Salivary gland tumor pathophysiology: Difference between revisions

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Latest revision as of 19:34, 16 May 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

The pathophysiology of salivary gland tumors depends on the histological subtype.^[1]

Pathophysiology

Pathogenesis

The parotid gland is the most frequent site of salivary gland tumors which accounts for approximately 80 to 85 percent of these tumors.^[2]^[3] About 75 percent of parotid lesions are benign and approximately 25 percent are malignant.^[4] Less frequently, salivary gland tumors originate in the sublingual, submandibular, and minor salivary glands, which are located throughout the submucosa of the upper aerodigestive tract and mouth.^[5]

In comparison to tumors arising in the parotid, 70 to 90 percent of sublingual gland tumors, 50 to 75 percent of minor salivary gland tumors, and 40 to 45 percent of submandibular gland tumors are malignant. Approximately 85% of salivary gland tumors occur in the parotid glands, followed by the minor salivary glands and submandibular, and approximately 1% occur in the sublingual glands. Overall approximately 80% of all parotid masses are benign.^[6]

Microscopic Pathology

Histologically, pleomorphic adenoma is the most common type of benign salivary gland tumor, which comprises about half of all salivary tumors. Other rarer benign salivary gland tumors include basal cell adenoma, Warthin's tumor, and canalicular adenoma. The most common malignant salivary gland tumors are adenoid cystic carcinoma and mucoepidermoid carcinoma, which together constitute approximately one-half of all malignant salivary gland tumors.

Histological features of benign tumors

Tabular form - adapted from Libre Pathology^[1]


Entity	Architecture	Morphology	Cell borders	Cytoplasm	Nucleus	Other

Pleomorphic adenoma	Variable	Mixed proportion; must include: Myoepithelium Mesenchymal stroma Epithelium (ductal cells) or Chondromyxoid stroma	Variable	Variable	Plasmacytoid	Occasionally encapsulated, mixed proportion of glandular, myoepithelial and mesenchymal cells
Warthin tumor	Papillary, bilayer	Cuboid (basal), columnar (apical)	Clearly seen	Eosinophilic, abundant	Unremarkable	AKA papillary cystadenoma lymphomatosum
Basal cell adenoma	Variable, islands surrounded by hyaline bands, lesion encapsulated	Basaloid	Subtle	Scant, hyperchromatic	Granular
Canalicular adenoma	Chains of cells	Cuboid or columnar	Subtle	Scant, hyperchromatic	Granular	Exclusively oral cavity, 80% in upper lip; immunohistochemistry: p63-
Sialoblastoma	Variable, islands surrounded by loose fibrous stroma	Basaloid	Subtle	Scant, hyperchromatic	Granular	Basal cell adenocarcinoma

Histological features of malignant tumors

Tabular form - adapted from Libre Pathology^[1]


Entity	Architecture	Morphology	Cell borders	Cytoplasm	Nucleus	Other

Mucoepidermoid carcinoma	Cystic and solid	Epitheloid	Distinct	Fuffy, clear, abundant	Nuclei small	Immunohistochemistry: p63+
Adenoid cystic carcinoma (AdCC)	Pseudocysts, cribriform, solid, hyaline stroma	Epitheloid	Subtle	Scant, hyperchromatic	Small+/-"carrot-shaped"	Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+
Acinic cell carcinoma (AcCC)	Sheets, acinar (islands)	Epithelioid	Clear	Granular abundant	Stippled, +/-occasional nucleoli	Stains: PAS +ve, PAS-D +ve; Immunohistochemistry: S-100 -ve, p63 -ve
Salivary duct carcinoma	Glandular, cribriform	Columnar	Subtle/clear	Hyperchromatic	Columnar	Similar to ductal breast carcinoma; male>female
Polymorphous low-grade adenocarcinoma	Variable, often small nests, may be targetoid	Epithelioid	Indistinct	Eosinophilic	Ovoid & small with small nucleoli	Minor salivary gland tumour, often in palate, cytologically monotonous; IHC: S-100+, CK+, vim.+, GFAP+/-, BCL2+/-
Epithelial-myoepithelial carcinoma	Nests (myoepithelial) with tubules (epithelial)	Epithelioid	Not distinct	Eosinophilic cytoplasm; epithelial: scant; myoepithelial: moderate	Focal clearing	Rare
Basal cell adenocarcinoma	Variable, islands surrounded by hyaline bands, lesion not encapsulated	Basaloid	Subtle	Scant, hyperchromatic	Granular	Rare, usually parotid gland, may arise from a basal cell adenoma

Tumor grades of salivary gland cancer

Grading is a way of classifying salivary cancer cells based on their appearance and behavior when viewed under a microscope. To find out the grade of a tumor, the biopsy sample is examined under a microscope. A grade is given based on how the cancer cells look and behave compared with normal cells (differentiation). This can give the healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread.^[7] The grade of salivary gland cancer is based on the degree of differentiation of cells and their rate of growth.


Grade	Description

low	Well differentiated – slow growing, less likely to spread
Intermediate	Moderately well-differentiated
High	poorly differentiated – tend to grow quickly, more likely to spread

Grading for salivary gland cancers is used mainly for mucoepidermoid carcinomas, adenocarcinomas, adenocarcinoma NOS, squamous cell carcinomas and adenoid cystic carcinomas. Other salivary gland cancers can also be graded in the same way. Grading plays an important part in planning salivary gland cancer treatment and can also be used to help estimate the prognosis. However, the grade is not the only factor used to predict the future outcome.
It must be considered together with staging information. Staging, in particular tumor size, is an important prognostic factor and may be more important than the grade in terms of successful treatment. For example, sometimes a stage I, intermediate or high-grade tumor can be treated with more success than a low-grade tumor that is a stage III.


Low grade	Low, intermediate or high grade	High grade

Acinic cell carcinoma	Adenocarcinoma not otherwise specified (NOS)	Adenoid cystic carcinoma*
Basal cell adenocarcinoma	Mucoepidermoid carcinoma	Anaplastic small cell carcinoma
Clear cell carcinoma	Squamous cell carcinoma	Carcinosarcoma
Cystadenocarcinoma		Small and large cell undifferentiated carcinoma
Epithelia-myoepithelial carcinoma		Salivary duct carcinoma
Mucinous adenocarcinoma		Carcinoma ex pleomorphic adenoma
Polymorphous low-grade adenocarcinoma (PLGA)

*Some adenoid cystic carcinomas can also be intermediate grade.

References

↑ ^1.0 ^1.1 ^1.2 Salivary glands. Libre pathology(2015) http://librepathology.org/wiki/index.php/Salivary_glands Accessed on November 11, 2015
↑ Barnes, Leon. Pathology and genetics of head and neck tumours. Lyon: IARC Press, 2005. Print.
↑ Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter |month= ignored (help)
↑ R. H. Spiro (1986). "Salivary neoplasms: overview of a 35-year experience with 2,807 patients". Head & neck surgery. 8 (3): 177–184. PMID 03744850. Unknown parameter |month= ignored (help)
↑ Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter |month= ignored (help)
↑ Salivary gland tumors. Radiopedia(2015) http://radiopaedia.org/articles/salivary-gland-tumours Accessed on November 8, 2015
↑ Grades of salivary gland cancer. Canadian cancer society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/grading/?region=sk Accessed on November 8, 2015

Template:WikiDoc Sources

[librepathology-1] 1.0 ^1.1 ^1.2 Salivary glands. Libre pathology(2015) http://librepathology.org/wiki/index.php/Salivary_glands Accessed on November 11, 2015

[2] Barnes, Leon. Pathology and genetics of head and neck tumours. Lyon: IARC Press, 2005. Print.

[3] Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter |month= ignored (help)

[4] R. H. Spiro (1986). "Salivary neoplasms: overview of a 35-year experience with 2,807 patients". Head & neck surgery. 8 (3): 177–184. PMID 03744850. Unknown parameter |month= ignored (help)

[5] Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter |month= ignored (help)

[radio-6] Salivary gland tumors. Radiopedia(2015) http://radiopaedia.org/articles/salivary-gland-tumours Accessed on November 8, 2015

[CCS-7] Grades of salivary gland cancer. Canadian cancer society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/grading/?region=sk Accessed on November 8, 2015

[1]

[2]

[3]

[4]

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[7]

@@ Line 14: / Line 14: @@
   | title = Major and minor salivary gland tumors | journal = [[Critical reviews in oncology/hematology]] | volume = 74 | issue = 2 | pages = 134–148 | year = 2010
   | month = May | doi = 10.1016/j.critrevonc.2009.10.004 | pmid = 019939701}}</ref>
-*In comparison to tumors arising in the parotid, 70 to 90 percent of sublingual gland tumors, 50 to 75 percent of minor salivary gland tumors, and 40 to 45 percent of [[submandibular]] gland tumors are [[malignant]]. Approximately 85% of salivary gland tumors occur in the parotid glands, followed by the minor salivary glands and submandibular, and about 1% occur in the [[sublingual]] [[glands]]. Overall approximately 80% of all parotid masses are benign.<ref name="radio">  Salivary gland tumors. Radiopedia(2015) http://radiopaedia.org/articles/salivary-gland-tumours Accessed on November 8, 2015</ref>
+*In comparison to tumors arising in the parotid, 70 to 90 percent of sublingual gland tumors, 50 to 75 percent of minor salivary gland tumors, and 40 to 45 percent of [[submandibular]] gland tumors are [[malignant]]. Approximately 85% of salivary gland tumors occur in the parotid glands, followed by the minor salivary glands and submandibular, and approximately 1% occur in the [[sublingual]] [[glands]]. Overall approximately 80% of all parotid masses are benign.<ref name="radio">  Salivary gland tumors. Radiopedia(2015) http://radiopaedia.org/articles/salivary-gland-tumours Accessed on November 8, 2015</ref>
 ===Microscopic Pathology===
-*Histologically, [[pleomorphic adenoma]] is the most common type of benign salivary gland tumor, which comprises about half of all salivary tumors. Other rarer benign salivary gland tumors include  [[basal cell]] [[adenoma]], [[Warthin]] [[tumor]], and [[canalicular adenoma]]. The most common malignant salivary gland tumors are [[adenoid]] [[cystic]] carcinoma and [[mucoepidermoid]] carcinoma, which together constitute approximately one-half of all malignant salivary gland tumors.
+*Histologically, [[pleomorphic adenoma]] is the most common type of benign salivary gland tumor, which comprises about half of all salivary tumors. Other rarer benign salivary gland tumors include  [[basal cell]] [[adenoma]], [[Warthin's tumor]], and [[canalicular adenoma]]. The most common malignant salivary gland tumors are [[adenoid]] [[cystic]] carcinoma and [[mucoepidermoid]] carcinoma, which together constitute approximately one-half of all malignant salivary gland tumors.
 ===Histological features of benign tumors===
+Tabular form - adapted from Libre Pathology<ref name="librepathology">  Salivary glands. Libre pathology(2015) http://librepathology.org/wiki/index.php/Salivary_glands Accessed on November 11, 2015</ref>
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 800px;" align=center
 |valign=top|
@@ Line 23: / Line 27: @@
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Entity}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Architecture}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Morphology}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Cell borders}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Cytoplasm}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Nucleus}}
-! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Other}}
 |-
@@ Line 41: / Line 43: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Variable
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Plasmacytoid
-| style="padding: 5px 5px; background:  #F5F5F5;"  |Adenoid cystic carcinoma
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Occasionally encapsulated, mixed proportion of glandular, myoepithelial and mesenchymal cells
 |-
@@ Line 50: / Line 51: @@
 | style="padding: 5px 5px; background:  #F5F5F5;" |Eosinophilic, abundant
 | style="padding: 5px 5px; background:  #F5F5F5;" |Unremarkable
-| style="padding: 5px 5px; background:  #F5F5F5;" |Sebaceous lymphadenoma
 | style="padding: 5px 5px; background:  #F5F5F5;" |AKA papillary cystadenoma lymphomatosum
 |-
@@ Line 59: / Line 59: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Scant, hyperchromatic
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Granular
-| style="padding: 5px 5px; background:  #F5F5F5;"   |Basal cell adenocarcinoma
 | style="padding: 5px 5px; background:  #F5F5F5;"   |
 |-
@@ Line 68: / Line 67: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Scant, hyperchromatic
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Granular
-| style="padding: 5px 5px; background:  #F5F5F5;"  |Basal cell adenoma
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Exclusively oral cavity, 80% in upper lip; immunohistochemistry: p63-
 |-
@@ Line 77: / Line 75: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Scant, hyperchromatic
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Granular
-| style="padding: 5px 5px; background:  #F5F5F5;"  |Adenoid cystic carcinoma
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Basal cell adenocarcinoma
 |-
@@ Line 83: / Line 80: @@
 ===Histological features of malignant tumors===
+Tabular form - adapted from Libre Pathology<ref name="librepathology">  Salivary glands. Libre pathology(2015) http://librepathology.org/wiki/index.php/Salivary_glands Accessed on November 11, 2015</ref>
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 800px;" align=center
 |valign=top|
@@ Line 88: / Line 86: @@
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Entity}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Architecture}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Morphology}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Cell borders}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Cytoplasm}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Nucleus}}
-! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Other}}
 |-
@@ Line 102: / Line 98: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Fuffy, clear, abundant
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Nuclei small
-| style="padding: 5px 5px; background:  #F5F5F5;"  |SCC (?)
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Immunohistochemistry: p63+
 |-
@@ Line 111: / Line 106: @@
 | style="padding: 5px 5px; background:  #F5F5F5;" |Scant, hyperchromatic
 | style="padding: 5px 5px; background:  #F5F5F5;" |Small+/-"carrot-shaped"
-| style="padding: 5px 5px; background:  #F5F5F5;" |Pleomorphic adenoma, Polymorphous low grade adenocarcinoma (PLGA)
 | style="padding: 5px 5px; background:  #F5F5F5;" |Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+
 |-
@@ Line 120: / Line 114: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Granular abundant
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Stippled, +/-occasional nucleoli
-| style="padding: 5px 5px; background:  #F5F5F5;"   |Adenocarcinoma not otherwise specified, oncocytoma of salivary gland
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Stains: PAS +ve, PAS-D +ve; Immunohistochemistry: S-100 -ve, p63 -ve
 |-
@@ Line 129: / Line 122: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Hyperchromatic
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Columnar
-| style="padding: 5px 5px; background:  #F5F5F5;"  |Metastatic breast carcinoma
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Similar to ductal breast carcinoma; male>female
 |-
@@ Line 138: / Line 130: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Eosinophilic
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Ovoid & small with small nucleoli
-| style="padding: 5px 5px; background:  #F5F5F5;"  | Adenoid cystic carcinoma (AdCC)
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Minor salivary gland tumour, often in palate, cytologically monotonous; IHC: S-100+, CK+, vim.+, GFAP+/-, BCL2+/-
 |-
@@ Line 147: / Line 138: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Eosinophilic cytoplasm; epithelial: scant; myoepithelial: moderate
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Focal clearing
-| style="padding: 5px 5px; background:  #F5F5F5;"  | Adenoid cystic carcinoma (AdCC), pleomorphic adenoma
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Rare
 |-
@@ Line 156: / Line 146: @@
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Scant, hyperchromatic
 | style="padding: 5px 5px; background:  #F5F5F5;"   |Granular
-| style="padding: 5px 5px; background:  #F5F5F5;"  | Basal cell adenoma
 | style="padding: 5px 5px; background:  #F5F5F5;"  |Rare, usually parotid gland, may arise from a basal cell adenoma
 |-
 |}
-<gallery>
-px-Polymorphous low-grade adenocarcinoma - very low mag.jpg|Polymorphous low-grade adenocarcinoma
+===Tumor grades of salivary gland cancer===
-px-Papillary cystadenoma lymphomatosum2.jpg|Warthin tumor
+*Grading is a way of classifying salivary cancer cells based on their appearance and behavior when viewed under a microscope. To find out the grade of a tumor, the [[biopsy]] sample is examined under a microscope. A grade is given based on how the cancer [[cells]] look and behave compared with normal cells (differentiation). This can give the healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread.<ref name="CCS">  Grades of salivary gland cancer. Canadian cancer society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/grading/?region=sk Accessed on November 8, 2015</ref> The grade of salivary gland cancer is based on the degree of differentiation of cells and their rate of growth.
-px-Adenoid cystic carcinoma - high mag.jpg|Adenoid cystic carcinoma
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
-px-Basal cell adenocarcinoma - parotid gland - high mag.jpg|Basal cell adenocarcinoma
+|valign=top|
-px-Epithelial-myoepithelial carcinoma - high mag (1).jpg|Epithelial-myoepithelial carcinoma
+|+
-px-Salivary duct carcinoma -a- low mag.jpg|Salivary duct carcinoma
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Grade}}
-Mucoepidermoid carcinoma (2) HE stain (1).jpg|Mucoepidermoid carcinoma
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
-Pleomorphic adenoma (1) parotid gland.jpg|Pleomorphic adenoma
+|-
-px-Acinic cell carcinoma - high mag.jpg|Acinic cell carcinoma
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |low
-</gallery>
+| style="padding: 5px 5px; background: #F5F5F5;" |Well differentiated – slow growing, less likely to spread
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Intermediate
+| style="padding: 5px 5px; background: #F5F5F5;" |Moderately well-differentiated
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |High
+| style="padding: 5px 5px; background: #F5F5F5;" |
+poorly differentiated – tend to grow quickly, more likely to spread
+|-
+|}
+*Grading for salivary gland cancers is used mainly for [[mucoepidermoid]] carcinomas, [[adenocarcinomas]], adenocarcinoma NOS, [[squamous cell carcinomas]] and [[adenoid]] [[cystic]] carcinomas. Other salivary gland cancers can also be graded in the same way. Grading plays an important part in planning salivary gland cancer treatment and can also be used to help estimate the prognosis. However, the grade is not the only factor used to predict the future outcome.
+*It must be considered together with staging information. Staging, in particular tumor size, is an important prognostic factor and may be more important than the grade in terms of successful treatment. For example, sometimes a stage I, intermediate or high-grade tumor can be treated with more success than a low-grade tumor that is a stage III.
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
+|valign=top|
+|+
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Low grade}}
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Low, intermediate or high grade}}
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|High grade}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Acinic cell carcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |Adenocarcinoma not otherwise specified (NOS)
+| style="padding: 5px 5px; background: #F5F5F5;" |Adenoid cystic carcinoma*
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Basal cell adenocarcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |Mucoepidermoid carcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |Anaplastic small cell carcinoma
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Clear cell carcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |Squamous cell carcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |Carcinosarcoma
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Cystadenocarcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |
+| style="padding: 5px 5px; background: #F5F5F5;" |Small and large cell undifferentiated carcinoma
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Epithelia-myoepithelial carcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |
+| style="padding: 5px 5px; background: #F5F5F5;" |Salivary duct carcinoma
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Mucinous adenocarcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |
+| style="padding: 5px 5px; background: #F5F5F5;" |Carcinoma ex pleomorphic adenoma
+|-
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Polymorphous low-grade adenocarcinoma (PLGA)
+| style="padding: 5px 5px; background: #F5F5F5;" |
+| style="padding: 5px 5px; background: #F5F5F5;" |
+|-
+|}
+* *Some adenoid cystic carcinomas can also be intermediate grade.
 ==References==
@@ Line 179: / Line 218: @@
 [[Category:Disease]]
 [[Category:Rare cancers]]
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Gastroenterology]]
+[[Category:Surgery]]
+[[Category:Otolaryngology]]