Home   Chapter Home   Jobs   Conferences   Fellowships   Books



Advertisement

Salivary glands

Epithelial / myoepithelial tumors

Adenocarcinoma, not otherwise specified (NOS)


Reviewer: Adriana Handra-Luca, M.D. (see Reviewers page)
Revised: 8 April 2014, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
=========================================================================

● Invasive tumor, often aggressive, with glandular or ductal differentiation but no features characteristic of other specific types (Arch Pathol Lab Med 2004;128:1385)
● Common, 5-10% of salivary gland tumors
● 6-10% of salivary gland malignancies, 17% of parotid gland malignancies, 15% of minor salivary gland malignancies

Clinical features
=========================================================================

● Mean age 58 years (median 67 years), range 10-93 years
● Usually asymptomatic
● Often fixed to skin or deep tissues
● Palatal lesions often ulcerated and involve bone
● Gender predominance debated, recent reports show male predominance
● Cervical lymph node metastases in 23%, distant metastases in 37%
● Diagnosis of exclusion (not metastatic, not another salivary gland carcinoma)
● 5 year disease specific survivals is 57%

Sites
=========================================================================

● Parotid gland, submandibular gland, palate, buccal mucosa

Case reports
=========================================================================

● 49 year old man with parotid mass (Arch Pathol Lab Med 2004;128:487)

Treatment
=========================================================================

● Complete surgical excision

Gross description
=========================================================================

● Poorly circumscribed with infiltrative borders
● Solid tan cut surface with hemorrhage and necrosis

Micro description
=========================================================================

● Invasive with glandular or ductal differentiation but no features characteristic of other specific types
● Patterns include glandular spaces with cyst formation, papillary formation, solid sheets, comedonecrosis, hyalinized “shadow” nodules
● Small clusters of cuboidal, round or ovoid cells with distinct borders and abundant cytoplasm
● May have clear cell or oncocytic features
● Low, intermediate or high grade based on cytomorphic features
● In situ component in 68% (Virchows Arch 2006;449:159)

Micro images
=========================================================================



Cellular tumor with glandular or ductlike structures, occasional pink cytoplasmic granules, occasional mucicarmine+ cells


Various images


Oncocytic carcinoma, H&E and p63

Positive stains
=========================================================================

● CK7+/CK20- (Mod Pathol 2004;17:407), positive for EGFR, survivin, phosphoSTAT3, CK18, HER2
Uniform periductal staining of reactive myofibroblastic cells with calponin, smooth muscle actin, smooth muscle myosin heavy chain (Arch Pathol Lab Med 1999;123:801)

Negative stains
=========================================================================

● MYB (Mod Pathol 2011;24:1169)

Molecular / cytogenetics description
=========================================================================

● EGFR gene amplification, increased EGFR gene copy number
● HER2 amplification, high HER2 gene copy number
● KRAS mutation rarely (Arch Pathol Lab Med 2000;124:836)

Differential diagnosis
=========================================================================

Hybrid carcinoma
● Membranous adenoma
Metastatic adenocarcinoma
Polymorphous low grade adenocarcinoma
● Undifferentiated carcinoma

End of Salivary glands > Epithelial / myoepithelial tumors > Adenocarcinoma, not otherwise specified (NOS)


This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).