Salivary Gland Tumours

Transcription

1 Salivary Gland Tumours

2 Monographs in Clinical Cytology Vol. 15 Series Editor Svante R. Orell, Kent Town Basel Freiburg Paris London New York New Delhi Bangkok Singapore Tokyo Sydney

3 Salivary Gland Tumours Jerzy Klijanienko, Institut Curie, Paris Philippe Vielh, Institut Curie, Paris In collaboration with John D. Batsakis, M.D. Anderson Cancer Center, Houston, Tex. Adel K. El-Naggar, M.D. Anderson Cancer Center, Houston, Tex. Michal Jelen, Akademia Medyczna, Wrocław Jean-Daniel Piekarski, Fondation Adolphe de Rothschild, Paris 215 figures, 212 in color, and 52 tables, 2000 Basel Freiburg Paris London New York New Delhi Bangkok Singapore Tokyo Sydney

4 Salivary Gland Tumours Dr. Jerzy Klijanienko Dr. Philippe Vielh Institut Curie, Section Médicale 26, rue d Ulm F Paris Cedex 05 (France) Tel , Fax Jerzy.Klijanienko@curie.net Philippe.Vielh@curie.net Library of Congress Cataloging-in-Publication Data Salivary gland tumours/editors, Jerzy Klijanienko, Philippe Vielh; contributors, John D. Batsakis [et al.]. p.;cm. (Monographs in clinical cytology; vol. 15) Includes bibliographical references and index. ISBN (hard cover: alk, paper) 1. Salivary glands Tumors Cytopathology. 2. Salivary glands Tumors Cytopathology Atlases. I. Klijanienko, Jerzy. II. Vielh, Philippe. III. Batsakis, John D. IV. Series. [DNLM: 1. Salivary Gland Neoplasm diagnosis Atlases. 2. Adenocarcinoma physiopathology Atlases. 3. Biopsy, Needle methods Atlases. 4. Salivary Gland Neoplasms physiopathology Atlases. WI 17 S ] RC280.S3. S dc21 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and Index Medicus. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microscopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2000 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISBN

5 To my daughters: Alice and Julie, my parents: Teresa and Tadeusz, to my sorely missed grandmother Wiktoria and Aunt Iwona, and to Marie. J. Klijanienko To Laetitia Gorce, my nephews: Laure, Eric and Luc, and my forward-looking father. Ph. Vielh

6 Contents X XI XII Foreword Preface Acknowledgements Chapter Introduction 1.1. Demographics of Salivary Gland Tumours 1.2. History and Current Aspects of Fine-Needle Aspiration Cytology of Salivary Tumours 1.3. Accuracy of Fine-Needle Aspiration Cytology in Salivary Tumours 1.4. Clinical Indications for Fine-Needle Aspiration Cytology 1.5. Complications of Fine-Needle Aspiration Cytology Chapter Fine-Needle Aspiration Cytology Procedure and Ancillary Techniques 2.1. Specimen Processing 2.2. Choice of Ancillary Techniques Cytochemistry Immunocytochemistry Cytogenetic Analysis Molecular Genetic Analysis DNA Content Analysis by Flow Cytometry Microbiology Cultures Chapter 3 7 Imaging of Salivary Gland Tumours In collaboration with J.-D. Piekarski Chapter Salivary Gland Anatomy and Tumour Histogenesis In collaboration with M. Jelen and A.K. El-Naggar 4.1. Structure and Anatomy Parotid Gland Submandibular Gland Sublingual Gland Minor Salivary Glands 4.2. Tumour Histogenesis

7 Chapter Basic Cytological Components and Diagnostic Approach In collaboration with A.K. El-Naggar 5.1. Components Cells Stroma 5.2. Tumour Classification 5.3. Diagnostic Approach Chapter Adenomas 6.1. Adenomas with Prominent Myoepithelial Cells Pleomorphic Adenoma Myoepithelioma (Myoepithelial Adenoma) 6.2. Adenomas with Prominent Oncocytes Warthin s Tumour (Adenolymphoma) Oncocytoma (Oncocytic Adenoma) and Oncocytosis 6.3. Adenomas with Prominent Basaloid Cells: Basal Cell and Canalicular Adenomas 6.4. Adenomas with Prominent Sebaceous Cells Sebaceous Adenoma and Sebaceous Lymphadenoma 6.5. Papillary and Cystic Adenomas Ductal Papilloma Cystadenomas Chapter High- and Intermediate-Grade Carcinomas 7.1. Carcinomas with Squamous Cells High-Grade Mucoepidermoid Carcinoma Primary Squamous Cell Carcinoma 7.2. Undifferentiated Carcinoma Large Cell Undifferentiated Carcinoma Lymphoepithelial Carcinoma (Nasopharyngeal Type) 7.3. Carcinomas with Prominent Myoepithelial Cells Adenoid Cystic Carcinoma Epithelial-Myoepithelial (Clear Cell) Carcinoma Malignant Myoepithelioma (Myoepithelial Carcinoma) 7.4. Carcinomas with Oncocytes Malignant Oncocytoma (Oncocytic Carcinoma) Carcinoma Ex Warthin s Tumour 7.5. Carcinomas with Sebaceous Cells Sebaceous Carcinoma and Sebaceous Lymphadenocarcinoma 7.6. Other Carcinomas Salivary Duct Carcinoma Adenocarcinoma Not Otherwise Specified (NOS) Small Cell Carcinoma Mucinous Adenocarcinoma Carcinoma Ex Pleomorphic Adenoma Carcinosarcoma (True Malignant Mixed Tumour) VIII Contents

8 Chapter Low-Grade Carcinomas 8.1. Low-Grade Mucoepidermoid Carcinoma 8.2. Acinic Cell Carcinoma 8.3. Polymorphous Low-Grade Adenocarcinoma 8.4. Papillary Cystadenocarcinoma 8.5. Basal Cell Adenocarcinoma Chapter Benign and Malignant Mesenchymal Tumours and Miscellaneous Lesions 9.1. Benign Mesenchymal Tumours 9.2. Malignant Mesenchymal Tumours 9.3. Miscellaneous Lesions Chapter Lymphomas In collaboration with M. Jelen Chapter Secondary Tumours Chapter Tumour-Like Lesions Sialadenosis Necrotizing Sialometaplasia Lymphoepithelial Lesions Salivary Gland Cysts Küttner s Tumour (Chronic Sclerosing Sialadenitis) Reactive Processes References Index Contents IX

9 Foreword Who better to prepare a monograph of the cytopathology of salivary gland tumors than investigators from the Institut Curie, Paris, France? Drs. Klijanienko and Vielh are the latest in a galaxy of international authorities from that famed institution, which include Antoine Zajdela, Jacques Brugère, and Pierre Bataïni. These giants of Cytopathology, Head and Neck Surgery and Radiation Oncology were forerunners in what today is called interdisciplinary management of patients with cancer. And this was being done at the Institut Curie as long as 1954! The fine-needle aspiration cytopathology of salivary gland lesions has clinically and diagnostically matured over the past four decades. With the maturation of cytopathologic sensitivity and specificity, as well as accuracy of benign from malignant, has come the recognition of the clinical utility and limitations of the procedure. Overzealous adherents, who seemed more concerned with their diagnostic acumen, have been replaced by workers like Klijanienko and Vielh who, as they have in the monograph, in presenting a balanced viewpoint, see themselves as part of a team. Because of this leitmotif, the monograph stands out as not only an atlas but as a contemporary assessment of salivary gland oncology. It is as fine tribute to the authors teachers. John G. Batsakis, MD Professor Emeritus of Pathology and Former Head, Division of Pathology University of Texas M.D. Anderson Cancer Center Houston, Tex. X Foreword

10 Preface Salivary gland tumours constitute a special and difficult area of histopathology. Only pathologists who work for several years in specialized hospitals or oncology units accumulate sufficient experience to become confident in this field. Experience in diagnostic cytology of salivary gland tumours is also limited. Although fine-needle aspiration cytology is widely accepted as a tool in the pretreatment diagnostic work-up in several types of cancer, it remains controversial in salivary gland tumours despite numerous reports describing its high level of accuracy and simplicity. Knowledge about salivary gland tumours has increased tremendously since the first edition of Histological Typing of Salivary Gland Tumours in Nine types of adenomas and 18 types of primary carcinomas are currently recognized [300]. This classification is designed to facilitate the surgical pathologist s routine work. It reflects differences in prognosis and treatment, but still does not cover the whole spectrum of salivary gland tumours. This wide variety of tumours may make histological diagnosis difficult. The variability of histological patterns within the same tumour is an even more important problem in cytology, which can be only partly overcome by extensive sampling. At the Institut Curie, fine-needle aspiration cytology of salivary gland lesions has been integrated into routine clinical practice since 1954, allowing review of a large series of cytology smears, but this long recruitment period has required histological reclassification to include more recently defined entities. We have used the most recent [300] World Health Organization classification including several modifications proposed by the Armed Forces Institute of Pathology [89]. This manual focuses on the cytology of salivary gland tumours. We apologize to the many authors dealing with the histological aspects, who are not referred to in this monograph. We hope that this monograph will be useful to pathologists practising cytological diagnosis of salivary gland lesions. J. Klijanienko, Ph. Vielh Preface XI

11 Acknowledgements We would like to thank Dr. Antoine Zajdela, the pioneer of cytopathology and former Head of Cytopathology at the Institut Curie. He collected many of the cases presented in this monograph during his 40 years of practice. We also thank him for his constructive comments and moral support. This work would not have been possible without the help of Drs. Jacques Brugère and Pierre Bataïni, former Heads of Head and Neck Surgery and Radiotherapy, respectively, who encouraged us and furthered our experience in salivary gland pathology. We thank Mrs. Françoise Smadja for her precious skills in keeping the Institut Curie s archives in an exemplary order and Mrs. Véronique Marck and Eliane Padoy for their outstanding help in collecting cytology files. We also greatly appreciate Mr. Jean-Pierre Laborde for his crucial professional and friendly help for illustrations. We gratefully acknowledge Prof. Jean-Pierre Camilleri, Director of the Medical Section of the Institut Curie, for his invaluable help during this work. J. Klijanienko, Ph. Vielh I would like to thank Dr. Christian Micheau, retired Head of Pathology at the Institut Gustave-Roussy (Villejuif), and Prof. Esteban Cvitkovic (Hôpital Paul Brousse, Villejuif) who initiated me in head and neck pathology, and Prof. Gerhard Seifert (Hamburg, Germany) who tolerated me as a young resident during the EORTC Salivary Tumours Histologic Panels. J. Klijanienko XII Acknowledgements