Week 12 Part 2 - Salivary Glands Continued Flashcards
Basal Cell Adenoma
Peak incidence 6th decade, major salivary gland
Slow growing - well defined margins
Benign behavior: treatment is complete surgical excision
Basal Cell Adenoma Cytology
Numerous monotonous small basaloid cells singly, in cohesive clusters with peripheral palisading
Scanty ill-defined cytoplasm
Dispersed naked nuclei - regular round or oval nuclei, may appear dark but v bland, granular chromatin pattern
Small hyaline globules - scanty fibrous stroma
Squamous whorls if present is a good diagnostic clue, frequent
squamous metaplasia
Mucoepidermoid Carcinoma
Most common of all SG tumours
F>M with a mean age at onset in the 5th decade
MEC is most common SG in children
Symptoms included;
- painless, fixed, slow growing swelling of varying duration
- tenderness
- otorrhea
- dysphagia
- trismus
Treatment is radiotherapy +/- adjunctive therapy
Mucoepidermoid Carcinoma Cytology
Dirty background of mucus and debris
See lots of cell in cell engulfment
Clumps and sheets of cells are present with small streams of cells within mucus
Variation in cell type - intermediate, squamous, mucus secreting (most with abundant cytoplasm)
‘Regular’ nuclei with prominent nucleoli and mitoses
Adenoid Cystic Carcinoma Overview
Peak incidence 5th-7th decade (but can occur in young patients) in both major and minor salivary glands
Second most common SG malignancy in the minor salivary gland
Slow growing, ill defined margins, nerve involvement frequent
Malignant behavior - high local recurrence rate, frequent late metastases; rare solid variants are even more aggressive
Treatment is radical excision +/- adjuvant therapy
Adenoid Cystic Cell Carcinoma - Cytology
Epithelial cells – cellular smears
- small uniform, round to oval/some angulation
- globular component (not fibrillary/no matrix)
- cell fragments with finger-like or beaded cords or strands of hyaline stroma
- multilayered dense cell clusters of tumour cells
- scanty cytoplasm, high NC ratio, nuclear molding, naked/stripped nuclei, nucleoli
- relatively uniform round to oval hyperchromatic nuclei with coarse chromatin pattern
Adenoid Cystic Carcinoma Ancillary Testing
IHC
- cytokeratins
- epithelial membrane antigen (EMA)
- Sox10
- CD117
- smooth muscle actin (SMA)
- P63
Chromosomal translocation t(6;9)(p22-23;q23-24) resulting in MYB-NF1B fusion
Acinic Cell Carcinoma
F>M
Peak 5th and 6th decades; uncommon in kids and
Mainly occurs in the parotid; uncommon in submandibular and minor salivary glands
Slow growing, often circumscribed
Malignant behavior, with moderate metastatic potential
Treatment is radical excision +/- adjuvant therapy
Acinic Cell Carcinoma Cytology
Nuclei are round to medium size, uniform, bland, nucleoli variable
Abundant delicate/foamy cytoplasm (PAS positive)
Loose sheets/clusters
Many stripped nuclei in the bg
Cystic bg
Lymphoid population
Acinic Cell Carcinoma IHC
Positive for CAM5.2, CK7, DOG1 and SOX10
Negative for P63, CK20 and SMA
Acinic Cell Carcinoma - Pitfalls
Normal/hyperplastic salivary acini
Lymphoid rich stroma
Oncocytic neoplasms
Watch recorded lecture for photos
Mammory Analogue Secretory Carcinoma
Cellular aspirate
Large polygonal cells in crowded clusters, papillary groups, and single cells
- rounded nuclei with distinct nucleoli
- abundant finely vacuolated cytoplasm with occasional intracytoplasmic mucin containing vacuoles
- absence of cytoplasmic granules
Extracellular mucoid material
- described as filamentous, web-like, or “colloid-like”
Mammory Analogue Secretory Carcinoma IHC
Mammaglobin +ve
S100 +ve
GCDFP15 +ve
ETV6-NTRK3 fusion
>90% have translocation
t(12;15)(p13;q25)
Acinic Cell Carcinoma vs MASC
Asinic has papillary architecture
Asinic tumour cells bland with granules
MASC can mimic pattern of ACC
MASC cells have more delicate cytoplasm than ACC
Salivary Duct Carcinoma
Older adults
Overt malignant features – clearly malignant cells, present singly or in clusters
- pleomorphic nuclei
- necrotic debris
- abundant cytoplasm, squamoid, oncocyte features
- no stromal component
- low grade tumours with a cribriform pattern and uniform cells
Metastatic Malignancy
> 90% are LNd mets to parotid
- submandibular mets uncommon and almost via haematological spread
80% mets are from head and neck sites
- SCC, Melanoma, Merkel cell carcinoma
Less commonly from other visceral organs
- lung, breast, kidney, prostate
