Salivary glands
Epithelial / myoepithelial tumors
Salivary duct carcinoma

Editorial Board Member: Kelly Magliocca, D.D.S., M.P.H.
Editor-in-Chief: Debra Zynger, M.D.

Topic Completed: 28 December 2018

Revised: 21 March 2019

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PubMed Search: Salivary duct carcinoma[TI] free full text[sb]

See also: Colloid (mucin rich), Low grade
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Cite this page: Jalaly, JB. Salivary duct carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/salivaryglandssalivaryductcarcinoma.html. Accessed March 24th, 2019.
Definition / general
Essential features
  • High grade salivary gland malignancy
  • Histology is similar to invasive ductal carcinoma of the breast (specifically luminal androgen receptor (AR) positive subtype)
  • In situ areas frequently have comedo necrosis
  • Nearly all cases (> 90%) are AR positive
  • Poor prognosis
Terminology
  • Also known as high grade ductal carcinoma
ICD coding
  • ICD-O: 8500/3 - infiltrating duct adenocarcinoma - salivary glands
  • ICD-10: C07-C08 - malignant neoplasm of salivary gland
Epidemiology
Sites
  • Most commonly affects the parotid gland
  • Other sites include the submandibular gland and minor salivary glands
Etiology
Clinical features
  • Rapidly growing neck mass, typically in the vicinity of the parotid gland
  • Facial pain
  • Facial weakness or paralysis
  • Regional or distance metastasis (lung, bone, brain or other sites)
Radiology description
  • CT (Neuroradiology 2012;54:631):
    • Typically shows a mass with heterogonous enhancement
    • Can show foci of calcifications
  • MRI (AJNR Am J Neuroradiol 2005;26:1201):
    • Invasive or ill defined margins
    • Can appear well circumscribed in a minority of cases (~15%) (Neuroradiology 2012;54:631)
    • On T1 weighted images, tumors appear hypointense compared with the surrounding salivary gland and isointense compared with the skeletal muscle
    • On T2 weighted images, tumors are hyperintense compared with contralateral parotid
    • Cellular components of the tumor enhance early with a high washout ratio
    • Fibrotic and cellular poor areas show gradual upward enhancement
    • Cellular areas with necrosis enhance early and poorly washout
Radiology images

Contributed by Jalal B. Jalaly, MBBS

CT cross sectional view

CT coronal view

Prognostic factors
  • Prognosis is poor with overall survival rate of ~35%
  • Median overall survival is 3.1 years (AMA Otolaryngol Head Neck Surg 2016;142:489)
  • Poor prognostic factors:
    • Higher tumor stage (especially nodal category N2 or higher), 5 year survival rates for stage I is 42% while is 23% for stage IV (Cancer 2005;103:2526)
    • Perineural invasion (especially if the facial nerve is involved and is sacrificed during surgery)
    • Extranodal extension
    • 50 years or older (Head Neck 2014;36:694)
Case reports
Treatment
Clinical images

Images hosted on other servers:

Nasopharyngoscopy

Gross description
  • Mean gross greatest dimension is 3.2 cm and ranges from 0.5 - 9 cm (Am J Surg Pathol 2015;39:705)
  • Tumors typically have ill defined borders but may appear well circumscribed
  • Cut surface is heterogeneous and can show gross evidence of necrosis
  • Regional lymphadenopathy is common
Gross images

Contributed by Jalal B. Jalaly, MBBS

Enlarged intraparotid lymph nodes

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Jalal B. Jalaly, MBBS

Infiltrating nests and glands

Eosinophilic cytoplasm

Comedo necrosis

High grade nuclear cytology

Pleomorphic nuclei

AR+


Carcinoma ex pleomorphic adenoma

AR+

HER2+


Intracytoplasmic mucin

Mucicarmine+

AR+

Cytology description
  • Cellular smears with dirty necrotic background
  • Clusters of epithelial cells with high grade pleomorphic nuclei and ample cytoplasm
  • Mitotic figures and apoptotic debris
  • Immunohistochemical stains can be done on cell block slides to confirm the diagnosis (AR positive) and rule out metastasis / other primary high grade neoplasms of the salivary gland (see IHC section)
Cytology images

Contributed by Jalal B. Jalaly, MBBS

Diff-Quik

Pap stain


ThinPrep

Positive stains
Molecular / cytogenetics description
Differential diagnosis
Metastatic squamous cell carcinoma: histologic overlap especially if nonkeratinizing; p63 and CK5 / 6 positive, AR negative
Board review question #1
Which of the following immunohistochemical stains is characteristic of salivary duct carcinoma?

  1. Androgen receptor
  2. DOG1
  3. Estrogen receptor
  4. GATA3
  5. SOX10
Board review answer #1
D. Androgen receptor. Although GATA3 is frequently positive in salivary duct carcinoma, it is also positive in other salivary and nonsalivary gland malignancies. DOG1, SOX10 and estrogen receptor are usually negative.
Board review question #2
What percentage of salivary duct carcinomas arise from preexisting pleomorphic adenoma (i.e., carcinoma ex pleomorphic adenoma) as seen in the photomicrograph?



  1. 10 - 20%
  2. 40 - 50%
  3. 60 - 70%
  4. 80 - 90%
Board review answer #2
B. 40 - 50%
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