Difference between revisions of "Salivary duct carcinoma"
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| Width = | | Width = | ||
| Caption = Salivary duct carcinoma. [[H&E stain]]. | | Caption = Salivary duct carcinoma. [[H&E stain]]. | ||
| Micro = varied arch. (sheets, nests, cords, cribriform, micropapillary), neoplastic cells line-up around cystic spaces "Roman bridges", nuclear atypia, apocrine snouts, decapitation secretions | | Micro = varied arch. (sheets, nests, cords, [[cribriform]], micropapillary), neoplastic cells line-up around cystic spaces "Roman bridges", nuclear atypia, apocrine snouts, decapitation secretions | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[ductal carcinoma of the breast]] | | LMDDx = [[carcinoma ex pleomorphic adenoma]] with SDC component, [[ductal carcinoma of the breast]], [[intraductal carcinoma of the salivary gland]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = LMWK, EMA, CK7, CK19 +ve, AR +ve, BRST2 (GCDFP-15) +ve, HER2 -ve/+ve, p63 -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 14: | Line 14: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[salivary gland]] | | Site = [[salivary gland]] - usu. parotid gland | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = typically male, usu. >50 years old | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = | | Prevalence = rare | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = | ||
| Line 39: | Line 39: | ||
==Microscopic== | ==Microscopic== | ||
Features - resembles ductal breast carcinoma:<ref name=pmid21393874/> | Features - resembles ductal breast carcinoma:<ref name=pmid21393874/> | ||
*Architecture: sheets, nests, cords, cribriform, micropapillary. | *Architecture: sheets, nests, cords, [[cribriform]], micropapillary. | ||
*Neoplastic cells line-up around cystic spaces "Roman bridges". | *Neoplastic cells line-up around cystic spaces "Roman bridges". | ||
*Nuclear atypia (variation in size, shape, staining). | *Nuclear atypia (variation in size, shape, staining). | ||
| Line 50: | Line 50: | ||
DDx: | DDx: | ||
*[[Carcinoma ex pleomorphic adenoma]] with SDC component. | *[[Carcinoma ex pleomorphic adenoma]] with SDC component. | ||
*[[Intraductal carcinoma of the salivary gland]] - previously referred to as ''low-grade salivary duct carcinoma''. | |||
===Images=== | ===Images=== | ||
| Line 63: | Line 64: | ||
Image:Salivary duct carcinoma -a- intermed mag.jpg | SDC - intermed. mag. (WC/Nephron) | Image:Salivary duct carcinoma -a- intermed mag.jpg | SDC - intermed. mag. (WC/Nephron) | ||
</gallery> | </gallery> | ||
[[File: 5 3689176038337 sl 1.png|salivary duct carcinoma]] | |||
[[File: 5 3689176038337 sl 2.png|salivary duct carcinoma]] | |||
[[File: 5 3689176038337 sl 3.png|salivary duct carcinoma]] | |||
[[File: 5 3689176038337 sl 4.png|salivary duct carcinoma]] | |||
[[File: 5 3689176038337 sl 5.png|salivary duct carcinoma]] | |||
[[File: 5 3689176038337 sl 6.png|salivary duct carcinoma]] | |||
Salivary duct carcinoma. 59 y man with a 3 cm right superficial parotid mass. A. Low power shows a predominance of patterns similar to in situ, micropapillary (white arrow), Roman bridge (green arrow), cribriform (blue arrow) patterns. B. Careful search reveals occasional invasive bars (arrow). C. The bar comprises the usual invasive pattern of adenocarcinoma, with cancerous cell clusters, isolated glands, incomplete glands, and adjoined/fused glands. Note the lighter color of stromal desmoplasia (arrows). D. The in situ component has more uniform nuclei than the invasive component. Note the comedo necrosis. E. Cancer cells expressed CK7. F. Cancer cell nuclei were positive for androgen receptor. Not shown: tumor was negative for SOX10 and P63. | |||
===Subtypes=== | ===Subtypes=== | ||
| Line 74: | Line 83: | ||
==IHC== | ==IHC== | ||
*LMWK, EMA, CK7, CK19 +ve. | *LMWK, EMA, CK7, CK19 +ve. | ||
*p63 -ve. | *[[p63]] -ve. | ||
*Androgen receptor +ve. | *[[Androgen receptor]] +ve (~90% of cases).<ref name=pmid10757407>{{Cite journal | last1 = Fan | first1 = CY. | last2 = Wang | first2 = J. | last3 = Barnes | first3 = EL. | title = Expression of androgen receptor and prostatic specific markers in salivary duct carcinoma: an immunohistochemical analysis of 13 cases and review of the literature. | journal = Am J Surg Pathol | volume = 24 | issue = 4 | pages = 579-86 | month = Apr | year = 2000 | doi = | PMID = 10757407 }}</ref> | ||
*BRST2 (GCDFP-15) +ve. | *BRST2 ([[GCDFP-15]]) +ve. | ||
*HER2 +ve ~21%; use of [[trastuzumab]] (Herceptin) not systematically studied. | *HER2 +ve ~21%; use of [[trastuzumab]] (Herceptin) not systematically studied. | ||
Curiosity: | Curiosity: | ||
*PSA +/-. | *[[PSA]] +ve/-ve. | ||
*PSAP +/-. | *[[PSAP]] +ve/-ve. | ||
*ER-beta +ve.<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf]. Accessed on: 3 April 2012.</ref> | *ER-beta +ve.<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf]. Accessed on: 3 April 2012.</ref> | ||
*ER-alpha -ve (the common ''ER'' stain). | *ER-alpha -ve (the common ''ER'' stain). | ||
| Line 93: | Line 102: | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Head and neck pathology]] | [[Category:Head and neck pathology]] | ||
[[Category:Salivary gland]] | |||
Latest revision as of 13:35, 2 July 2021
| Salivary duct carcinoma | |
|---|---|
| Diagnosis in short | |
 Salivary duct carcinoma. H&E stain. | |
|
| |
| LM | varied arch. (sheets, nests, cords, cribriform, micropapillary), neoplastic cells line-up around cystic spaces "Roman bridges", nuclear atypia, apocrine snouts, decapitation secretions |
| LM DDx | carcinoma ex pleomorphic adenoma with SDC component, ductal carcinoma of the breast, intraductal carcinoma of the salivary gland |
| IHC | LMWK, EMA, CK7, CK19 +ve, AR +ve, BRST2 (GCDFP-15) +ve, HER2 -ve/+ve, p63 -ve |
| Site | salivary gland - usu. parotid gland |
|
| |
| Clinical history | typically male, usu. >50 years old |
| Prevalence | rare |
| Prognosis | poor |
| Clin. DDx | other salivary gland tumours |
Salivary duct carcinoma, abbreviated SDC, is a rare salivary gland tumour that typically has an aggressive course.
General
- Malignant counterpart of salivary duct adenoma.
- Male:female ~= 4:1.
- Dismal prognosis.[1]
- Typically >50 years old.
- Mostly in the parotid.
Microscopic
Features - resembles ductal breast carcinoma:[1]
- Architecture: sheets, nests, cords, cribriform, micropapillary.
- Neoplastic cells line-up around cystic spaces "Roman bridges".
- Nuclear atypia (variation in size, shape, staining).
- Apocrine snouts - pseudopod-like/lollipop-like undulations of the cell membrane.
- Decapitation secretions - apocrine snouts (membrane bound blobs of cytoplasm) that have separated from its mother cell.
Notes:
- Similar to ductal breast carcinoma - key to remember.
DDx:
- Carcinoma ex pleomorphic adenoma with SDC component.
- Intraductal carcinoma of the salivary gland - previously referred to as low-grade salivary duct carcinoma.
Images
SDC - very low mag. (WC/Nephron)
SDC - low mag. (WC/Nephron)
SDC - intermed. mag. (WC/Nephron)
SDC - high mag. (WC/Nephron)
SDC - very high mag. (WC/Nephron)
SDC - low mag. (WC/Nephron)
SDC - intermed. mag. (WC/Nephron)
Salivary duct carcinoma. 59 y man with a 3 cm right superficial parotid mass. A. Low power shows a predominance of patterns similar to in situ, micropapillary (white arrow), Roman bridge (green arrow), cribriform (blue arrow) patterns. B. Careful search reveals occasional invasive bars (arrow). C. The bar comprises the usual invasive pattern of adenocarcinoma, with cancerous cell clusters, isolated glands, incomplete glands, and adjoined/fused glands. Note the lighter color of stromal desmoplasia (arrows). D. The in situ component has more uniform nuclei than the invasive component. Note the comedo necrosis. E. Cancer cells expressed CK7. F. Cancer cell nuclei were positive for androgen receptor. Not shown: tumor was negative for SOX10 and P63.
Subtypes
- Conventional.
- Mucinous - worse prognosis; opposite of what would one expect from the outcomes in breast cancer.
- Micropapillary - assoc. with a poor prognosis.
- Sarcomatoid/spindle cell.
IHC
- LMWK, EMA, CK7, CK19 +ve.
- p63 -ve.
- Androgen receptor +ve (~90% of cases).[2]
- BRST2 (GCDFP-15) +ve.
- HER2 +ve ~21%; use of trastuzumab (Herceptin) not systematically studied.
Curiosity:
See also
References
- ↑ 1.0 1.1 Rajesh, NG.; Prayaga, AK.; Sundaram, C.. "Salivary duct carcinoma: correlation of morphologic features by fine needle aspiration cytology and histopathology.". Indian J Pathol Microbiol 54 (1): 37-41. doi:10.4103/0377-4929.77321. PMID 21393874. http://www.ijpmonline.org/text.asp?2011/54/1/37/77321.
- ↑ Fan, CY.; Wang, J.; Barnes, EL. (Apr 2000). "Expression of androgen receptor and prostatic specific markers in salivary duct carcinoma: an immunohistochemical analysis of 13 cases and review of the literature.". Am J Surg Pathol 24 (4): 579-86. PMID 10757407.
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/MajorSalGlands_11protocol.pdf. Accessed on: 3 April 2012.