Intercalated Duct Lesions of Salivary Gland: A Morphologic Spectrum From Hyperplasia to Adenoma
Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario M5G 2C4, Canada. The American journal of surgical pathology
(Impact Factor: 5.15).
07/2009; 33(9):1322-9. DOI: 10.1097/PAS.0b013e3181a55c15
Intercalated duct lesions (IDLs) are rare, poorly understood and not well-studied lesions that have been associated with a small number of epithelial-myoepithelial carcinomas (EMC) and basal cell adenomas. To examine the nature of IDLs and their association with salivary gland tumors, we reviewed 34 lesions in 32 patients. The IDLs were stained with CK7, estrogen receptors (ER), progesterone receptors, lysozyme, S100, calponin, and CK14. The patients ranged in age from 19 to 80 years (mean 53.8) with a 1.7:1 female predominance. The majorities of IDLs were parotid lesions (82%), were small and nodular (average size 3.1 mm) and showed 3 architectural patterns: hyperplasia (20), adenoma (9), and hybrid forms (5). In 59% of cases, IDLs were seen in conjunction with another salivary gland tumor, most commonly basal cell adenoma (8 cases), followed by EMC (3 cases). One case showed a combination of intercalated duct hyperplasia and basal cell adenoma. The IDLs stained diffusely with CK7 (100%) and S100 (73%) and focally for ER (91%) and lysozyme (100%). Calponin and CK14 highlighted a thin myoepithelial cell layer around all ducts (100%). Normal intercalated ducts were also consistently positive for CK7 and lysozyme, and focally for ER, but were S100 negative. In summary, IDLs have a variety of patterns ranging from hyperplasia to adenoma with hybrid lesions and share morphologic and immunophenotypic features with normal intercalated ducts. There is an association with basal cell adenomas and EMC, which lends credence to their role as a putative precursor lesion.
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- "AR ER-a ER-b Not specified ER PR Acini + 1,2 ) 3,4 + 4,5 + ⁄ ) 7 Intercalleted ducts + 2 ) 3,4 + 4,5 + 6,7 + 7 Striated ducts + 1,2 ) 3,4 + 4,5 + 7 + 7 Excretory ducts + 2 ) 3,4 + 4,5 + 7 1 Morrell et al, 1987; 2 Laine et al, 1993; 3 Vadlamudi et al, 2005; 4 Ohshiro et al, 2006; 5 Williams et al, 2007; 6 Weinreb et al, 2009; 7 Ozono et al, 1992 "
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ABSTRACT: Oral Diseases (2010) 16, 577–585
Usually no distinction is made between female and male salivary glands although cyclic changes of and/or differences in serum and salivary sex steroid concentrations characterize women and men. Moreover, sexual dimorphism is well recognized in salivary glands of rodents. Salivary glands contain estrogen and androgen receptors and are, according to modern high throughput technologies, subjected to gender differences not explainable by gene dose effects by the X chromosome alone. Because sex steroids are lipophilic, it is often thought that approximately 10% of them passively diffuse from plasma to saliva. Indeed, saliva can find use as sample material in sports medicine, pediatrics, veterinary medicine and behavioral sciences. Last but not least, humans and other primates are unique in that they have a reticular zone in their adrenal cortex, which produces dehydroepiandrosterone and androstendione pro-hormones. These are processed in peripheral tissues, not only in female breast and uterus and male prostate, but also in salivary glands by an intracrine enzymatic machinery to active 17β-estradiol, dihydrotestosterone and others, to satisfy and buffer against a constantly changing needs caused by circadian, menstrual, pregnancy and chronobiological hormonal changes in the systemic circulation. Female dominance of Sjögren’s syndrome and certain forms of salivary gland cancer probably reflect these gender-based differences.
Oral Diseases 10/2010; 16(7):577-85. DOI:10.1111/j.1601-0825.2010.01669.x · 2.43 Impact Factor
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ABSTRACT: This review concentrates on significant developments in salivary pathology since the 2005 WHO classification was written.•Sclerosing polycystic adenosis is a rare lesion often mistaken histologically for carcinoma. Previously thought to be a reactive fibro-inflammatory process, recent evidence of clonality suggests it may be neoplastic.•Histological grading of mucoepidermoid carcinoma has been shown to have clinical relevance, but it is not clear yet which is the best method. Also, other prognostic indices, particularly MIB1 proliferation may be useful in practice.•Epithelial–myoepithelial carcinoma has been known as mainly a clear cell tumour, but it has now been recognized to have a much wider spectrum of histological appearances.•Various morphological variants of salivary duct carcinoma have been described, and a possibly clinically significant molecular classification has been proposed.•The relationship between low-grade cribriform cystadenocarcinoma and salivary duct carcinoma remains unclear.
Diagnostic Histopathology 06/2010; 16(6-16):276-286. DOI:10.1016/j.mpdhp.2010.03.007
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ABSTRACT: To describe a salivary adenoma composed largely of unilayered ducts resembling striated ducts, and to differentiate it from similar adenomas, including canalicular and intercalated duct adenoma.
Six unilayered ductal adenomas were identified in parotid (four) and palate (two). They were encapsulated, ranged from 0.5 to 3.0 cm and composed of closely apposed ducts with virtually no stroma. The ducts varied in size and showed cysts up to 0.1 cm. The cells were eosinophilic and bland. Prominent cell membranes, reminiscent of 'striations' of normal striated ducts, were seen. The typical epithelial 'beading' pattern with abundant stroma of canalicular adenoma was absent. The tumours expressed keratins (six of six) and S100 (five of six). Smooth muscle actin (SMA) revealed no myoepithelial cells. Two tumours showed focal bilayered ducts with calponin or smooth muscle myosin heavy chain, but the tumours were largely unilayered. Only isolated cells in three tumours were positive with p63; a pattern identical to striated ducts. In contrast, the normal excretory and intercalated ducts all contained diffuse bilayering with basal or myoepithelial markers.
Striated duct adenomas are unilayered ductal tumours that recapitulate normal striated ducts.
Histopathology 11/2010; 57(5):707-15. DOI:10.1111/j.1365-2559.2010.03682.x · 3.45 Impact Factor
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