Salivary glands - Basal cell adenocarcinoma

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Salivary glands

Epithelial / myoepithelial tumors

Basal cell adenocarcinoma

Reviewer: Adriana Handra-Luca, M.D. (see Reviewers page)
Revised: 23 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Low grade malignant counterpart of basal cell adenoma; infiltrative with perineurial invasion and vascular invasion (Mod Pathol 2002;15:298)
● Also called basaloid carcinoma

Clinical features
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● 1-2% of salivary gland carcinomas
● Malignant counterpart of basal cell adenoma - 23% arise within preexisting basal cell adenomas
● Associated with dermal cylindromas
● Slow growing
● Usually parotid gland, adults, ages 50+, also in minor salivary glands
● No gender predilection
● Locally destructive
● 37% recur locally, 8% metastasize (solid pattern) to lymph nodes, 4% to lungs, but death from disease is unusual

Treatment
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● Excision with clear margins, radiotherapy for minor salivary gland lesions (Arch Pathol Lab Med 2007;131:1602)

Gross images
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Bisected specimen with focal hemorrhage

Micro description
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● Low grade malignancy similar to basal cell adenoma but infiltrative with perineurial invasion and vascular invasion
● Multicentric, variable cytologic atypia and mitotic activity
● Two cell types: small cells with scant cytoplasm and dark nuclei (may show palisading pattern) and polygonal cells with eosinophilic/amphophilic cytoplasm and clear nuclei
● Patterns: solid, trabecular, tubular, membranous
● No myxoid matrix, no cyst formation

Micro images
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Various images

Figure A is basal cell adenocarcinoma; others are mimics

Positive stains
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● CK7+/CK20- (Mod Pathol 2004;17:407), p53, HER2, CD117/c-kit (60%, heterogeneous, epithelial cells and not myoepithelial cells, Mod Pathol 2003;16:1224), BCL2, PS100, CEA, EMA, CK7

Negative stains
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● GFAP, smooth muscle actin

Differential diagnosis
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● Adenoid cystic carcinoma: true cribriform structures, angular and hyperchromatic nuclei or prominent nucleoli, strong muscle marker staining
● Adenosquamous carcinoma
● Basaloid ameloblastoma
● Basaloid squamous cell carcinoma: dysplasia in mucosal epithelium
● Low grade pleomorphic adenocarcinoma
● Pleomorphic adenoma
● Small cell carcinoma

End of Salivary glands > Epithelial / myoepithelial tumors > Basal cell adenocarcinoma

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