Salivary glands

Primary salivary gland neoplasms

Malignant

Salivary duct carcinoma


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Editor-in-Chief: Debra L. Zynger, M.D.
Jalal B. Jalaly, M.B.B.S., M.S.

Topic Completed: 25 June 2021

Minor changes: 25 June 2021

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

Jalal B. Jalaly, M.B.B.S., M.S.
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Cite this page: Jalaly JB. Salivary duct carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/salivaryglandssalivaryductcarcinoma.html. Accessed September 19th, 2021.
Definition / general
Essential features
  • High grade salivary gland malignancy
  • Histology is similar to invasive ductal carcinoma of the breast (specifically luminal androgen receptor [AR]+ 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
Pathophysiology
Etiology
Clinical features
Diagnosis
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, M.B.B.S., M.S.
CT cross sectional view

CT cross sectional view

CT coronal 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% and 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

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, M.B.B.S., M.S.
Enlarged intraparotid lymph nodes

Enlarged intraparotid lymph nodes

Frozen section description
  • Typically not indicated as cytology is usually diagnostic of a high grade malignancy
  • High grade malignancy with necrosis and cellular pleomorphism
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Jalal B. Jalaly, M.B.B.S., M.S.
Infiltrating nests and glands

Infiltrating nests and glands

Eosinophilic cytoplasm

Eosinophilic cytoplasm

Comedo necrosis

Comedo necrosis

High grade nuclear cytology

High grade nuclear cytology

Pleomorphic nuclei

Pleomorphic nuclei

AR+

AR+


Carcinoma ex pleomorphic adenoma Carcinoma ex pleomorphic adenoma

Carcinoma ex pleomorphic adenoma

AR+

AR+

HER2+

HER2+


Intracytoplasmic mucin Intracytoplasmic mucin

Intracytoplasmic mucin

Mucicarmine+

Mucicarmine+

AR+

AR+

Virtual slides

Images hosted on other servers:

Salivary duct carcinoma

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)
  • Reference: Cancer Cytopathol 2020;128:693
Cytology images

Contributed by Jalal B. Jalaly, M.B.B.S., M.S. and Jen-Fan Hang, M.D.
Diff-Quik Diff-Quik

Diff-Quik

Pap stain Pap stain Pap stain

Pap stain


ThinPrep ThinPrep

ThinPrep

Prominent nucleoli

Prominent nucleoli

Hyperchromasia

Hyperchromasia

Immunofluorescence description
  • HER2 amplification by FISH analysis may be necessary for 2+ cases by HER2 immunohistochemistry (as defined by the American Society of Clinical Oncology / College of American Pathologists (ASCO / CAP) guidelines for breast cancer) (Arch Pathol Lab Med 2018;142:1364)
  • Samples are considered to be amplified when the average copy number ratio (HER2 / CEP17) is ≥ 2.0 (Oncotarget 2017;8:59023)
Immunofluorescence images

Images hosted on other servers:
HER2 amplification by FISH

HER2 amplification by FISH

Positive stains
Molecular / cytogenetics description
Sample pathology report
  • Parotid, right, parotidectomy:
    • Salivary duct carcinoma, 2 cm, with lymphatic, vascular and perineural invasion, within 0.1 cm from deep resection margin (see comment)
    • Comment: Metastatic carcinoma in 5 of 40 lymph nodes (5/40), largest metastatic focus measures 2.3 cm, with extranodal extension.
Differential diagnosis
Board review style 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 style answer #1
A. 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.

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Reference: Salivary duct carcinoma
Board review style 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 style answer #2
B. 40 - 50%

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Reference: Salivary duct carcinoma
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