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Salivary glands

Epithelial/myoepithelial tumors

Sialadenoma papilliferum

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 biphasic tumor with exophytic squamous component and endophytic glandular component
● Well differentiated papillary hyperplastic squamous epithelium covering ductal component of cleftlike cystic spaces lined by cuboidal or columnar epithelium with occasional goblet cells
● First described by Abrams in 1969 (Cancer 1969;24:1057)

Clinical features
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● Usually hard palate (Arch Pathol Lab Med 2001;125:1595) or parotid gland of men over 40 years; also children (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e51)
● Painless
● Tends to recur after excision

Case reports
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● 65 year old man with parotid tumor (Head Neck 2011 Nov 11 [Epub ahead of print])
● 79 year old woman with malignant transformation of sialadenoma papilliferum of the palate (Virchows Arch 2004;445:641)
● 82 year old woman with mucoepidermoid carcinoma arising in a background of sialadenoma papilliferum (Head Neck Pathol 2009;3:59)
● Recurrence in buccal mucosa 3 years after excision (J Laryngol Otol 1995;109:787)

Gross description
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● Well circumscribed, round/oval, papillary tumor of mucosal surface

Micro description
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● Biphasic, with well differentiated papillary hyperplastic squamous epithelium covering ductal component of cleftlike cystic spaces lined by cuboidal or columnar epithelium with occasional goblet cells
● Variable oncocytes and squamous metaplasia, dysplasia and in situ carcinoma in exophytic component (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e27)
● Has malignant counterpart, or evolves to mucoepidermoid carcinoma or epithelial-myoepithelial carcinoma with high grade carcinoma

Micro images
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Floor of mouth tumor


Hard palate cases

 
Mucoepidermoid carcinoma arising in a background of sialadenoma papilliferum

Positive stains
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● Squamous epithelium and ductal structures: CK7, AE1-AE3, CEA, EMA
● Ductal structures: also CAM 5.2, S100
● Also CK8, CK19 (Int J Oral Maxillofac Surg 2004;33:621)
● One study identified 2 subsets of basally-located cells: (a) positive for CK14, S100, GFAP, vimentin and smooth muscle actin - similar to myoepithelial cells; (b) CK13+ and CK14+ only (J Oral Pathol Med 1996;25:336)

Negative stains
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● CK20, desmin, muscle specific actin, HPV (J Cutan Pathol 1999;26:259)

Electron microscopy description
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● Oncocyte is predominant cell; contains numerous mitochondria, parallel filaments within cell cytoplasm attached by desmosomes (Arch Pathol Lab Med 1986;110:523)

Differential diagnosis
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● Papillary syringocystadenoma
● Warthin’s tumor

End of Salivary glands > Epithelial/myoepithelial tumors > Sialadenoma papilliferum

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