Salivary glandtype carcinomas

J.W. Eveson

Fig. 1.16 Adenoid cystic carcinoma. A CT scan shows a nasal sinus mass focally extending into the bone. B The tumour (T) is inhomogenous and extends from the maxillary sinus into the infratemporal (black arrowhead) and the pterygopalatine fossa (black arrow). Perineural spread follows the Vidian cana (white arrowhead).

Fig. 1.16 Adenoid cystic carcinoma. A CT scan shows a nasal sinus mass focally extending into the bone. B The tumour (T) is inhomogenous and extends from the maxillary sinus into the infratemporal (black arrowhead) and the pterygopalatine fossa (black arrow). Perineural spread follows the Vidian cana (white arrowhead).

Salivary gland neoplasms of the sinonasal tract are uncommon, and the majority are malignant {1039}. For details see Chapter 5 on tumours of salivary glands.

ICD-O codes

Adenoid cystic carcinoma 8200/3 Acinic cell carcinoma 8550/3 Mucoepidermoid carcinoma

8430/3

Epithelial-myoepithelial carcinoma 8562/3

Clear cell carcinoma 8310/3

Adenoid cystic carcinoma

Adenoid cystic carcinoma is the most frequent malignant salivary gland-type tumour of the sinonasal tract. The age range is from 11-92 years {1039}. The majority develop in the maxillary sinus (about 60%) and nasal cavity (about 25%) {130}. The disease is often insidious, and symptoms include nasal obstruction, epistaxis, and pain, paraes-thesia or anaesthesia. Swelling of the palate or face, and loosening of the teeth may be the presenting symptom. Many tumours are large and extensively infiltrative at the time of diagnosis. These tumours can be difficult to detect on plain film radiographs and often extend widely through bone before there is radiograph-ical evidence of osseous destruction. In addition, the true extent of tumour spread is often underestimated by imaging techniques. The long-term prognosis is poor and the 10-year survival rate is only 7% {2444}. Most patients die as a result of local spread rather than metastatic disease {2799}.

Acinic cell carcinoma

Acinic cell carcinoma is rare in the sinonasal tract and cases have been reported in the nasal cavity {996,1950, 2014,2244,2698} and maxillary sinuses {829,2860}. The signs and symptoms are non-specific but they include nasal obstruction and epiphora.

Mucoepidermoid carcinoma

Mucoepidermoid carcinomas are rare at this site, and should be distinguished from the more aggressive variants of squamous cell carcinoma, especially adenosquamous carcinoma {1039, 1291,2588}.

Epithelial-myoepithelial carcinoma

Epithelial-myoepithelial carcinoma is rare in the sinonasal tract. Cases have been reported to involve the nasal septum, nasal cavity and maxillary sinus {1011,1221,1450,2506}. Signs and symptoms are non-specific but have

Fig. 1.17 Adenoid cystic carcinoma of nasal cavity. A Solid as well as tubular growth patterns are seen. B An intact surface mucosa overlying the cribriform and cystic patterns of a sinonasal adenoid cystic carcinoma. C A high power illustrating the relatively bland nuclear appearance with an intermediate to high nuclear to cytoplasmic ratio. Palisading is noted, along with small gland or tubule formation, in addition to the larger cyst-like spaces.

Fig. 1.17 Adenoid cystic carcinoma of nasal cavity. A Solid as well as tubular growth patterns are seen. B An intact surface mucosa overlying the cribriform and cystic patterns of a sinonasal adenoid cystic carcinoma. C A high power illustrating the relatively bland nuclear appearance with an intermediate to high nuclear to cytoplasmic ratio. Palisading is noted, along with small gland or tubule formation, in addition to the larger cyst-like spaces.

Fig. 1.18 Clear cell carcinoma.

Fig. 1.19 Mucoepidermoid carcinoma. A low grade mucoepidermoid carcinoma has variable sized mucus filled cystic spaces lined by mucocytes and intermediate cells.

included the formation of polypoid masses and nasal obstruction.

Clear cell carcinoma

Clear cell carcinoma, N.O.S., of the sinonasal tract is rare {1757,1874} and it is important to exclude metastatic renal clear cell carcinoma {1664,2918}. Microscopically, these tumours consist of closely packed, polygonal clear cells arranged in sheets and theques. They contain glycogen but no mucin.

Other tumours

A variety of other salivary gland-type carcinomas have been rarely reported in the nasal cavity and paranasal sinuses. These include: malignant myoepithe-lioma {2918}, carcinoma ex pleomorphic adenoma {435}, polymorphous low-grade adenocarcinoma {1536} and basal cell adenocarcinoma {785}.

Fig. 1.20 Mucoepidermoid carcinoma. Solid epithelial growth pattern with occasional mucocytes (left); predominant cystic pattern with numerous mucocytes and a few intermediate cells (right).

Table 1.2 Sinonasal glandular tumours*

Fig. 1.21 Mucoepidermoid carcinoma. The mucin production (left) can be accentuated with a muci-carmine stain where both the intracytoplasmic and extracellular mucin is highlighted (right)

Table 1.2 Sinonasal glandular tumours*

Tumour types

No of cases

Percentage

Pleomorphic adenoma

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