Salv-glnd-histopath-slides-051116

Salv-glnd-histopath-slides-051116 - Histopathology of Major...

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Unformatted text preview: Histopathology of Major Histopathology Salivary Gland Neoplasms Salivary Sam J. Cunningham, MD, PhD Shawn D. Newlands, MD, PhD David C. Teller, MD University of Texas Medical Branch November 16, 2005 Introduction Introduction Neoplasms of the major salivary glands constitute minor portion of head and neck neoplasms Less than 2% are malignant Most neoplasms in parotid 75%, 0.8% in sublingual glands Remainder equally distributed between submandibular gland and minor salivary glands Introduction Introduction Incidence rises at age 15 and peaks at 65­ 75. Incidence of malignant neoplasms increases after 4th and 5th decades and peaks 65­75 years. Benign neoplasms present slightly earlier Malignant neoplasms occur most often in men. Introduction Introduction Cancers of the salivary glands account for only 6% of H&N cancers Only 0.3% of all cancers Proportion of malignant and benign varies with the gland of origin. Introduction Introduction Salivary Gland Microanatomy Salivary Saliva transported from central structure (acini) in complex ductal system to the oral cavity System is a bilayer with internal luminal layer and external reserve layer. Internal layer forms acini and ductal epithelium External layer forms myoepithelium and reserve cells Salivary Gland Microanatomy Salivary Bicellular Theory Bicellular Intercalated Ducts • • • • • Pleomorphic adenoma Warthin’s tumor Oncocytoma Acinic cell Adenoid cystic Excretory Ducts • Squamous cell • Mucoepidermoid Multicellular Theory Multicellular Striated duct—oncocytic tumors Acinar cells—acinic cell carcinoma Excretory Duct—squamous cell and mucoepidermoid carcinoma Intercalated duct and myoepithelial cells— pleomorphic tumors Classification of Salivary Gland Neoplasms Neoplasms WHO • • • • • • • Adenomas Carcinomas Nonepithelial Tumors Malignant lymphomas Secondary tumors Unclassified tumors Tumor­like lesions Classification of Salivary Gland Neoplasms Neoplasms Armed Forces Institute of Pathology • • • • • • Benign Epithelial Neoplasms Malignant Epithelial Neoplasms Mesenchymal Neoplasms Malignant Lymphomas Metastatic Tumors Nonneoplastic Tumor­like Conditions Benign Neoplasms Benign Pleomorphic Adenoma Warthin’s Tumor Basal Cell Adenoma Oncocytoma Canalicular Adenoma Myoepithelioma Pleomorphic Adenoma Pleomorphic Histology • Mixture of epithelial, myopeithelial and stromal components • Epithelial cells: nests, sheets, ducts, trabeculae • Stroma: myxoid, chrondroid, fibroid, osteoid • No true capsule • Tumor pseudopods Pleomorphic Adenoma Pleomorphic Necrosis and mitosis rare IHC profile consistent with dual architecture Glandular areas stain with CEA and S­100, actin, epithelial membrane antigen Mesemchymal areas stain with S­100 and actin only Warthin’s Tumor Warthin’s Histology • Papillary projections into cystic spaces surrounded by lymphoid stroma • Epithelium: double cell layer Luminal cells Basal cells • Stroma: mature lymphoid follicles with germinal centers Warthin’s Tumor Warthin’s Basal Cell Adenoma Basal Solid nests of cells with scant cytoplasm and hyperchromatic nuclei Tendency for peripheral pallisading. Basal Cell Adenoma Basal Solid • Most common • Solid nests of tumor cells • Uniform, hyperchromatic, round nuclei, indistinct cytoplasm • Peripheral nuclear palisading • Scant stroma Basal Cell Adenoma Basal Trabecular • Cells in elongated trabecular pattern • Vascular stroma Basal Cell Adenoma Basal Tubular • Multiple duct­like structures • Columnar cell lining • Vascular stroma Basal Cell Adenoma Basal Membranous • Thick eosinophilic hyaline membranes surrounding nests of tumor cells • “jigsaw­puzzle” appearance Basal Cell Adenoma Basal Oncocytoma Oncocytoma Histology • Cords of uniform cells and thin fibrous stroma • Large polyhedral cells • Distinct cell membrane • Granular, eosinophilic cytoplasm • Central, round, vesicular nucleus Oncocytoma Oncocytoma Positive staining for phosphotungstic acid:hematoxylin, cytokeratin, epithelial membrane antigen Negative for S­100 glial fibrillary, smooth muscle actin Canalicular Adenoma Canalicular Histology Well­circumscribed Multiple foci Tubular structures line by columnar or cuboidal cells • Vascular stroma • • • Myoepithelioma Myoepithelioma Histology • Spindle cell More common Parotid Uniform, central nuclei Eosinophilic granular or fibrillar cytoplasm • Plasmacytoid cell Polygonal Eccentric oval nuclei Myoepithelioma Myoepithelioma Malignant Neoplasms Malignant Mucoepidermoid Carcinoma Adenoid Cystic Carcinoma Polymorphous Low­Grade Adenocarcinoma Acinic Cell Carcinoma Adenocarcinoma Malignant Mixed Tumor Epithelial­Myoepithelial Carcinoma Salivary Duct Carcinoma Squamous Cell Carcinoma Undifferentiated Carcinoma Mucoepidermoid Carcinoma Mucoepidermoid Histology—Low­grade • Mucus cell > epidermoid cells • Prominent cysts • Mature cellular elements Mucoepidermoid Carcinoma Mucoepidermoid Histology— Intermediate­ grade • • • Mucus = epidermoid Fewer and smaller cysts Increasing pleomorphism and mitotic figures Mucoepidermoid Carcinoma Mucoepidermoid Histology—High­grade • Epidermoid > mucus • Solid tumor cell proliferation • Mistaken for SCCA Mucin staining Low Grade Mucoepidermoid Carcinoma Carcinoma High Grade Mucoepidermoid Carcinoma Carcinoma Adenoid Cystic Carcinoma Adenoid Histology—cribriform pattern • Most common • “swiss cheese” appearance Adenoid Cystic Carcinoma Adenoid Histology—tubular pattern • Layered cells forming duct­like structures • Basophilic mucinous substance Histology—solid pattern • Solid nests of cells without cystic or tubular spaces Adenoid Cystic Carcinoma Adenoid Polymorphous Low-Grade Adenocarcinoma Adenocarcinoma Histology • Isomorphic cells, indistinct borders, uniform nuclei • Peripheral “Indian­file” pattern Polymorphous Low-Grade Adenocarcinoma Adenocarcinoma Markedly positive staining for S­100, epithelial membrane antigen, and cytokeratins. Less predictable with CEA and muscle­specific actin Acinic Cell Carcinoma Acinic Histology • Solid and microcystic patterns Most common Solid sheets Numerous small cysts • Polyhedral cells • Small, dark, eccentric nuclei • Basophilic granular cytoplasm Acinic Cell Carcinoma Acinic Positive staining with cytokeratins and CEA, mixed results with others Vacuolated cells with eccentrically located nuclei and granular, basophilic cytoplasm, scant stroma Adenocarcinoma Adenocarcinoma Histology • Heterogeneity • Presence of glandular structures and absence of epidermoid component • Requires exclusion of other specific salivary gland carcinomas Adenocarcinoma Adenocarcinoma Malignant Mixed Tumors Malignant Carcinoma ex­pleomorphic adenoma Carcinosarcoma Carcinoma developing in the epithelial component of preexisting pleomorphic adenoma True malignant mixed tumor—carcinomatous and sarcomatous components Metastatic mixed tumor Metastatic deposits of otherwise typical pleomorphic adenoma Carcinoma Ex-Pleomorphic Adenoma Adenoma Histology • Malignant cellular change adjacent to typical pleomorphic adenoma • Carcinomatous component Adenocarcinoma Undifferentiated Carcinosarcoma Carcinosarcoma Histology • Biphasic appearance • Sarcomatous component Dominant chondrosarcoma • Carinomatous component Moderately to poorly differentiated ductal carcinoma Undifferentiated Malignant Mixed Tumor Malignant Epithelial-Myoepithelial Carcinoma Epithelial-Myoepithelial Dual epithelial component Irregular, eccentric nuclei w vacuolated cytoplasm IHC reveals dual cell origin epithelial:cytokeratins Myoep:S­100, actin Epithelial-Myoepithelial Carcinoma Carcinoma Tumor cell nests Two cell types Thickened basement membrane Salivary Duct Carcinoma Salivary Large polygonal cells w well defined borders Pleomorphic nuclei w prominent nucleoli and granular, eosinophilic cytoplasm IHC patterns similar to breast CA except neg for estrogen CEA, epithelial membrane + S­100, cytokeratins ­ Squamous Cell Carcinoma Squamous Histology • • • Infiltrating Nests of tumor cells Well differentiated Keratinization • Moderately­well differentiated • Poorly differentiated No keratinization Squamous Cell Carcinoma Squamous Undifferentiated Carcinoma Undifferentiated High grade, high mitotic activity, scant cytoplasm, hyperchromatic nuclei IHC:cytokeratins, epithelial membrane antigen +/­ neuroendocrine References References Seifert, Diseases of the Salivary Glands. Thieme Publishers, NY. 1986 Otolaryngologic clinics of North America. Salivary Gland Disorders. WB Saunders, Phila, PA Oct. 1999. Ellis, Surgerical Pathology of the Salivary Glands. WB Saunders, Phila PA, 1991. Salivary Gland Neoplasms: A Clinicopathologic Approach to Treatment. 3rd ed. American Academy of Otolaryngology, Head and Neck Surgery Foundation Inc. 2003. Bailey, Head and Neck Surgery­Otolaryngology. Lippencott, Williams, Wilkins. 3rd ed. 2001. Rosen, Salivary Gland Neoplasms. Dr. Quinns online textbook of Otolaryngology. 2002. Cummings, Otolaryngology Head and Neck Surgery. Elsiever and Mosby. 2005. Question 1 Question The highlighted area represents: a. the acini b. the intercalated duct c. the striated duct d. the excretory duct Question 2 Question The highlighted area represents: a. the acini b. the intercalated duct c. the striated duct d. the excretory duct Question 3 Question The highlighted area represents: a. the acini b. the intercalated duct c. the striated duct d. the excretory duct Question 4 Question The highlighted area represents: a. the acini b. the intercalated duct c. the striated duct d. the excretory duct Question 5 Question The parotid gland neoplasms are: a.) Mostly Benign b.) Mostly Malignant c.) About equal distribution, benign=malignant Question 6 Question The submandibular gland neoplasms are: a.) Mostly Benign b.) Mostly Malignant c.) About equal distribution, benign=malignant Question 7 Question The sublingual gland neoplasms are: a.) Mostly Benign b.) Mostly Malignant c.) About equal distribution, benign=malignant Question 8 Question Identify the neoplasm: Question 9 Question Identify the neoplasm: Question 10 Question Identify the neoplasm: ...
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