Intercalated duct lesions of salivary gland: a morphologic spectrum from hyperplasia to adenoma.
ABSTRACT 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.
SourceAvailable from: Victor Montalli[Show abstract] [Hide abstract]
ABSTRACT: The morphological criteria for identification of intercalated duct lesions (IDLs) of salivary glands were recently defined. It has been hypothesized that IDL could be a precursor of basal cell adenoma (BCA). BCAs show a variety of histological patterns and the tubular variant is the one that presents stronger resemblance with IDLs. The aim of this study was to analyze the morphologic and immunohistochemical profiles of IDLs and BCAs classified into tubular and non-tubular subtypes to verify whether IDL and T-BCA would represent distinct entities. Eight cases of IDLs, 9 tubular BCA and 19 non-tubular BCA were studied. All tubular BCAs contained IDL-like areas, which represented 20% to 70% of the tumor. In non-tubular BCA, IDL-like areas were occasional and small (< 5%). One patient presented IDLs, tubular BCA and IDL/tubular BCA combined lesions. Luminal ductal cells of IDLs and tubular BCA exhibited positivity for CK7, lysozyme, S100 and DOG1. In non-tubular BCA group, few luminal cells exhibited such immunoprofile; they were mainly CK14 positive. Basal/myoepithelial cells of IDLs, tubular BCA and non-tubular BCA were positive for CK14, calponin, α-SMA and p63; they were more numerous in BCA lesions. IDL, tubular BCA and non-tubular BCA form a continuum of lesions where IDLs are closely related to tubular BCA. In both, the immunoprofile of luminal and myoepithelial cells recapitulates normal intercalated duct. The difference between adenoma-like subset of IDLs and tubular BCA rests mainly on the larger numbers of myoepithelial cells in the latter. Our findings indicate that at least some BCA can arise via IDL. This article is protected by copyright. All rights reserved.Histopathology 12/2013; 64(6). DOI:10.1111/his.12339 · 3.30 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Basal cell adenoma and basal cell adenocarcinoma represent uncommon basaloid salivary gland neoplasms that show marked morphologic similarity. We wished to compare clinical outcome and morphologic features as well as growth and proliferation associated markers for both neoplasms. We reviewed the pathologic features of 70 neoplasms diagnosed as basal cell adenoma or basal cell adenocarcinoma. Observations included maximum mitotic activity and presence or absence of invasion into surrounding normal tissues as well as immunohistochemical studies for Ki-67, caspase 3, p53, and bcl-2. Establishing malignancy on the basis of invasion into surrounding benign tissues, 41 basal cell adenomas and 29 basal cell adenocarcinomas were identified. For tumors with follow-up, recurrence rates were 6.7 % for basal cell adenoma and 16.7 % for basal cell adenocarcinoma. One patient with basal cell adenocarcinoma had distant metastases and died of disease. Overall basal cell adenocarcinomas showed significantly higher values for growth and proliferation markers compared to basal cell adenomas. Salivary gland basal cell adenoma and basal cell adenocarcinoma show morphologic similarity. Basal cell adenocarcinoma can exhibit a locally aggressive behavior and has potential metastatic behavior. The overall mitotic rate and Ki-67 expression were higher in basal cell adenocarcinoma compared to basal cell adenoma, but overlap between the results of these observations in each tumor did not allow for accurate diagnosis or prediction of outcome in individual cases. We conclude that morphologic observation of local tissue invasion is the best marker for separating basal cell adenoma from basal cell adenocarcinoma.Head and Neck Pathology 08/2014; DOI:10.1007/s12105-014-0562-4
Archives of Oto-Rhino-Laryngology 01/2014; 271(5). DOI:10.1007/s00405-014-2879-8 · 1.61 Impact Factor