Benign

Neoplasms of Salivary Glands

Banun Kusumawardani
Dept. Biomedical Sciences
Faculty of Den9stry – University of Jember
Salivary Gland
Salivary Gland
 A

B C
Pleomorphic •  Almost 75% of the paro9d tumors involve the superficial
lobe and present with a painless, slow growing mass in
front of or behind the ear. The remaining 25% involve the
Adenoma deep lobe of the paro9d and present as a parapharyngeal
mass.
•  Facial nerve paralysis should raise the suspicion for
malignant transformaDon.
•  The tail of paroDd is the most common site of occurrence.
•  Bilateral and mul9ple tumors are not common.
•  The characteris9c gross appearance with pink-tan rubbery
surface, well-defined pushing margins and translucent
areas of carDlaginous differenDaDon surrounded by a thin
rim of unremarkable salivary gland.
•  The consistency and the gross appearance depend upon the
degree of cellularity and the amount and type of stroma.
•  They are well circumscribed and usually encapsulated
lesions. The capsule may some9mes be deficient or even
absent.
•  Histologically, pleomorphic adenomas (PA) are divided in
three major types: classic or typical, cellular, and atypical
types.
•  Sharply demarcated greyish glassy tumor within the
lobulated brown parenchyma of the paro9d gland. The
gross appearance reflects the presence of prominent myxo-
chondroid matrix.
 Pleomorphic
Adenoma
•  PA arising in major salivary glands usually
have thick capsule
•  The capsule can be variable and rarely may
be absent

The tumor is on the lower leN of

the capsule and normal salivary
parenchyma is on the upper
right
 Pleomorphic Adenoma
•  Pleomorphic adenoma of minor salivary
glands shows a well demarcated tumor
without capsule and overlying normal oral
mucosa
•  The trabecular arrangement of epithelial
cells admixed with eosinophilic stroma
within the tumor.

•  A minor salivary gland (mucous

glands in right upper half of the slide)
and a well-defined pleomorphic
adenoma without encapsula9on (leN
lower half of the slide).
•  Foci of squamous metaplasia are
seen.
 Pleomorphic
Adenoma

•  Pleomorphic adenomas (PA) have epithelial, myoepithelial and stromal components

•  The histopathologic appearance of a classic PA can be variable depending upon the
rela9ve propor9on of these elements
•  PA shows a well-demarcated tumor with a lobulated growth paKern
•  The tubular and acinar structures formed by the epithelial component are admixed
with myoepithelial cells in a myxoid stroma
Pleomorphic
Adenoma

•  Pleomorphic adenoma involving the paro9d gland

•  Lobules of myxoid matrix containing myoepithelial cells are surrounded by
epithelial component displaying trabecular, tubular, and acinar architecture
Pleomorphic
Adenoma

•  A pleomorphic adenoma demonstrates classic appearance with an admixture of

epithelial, myoepithelial, and stromal elements
•  The epithelial cells form the inner layer of acinar and tubular structures, whereas
the myoepithelial cells form the outer layer
Pleomorphic
Adenoma

•  Classic appearance of a pleomorphic adenoma with an admixture of epithelial,

myoepithelial, and stromal elements
•  The stroma consists of abundant basophilic myxoid foci as well as eosinophilic
hyalinized areas
 Pleomorphic
Adenoma

•  The stroma of pleomorphic adenoma (PA) is synthesized by the myoepithelial cells

and can have myxoid to chondromyxoid, fibrous or vascular appearance
•  PA shows a circumscribed tumor with peripheral epithelial component with acinar and
tubular paSern, and inner stromal component made up of chondroidmyxoid matrix
•  The foci of carDlaginous differenDaDon appear translucent bluish-white
•  This feature is commonly seen in paro9d and submandibular tumors
•  PA arising in minor salivary glands rarely show car9laginous matrix produc9on
Pleomorphic
Adenoma

•  Epithelial component with acinar paKern

•  Stromal component made up of chondromyxoid matrix
 Pleomorphic
Adenoma

•  Cellular pleomorphic adenomas show increased cellularity, bizarre cells with

hyperchromaDc nuclei (oNen limited to focal areas), and focally increased mitoDc acDvity
•  These changes are not advanced enough to qualify them as malignant
•  The cellular pleomorphic adenoma with predominantly solid growth of the epithelial cells
and a few acinar structures
Pleomorphic
Adenoma

High magnifica9on of a cellular pleomorphic adenoma with solid and tubular

growth paSern of the epithelial cells and a few acinar structures
Pleomorphic
Adenoma

•  Atypical pleomorphic adenomas show features such as anaplasia, atypical

mitosis, coagulaDve tumor necrosis and zones of acellular hyalinizaDon
•  These features might portend malignant transforma9on
 Pleomorphic
Adenoma

The epithelial elements arranged in

anastomosing cords in a background of
myxoid stroma

•  The differen9al diagnosis includes

adenoid cysDc carcinoma,
monomorphic adenoma, and
polymorphous low grade
adenocarcinoma
•  This image depicts cribriform growth
paSern in a pleomorphic adenoma
that is reminiscent of adenoid cys9c
carcinoma
•  The cribriform areas are usually focal
and the remainder of the tumor has
more typical morphology
Pleomorphic
Adenoma :
OncocyDc
Cells

•  Various histologic changes can be seen in pleomorphic adenomas such as clear cell
change, oncocy9c change, sebaceous cell differen9a9on, and schwannoma-like foci
•  This image depicts oncocyDc change in the epithelial component
•  The oncocy9c cells have abundant eosinophilic, granular cytoplasm and eccentrically
placed round nucleus (plasmacytoid appearance)
Pleomorphic
Adenoma :
Clear Cells

This image depicts clear cell change (no9ce cytoplasmic clearing

of epithelial cells) in a pleomorphic adenoma
Pleomorphic
Adenoma :
Squamous
Metaplasia

•  Metaplas9c changes can be seen in pleomorphic adenoma following fine needle

aspira9on procedure
•  This type of change may raise the possibility of mucoepidermoid carcinoma but the
intercellular bridges and kera9niza9on are typically not seen in a mucoepidermoid
carcinoma
•  This image shows focal areas of squamous differen9a9on within pleomorphic adenoma
Pleomorphic
Adenoma :
Crystals

•  This image shows deposi9on of calcium phosphate crystals (Brushite) in the fibro9c stroma
of pleomorphic adenoma
•  Other components such as mucous cells, squamous cells with or without kera9niza9on,
calcifica9on, and tyrosine crystals may be noted in pleomorphic adenoma
 Pleomorphic
Adenoma

•  Recurrent pleomorphic adenomas usually exhibit mulDnodular and mulDfocal growth paKern
•  They can have variable size and may demonstrate extensive soN 9ssue involvement in spite of
benign histology
•  The stroma is predominantly myxochondroid in such cases
•  This image shows a mul9nodular pleomorphic adenoma with normal salivary gland parenchyma
intervening between the main tumor (boSom) and the satellite nodules (top).
Warthin's Tumor

•  WT predominantly involves the paro9d gland and presents as a painless mass

•  Rare cases involving the submandibular gland and minor salivary glands have been reported
•  Bilateral and mul9focal WT are not uncommon
•  This gross image of a WT shows solid and cys9c components
•  The pearly white nodules in the cyst wall are hyperplas9c lymphoid follicles covered by oncocy9c
epithelium
Warthin's
Tumor

•  Grossly Warthin’s tumor (WT) ranges in size from 1.0 - 8.0 cm and has smooth encapsulated outer
surface
•  The cut surface is usually shows solid and cys9c areas filled with mucoid, brown material
•  The cys9c areas may demonstrate papillary projec9ons
•  This low power view of WT shows papillary structures lined by oncocy9c epithelium (leN side) and
dense lymphocy9c infiltrate with germinal center forma9on (right side)
Warthin's
Tumor

Warthin’s tumor (WT) has a dis9nct morphologic appearance composed of papillary

structures lined by bi-layered oncocy9c epithelium forming cys9c spaces and the stroma
with lymphoid component (as seen in this low power micrograph)
Other inflammatory cells such as plasma cells, mast cells, his9ocytes and giant cells can
be seen. Mucous cells and sebaceous glands can also be seen and their presence may
raise the possibility of mucoepidermoid carcinoma
Warthin's
Tumor

•  High power view of Warthin’s tumor showing papillary structures lined by bi-layered
oncocy9c epithelium composed of tall columnar luminal cell layer and a discon9nuous
layer of basally located cuboidal cells
•  The stroma shows dense lymphocy9c infiltrate with germinal center forma9on
•  The cys9c spaces are filled with eosinophilic granular material
Warthin's
Tumor

•  Higher magnifica9on image of Warthin’s tumor demonstrates papillary structures

lined by bi-layered epithelium
•  The inner layer (basally located) is discon9nuous and composed cuboidal cells with
eosinophilic granular cytoplasm and vesicular round nuclei
•  The columnar cells are located on the luminal aspect
•  The stroma is well demarcated and composed of benign lymphocy9c infiltrate
Warthin's
Tumor

•  Warthin’s tumor (WT) is believed to develop from neoplas9c transforma9on of salivary duct
epithelium that is entrapped in intra-paro9d lymph nodes during embryonic development
•  The presence of subcapsular sinuses in some cases of WT, the occurrence of WT in periparo9d
lymph nodes, and the presence of B- and T-cells in the lymphoid component of WT appear to
support this theory
•  This high power image of WT shows bi-layered oncocy9c epithelium and the stroma composed
of dense lymphocy9c infiltrate with prominent germinal center forma9on.
Warthin's
Tumor

Warthin’s Tumor shows tubular structures composed of bi-layered

oncocy9c epithelium surrounded by stroma with dense lymphocy9c
infiltrate
Warthin's
Tumor

•  Warthin’s tumor showing oncocy9c cells with eosinophilic granular

cytoplasm and vesicular round nuclei with prominent nucleoli
•  The background shows benign lymphocytes and a few plasma cells
Warthin's
Tumor

•  The tumor has mul9cys9c appearance here with oncocy9c epithelium lining
fluid-filled spaces
•  The cys9c areas may contain cholesterol crystals, cellular debris, or
laminated bodies
•  The lymphoid stroma is deficient in this focus
Basal Cell Adenoma

•  Basal cell adenoma is a benign neoplasm which accounts for approximately 2% of salivary gland tumors and most
commonly occurs in major salivary glands (paro9d gland superficial lobe, 70% of cases)
•  It occurs in 4th to 9th decades of life, and there is no sex predisposi9on. Pa9ents usually present with a painless
slow growing, mobile mass
•  Grossly they are solid, encapsulated and sharply demarcated from the surrounding salivary gland parenchyma.
Basal Cell Adenoma

Basal cell adenoma shows a well-circumscribed encapsulated, cellular

and solid nodule
Basal Cell
Adenoma

•  Basal cell adenomas (BCA) are characterized by prolifera9on of basaloid cells in the absence of
mesenchyme-like stromal component (present in pleomorphic adenomas)
•  The histologic subtypes include solid, trabecular, tubular, and membranous (also known as Dermal
analogue tumor); combina9on of paSerns is not uncommon
•  BCA shows a sharply demarcated tumor (right side) composed of solid prolifera9on of basaloid cells
surrounded by eosinophilic basement membrane like material
•  The leN side of the image shows a normal salivary gland acini
Basal Cell
Adenoma

•  Basal cell adenomas include solid, trabecular, tubular, and membranous type (also
known as Dermal analogue tumor); combina9on of paSerns is not uncommon
•  This low power image shows encapsulated tumor with a jigsaw puzzle-like appearance
formed by eosinophilic basement membrane like material separa9ng the basaloid cell
nests
Basal Cell
Adenoma

•  Basal cell adenomas are composed of two cell types:

•  small cells with scanty cytoplasm and hyperchroma9c nuclei at periphery
of the cell island arranged in palisading manner
•  large polygonal cells with abundant cytoplasm and pale staining nuclei
•  Squamous whorls may be seen occasionally
•  The stroma is composed of spindle shaped myoepithelial cells
Basal Cell
Adenoma

•  Solid basal cell adenoma is most common morphologic variant

•  Basal cell adenoma composed of two cell types:
•  small cells with scanty cytoplasm and hyperchroma9c nuclei at periphery of the cell island
arranged in palisading manner
•  large polygonal cells with abundant cytoplasm and pale staining nuclei
•  The stroma is composed of spindle shaped myoepithelial cells
•  Mito9c ac9vity is not increased
Basal Cell
Adenoma

•  Basal cell adenoma shows anastomosing basaloid cell nests with a jigsaw puzzle-like
appearance
•  The nests contain eosinophilic basement membrane-like material and are surrounded
by hypocellular stroma containing a few myoepithelial cells
•  This type of growth paSern may raise suspicion for adenoid cys9c carcinoma
•  The presence of stromal myoepithelial cells serves as a clue
•  Stromal myoepithelial cells are absent in adenoid cys9c carcinoma
Basal Cell
Adenoma :
Mucinous
metaplasia

Mucus-secre9ng goblet cells are some9mes seen in basal cell adenomas

Basal Cell
Adenoma :
Mucinous
metaplasia

Mucus-secre9ng goblet cells are some9mes seen in basal cell adenomas

Dermal
Analog
Tumor

•  Dermal analogue tumor is a dis9nct variant of basal cell adenoma

and is also referred to as membranous type of basal cell adenoma
•  They are frequently mul9centric and unencapsulated
•  Dermal analogue tumor composed of a tumor cell islands separated
by eosinophilic hyaline material mimicking dermal cylindroma
•  The tumor is well circumscribed and covered by a thin capsule
•  The upper part of the image shows the normal salivary gland
Dermal
Analog
Tumor

•  In contrast to classic basal cell adenomas, dermal analogue

tumors are frequently mul9lobular and unencapsulated
•  The histologic appearance is characterized by the presence of
cell islands surrounded by thick eosinophilic membranes
resembling a jigsaw puzzle
•  The hyaline membrane material represents a reduplicated basal
lamina
•  Mitosis and perineural invasion is usually absent
Dermal
Analog
Tumor

Classic appearance of a dermal analogue tumor with islands of

basaloid cells surrounded by copious amounts of eosinophilic
basement membrane like material
Canalicular
Adenoma

•  Canalicular adenoma is a benign neoplasm of a salivary glands which originally was considered to be a variant of
basal cell adenoma
•  It has a greater tendency to involve the minor salivary glands
•  Approximately 70%-90% of the tumors occur in the oral cavity and is par9cularly common in the upper lip
•  Infrequently palate, buccal mucosa and paro9d gland may be involved. Pa9ents usually present with painless,
slowly enlarging nodule
•  Canalicular adenoma shows a well-circumscribed nodule composed of basaloid bi-layered epithelium arranged
in cords, rows and interconnec9ng tubules reminiscent of canals (right side)
•  There is rim of normal submucous salivary gland parenchyma and overlying normal oral mucosa (leN side).
Canalicular
Adenoma

•  Grossly, canalicular adenomas form a well-circumscribed, pink-tan nodule ranging in size from 0.5
cm to 3.0 cm
•  Cut surface may show cys9c spaces and mucoid material. Mul9focal nodules are common
•  Microscopically, the tumor shows bilayered basaloid epithelial cells forming interconnec9ng cords,
rows, and tubular structures
•  Cys9c dila9on of canalicular structures may be present and they are well demarcated from
surrounding edematous paucicellular stroma
Canalicular
Adenoma

•  Canalicular adenoma illustrates the bi-layered basaloid epithelium forming cords and
tubules surrounded by paucicellular stroma
•  The cells are cuboidal to columnar and have hyperchroma9c round to oval nucleus
with moderate amount of eosinophilic cytoplasm