Salivary glands
Epithelial / myoepithelial tumors
Salivary duct carcinoma

Author: Adriana Handra-Luca, M.D. (see Authors page)

Revised: 19 March 2018, last major update September 2012

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

See also: Colloid (mucin rich), Low grade
Cite this page: Handra-Luca, A. Salivary duct carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/salivaryglandssalivaryductcarcinoma.html. Accessed October 17th, 2018.
Definition / general
Clinical features
  • 0.2 - 2% of salivary gland tumors, 10% of salivary gland malignancies
  • Usually elderly (most 50+ years, range 22 - 91 years), 75% males, may cause facial palsy
  • Usually parotid gland (may be bilateral), also submandibular gland, minor salivary glands
  • May arise in pleomorphic adenoma, polymorphous low grade adenocarcinoma, Warthin tumor or de novo
  • May be associated with osteoclast type giant cell tumor, IgG4 related chronic sclerosing sialadenitis (Hum Pathol 2009;40:881)
  • May be hybrid tumor / synchronous with adenoid cystic carcinoma, epithelial myoepithelial carcinoma, pleomorphic adenoma, squamous cell carcinoma (head and neck), Warthin tumor (Arch Pathol Lab Med 2011;135:1088)
  • High grade tumors are aggressive with tumor infiltration into soft tissue and frequent recurrence (60%)
  • Metastases to regional lymph nodes and distant sites (bone, bowel, CNS, gingiva, inguinal lymph node, liver, lung, skin, uterus, vagina)
  • Disease specific survival at 2 years is 75%, at 5 years is 55%
Poor prognostic factors
  • > 3 cm, metastases, small intraductal component, ER beta-, p53+, HER2+, MMP9+, chromosome 7 polysomy
Treatment
  • Excision with regional lymph node sampling, radiation and chemotherapy
  • Possibly prostate cancer-like hormonal therapy, docetaxel, paclitaxel, trasuzumab
Gross description
  • White-tan mass with solid or cystic cut surface or necrosis; firm, ill defined, infiltration of adjacent parenchyma
  • Up to 7 cm (mean 3.5 cm)
Microscopic (histologic) description
  • Resembles invasive ductal carcinoma of breast, either high grade (papillary / micropapillary, sarcomatoid [Hum Pathol 2000;31:208], colloid) or low grade (cribriform)
  • Cells have eosinophilic cytoplasm, marked nuclear pleomorphism, vesicular nuclei, prominent nucleoli, squamoid
  • May have anaplastic keratin+ cells, spindle, multinucleated, oseosarcomatous, rhabdoid or squamoid cells; no goblet cells, no apocrine cells
  • Frequent perineurial and vascular invasion, fibrous and hyalinized stroma; numerous mitotic figures
  • May have dystrophic calcification or necrosis (comedonecrosis sometimes), neutrophil tumor cell cannibalism, cystic change, neuroendocrine features
  • May be in situ only (Am J Surg Pathol 2004;28:266)
  • May be associated with squamous cell carcinoma, bilateral chronic sialadenitis
Microscopic (histologic) images

Images hosted on other servers:

Various images

1: cribriform pattern
2: oncocyte-like cells
3: infiltrating in cords
4: perineurial invasion

Cytology description
  • Necrosis, large polygonal cells, cribriform groups, oncocytic appearance
Positive stains
Negative stains
Electron microscopy description
  • Interlobular or excretory duct origin (2 cell types: electron lucent cytoplasm with scant organelles and second type with numerous mitochondria)
Molecular / cytogenetics description
  • Diploid or aneuploid, 6q alterations more frequently and 17p / 17q less frequently than breast invasive ductal carcinoma
  • Also chromosome 7 polysomy, 12q amplification, 9p LOH, methylation of MGMT, DAPK, RASSF1
Differential diagnosis