Salivary glands - Salivary duct papilloma

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Salivary glands

Epithelial / myoepithelial tumors

Salivary duct papilloma

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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● Rare, benign papillary proliferations of bland cuboidal/columnar epithelial cells with fibrovascular cores, inflammation
● Also called intraductal papilloma, intraductal papillary tumor
● Usually in minor salivary glands, rare in parotid or sublingual glands

Clinical features
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● Usually adults, present with mass, discomfort with chewing (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:68)
● Probably of luminal ductal origin

Case reports
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● 41 year old man with parotid mass (Acta Otolaryngol 2002;122:314)
● 47 year old man with minor salivary gland tumor (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e34)
● Two cases, benign sublingual tumor and parotid papilloma with microinvasion and intraparotid lymph node metastases (Arch Pathol Lab Med 2000;124:291)

Treatment
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● Surgery

Micro description
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● Papillary proliferations of bland cuboidal/columnar epithelial cells with fibrovascular cores, inflammation, few mitoses
● May have acinar cell differentiation, ductal cyst by obliteration, malignant transformation to adenocarcinoma

Micro images
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Intraductal papillary proliferation

Papillary, tubular and solid patterns

Microinvasion

Smooth muscle actin demonstrates no invasion

Upper lip tumor has papillary proliferation of epithelial cells with numerous intricately branching fronds in cystically dilated duct lumen

Positive stains
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● Alcian blue and PAS+ mucous cells, CK7, CK18, EMA, vimentin; variable CEA, S100, GCDFP-15
● Malignant cases may be positive for p53, Ki67

Negative stains
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● HER2, smooth muscle actin, GFAP, CK14

Cytology description
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● Compact clusters of papillary monomorphic columnar cells with abundant finely vacuolar cytoplasm; oval nuclei basally located, indistinct nucleol; no squamous cells (Acta Cytol 1999;43:457)

Electron microscopy images
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A: secretary granules, rough endoplasmic reticulum, golgi apparatus and mitochondria; B: microvilli on luminal surface of epithelial cells appear to be secretory; C: annulate lamellae composed of parallel arrays of cisternae have small annuli or fenestrae

Differential diagnosis
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● Metastatic papillary thyroid carcinoma
● Papillary cystadenocarcinoma
● Papillary cystadenoma
● Acinic cell carcinoma-papillary cystic variant
● Polymorphous low grade adenocarcinoma
● Salivary duct carcinoma
● Sialadenoma papilliferum

End of Salivary glands > Epithelial / myoepithelial tumors > Salivary duct papilloma

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