6. 6
HISTOPATHOLOGY
• Composed of cells of varying degree of differentiation.
Well differentiated cells resemble normal acinar cells,
Whereas less differentiated cells resemble embryonic
ducts and immature acinar cells
4 patterns
• Solid
• Microcystic.
• Papillary cystic
• Follicular.
7. 7
•The tumor cells have abundant granular basophilic cytoplasm
and round darkly staining eccentric nuclei.
•Although they may appear to be benign microscopically, their
clinical behavior is unpredictable, and even the most
innocuous appearing lesions can metastasize.
8. 8
• Cells similar to the intercalated ducts (Smaller &
vacuolated) of the salivary gland.
• Connective tissue is fibro-vascular.
9. 9
TREATMENT
• Superficial lobe parotidectomy/complete removal.
• If cervical Lymph nodes involved-RND.
• Minor glands-local excision.
• Radiation usually not recommended.
10. 10
ADENOID CYSTIC CARCINOMA
• Cylindroma
• 1945-adenomyoepithelioma
• Foote & Frazell-Adenoid cystic carcinoma in 1953.
“A malignant epithelial neoplasm of ductal (luminal) and
myoepithelial (abluminal) cells growing in cribriform,
tubular, solid and cystic patterns”.
11. 11
CLINICAL FEATURES
• Most commonly affects the parotid, the submaxillary and
the accessory glands of the palate and tongue.
•5th – 7th decade.
• Female to male ratio: 3:2.
• Slow growing tumor.
• Small tumors- movable by palpation, larger tumors-
adherent to skin and soft tissues.
• Tenderness and pain.
• Facial nerve paralysis.
• Mucosal ulceration.
13. 13
HISTOPATHOLOGICAL FEATURES
• Adenoid cystic carcinoma composed of myoepithelial cells &
ductal cells which are arranged in 3 patterns.
3 Patterns
• Cribriform (Swiss cheese-like appearance)
• Tubular.
• Solid.
14. 14
• Cribriform pattern: Shows basloid cell nests that form
multiple cylindrical cyst like pattern resembling “swiss
cheese pattern or honey comb pattern” The lumina of
these spaces contain PAS +ve mucopolysaccharide
secretion. Most common type.
• Tubular pattern: Tubular structures lined by stratified
cuboidal epthelium.
• Solid pattern: Solid group of cuboidal cells with little
tendency towards duct or cyst formation. Least common
type, high recurrence rate upto 100%
21. POLYMORPHOUS LOW GRADE
ADENOCARCINOMA
• PLGA is a malignant epithelial tumour
which mainly affects minor salivary glands.
• They have characteristic architecture,
uniform nuclear features, infiltration &
perineural invasion.
22. CLINICAL FEATURES:
• In minor glands, PLGA is twice as
frequent as ACC.
• Usually affects people in 5th to 7th
decades of life.
• Slight female predilection.
• Usually affects Hard or Soft Palate
among the minor salivary gland.
• Seen as firm, non-tender swelling
associated with discomfort, bleeding,
ulceration.
23.
24. HISTOLOGICAL FEATURES:
• Well circumscribed.
• Unencapsulated and infiltrate into
adjacent structures.
• Termed as Polymorphous as it shows
variety of growth patterns; solid, ductal,
cystic & tubular.
• At times, cribriform pattern similar to
ACC is seen.
• Composed of cuboidal to columnar
isomorphic cells that have uniform
25.
26.
27. HISTOLOGICAL FEATURES:
• Scant or moderate Eosinophilic
cytoplasm may be seen.
• The stroma varies from mucoid to
hyaline or at times fibrovascular.
• Perineural invasion is observed and
thus resembles ACC.
Prognosis is usually good in spite of
repeated recurrences.
29. CARCINOMA IN PLEOMORPHIC ADENOMA
CARCINOMA EX PLEOMORPHIC ADENOMA
• Most common of the 3 salivary gland tumours that are
considered as malignant mixed tumours.
• Arises due to carcinoma within the epithelial component
of an existing Pleomorphic Adenoma.
• Affects major salivary glands.
• Usually a painless mass with rapid growth and at times
facial paralysis.
• Gross pathology shows poor encapsulation.
• Histologically malignant appearing cells are present
adjacent to a typical appearing pleomorphic adenoma.
Those cells can take the form of any epithelial
malignancy.
30. CARCINOMA IN PLEOMORPHIC ADENOMA
CARCINOMASARCOMA
(True malignant mixed tumour)
• Rare malignant salivary gland neoplasm.
• Contains both carcinoma & sarcoma components.
• They can arise from existing mixed tumours or as a
separate entity.
• Mainly affects parotid gland; average age- 60.
• Swelling, pain, nerve palsy & ulceration are seen.
• Histologically, both sarcoma & carcinoma features are
seen. Sarcomatous features dominate specially
chondrosarcoma cells are most common type.
31. CARCINOMA IN PLEOMORPHIC ADENOMA
METASTASIZING MIXED TUMOUR
• Very rare histologically benign salivary gland neoplasm.
• Although benign; this type of pleomorphic adenoma
develops metastatic deposits.
• The neoplastic deposits are usually single, well defined
masses.
• Recurrences may occur at times after several years after
excision.
![2
ACINIC CELL ADENOCARCINOMA
[Acinic cell carcinoma]
• Salivary gland malignancy with acinar cell differentiation.
• In 1953,Buxon- malignant potential.
• Origin from intercalated duct reserve cells.
• After Warthin’s tumor & pleomorphic tumor, ACC is the
third common bilateral tumor.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)