Salivary glands - Papillary adenocarcinoma

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Salivary glands

Epithelial / myoepithelial tumors

Papillary adenocarcinoma

Reviewer: Adriana Handra-Luca, M.D. (see Reviewers page)
Revised: 28 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Rare tumor of well defined papillary structures, usually mucin, no squamous or intermediate cell components; call papillary cystadenocarcinoma if prominent cystic component

Clinical features
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● 27% of salivary gland adenocarcinomas; also seen in oral cavity
● Mean age 64 years, median 48 years (different series), also occurs in children
● May arise in intraductal papilloma (Arch Pathol Lab Med 2000;124:291, ORL J Otorhinolaryngol Relat Spec 1994;56:112)
● Slow growth pattern with nodal metastases and recurrence
● Low grade tumors may be rare variant of polymorphous low-grade adenocarcinoma (PLGA)
● Even low grade tumors may have aggressive behavior (Oral Surg Oral Med Oral Pathol 1992;73:591)

Clinical features
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● 5 year old child with tumor in minor salivary gland (Arch Otolaryngol 1983;109:827)
● 12 year old boy with submandibular gland tumor (AJNR Am J Neuroradiol 1996;17:1038)
● 51 year old boy with palate mass and low grade tumor (Head Neck Pathol 2008;2:316)
● Arising in minor salivary glands (Head Neck 1989;11:237)

Gross description
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● Often large, with hemorrhage and necrosis

Micro description
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● Well defined papillary structures, usually mucin, no squamous or intermediate cell components (Am J Surg Pathol 1984;8:367)
● May appear as focal malignant component in otherwise benign mucinous cystadenoma; may occur in malignant mixed tumor associated with myoepithelial carcinoma (Ann Plast Surg 1997;39:656)

Micro images
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Papillary adenocarcinoma

51 year old man with low grade tumor with metastases

PLUNC protein expression

Positive stains
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● CK7+/CL20- (Histopathology 2007;51:26), TAG72 (Oral Dis 2000;6:112), CEA, p53, Ki67, PCNA higher in papillary zones (Anticancer Res 1996;16:2693)
● Also PLUNC proteins (Oral Dis 2008;14:613)

Molecular description
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● Aneuploid or diploid (J Oral Pathol Med 2007;36:371)

Differential diagnosis
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● Acinic cell carcinoma
● Metastases: may resemble thyroid primary
● Mucoepidermoid carcinoma: has intermediate and squamoid cells
● Polymorphous low-grade adenocarcinoma: FNA shows stromal fragments and hyaline globules

End of Salivary glands > Epithelial / myoepithelial tumors > Papillary adenocarcinoma

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