Salivary glands

Primary salivary gland neoplasms

Malignant

Secretory carcinoma



Minor changes: 16 April 2021

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PubMed Search: Secretory carcinoma[TI] salivary[TI]

Timothy Fielder, M.B.B.S., B.Med.Sci.
Ruta Gupta, M.D.
Page views in 2020: 11,513
Page views in 2021 to date: 12,184
Cite this page: Fielder T, Gupta R. Secretory carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/salivaryglandsmammary.html. Accessed September 21st, 2021.
Definition / general
Essential features
Terminology
  • Previously known as mammary analogue secretory carcinoma (MASC)
ICD coding
  • ICD-10: C07 - Malignant neoplasm of parotid gland
Epidemiology
Sites
Etiology
  • Unknown
Clinical features
Diagnosis
Radiology description
Prognostic factors
Case reports
Treatment
Gross description
Gross images

Contributed by Ruta Gupta, M.B.B.S., M.D.
Cystic tumor

Cystic tumor

Solid tumor Solid tumor

Solid tumor

Microscopic (histologic) description
  • Circumscribed or infiltrative edge
  • Lobulated architecture
  • Variable arrangements, including macrocystic, microcystic, solid, tubular, follicular and papillary cystic patterns (Am J Surg Pathol 2010;34:599, Am J Surg Pathol 2019;43:1483)
  • Pale eosinophilic colloid-like intraluminal secretions; secretions are periodic acid-Schiff (PAS) reagent positive and diastase resistant (Am J Surg Pathol 2010;34:599)
  • Tumor cells have eosinophilic or vacuolated cytoplasm and monomorphic round vesicular nuclei with small but distinctive nucleoli
  • Occasional lymphovascular invasion and perineural invasion are seen (Head Neck 2019;41:1227)
  • High grade transformation has been reported with a distinct population of tumor cells exhibiting solid or trabecular growth, infiltrative margins, desmoplastic stromal reaction, comedo-like necrosis, nuclear pleomorphism, increased mitotic rate, loss of secretory activity and perineural invasion
Microscopic (histologic) images

Contributed by Ruta Gupta, M.B.B.S., M.D.
Solid architecture Solid architecture

Solid architecture

Solid and cystic architecture

Solid and cystic architecture

Solid architecture

Solid architecture

Macrocystic lesion

Macrocystic lesion

Papilliform architecture

Papilliform architecture


Colloid-like secretions

Colloid-like secretions

Intraluminal secretions

Intraluminal secretions

Cytological features

Cytological features

Macrocystic lesion

Macrocystic lesion


Diastase resistant secretions

Diastase resistant secretions

S100

S100

MUC4

MUC4

Pan-TRK

Pan-TRK

Virtual slides

Images hosted on other servers:
42M secretory carcinoma parotid

42M secretory carcinoma parotid

33F secretory carcinoma parotid

33F secretory carcinoma parotid

Cytology description
Cytology images

Contributed by Ruta Gupta, M.B.B.S., M.D.
Cell block Cell block

Cell block



Contributed by Jeffrey Krane, M.D., Ph.D. and Jen-Fan Hang, M.D.
Missing Image

Sheets and clusters cells

Missing Image

Nuclei are uniform

Papillary pattern

Vacuolated cytoplasm

Papillary and secretory



Images hosted on other servers:
FNA cytology of secretory carcinoma FNA cytology of secretory carcinoma

FNA cytology of secretory carcinoma

Positive stains
Electron microscopy description
Molecular / cytogenetics description
Molecular / cytogenetics images

Contributed by Ruta Gupta, M.B.B.S., M.D.
ETV6 rearrangement by FISH

ETV6 rearrangement by FISH

NTRK3 rearrangement by FISH

NTRK3 rearrangement by FISH

Videos

Salivary gland neoplasms characterized by gene fusions

Case presentations of various salivary gland pathologies

Sample pathology report
  • Left parotid, excision:
    • Secretory carcinoma (see comment)
    • Comment: There is a well demarcated but focally infiltrative parotid neoplasm with lobulated growth, macrocystic and microcystic areas. The cysts are lined by relatively monomorphic epithelioid cells with moderate amounts of vacuolated eosinophilic cytoplasm and a central round nucleus with a small but distinctive nucleolus. The microcysts contain colloid-like eosinophilic secretions. Immunohistochemistry shows tumor cells to be positive for S100, MUC4, pan-TRK and GATA3 and negative for DOG1. The combined morphological and immunohistochemical features strongly support the diagnosis of secretory carcinoma, a primary salivary gland malignancy. This is further confirmed by fluorescent in situ hybridization using ETV6 break apart probe demonstrating ETV6 rearrangement. Lymphovascular or perineural involvement is not seen. The tumor is 2 mm from the closest margin of resection.
    • Secretory carcinoma generally demonstrates indolent behavior. However, it has a propensity to recur unless completely excised. Local lymph node metastasis occurs in up to 22% of patients and distant metastasis, while rare, has been reported in a subset of cases
Differential diagnosis
Board review style question #1

A 48 year old man has a parotid nodule for 9 - 12 months. Which of the following is true?

  1. It is characterized by PAS diastase resistant cytoplasmic zymogenic granules and immunohistochemically by positivity for DOG1 and S100
  2. It is characterized by PAS diastase resistant cytoplasmic zymogenic granules and immunohistochemically by positivity for ER and PR
  3. It is characterized histologically by PAS diastase resistant intraluminal secretions and immunohistochemically by positivity for androgen receptor and p63
  4. It is characterized histologically by PAS diastase resistant intraluminal secretions and immunohistochemically by positivity for pan-TRK, S100 and mammaglobin
  5. It is generally a highly aggressive malignancy with most patients showing distant solid organ metastases at presentation
Board review style answer #1
D. It is characterized histologically by PAS diastase resistant intraluminal secretions and immunohistochemically by positivity for pan-TRK, S100 and mammaglobin. The image shows a secretory carcinoma with abundant secretions.

Comment Here

Reference: Secretory carcinoma
Board review style question #2

A 49 year old woman has a lesion on the floor of the mouth with metastases to lymph nodes. The tumor cells show strong staining with S100 and MUC4. Which of the following genetic changes are likely to be found in this tumor?

  1. ETV6-NTRK3 translocation
  2. HER2 amplification
  3. MAML2-CRTC1 translocation
  4. MYB-NFIB translocation
  5. PLAG1 translocation
Board review style answer #2
A. ETV6-NTRK3 translocation. The image shows a secretory carcinoma with papilliform architecture.

Comment Here

Reference: Secretory carcinoma
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