Papillary adenocarcinoma possibly arising from an intraductal papilloma of the parotid gland

Intraductal Papillomas From the Parotid Gland

Intraductal papillomas have been mostly described in minor salivary glands but are extremely rare in the parotid gland. Consequently, limited information is available to guide otolaryngologists and pathologists in managing intraductal papillomas, specifically in the parotid gland. Diagnosing intraductal papillomas in this location poses significant challenges. In this report, the authors present a new case and first conduct a systematic literature review of the intraductal papillomas originating from the parotid gland. This study contributes valuable insights that can improve diagnostic accuracy, providing more precise treatments, and patient outcomes in cases of intraductal papillomas in the parotid gland.

Papillary Neoplasms of the Salivary Duct System: A Review

Papillary lesions of the salivary duct systems are uncommon. They encompass a heterogeneous group of benign, intermediate, and potentially aggressive neoplasms. With a few exceptions, historical descriptive terms such as papillary adenocarcinoma, papillary cystadenocarcinoma, and papillary adenoma are being replaced by defined entities, at same time acknowledging the papillary features as a histologic pattern. The evolving genetic landscape of these lesions increasingly permits their reproducible categorization. This article discusses those papillary proliferations encountered in the salivary glands with a focus on intraductal papillary mucinous neoplasms and cystadenomas. Intraductal carcinomas and sialadenoma papilliferum are addressed in separate articles in this issue.

Intraductal Papilloma Arising From the Minor Salivary Glands of the Larynx: A Case Report

It is rare for intraductal papilloma, a benign papillary tumor, to occur in the salivary glands. To our knowledge, intraductal papilloma occurring in the minor salivary glands of the larynx has not been reported. In this report, we describe a case of intraductal papilloma that occurred in the minor salivary glands of the larynx. A woman in her 30s presented with hoarseness and dyspnea since a year. Fiber-optic laryngoscopy revealed a submucosal tumor involving the left aryepiglottic fold and the left false vocal fold. Computed tomography and magnetic resonance imaging revealed a 17 × 15 × 10 mm³ mass with homogenous isodensity, with regular, well-defined margins located on the left aryepiglottic fold and the left false vocal fold. Surgical resection was performed, and subsequently a diagnosis of intraductal papilloma was made by pathologic evaluation. During the follow-up period of over 3 years, the lesion has not recurred. In conclusion, intraductal papilloma of the minor salivary glands should be considered in the differential diagnosis of laryngeal submucosal tumors.

Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours

INTRODUCTION

A vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, for several reasons, this has not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour.

METHODS

A search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically.

RESULTS

Pleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur.

CONCLUSIONS

A correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types of basal cell adenoma can occasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.

Papillary Carcinoma of Stensen's Duct with Intestinal Differentiation

Stensen's duct carcinoma (StDC) is an extremely rare neoplasm, with fewer than 40 cases reported in the literature. We report a unique case of primary StDC with papillary features and intestinal differentiation of a 74-year-old male. We discuss the radiologic and pathologic correlation along with the differential diagnosis of this rare entity.

Intraductal papilloma arising from the accessory parotid gland: A case report and literature review

RATIONALE

Intraductal papillomas of the accessory parotid glands are extremely rare benign tumors that are most commonly derived from minor salivary glands and are easily misdiagnosed as other diseases. Studying these lesions by pathology and immunohistochemistry can raise awareness of the disease, reduce the rate of misdiagnosis, and provide more precise treatments.

PATIENT CONCERNS

A 35-year-old man first presented to our hospital with a 6-month history of a painless mass on his left parotid gland.

DIAGNOSES

The patient was diagnosed with intraductal papilloma of the accessory parotid gland by pathology and immunohistochemistry.

INTERVENTIONS

The mass was completely resected.

OUTCOMES

After 2 years of postoperative follow-up, the patient recovered well without recurrence.

LESSONS

Intraductal papilloma of the accessory parotid gland is very rare, and can easily be misdiagnosed as sialadenoma papilliferum, inverted ductal papilloma, or papillary cystadenoma, among others. It is necessary to analyze its pathology and immunohistochemistry in comparison with other diseases. Early excision and long-term follow-up are necessary to provide optimal treatment and to better understand the pathological processes of intraductal papilloma.

Stensen's Duct Carcinoma with a Papillary Architecture

Primary carcinoma of the parotid duct (Stensen's duct carcinoma) is a rare entity, first described in 1927 and with approximately thirty-one cases reported in the English literature. Criteria for diagnosis are primarily demonstration of an origin from the Stensen's duct lining and exclusion of parotid gland, accessory parotid, oral mucosal and adjacent minor salivary gland origin. The carcinoma is usually of a specific type, and most have been described as squamous, mucoepidermoid, or undifferentiated adenocarcinomas. We report an unusual case of Stensen's duct carcinoma showing a primarily basaloid phenotype with focal squamous differentiation and a partial papillary architecture raising the possibility of malignant transformation in a ductal papilloma. Wide local excision was performed with postoperative radiotherapy and the patient is free of complications one and a half years postoperatively. Due to the small number of cases reported, the overall prognosis is not well defined, but seems to depend on the tumour size. Regional metastasis confers a 14 % mortality rate but there appears to be no relationship between histological type and prognosis.

Intraductal papilloma of the parotid gland in a child

Intraductal papillomas are rare benign tumors, most commonly encountered in minor salivary glands and rarely in major salivary glands. They are cystic, solitary neoplasm that arise from ductal epithelium and produce painless swelling. We report a case of intraductal papilloma of the parotid gland in a child.

Intraductal papilloma in the parotid duct

Intraductal papilloma arising in the major salivary gland is uncommon. We treated intraductal papilloma of the parotid gland in a 41-year-old man with a 3-week history of a painless mass in his right parotid gland. Radiologic imaging studies revealed a well-circumscribed solitary mass, 1 cm in diameter, at the posterior edge of the right parotid superficial lobe. Complete excision of the mass was performed under general anesthesia. Pathologically, the mass consisted mainly of a cystically dilated salivary duct filled with dark brown muddy components and a cluster of growing papillary cells, leading to the diagnosis of intraductal papilloma. The literature on intraductal papillomas of the major salivary glands is reviewed, with particular focus on preoperative diagnosis of this condition.

Ductal papillomas of salivary gland origin: A report of 19 cases and a review of the literature

The term ductal papilloma is used to identify a group of 3 rare benign papillary salivary gland tumors known as inverted ductal papilloma, sialadenoma papilliferum, and intraductal papilloma. They represent adenomas with unique papillary features and arise from the salivary gland duct system. We describe the clinical and microscopic features of 19 new cases of ductal papillomas and combine them with 116 cases previously published in the English-language medical literature. These 19 cases were composed of 13 inverted ductal papillomas, 3 sialadenoma papilliferums, and 3 intraductal papillomas. Collectively, these 19 ductal papillomas occurred most commonly in the sixth to eighth decade of life, with an average patient age of 54 years. Men predominated 1.37:1. The sialadenoma papilliferums presented as papillary lesions clinically with all 3 misinterpreted as squamous papillomas by the surgeons. The inverted ductal papillomas and intraductal papillomas appeared as submucosal nodules. The lip and the palate were the most common locations for inverted ductal papilloma and sialadenoma papilliferum, respectively. The sites for the 3 intraductal papillomas were the parotid papilla of the Stensen's duct, the upper lip, and the buccal mucosa. With light microscopy, inverted ductal papillomas appeared to arise from the excretory ducts near the mucosal surface, whereas intraductal papillomas appeared to arise from the excretory ducts at a deeper level. Sialadenoma papilliferum had a more complex histology, with a biphasic growth pattern of exophytic papillary and endophytic components. All 19 cases were treated by surgical excision. Follow-up information was available in only 2 cases, both inverted ductal papillomas. Neither case recurred during a 20-year period. Sialadenoma papilliferum, with a literature-derived recurrence rate of 10% to 15%, seems to assert a more significant biological behavior than inverted ductal papilloma and intraductal papilloma. Our findings justify the separation of these 3 entities based on clinical and histologic parameters. They are tumors of adulthood and, in addition, have in common their relationship to the excretory duct system, their anatomical distribution, and their general behavior.

Intraductal papillary tumors of the major salivary glands: case reports of benign and malignant variants

Intraductal papilloma is an extremely rare benign salivary gland tumor that occurs most commonly in the minor salivary glands. To our knowledge, a malignant counterpart of intraductal papilloma has not been described previously. We report one case each of benign and malignant intraductal papillary tumors. The benign tumor occurred in the sublingual gland and was a typical example of intraductal papilloma, with the exception that we found no previously published reports of this type of tumor in this location. The other patient had a left parotid gland tumor that was architecturally similar to the intraductal papilloma, with the addition of cytologic atypia, intraductal extension, microinvasion, and lymph node metastases. This tumor was diagnosed as intraductal papillary adenocarcinoma with an invasive component. Both patients were alive and well without evidence of recurrence 2 years and 6 months (case 1) and 6 years (case 2) after surgery. Immunohistochemical examination revealed that the tumor cells resembled duct luminal cells in both cases. The 2 tumors had different immunoreactivities for carcinoembryonic antigen, p53, and Ki-67. The malignant counterpart of intraductal papilloma should be considered in the differential diagnosis of salivary gland tumors with a predominantly papillary structure, even though this tumor is extremely rare.

Salivary gland cystadenocarcinomas. A clinicopathologic study of 57 cases

Current classification schemes for salivary gland neoplasms categorize cystadenocarcinomas on the basis of a recurring histomorphologic pattern of cystic, and often, papillary growth without features of other specific types of salivary gland tumors. To ascertain the clinicomorphologic spectrum and biologic behavior of this tumor, the clinicopathologic features of 57 cystadenocarcinomas from the files of the Armed Forces Institute of Pathology were studied. Excluding five Veterans Administration military cases, men and women were equally affected. Patients ranged in age from 20 to 86 years (mean, 58.8; median, 64), and patients aged over 50 years accounted for 71% of cases. Thirty-seven tumors (65%) occurred in major salivary glands, 35 in the parotid, and two in the sublingual glands. The 20 minor salivary gland tumors (35%) involved, in descending order, the lips, buccal mucosa, palate, tongue, retromolar area, and floor of mouth. Grossly, the lesions were cystic or multicystic masses that ranged in size from 0.4 to 6.0 cm. Microscopically, all tumors demonstrated an invasive, cystic growth pattern, and 75% had a conspicuous papillary component. The predominant cell type varied among tumors and included small cuboidal cells (35 cases), large cuboidal cells (nine cases), and tall columnar cells (seven cases). Six cases exhibited an admixture of cell types. Ruptured cysts with hemorrhage and granulation tissue were common. All 40 patients with follow-up data were either alive or had died of other causes and were free of tumor a mean interval of 59 months after their initial surgery. Three tumors recurred locally (mean interval, 76 months). Three tumors were metastatic to regional lymph nodes at the time of diagnosis, and one patient developed a regional lymph node metastasis after 55 months. Salivary gland cystadenocarcinomas represent a distinct group of malignancies that have an indolent biologic behavior.

Intraductal papilloma as a cause of a parotid duct cyst. A case report

A case is presented of a rare intraductal papilloma being found simultaneously with a parotid duct cyst, which is a relatively common parotid disorder. The papilloma most probably played a significant role in the obstruction of the duct and thus caused the ductal cyst. Intraductal papillomas have been mostly described in minor salivary glands, but are rare in the parotid gland.