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Salivary glands

Epithelial / myoepithelial tumors

Canalicular adenoma

Reviewer: Adriana Handra-Luca, M.D. (see Reviewers page)
Revised: 26 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Distinct monomorphic adenoma with bilayered strands or ribbons of columnar cells with pure luminal ductal epithelial differentiation and loose, well vascularized stroma (Oral Surg Oral Med Oral Pathol 1983;56:608, Cancer 1973;31:1511)
● 1% of salivary gland tumors; 4-6% of minor salivary gland tumors (J Oral Pathol Med 2007;36:207)
● 20% of benign minor salivary gland tumors

Clinical features
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● Usually arises from minor salivary glands of upper lip or palate (Ann Diagn Pathol 1998;2:224); also parotid gland (Mod Pathol 2002;15:298)
● Female predominance for palate tumors
● Usually ages 50+ years
● Recurrence is uncommon
● Symptoms: pain, multifocal swelling or synchronous bilateral tumors, ulceration

Case reports
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● 55 year old woman with tumor of upper lip (Med Oral Patol Oral Cir Bucal 2007;12:E1)
● 61 year old man with tumor of upper lip (Bull Tokyo Dent Coll 2004;45:229)
● 78 year old woman with multiple, bilateral tumors with synchronous occurrence (Clin Exp Dermatol 2009;34:e587)

Treatment
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● Excision, radiotherapy

Gross description
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● Often encapsulated, 22% multifocal
● Tumor may be received as fragmented specimen

Micro description
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● Bilayered strands or ribbons of columnar cells with loose, well vascularized stroma
● Often basaloid cells or trabecular features
● May infiltrate capsule and exhibit extracapsular tumor islands
● Often cystic change, apocrine, mucous or pigmented cells (Histopathology 1999;35:502)

Micro images
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Various images

 
GFAP staining


Figure 1: H&E and calponin-


Figure 1: H&E and calponin-

Positive stains
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● S100, AE1/3, CK19, CK7 (Oral Oncol 2001;37:365, Oral Surg Oral Med Oral Pathol 1994;78:761), EMA, vimentin
● Distinctive linear immunoreactive pattern of GFAP among cells in proximity to connective tissue interface (Head Neck Pathol 2007;1:27)
● Focal GFAP, focal CK8; PCNA

Negative stains
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● E-cadherin (Oral Oncol 2009;45:594)
● Myoepithelial markers (alpha smooth muscle actin, smooth muscle myosin heavy chain, calponin, Arch Pathol Lab Med 2000;124:401, Arch Pathol Lab Med 1999;123:801), CK14

Differential diagnosis
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● Adenocarcinoma NOS
● Adenoid cystic carcinoma: destructive infiltration, cribriform pattern, strong muscle markers+
● Pleomorphic adenoma
● Polymorphous low grade adenocarcinoma: vimentin- (Ann Diagn Pathol 2003;7:278), lack of linear GFAP at the tumor/connective tissue interface

End of Salivary glands > Epithelial / myoepithelial tumors > Canalicular adenoma

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