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CASE REPORT Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 808-810
Sarcomatoid salivary duct carcinoma of minor salivary gland: A rare case


1 Department of Pathology, Vinayaka Mission's Kirupananda Variyar Medical College, Salem, India
2 Department of Oto-Rhino-laryngology, Vinayaka Mission's Kirupananda Variyar Medical College, Salem, India

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Date of Web Publication27-Oct-2010
 

   Abstract 

A 35-year-old female presented with swelling in the soft palate. Fine needle aspiration cytology (FNAC) revealed pleomorphic adenoma, and on histopathological examination, it was diagnosed as carcinosarcoma/salivary duct carcinoma in the minor salivary gland, which was confirmed by immunohistochemical stains. We report this case for its rarity.

Keywords: Carcinosarcoma, pleomorphic adenoma, salivary duct carcinoma, soft palate

How to cite this article:
Thamilselvi R, Subramaniam P M, Shivarudrappa A S, Venugeethan A, Sinha P. Sarcomatoid salivary duct carcinoma of minor salivary gland: A rare case. Indian J Pathol Microbiol 2010;53:808-10

How to cite this URL:
Thamilselvi R, Subramaniam P M, Shivarudrappa A S, Venugeethan A, Sinha P. Sarcomatoid salivary duct carcinoma of minor salivary gland: A rare case. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 23];53:808-10. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/808/72102



   Introduction Top


Salivary duct carcinoma is a rare, high grade neoplasm that affects the parotid gland more frequently. Neoplasms of this type are infrequent in minor salivary gland. They are less aggressive and can be early diagnosed before distant metastases could occur. The term salivary duct carcinoma was applied first by Klein Sesser and Klein, as cited by Henley et al. [1] to describe a malignant neoplasm of salivary gland having resemblance to ductal carcinoma of the breast. The sarcomatoid variant is a rare subtype of salivary duct carcinoma, which comprises epithelial and sarcomatoid components.


   Case Report Top


A 35-year-old female presented with swelling in the soft palate since 15 years, with history of difficulty in swallowing and change in the voice.

On examination, a huge swelling on the left side of the palate was seen, extending superiorly up to the junction of hard and soft palate and inferiorly to the submandibular area. The lateral pharyngeal wall was hidden by the tumor. The epiglottis and the laryngeal orifice were pushed to the right side. On palpation, the tumor was non-tender and firm in consistency. There were no palpable neck nodes. Computed tomography of neck showed enlarged, well-defined, polypoidal, calcific, hyperdense mass arising from left tonsillar fossa [Figure 1]. Fine needle aspiration cytology (FNAC) of the oral mass revealed pleomorphic adenoma of the minor salivary gland [Figure 2]. The mass was excised and sent for histopathological examination. Grossly, two lobulated, firm masses were received. Superficial mass measuring 5.5 cm × 4.5 cm was gray white in color and deeper mass measuring 5 cm × 4 cm was received. Cut surface showed glistening area with homogenous appearance [Figure 3]. Microscopy of superficial mass showed sheets and acini of cuboidal epithelial cells in a myxoid background. The deeper mass showed two components, i.e., the carcinomatous and the sarcomatous areas. The carcinomatous area showed cuboidal cells in micropapillary, acinar and ductal pattern and the sarcomatous areas showed fascicles of spindle-shaped cells [Figure 4]. There was no heterogenous sarcomatous element. Immunohistochemistry was done. Epithelial component was positive for cytokeratin and epithelial membrane antigen [Figure 5] and negative for vimentin. The stromal component was positive for vimentin and predominantly negative for cytokeratin and epithelial membrane antigen. Few cells showed positivity for EMA and cytokeratin in stromal area [Figure 6].
Figure 1 :CT scan shows a large, well-defined, polypoidal, hyperdense, enhancing mass arising from left tonsillar fossa, causing oropharyngeal lumen narrowing

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Figure 2 :FNAC showing cohesive clusters and sheets of epithelial cells (Leishman's stain, ×100). (Inset) Aspiration cytology showing stromal matrix (Leishman's stain, ×100)

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Figure 3 :Cut surface of the mass shows glistening area with homogenous appearance

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Figure 4 :Comedopattern composed of neoplastic, cuboidal epithelial cells with central necrosis (H and E, ×10). Inset shows spindle-shaped cells arranged in fascicles (H and E, ×450)

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Figure 5 :Epithelial element shows epithelial membrane antigen positivity (immunostain, ×100). Inset shows epithelial element positive for cytokeratin (immunostain, ×100)

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Figure 6 :Stromal element shows vimentin positivity (immunostain, ×100). Inset shows occasional epithelial cells positive for vimentin (immunostain, ×100)

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   Discussion Top


The most frequently encountered neoplasm of salivary gland tissue is the benign mixed tumor. Its counterpart, the malignant mixed tumor, is rare, representing approximately 3-4% of all salivary gland tumors. [2] Recently, a variant of salivary duct carcinoma has been proposed. [1] Over 80% of the tumors are found in the parotid, more commonly in elderly men, with peak incidence in the sixth decade. Salivary duct carcinoma involving minor salivary gland of the oral cavity is rare. [3]

There are two types of malignant mixed tumors, i.e., carcinoma ex pleomorphic adenoma and carcinosarcoma.

Salivary duct carcinoma is a rare, high grade neoplasm that more frequently affects the parotid gland. The term salivary duct carcinoma was applied first by Klein Sesser and Klein, as cited by Henley et al. [1] to describe a malignant neoplasm of salivary gland having resemblance to ductal carcinoma of the breast. [1] It is characterized microscopically by intraductal tumor cell island with papillary, cribriform or solid configurations of cells, often with central comedonecrosis. Delgado et al. [4] suggested that cribriform growth and comedonecrosis are more frequently encountered in high grade tumors than in low grade.

Both salivary duct carcinoma and carcinosarcoma may arise from pre-existing pleomorphic adenoma. Recently, sarcomatoid salivary duct carcinoma has been described in an attempt to define those carcinosarcomas that manifest salivary duct carcinoma microscopically as a variant of salivary duct carcinoma rather than carcinosarcoma. The variants of salivary duct carcinoma are sarcomatoid, mucin-rich and invasive micropapillary variants. Invasive micropapillary variant appears to be particularly aggressive. [5]


   Conclusion Top


Sarcomatoid salivary duct carcinoma is an uncommon histological variant of salivary duct carcinoma. We reported this case for its rarity in age, site of malignancy and histomorphologic character.

 
   References Top

1.Henley JD, Seo IS, Dayan D, Gnepp DR. Sarcomatoid Salivary duct carcinoma of the parotid gland. Hum Pathol 2000;31:208-13.  Back to cited text no. 1
[PUBMED]    
2.Gnepp DR. Malignant mixed tumors of the salivary glands: A review. Pathol Annu 1993;28:279-328.  Back to cited text no. 2
[PUBMED]    
3.Brandwein MS, Jagirdar J, Patil T, Biller H, Kaneko M. Salivary duct carcinoma [Cribriform Salivary Carcinoma of Excretory Ducts]. A clinicopathologic and immunohistochemical study of 12 cases. Cancer 1990;65:2307-14.  Back to cited text no. 3
    
4.Delgado R. Klimstra D, Albores-Saavedra J. Low grade salivary duct carcinoma: a distinct variant with a low grade histology and a predominant intraductal growth pattern. Cancer 1996;78:958-67.  Back to cited text no. 4
    
5.Brandwin Gensler MS, Skalova A, Nagao T. Tumours of the salivary glands. In: Barnes L, Eveson JW, Reichar P, Sidransky D, editors. WHO Classification of tumors Head and neck 1 st ed. Lyon: IARC Press; 2005. p. 236-7.  Back to cited text no. 5
    

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Correspondence Address:
R Thamilselvi
Department of Pathology, Vinayaka Mission's Kirupananda Variyar Medical College, Seeragapadi, Salem - 636 308
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72102

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

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    Abstract
    Introduction
    Case Report
    Discussion
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