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Salivary glands

Epithelial / myoepithelial tumors

Intraductal carcinoma


Reviewer: Adriana Handra-Luca, M.D. (see Reviewers page)
Revised: 27 January 2013, last major update September 2012
Copyright: (c) 2003-2013, Pathol2gyOutlines.com, Inc.

General
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● Rare (< 20 cases reported), in situ form of salivary duct carcinoma, entity is controversial
● First described in 1983 by Chen (J Laryngol Otol 1983;97:189)
● Also called low grade cribriform cystadenocarcinoma, low grade salivary dyct carcinoma; ambiguity exists regarding non-invasive ex-pleomorphic adenoma
● May represent preinvasive phase of some salivary duct carcinomas

Clinical features
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● Mean age 62 years, range 32-91 years, usually female
● Usually affects major salivary glands (parotid), intraparotid lymph nodes (Head Neck Pathol 2011;5:321), palate
● Excellent prognosis - no metastases or mortality reported
● May recur with incomplete excision as intraductal or invasive tumor
● Recommended to sample extensively and stain for myoepithelial cells with p63 and actin to rule out invasion

Treatment
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● Total parotidectomy (if parotid location) or wide excision to prevent recurrence / progression

Case reports
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● 44 year old woman with mass in buccal mucosa arising from minor salivary glands (Am J Surg Pathol 2004;28:266)
● 59 year old woman with tumor arising in intraparotid lymph node (Head Neck Pathol 2011;5:321)

Gross description
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● May be multifocal, cystic

Micro description
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● Unencapsulated but circumscribed intraductal neoplasm in micropapillary, cribriform, solid, comedo or clinging patterns, with preservation of myoepithelial cells surrounding intraductal tumor
● Resembles breast DCIS with pure intraductal proliferation of tumor cells
● May have apocrine-like vacuoles (Am J Surg Pathol 2006;30:1014), focal necrosis, sclerotic stroma, lipofuschin
● Variable atypia, variable mitotic figures, no invasion

Micro images
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Intraductal tumors resembling breast DCIS


Arising in intraparotid lymph node

Cytology description
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● Overlapping, cytoplasmic vacuoles, inconspicuous atypia (Diagn Cytopathol 2011;39:218)

Positive stains
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Epithelial cells: high molecular weight cytokeratin, EMA, AE1-AE3, CK7, CK19, BRST2, AR; S100 (50%)
Myoepithelial cells: p63 (nuclear stain), muscle specific actin, CK14, calponin, AR, BRST2

Negative stains
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● ER, PR, p53, HER2, CK20

Differential diagnosis
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Acinic cell carcinoma-papillary cystic variant
● Cribriform adenocarcinoma: arises in tongue
Cystadenocarcinoma
Metastases when intranodal
Salivary duct carcinoma: males, invasive, CK19+
Warthin tumor

End of Salivary glands > Epithelial / myoepithelial tumors > Intraductal carcinoma


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