelial cells
Clear myoepithelial cells
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Figure 2B
Lacrimal gland
IgG4 positive plasma cells
Contributed by Kim A. Ely, M.D.
Well circumscribed
Cystic foci
Cribriform pattern
Intercalated duct-like subtype
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37 year old man with parotid tumor
Case #49
Well circumscribed tumor
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Parotid sialoangiolipoma
Case #49
Acini and dilated ducts
Ducts with fibrosis of wall infiltrated by lymphocytes
Peripheral
lipomatous tissue
with central salivary
gland elements
Lipoma-like areas
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Lower lip tumor
Submandibular sialoangiolipoma
Parotid sialoangiolipoma
Pleomorphic lipoma with classic floret-like cells
Chondroid lipoma
of lip has chondroid
and lipomatous
features
Oncocytic lipoadenoma of parotid
Spindle cell lipoma of parotid gland
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In parotid gland of HIV+ man
Case #103
Large nodule is
sebaceous adenoma,
small nodule on left
is oncocytoma
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Parotid gland masses
Case #103
Large nodule
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Benign parotid mass with sebaceous features and lymphoid stroma
Parotid gland mass
With synchronous squamous cell carcinoma
Case #103
Diff-Quik touch prep
Contributed by Michael Kraut, M.D.
Lymphoepithelial cyst on coronal section
Lymphoepithelial cyst on axial section
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Well defined mass
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Diffuse swelling involving the left parotid gland
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Unilocular cyst with straw colored fluid
Contributed by Zahra Maleki, M.D.
Epithelial and lymphoid component
Squamous lining and lymphoid tissue
Epithelium surrounded by inflammatory cells
Epithelial and inflammatory cells
Contributed by Zahra Maleki, M.D.
Numerous lymphocytes and histiocytes
Large epithelial fragment
Dispersed squamous cells
Polymorphous lymphocytes
Cyst content
Contributed by James S. Lewis, M.D.
Maintenance of lobular architecture
Intense chronic inflammation
Plasma cells
Lymphoepithelial lesion
Contributed by Jen-Fan Hang, M.D.
Mucoepidermoid carcinoma
Acinic cell carcinoma
Salivary duct carcinoma
Adenoid cystic carcinoma
Secretory carcinoma
Malignant category 1
Malignant category 2
Contributed by Michael Mikula, M.D.
Unencapsulated and well circumscribed
Subtle invasive growth
Microcysts
Basophilic secretions
Fibromyxoid stroma
Monotonous hyperchromatic nuclei
S100
p63
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SS18 rearrangement by FISH
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Milan system
Contributed by Jen-Fan Hang, M.D.
Nondiagnostic
Nonneoplastic acinar cells
Benign skeletal muscle
Cystic fluid only
Atypia of undetermined significance (AUS)
Mucinous cyst
Atypical lymphoid proliferation
Neoplasm: benign
Pleomorphic adenoma (PA): fibrillary extracellular matrix
PA: plasmacytoid
myoepithelial cells
PA with squamous metaplasia
Warthin tumor
Warthin tumor
Oncocytoma
Neoplasm: salivary gland neoplasm of uncertain malignant potential (SUMP)
With oncocytic / oncocytoid features
With basaloid features
Malignant
Mucoepidermoid carcinoma
Acinic cell carcinoma
Salivary duct carcinoma
Adenoid cystic carcinoma
Secretory carcinoma
Milan system
Algorithmic approach to everyday salivary gland cytology
Contributed by Ulrike Hamper, M.D., M.B.A.
Ultrasound, cyst
Contributed by Zahra Maleki, M.D.
Cystic lined cavity
Contributed by Zahra Maleki, M.D.
Fine needle aspiration
Contributed by Kelly Magliocca D.D.S., M.P.H.
Cut surface, high grade
Contributed by Rema A. Rao, M.D. and Saeed Asiry, M.D.
Tumor architecture
Tumor cell types
Epidermoid cells
Mucus cells
Intermediate cells
Clear cell changes
Case #346
4 year old boy
Ki67
Mucicarmine
Contributed by Rema A. Rao, M.D. and Saeed Asiry, M.D.
Background mucin
Neoplastic cells
Mucus cells
Neoplastic cells in sheets
Keratinizing cells
Single keratinizing cells
Crowded squamous cells
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Low grade and oncocytic tumors
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FISH analysis of MAML2
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Multinodular parotid mass (arrows)
Contributed by Abeer Salama, M.D. and Bin Xu, M.D., Ph.D.
Lobulated parotid mass
Contributed by Abeer Salama, M.D. and Bin Xu, M.D., Ph.D.
Multinodular invasive growth
Expansile lobulated growth
Necrotic hypocellular central zone
Myoepithelial carcinoma ex PA
Epithelioid features
Plasmacytoid features
Clear cell features
Spindle cell features
S100 immunostain
CAM5.2 immunostain
Calponin immunostain
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Diff-Quik stain
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Molecular signature (oncoprint)
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Plasmacytoid myoepithelioma of minor salivary glands
Contributed by Xiaofeng Zhao, M.D., Ph.D. and Shuanzeng Wei, M.D., Ph.D.
Spindle cell type
Epithelioid type
Nest / trabecular pattern
Contributed by Shuanzeng Wei, M.D., Ph.D.
Cellular specimen
Monotonous epithelioid cells
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Rare bony erosion
Contributed by Douglas Damm, D.D.S., Ashley Clark, D.D.S.,
Eric Mencarelli, M.D., D.D.S. and Molly Housley Smith, D.M.D.
Palatal ulceration and erythema
Midline palatal ulceration
Bilateral palatal ulcerations
Contributed by Kelly Magliocca, D.D.S., M.P.H. (Case #497) and Molly Housley Smith, D.M.D.
Metaplasia of residual salivary ducts
Pseudoepitheliomatous
hyperplasia
Bland cytology
Spilled mucin
Surface ulceration
Glandular necrosis
Acute inflammation
Healing stage
Contributed by Jen-Fan Hang, M.D.
Pleomorphic adenoma (PA): fibrillary extracellular matrix
PA: plasmacytoid
myoepithelial cells
PA with squamous metaplasia
Warthin tumor
Warthin tumor
Oncocytoma
Benign neoplasm 1
Benign neoplasm 2
Contributed by Jen-Fan Hang, M.D.
SUMP subcategories
Contributed by Jen-Fan Hang, M.D.
Basaloid SUMP
Basaloid SUMP
Oncocytic / oncocytoid SUMP
Spindle cell features
Squamoid features
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Parotid mass
Contributed by Lulu Sun, M.D., Ph.D. and Rebecca Chernock, M.D.
Small cell neuroendocrine carcinoma
Infiltration of salivary parenchyma
Necrosis
Nuclear features
Chromogranin
Synaptophysin
Cytokeratin 5/6
MCPyV IHC
Large cell neuroendocrine carcinoma
Nested architecture
Necrosis
Cytologic features
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Parotid gland specimen
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Various images
Contributed by Jen-Fan Hang, M.D.
Nonneoplastic acinar cells
Benign skeletal muscle
Cystic fluid only
Contributed by Jose Manuel Gutierrez Amezcua, M.D. and Tamar C. Brandler, M.D., M.S.
Deep parotid lobe nodule
Solid and cystic parotid lesion
Parotid solid enhancing lesion
Enlarged periparotid lymph node
Contributed by Jose Manuel Gutierrez Amezcua, M.D., Pascale G. Levine, M.D. and Tamar C. Brandler, M.D., M.S.
Amylase crystalloids
Cyst contents
Cyst with lymphoid and squamous cells
Benign epithelial cells and lymphocytes
Lymphoepithelial cyst excision
Granulomatous sialadenitis
Giant cell
Acute sialadenitis
Chronic sialadenitis
Reactive lymph node
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Various images
Contributed by Jen-Fan Hang, M.D.
Clean background
Bland oncocytes
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MRI parotid tumor
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Minor salivary gland tumor
Mass over mandible
Parotid tumor
Large submandibular mass
Parotid tumor
Contributed by Bin Xu, M.D., Ph.D. and Kelly Magliocca D.D.S., M.P.H.
Primary pleomorphic adenoma
Recurrent pleomorphic adenoma
Pleomorphic adenoma
Case #392
External surface
Cut surface
Contributed by Bin Xu, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Encapsulated mass
Bosselated interface
Pseudopods
Recurrent pleomorphic adenoma
Triphasic tumor
Clear myoepithelial cells
Plasmacytoid myoepithelial cells
Spindle myoepithelial cells
Squamous and mucinous metaplasia
Adipose and osseous metaplasia
Tyrosine crystals
Biphasic population
Case #404
Pleomorphic adenoma
Myoepithelial cells
Chondroid stroma
Myoepithelial cells
Contributed by Bin Xu, M.D., Ph.D. and Jen-Fan Hang, M.D.
Diff-Quik smear
Papanicolaou stain
Fibrillary extracellular matrix
Plasmacytoid
myoepithelial cells
Squamous metaplasia
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FISH for PLAG1
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CT
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Submucosal mass involving maxilla
Palate nodule
Contributed by Bin Xu, M.D., Ph.D.
Macroscopic appearance
Contributed by Bin Xu, M.D., Ph.D.
Infiltrative mass
Optical clearing of nuclei
Targetoid arrangement and perineural invasion
Papillary architecture
Cribriform architecture
Reticular pattern
Solid pattern
Oncocytic changes
Cribriform adenocarcinoma of salivary gland
S100
CK7
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Papanicolaou stain
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PRKD mutations and fusions
Contributed by Jalal B. Jalaly, M.B.B.S., M.S.
CT cross sectional view
CT coronal view
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Nasopharyngoscopy
Contributed by Jalal B. Jalaly, M.B.B.S., M.S.
Enlarged intraparotid lymph nodes
Contributed by Jalal B. Jalaly, M.B.B.S., M.S.
Infiltrating nests and glands
Eosinophilic cytoplasm
Comedo necrosis
High grade nuclear cytology
Pleomorphic nuclei
AR+
Carcinoma ex pleomorphic adenoma
AR+
HER2+
Intracytoplasmic mucin
Mucicarmine+
AR+
Contributed by Jalal B. Jalaly, M.B.B.S., M.S. and Jen-Fan Hang, M.D.
Diff-Quik
Pap stain
ThinPrep
Prominent nucleoli
Hyperchromasia
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Tongue tumor
Floor of mouth mass and enlarged lymph node
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Ulcerated palate tumor
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Tongue tumor
Contributed by Marc Pusztaszeri, M.D.
Infiltrative tubules and poorly formed glands
Perineural invasion
Perineural invasion
CK7 and p63
CK5/6 and p40
CK AE1 / AE3 and SOX10
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Parotid lesion
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Palate lesion
Contributed by Jiancong Liang, M.D.
Preservation of lobular architecture
Variably sized ducts
Hyperplastic intraluminal epithelium
Acini with eosinophilic granules
Contributed by Ruta Gupta, M.B.B.S., M.D.
Cystic tumor
Solid tumor
Contributed by Ruta Gupta, M.B.B.S., M.D.
Solid architecture
Solid and cystic architecture
Solid architecture
Macrocystic lesion
Papilliform architecture
Colloid-like secretions
Intraluminal secretions
Cytological features
Macrocystic lesion
Diastase resistant secretions
S100
MUC4
Pan-TRK
Contributed by Ruta Gupta, M.B.B.S., M.D.
Cell block
Contributed by Jeffrey Krane, M.D., Ph.D. and Jen-Fan Hang, M.D.
Sheets and clusters cells
Nuclei are uniform
Papillary pattern
Vacuolated cytoplasm
Papillary and secretory
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FNA cytology of secretory carcinoma
Contributed by Ruta Gupta, M.B.B.S., M.D.
ETV6 rearrangement by FISH
NTRK3 rearrangement by FISH
Salivary gland neoplasms characterized by gene fusions
Case presentations of various salivary gland pathologies
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Floor of mouth tumor
Mucoepidermoid carcinoma arising in a background of sialadenoma papilliferum
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Recurrent and metastatic tumor
Nests of basaloid cells
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ACR / EULAR
classification criteria
for primary Sjögren
syndrome
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Sialography findings: normal versus Sjögren
Ultrasound findings
suggestive of
primary Sjögren
syndrome
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Bilateral parotid gland enlargement
Contributed by Alice Ormandy, M.B.B.S., M.P.H. and Salman Marvi, M.D.
Multiple nodular lymphocytic aggregates
Lymphocytic aggregates with germinal centers
Nodular lymphocytic aggregate
Core biopsy parotid
Germinal center
Submandibular gland lymphoid aggregates
Submandibular gland germinal centre
Contributed by Alice Ormandy, M.B.B.S., M.P.H.
Lymphoid clusters
Lymphocytic infiltrate
Contributed by Manish Mahadeorao Bundele, M.B.B.S., M.D. and Rebecca Tian Mei Au, M.B.B.S.
Suspicious for acinic cell carcinoma
Suspicious for adenoid cystic carcinoma
Suspicious for mucoepidermoid carcinoma
Suspicious for large cell lymphoma
Suspicious for metastatic carcinoma
Suspicious for high grade basal cell adenocarcinoma
Contributed by Sapna Balgobind, M.B.B.Ch.
Cut surface
Contributed by Sapna Balgobind, M.B.B.Ch. and @AnaPath10 on Twitter
Parotid gland with
circumscribed
tumor
Bilayered oncocytic epithelium with lymphoid background
Mucinous metaplasia
Squamous metaplasia
Warthin tumor
p40 staining
p63 staining
Contributed by Sapna Balgobind, M.B.B.Ch.
Oncocytic cells in groups
Oncocytic cells
Proteinaceous debris
Oncocytic cells with dense cytoplasm
Bishop: 2021
Cardesa: 2016
Carlson: 2015
Faquin: 2023
Franchi: 2020
García : 2019
Gnepp: 2021
IARC: 2024
Jiang: 2023
Mody: 2022
Neville: 2023
Stelow: 2020
Thompson: 2022
VandenBussche: 2017
Wenig: 2017
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