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Salivary Glands and Other Head and Neck Structures

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Handbook of Practical Fine Needle Aspiration and Small Tissue Biopsies

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Abstract

Fine needle aspiration and small tissue biopsies have become a primary modality to achieve a definitive diagnosis of a mass-like lesion of the salivary gland. This chapter delineated cytologic and histologic features of common and rare neoplastic and nonneoplastic lesions of the salivary gland. The utilities and pitfalls of commonly used diagnostic immunohistochemical (IHC) stains, such as CD117, p63, GATA3, AR, GCDFP-15, and S100, and small diagnostic IHC panels, were described. Multiple challenging and yet practical cases at the end of the chapter were used to reemphasize important points illustrated throughout the chapters.

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Suggested Reading

Cytology

  • Bibbo M, Wilbur DC. Comprehensive cytopathology. 4th ed. Philadelphia: Elsevier, Saunders; 2015.

    Google Scholar 

  • Cibas ES, Ducatman BS. Cytology: diagnostic principles and clinical correlates. 2nd ed. Philadelphia: Saunders; 2003.

    Google Scholar 

  • Colella G, Cannavale R, Flamminio F, Foschini MP. Fine-needle aspiration cytology of salivary gland lesions: a systematic review. J Oral Maxillofac Surg. 2010;68(9):2146–53.

    Article  PubMed  Google Scholar 

  • DeMay RM. The art and science of cytopathology. 2nd ed. Chicago: American Society for Clinical Pathology (ASCP) Press; 2012.

    Google Scholar 

  • Hughes JH, Volk EE, Wilbur DC, Cytopathology Resource Committee, College of American Pathologists. Pitfalls in salivary gland fine-needle aspiration cytology: lessons from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic cytology. Arch Pathol Lab Med. 2005;129(1):26–31.

    PubMed  Google Scholar 

  • Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg. 1930;92(2):169–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schmidt RL, Hunt JP, Hall BJ, Wilson AR, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of frozen section for parotid gland lesions. Am J Clin Pathol. 2011;136(5):729–38.

    Article  PubMed  Google Scholar 

  • Stewart FW. The diagnosis of tumors by aspiration. Am J Pathol. 1933;9(Suppl):801–812.3.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Yousem DM, Kraut MA, Chalian AA. Major salivary gland imaging. Radiology. 2000;216(1):19–29.

    Article  CAS  PubMed  Google Scholar 

Histology

  • Chan JKC, Cheuk W. Tumors of the salivary glands. In: Fletcher CDM, editor. Diagnostic histopathology of tumors. 4th ed. Philadelphia: Saunders; 2013. p. 270–377.

    Google Scholar 

  • El-Naggar AK, JKC C, Grandis JR, Takata T, Slootweg PJ. WHO classification of head and neck tumours. Lyon: IARC; 2017.

    Google Scholar 

  • Gnepp DR. Diagnostic surgical pathology of the head and neck. 2nd ed. Philadelphia: Saunders; 2009.

    Google Scholar 

  • Harnes L, Eveson JW, Reichart P, et al. WHO classification of tumours: pathology and genetics, head and neck tumours. Lyon: IARC; 2005.

    Google Scholar 

Ancillary Studies

  • Abd Raboh NM, Hakim SA. Diagnostic role of DOG1 and p63 immunohistochemistry in salivary gland carcinomas. Int J Clin Exp Pathol. 2015;8(8):9214–22.

    PubMed  PubMed Central  Google Scholar 

  • Angiero F, Sozzi D, Seramondi R, Valente MG. Epithelial-myoepithelial carcinoma of the minor salivary glands: immunohistochemical and morphological features. Anticancer Res. 2009;29(11):4703–9.

    PubMed  Google Scholar 

  • Behboudi A, Enlund F, Winnes M, Andrén Y, Nordkvist A, Leivo I, et al. Molecular classification of mucoepidermoid carcinomas-prognostic significance of the MECT1-MAML2 fusion oncogene. Genes Chromosomes Cancer. 2006;45(5):470–81.

    Article  CAS  PubMed  Google Scholar 

  • Bishop JA. Unmasking MASC: bringing to light the unique morphologic, immunohistochemical and genetic features of the newly recognized mammary analogue secretory carcinoma of salivary glands. Head Neck Pathol. 2013;7(1):35–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bishop JA, Yonescu R, Batista DA, Westra WH, Ali SZ. Cytopathologic features of mammary analogue secretory carcinoma. Cancer Cytopathol. 2013;121(5):228–33.

    Article  CAS  PubMed  Google Scholar 

  • Brill LB 2nd, Kanner WA, Fehr A, Andrén Y, Moskaluk CA, Löning T, et al. Analysis of MYB expression and MYB-NFIB gene fusions in adenoid cystic carcinoma and other salivary neoplasms. Mod Pathol. 2011;24(9):1169–76.

    Article  CAS  PubMed  Google Scholar 

  • Chan JK, Suster S, Wenig BM, Tsang WY, Chan JB, Lau AL. Cytokeratin 20 immunoreactivity distinguishes Merkel cell (primary cutaneous neuroendocrine) carcinomas and salivary gland small cell carcinomas from small cell carcinomas of various sites. Am J Surg Pathol. 1997;21(2):226–34.

    Article  CAS  PubMed  Google Scholar 

  • Chandan VS, Wilbur D, Faquin WC, Khurana KK. Is c-kit (CD117) immunolocalization in cell block preparations useful in the differentiation of adenoid cystic carcinoma from pleomorphic adenoma? Cancer. 2004;102(4):207–9.

    Article  PubMed  Google Scholar 

  • Chênevert J, Duvvuri U, Chiosea S, Dacic S, Cieply K, Kim J, et al. DOG1: a novel marker of salivary acinar and intercalated duct differentiation. Mod Pathol. 2012;25(7):919–29.

    Article  PubMed  Google Scholar 

  • Connor A, Perez-Ordoñez B, Shago M, Skálová A, Weinreb I. Mammary analog secretory carcinoma of salivary gland origin with the ETV6 gene rearrangement by FISH: expanded morphologic and immunohistochemical spectrum of a recently described entity. Am J Surg Pathol. 2012;36(1):27–34.

    Article  PubMed  Google Scholar 

  • Debiec-Rychter M, Van Valckenborgh I, Van den Broeck C, Hagemeijer A, Van de Ven WJ, Kas K, et al. Histologic localization of PLAG1 (pleomorphic adenoma gene 1) in pleomorphic adenoma of the salivary gland: cytogenetic evidence of common origin of phenotypically diverse cells. Lab Investig. 2001;81(9):1289–97.

    Article  CAS  PubMed  Google Scholar 

  • do Prado RF, Consolaro A, Taveira LA. Expression of beta catenin in carcinoma in pleomorphic adenoma, pleomorphic adenoma and normal salivary gland: an immunohistochemical study. Med Oral Pathol Oral Cir Bucal. 2006;11(3):E247–51.

    Google Scholar 

  • Edwards PC, Bhuiya T, Kelsch RD. C-kit expression in the salivary gland neoplasms adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma, and monomorphic adenoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(5):586–93.

    Article  PubMed  Google Scholar 

  • Foo WC, Jo V, Krane JF. Utility of Myb, CD117 and PLAG1 Immunocytochemistry in fine needle aspiration diagnosis of salivary gland neoplasms. J Am Soc Cytopathol. 2013;2(suppl):S51–2.

    Article  Google Scholar 

  • Genelhu MC, Gobbi H, Arantes DC, Cardoso SV, Cassali GD. Immunolocalization of beta-catenin in pleomorphic adenomas and carcinomas ex-pleomorphic adenomas of salivary glands. Appl Immunohistochem Mol Morphol. 2007;15(3):273–8.

    Article  CAS  PubMed  Google Scholar 

  • Griffith CC, Stelow EB, Saqi A, Khalbuss WE, Schneider F, Chiosea SI, et al. The cytological features of mammary analogue secretory carcinoma: a series of 6 molecularly confirmed cases. Cancer Cytopathol. 2013;121(5):234–41.

    Article  CAS  PubMed  Google Scholar 

  • Jazaerly T, Bandyopadhyay S, Almardini N, Husain M. Diagnosis of sebaceous lymphadenoma by fine needle aspiration in a patient with Cowden syndrome: case report and review of the literature. Cytojournal. 2014;11:25.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jung MJ, Kim SY, Nam SY, Roh JL, Choi SH, Lee JH, et al. Aspiration cytology of mammary analogue secretory carcinoma of the salivary gland. Diagn Cytopathol. 2015;43(4):287–93.

    Article  PubMed  Google Scholar 

  • Jung MJ, Roh JL, Choi SH, Nam SY, Kim SY, Lee SW, et al. Basal cell adenocarcinoma of the salivary gland: a morphological and immunohistochemical comparison with basal cell adenoma with and without capsular invasion. Diagn Pathol. 2013;8:171.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kas K, Voz ML, Roijer E, Aström AK, Meyen E, Stenman G, et al. Promoter swapping between the genes for a novel zinc finger protein and beta-catenin in pleiomorphic adenomas with t(3;8)(p21;q12) translocations. Nat Genet. 1997;15:170–4.

    Article  CAS  PubMed  Google Scholar 

  • Kawahara A, Harada H, Abe H, Yamaguchi T, Taira T, Nakashima K, et al. Nuclear β-catenin expression in basal cell adenomas of salivary gland. J Oral Pathol Med. 2011;40(6):460–6.

    Article  CAS  PubMed  Google Scholar 

  • Kawahara A, Taira T, Abe H, Takase Y, Kurita T, Sadashima E, et al. Diagnostic utility of phosphorylated signal transducer and activator of transcription 5 immunostaining in the diagnosis of mammary analogue secretory carcinoma of the salivary gland: a comparative study of salivary gland cancers. Cancer Cytopathol. 2015;123(10):603–11.

    Article  CAS  PubMed  Google Scholar 

  • Levine P, Fried K, Krevitt LD, Wang B, Wenig BM. Aspiration biopsy of mammary analogue secretory carcinoma of accessory parotid gland: another diagnostic dilemma in matrix-containing tumors of the salivary glands. Diagn Cytopathol. 2014;42(1):49–53.

    Article  PubMed  Google Scholar 

  • Lin F, Liu H. Immunohistochemistry in undifferentiated neoplasm/tumor of uncertain origin. Arch Pathol Lab Med. 2014;138(12):1583–610.

    Article  PubMed  Google Scholar 

  • Mariano FV, dos Santos HT, Azañero WD, da Cunha IW, Coutinho-Camilo CM, de Almeida OP, et al. Mammary analogue secretory carcinoma of salivary glands is a lipid-rich tumour, and adipophilin can be valuable in its identification. Histopathology. 2013;63(4):558–67.

    PubMed  Google Scholar 

  • Matsuyama A, Hisaoka M, Nagao Y, Hashimoto H. Aberrant PLAG1 expression in pleomorphic adenomas of the salivary gland: a molecular genetic and immunohistochemical study. Virchows Arch. 2011;458(5):583–92.

    Article  CAS  PubMed  Google Scholar 

  • Mino M, Pilch BZ, Faquin WC. Expression of KIT (CD117) in neoplasms of the head and neck: an ancillary marker for adenoid cystic carcinoma. Mod Pathol. 2003;16(12):1224–31.

    Article  CAS  PubMed  Google Scholar 

  • Mitani Y, Li J, Rao PH, Zhao YJ, Bell D, Lippman SM, et al. Comprehensive analysis of the MYB-NFIB gene fusion in salivary adenoid cystic carcinoma: incidence, variability, and clinicopathologic significance. Clin Cancer Res. 2010;16(19):4722–31.

    Article  CAS  PubMed  Google Scholar 

  • Mitani Y, Rao PH, Futreal PA, Roberts DB, Stephens PJ, Zhao YJ, et al. Novel chromosomal rearrangements and break points at the t(6;9) in salivary adenoid cystic carcinoma: association with MYB-NFIB chimeric fusion, MYB expression, and clinical outcome. Clin Cancer Res. 2011;17(22):7003–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nagao T, Sugano I, Ishida Y, Hasegawa M, Matsuzaki O, Konno A, et al. Basal cell adenocarcinoma of the salivary glands: comparison with basal cell adenoma through assessment of cell proliferation, apoptosis, and expression of p53 and bcl-2. Cancer. 1998;82(3):439–47.

    Article  CAS  PubMed  Google Scholar 

  • Nikitakis NG, Tosios KI, Papanikolaou VS, Rivera H, Papanicolaou SI, Ioffe OB. Immunohistochemical expression of cytokeratins 7 and 20 in malignant salivary gland tumors. Mod Pathol. 2004;17(4):407–15.

    Google Scholar 

  • Ohtomo R, Mori T, Shibata S, Tsuta K, Maeshima AM, Akazawa C, et al. SOX10 is a novel marker of acinus and intercalated duct differentiation in salivary gland tumors: a clue to the histogenesis for tumor diagnosis. Mod Pathol. 2013;26(8):1041–50.

    Article  CAS  PubMed  Google Scholar 

  • Ozolek JA, Bastacky SI, Myers EN, Hunt JL. Immunophenotypic comparison of salivary gland oncocytoma and metastatic renal cell carcinoma. Laryngoscope. 2005;115(6):1097–100.

    Article  PubMed  Google Scholar 

  • Patel KR, Solomon IH, El-Mofty SK, Lewis JS Jr, Chernock RD. Mammaglobin and S-100 immunoreactivity in salivary gland carcinomas other than mammary analogue secretory carcinoma. Hum Pathol. 2013;44(11):2501–8.

    Article  CAS  PubMed  Google Scholar 

  • Penner CR, Folpe AL, Budnick SD. C-kit expression distinguishes salivary gland adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma. Mod Pathol. 2002;15(7):687–91.

    Article  PubMed  Google Scholar 

  • Persson M, Andren Y, Mark J, Horlings HM, Persson F, Stenman G. Recurrent fusion of MYB and NFIB transcription factor genes in carcinomas of the breast and head and neck. Proc Natl Acad Sci U S A. 2009a;106:18740–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Persson F, Andren Y, Winnes M, Wedell B, Nordkvist A, Gudnadottir G, et al. High-resolution genomic profiling of adenomas and carcinomas of the salivary glands reveals amplification, rearrangement, and fusion of HMGA2. Genes Chromosomes Cancer. 2009b;48(1):69–82.

    Article  CAS  PubMed  Google Scholar 

  • Pinto A, Nosé V, Rojas C, Fan YS, Gomez-Fernandez C. Searching for mammary analogue [corrected] secretory carcinoma of salivary gland among its mimics. Mod Pathol. 2014;27(1):30–7.

    Article  CAS  PubMed  Google Scholar 

  • Pusztaszeri MP, García JJ, Faquin WC. Salivary gland FNA: new markers and new opportunities for improved diagnosis. Cancer Cytopathol. 2016;124(5):307–16.

    Article  PubMed  Google Scholar 

  • Rotellini M, Palomba A, Baroni G, Franchi A. Diagnostic utility of PLAG1 immunohistochemical determination in salivary gland tumors. Appl Immunohistochem Mol Morphol. 2014;22(5):390–4.

    Article  CAS  PubMed  Google Scholar 

  • Schmitt AC, Cohen C, Siddiqui MT. Expression of SOX10 in salivary gland oncocytic neoplasms: a review and a comparative analysis with other immunohistochemical markers. Acta Cytol. 2015;59(5):384–90.

    Google Scholar 

  • Schmitt AC, McCormick R, Cohen C, Siddiqui MT. DOG1, p63, and S100 protein: a novel immunohistochemical panel in the differential diagnosis of oncocytic salivary gland neoplasms in fine- needle aspiration cell blocks. J Am Soc Cytopathol. 2014;3(6):303–8.

    Article  Google Scholar 

  • Schuerch C, Zhu S. Salivary glands and head and neck. In: Lin F, Prichard JW, Liu H, Wilkerson M, Chen ZE, editors. Handbook of practical immunohistochemistry: frequent asked questions. 2nd ed. New York: Springer Science+Business Media; 2015. p. 287–311.

    Google Scholar 

  • Schwartz LE, Begum S, Westra WH, Bishop JA. GATA3 immunohistochemical expression in salivary gland neoplasms. Head Neck Pathol. 2013;7(4):311–5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sedassari BT, Dos Santos HT, Mariano FV, da Silva Lascane NA, Altemani A, Sousa S. Carcinoma ex pleomorphic adenoma of minor salivary glands with major epithelial-myoepithelial component: clinicopathologic and immunohistochemical study of 3 cases. Ann Diagn Pathol. 2015;19(3):164–8.

    Article  PubMed  Google Scholar 

  • Seethala RR, Thompson LD, Gnepp DR, Barnes EL, Skalova A, Montone K, et al. Lymphadenoma of the salivary gland: clinicopathological and immunohistochemical analysis of 33 tumors. Mod Pathol. 2012;25(1):26–35.

    Article  PubMed  Google Scholar 

  • Shah AA, Wenig BM, LeGallo RD, Mills SE, Stelow EB. Morphology in conjunction with immunohistochemistry is sufficient for the diagnosis of mammary analogue secretory carcinoma. Head Neck Pathol. 2015;9(1):85–95.

    Article  PubMed  Google Scholar 

  • Skalova A. Mammary analogue secretory carcinoma of salivary gland origin: an update and expanded morphologic and immunohistochemical spectrum of recently described entity. Head Neck Pathol. 2013;7(Suppl 1):S30–6.

    Article  PubMed  Google Scholar 

  • Skálová A, Simpson RH, Lehtonen H, Leivo I. Assessment of proliferative activity using the MIB1 antibody help to distinguish polymorphous low grade adenocarcinoma from adenoid cystic carcinoma of salivary glands. Pathol Res Pract. 1997;193(10):695–703.

    Article  PubMed  Google Scholar 

  • Skálová A, Vanecek T, Sima R, Laco J, Weinreb I, Perez-Ordonez B, et al. Mammary analogue secretory carcinoma of salivary glands, containing the ETV6-NTRK3 fusion gene: a hitherto undescribed salivary gland tumor entity. Am J Surg Pathol. 2010;34(5):599–608.

    PubMed  Google Scholar 

  • Tognon C, Knezevich SR, Huntsman D, Roskelley CD, Melnyk N, Mathers JA, et al. Expression of the ETV6-NTRK3 gene fusion as a primary event in human secretory breast carcinoma. Cancer Cell. 2002;2(5):367–76.

    Article  CAS  PubMed  Google Scholar 

  • Tonon G, Modi S, Wu L, Kubo A, Coxon AB, Komiya, et al. t(11;19)(q21;p13) translocation in mucoepidermoid carcinoma creates a novel fusion product that disrupts a notch signaling pathway. Nat Genet. 2003;33(2):208–13.

    Article  CAS  PubMed  Google Scholar 

  • Urano M, Nagao T, Miyabe S, Ishibashi K, Higuchi K, Kuroda M. Characterization of mammary analogue secretory carcinoma of the salivary gland: discrimination from its mimics by the presence of the ETV6-NTRK3 translocation and novel surrogate markers. Hum Pathol. 2015;46(1):94–103.

    Article  CAS  PubMed  Google Scholar 

  • Voz ML, Astrom AK, Kas K, Mark J, Stenman G, Van de Ven WJ. The recurrent translocation t(5;8)(p13;q12) in pleomorphic adenomas results in upregulation of PLAG1 gene expression under control of the LIFR promoter. Oncogene. 1998;16(11):1409–16.

    Article  CAS  PubMed  Google Scholar 

  • Woo VL, Bhuiya T, Kelsch R. Assessment of CD43 expression in adenoid cystic carcinomas, polymorphous low-grade adenocarcinomas, and monomorphic adenomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(4):495–500.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Laboratory Medicine, Geisinger Health System, Danville, PA, USA

    Haiyan Liu & Fan Lin

  2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA

    Jun Zhang

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  1. Haiyan Liu
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Liu, H., Zhang, J., Lin, F. (2018). Salivary Glands and Other Head and Neck Structures. In: Handbook of Practical Fine Needle Aspiration and Small Tissue Biopsies. Springer, Cham. https://doi.org/10.1007/978-3-319-57386-1_2

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  • DOI: https://doi.org/10.1007/978-3-319-57386-1_2

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