Salivary Glands 3/7/2017

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1 Salivary Glands 3/7/2017

2 Goals and objectives Focus on the entities unique to H&N Common board type facts Information for your future practice

3 Salivary Glands

4 Salivary Glands Major gland. Paratid. Submandibular. Sublinguinal Minor salivary glands. Oral cavity. Nasopharynx. Trachea and bronchus

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7 Salivary Glands

8 Salivary Glands Selected Lesions Inflammtory/ benign - Necrotizing sialometaplasia - Benign lymphoepithelial cyst Benign neoplastic Pleomorphic Adenoma Basal cell adenoma Warthin Tumor (Papillary Cystadenoma Lymphomatosum) Malignant Mucoepidermoid Carcinoma Acinic Cell Carcinoma Adenoid Cystic Carcinoma Polymorphous Low Grade Adenocarcinoma Salivary Duct Carcinoma

9 Necrotizing sialometaplasia Painless ulcer at hart palate Primary or secondary Reactive/inflammatory Mimics malignancy clinically/ histologically

10 Necrotizing sialometaplasia Dence subacute inflammation with mucin extravasation Coagulative necrosis and squamous metaplasia Pseudoepitheliomatous hyperplasia

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14 Benign lymphoepithelial cyst Slow growing unilocular or multilocular lesions HIV infection as part of diffuse infiltrative lymphocytosis syndrome (DILS) or Non-HIV individuals with autoimmune disease (e.g. Sjogren syndrome )

15 Benign lymphoepithelial cyst Dense lymphoid tissue closely associated with squamous or glandular lining epithelium of cyst Lymphocytes may permeate the epithelial cyst lining cells

16 Pleomorphic Adenoma Most common neoplasm of salivary gland origin 45%-76% of all salivary gland neoplasms Parotid gland most common site (80%) Usually painless, slow growing

17 Pleomorphic Adenoma Histologic Features Innumerable architectural patterns Epithelial tissue shows variable morphology Mesenchymal-like stroma; chondroid, hyalinized and myxoid Myoepithelial and ductal cells Rarely, tyrosine-rich crystals are present Occasionally squamous metaplasia is identified Rarely necrosis

18 Pleomorphic Adenoma Biphasic tumor with epithelial and myoepithelial markers are positive Wide local excision Local recurrence is less than 5% Malignant degeneration is 5% to 25%

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20 Pleomorphic Adenoma

21 Basal cell adenoma Benign tumor with basaloid cell Solid, trabecular, trabecular-tubular, membranous or tubular growth of epithelial cells No invasion, no mesenchymal component, no perineurial invasion, no myxoid matrix

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23 Warthin Tumor 2 nd most common benign tumor salivary gland origin Accounts for approximately 5-6% of all salivary gland tumors Represents up to 12% of benign parotid gland tumors Almost exclusively in parotid Strong link with cigarette smoking Most common multifocal and bilateral

24 Warthin Tumor Epithelial component lining the papillary double layer of granular eosinophilic cells Lymphoid component - mature lymphocytes containing lymphoid May undergo degenerative alterations, spontaneously or following manipulation (e.g., post-fine needle aspiration biopsy), including Infarction/necrosis, squamous metaplasia, and cytologic atypia

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26 Warthin Tumor

27 Salivary Glands Selected Lesions Inflammatory - Necrotizing sialometaplasia Benign neoplastic Pleomorphic Adenoma Warthin Tumor (Papillary Cystadenoma Lymphomatosum) Malignant Mucoepidermoid Carcinoma Acinic Cell Carcinoma Adenoid Cystic Carcinoma Polymorphous Low Grade Adenocarcinoma Salivary Duct Carcinoma

28 Mucoepidermoid Carcinoma Most common malignant salivary gland tumor 16% of all salivary gland tumors Major and minor salivary glands Malignant epithelial tumor with variable components of mucous, epidermoid, and intermediate cells

29 Mucoepidermoid Carcinoma Histologic features Cystic spaces Epidermoid cells Intermediate cells Mucous cells Clear cells Spilled mucus

30 Mucoepidermoid Carcinoma Grading; Cystic component, mitosis, infiltrative borders, cell predominance and anaplasia t(11;19) MECT1-MAML2 Translocation in Mucoepidermoid Carcinoma Relates to Tumor Grade

31 Mucoepidermoid Carcinoma AFIP point system: 2 points if <20% intracystic component 2 points if neural invasion 3 points if necrosis 3 points if 4+ mitotic figures/10 HPF 4 points if anaplasia Low grade if total score is 0-4 points, intermediate grade if 5-6 points, high grade if 7+ points

32 Mucoepidermoid Carcinoma

33 Acinic Cell Carcinoma Accounts for about 6% of salivary gland tumors Represents approximately 10-12% of all malignant salivary gland tumors 2nd to mucoepidermoid carcinoma in frequency Parotid 80%

34 Acinic Cell Carcinoma Multiple cell types Serous acinar: Large, polygonal cells, abundant lightly basophilic, granular cytoplasm Intercalated duct type: Smaller, eosinophilic to amphophilic cells Vacuolated: Clear, cytoplasmic vacuoles Nonspecific glandular:round to polygonal, often syncytial, and smaller than acinar cells Clear cells: Nonstaining cytoplasm and prominent cell borders

35 Acinic Cell Carcinoma Architectural pattern; solid, follicular, microcystic, pap-cystic PAS-D positive Outcome more associated with stage

36 Acinic Cell Carcinoma

37 Adenoid Cystic Carcinoma Malignant salivary gland tumor with myoepithelial and ductal differentiation Similar frequency in major and minor glands Slow growing, indolent by aggressive Rarely lymph node metastatis

38 Adenoid Cystic Carcinoma Histologic features Infiltrative Cribriform Tubular Solid Cytologic features Small to medium cells with eosinophilic to clear cytoplasm Nuclei are oval to sharply angulated with coarse, basophilic chromatin Mitoses rare except for solid

39 Adenoid Cystic Carcinoma

40 Polymorphous Low Grade Adenocarcinoma Malignant epithelial tumor characterized by infiltrative growth of cytologically uniform cells arranged in architecturally diverse patterns Almost always in minor glands (palate: 60%) ~ 2% of salivary gland tumors Indolent course

41 Polymorphous Low Grade Histologic features Adenocarcinoma Infiltrative growth, architectural diversity, and cytologic uniformity, set in characteristic matrix Low power gives "eye of the storm," "streaming" or "whorled" appearance Periphery often shows linear, single-file cell infiltration

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44 Salivary Duct Carcinoma High-grade adenocarcinoma resembling highgrade breast ductal carcinoma Parotid gland is most commonly involved (70-95% of cases) Often cribriform architecture Usually androgen receptor positive Micropapillary architecture worse prognosis

45 Salivary Duct Carcinoma

46 Questions?

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