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Salivary glands

Epithelial / myoepithelial tumors

Oncocytoma


Reviewer: Adriana Handra-Luca, M.D. (see Reviewers page)
Revised: 29 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Benign tumor composed of oncocytes
● Also called oxyphilic adenoma
● 1-2% of salivary gland neoplasms; more frequent than oncocytosis and oncocytic carcinoma

Clinical features
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● Usually parotid gland mass, also submandibular gland or minor salivary glands
● Mean age 60 years
● 20% associated with radiation therapy or radiation exposure
● Rarely bilateral, multiple
● Rarely synchronous with Warthin tumor or carcinoma ex-pleomorphic adenoma
● May occur in trisomy 7 or in BHD syndrome
● Specific MRI features: T1 hypointense, isointense to normal gland on fat-saturated T2 and postcontrast T1; CT features: enhancing tumor and nonenhancing cystic component (AJNR Am J Neuroradiol 2011;32:1703, AJNR Am J Neuroradiol 2010;31:1413)

Case reports
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● 68 year old man with parotid mass (J Cytol 2012;29:80)
● 79 year old woman with parotid tumor with multinodular oncocytic hyperplasia (Arch Pathol Lab Med 2003;127:e53)

Treatment
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● Local excision
● Excellent prognosis, but may have late recurrence

Gross description
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● Well circumscribed with fibrous capsule, solid, tan-red-brown, lobulated, often small, may have cystic spaces

Gross images
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Red-brown tumor

Micro description
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● Eosinophilic or clear cell (glycogen) with sheets, trabeculae, acini or follicular patterns of monotonous large polygonal cells with well defined cell borders, deeply eosinophilic, granular cytoplasm, small round nuclei
● Vascular stroma, may have clear cell change, background of oncocytic nodular hyperplasia, psammoma bodies, tyrosine-rich crystals
● No mitotic figures, no elastosis

Micro images
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Various images


Red brown tumor with central scar, oncocytes packed with mitochondria, oncocytic metaplasia of ducts

Cytology images
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Various images


Figure A: oncocytoma, B: acinic cell carcinoma

Positive stains
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● PTAH, CK5/6, CK8/18, CK10/13, EMA, Ki-67, p63 (Head Neck Pathol 2007;1:123)
● Also antimithocondrial antibody, CK7+/CK20-
● High viral load of high risk HPV (Int J Biol Markers 2007;22:239), CEA, GFAP, variable S100

Negative stains
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● Myoepithelial markers (alpha smooth muscle actin, smooth muscle myosin heavy chain, calponin, Arch Pathol Lab Med 1999;123:801), CEA, GFAP

Electron microscopy description
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● Packed with mitochondria with partitions

Differential diagnosis
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Metastases: prostate carcinoma is PSA+, renal cell carcinoma is p63+, CD10+, CK20+
● Oncocytic carcinoma: malignant features, invasive, high Ki-67, regional nodal or distant metastases
● Oncocytic metaplasia: no mass
● Oncocytoid artifact: electrocautery
Oncocytosis
Warthin tumor: FNA has lymphoid component, mucus, necrosis

End of Salivary glands > Epithelial / myoepithelial tumors > Oncocytoma


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