Prognosis and predictive factors

SDC is one of the most aggressive salivary malignancies. A review of 104 cases concluded that 33% of patients developed local recurrence and 46% developed distant metastasis {135}. Sites for distant metastasis include lungs, bones, liver, brain and skin. Sixty-five percent of patients died of disease, between 5 months to 10 years, usually within 4 years of diagnosis. The clinical course is characterized by early distant metastases. Tumour size, distant metastasis, and HER-2/neu overexpression are putative prognostic parameters for SDC, while expression of p53 protein, DNA aneu-ploidy, and proliferative activity do not correlate with outcome {2393}. The clinical outcome for the mucin-rich variant of SDC is similar to that of conventional SDC {2371}. The invasive micropapillary variant appears to be particularly aggressive {1820}.

Fig. 5.26 The intraductal proliferations of salivary duct carcinoma resemble intraductal breast carcinoma. The tumour forms "rigid" intraductal fenestrations.

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