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Salivary gland-like tumours of the breast: surgical and molecular pathology.

ABSTRACT: Breast glands and salivary glands are tubulo-acinar exocrine glands that can manifest as tumours with similar morphological features, but that differ in incidence and clinical behaviour depending on whether they are primary in breast or salivary glands. Salivary gland-like tumours of the breast are of two types: tumours with myoepithelial differentiation and those devoid of myoepithelial differentiation. The first and more numerous group comprises a spectrum of lesions ranging from "bona fide" benign (such as benign myoepithelioma and pleomorphic adenoma), to low grade malignant (such as adenoid cystic carcinoma, low grade adenosquamous carcinoma, and adenomyoepithelioma), to high grade malignant lesions (malignant myoepithelioma). The second group comprises lesions that have only recently been recognised, such as acinic cell carcinoma, oncocytic carcinoma of the breast, and the rare mucoepidermoid carcinoma.

SUBMITTER: Pia-Foschini M

PROVIDER: S-EPMC1769991 | biostudies-literature | 2003 Jul

REPOSITORIES: biostudies-literature

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Salivary gland-like tumours of the breast: surgical and molecular pathology.

Pia-Foschini M M Reis-Filho J S JS Eusebi V V Lakhani S R SR

Journal of clinical pathology 20030701 7

Breast glands and salivary glands are tubulo-acinar exocrine glands that can manifest as tumours with similar morphological features, but that differ in incidence and clinical behaviour depending on whether they are primary in breast or salivary glands. Salivary gland-like tumours of the breast are of two types: tumours with myoepithelial differentiation and those devoid of myoepithelial differentiation. The first and more numerous group comprises a spectrum of lesions ranging from "bona fide" b ...[more]

PMID: 12835294

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Project description:IntroductionA 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.MethodsA 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.ResultsPleomorphic 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.ConclusionsA 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.

Project description:Introduction and importanceSalivary calculi represent the most common salivary gland disease. It can vary significantly in size, ranging from less than 1 mm to several centimeters. As the size of the stone increases, the surgical approach becomes more complex and the function of the gland may be compromised, potentially necessitating total gland removal. Successful outcomes depend on appropriate indications, precise surgical techniques, and comprehensive postoperative care.Case presentationA 50-year-old male presented with a chief complaint of pain and swelling in the submandibular region. The patient reported persistent discomfort in the submandibular area for several weeks. Over the last three weeks, his symptoms had intensified, accompanied by an unpleasant taste in his mouth with pain and swelling, especially during meat time. Clinical examination had shown no salivary secretion observed with tenderness across the Wharton duct. Radiological assessment revealed a large salivary stone obstructing the duct of the submandibular gland, the patient underwent surgery under general anesthesia, and an incision was made over the bulge corresponding to the stone. Dissection proceeded through the mucosa until the duct was accessed. The function of the salivary gland was observed, and the return of salivary secretion was confirmed, which was observed immediately after the surgery, and the patient was discharged 5 days after the surgery.DiscussionThe treatment plans for such cases vary between non-invasive conservative management of sialolithiasis, which includes gland massage (combined with the use of sialogogues and irrigation), and advance aggressive management, which may involve extracorporeal shock-wave lithotripsy, sialoendoscopy, or surgical removal.ConclusionTransoral surgical removal of large stones from the submandibular gland and duct can be an effective and minimally invasive treatment option for sialolithiasis. Proper indications, surgical techniques, and postoperative care are essential for achieving optimal outcomes, minimizing complications, and ensuring successful results.

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Salivary gland-like tumours of the breast: surgical and molecular pathology.

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Salivary gland-like tumours of the breast: surgical and molecular pathology.

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