Salivary Glands برای بزرگنمایی عکسها کلیک را روی ان نگه دارید Figure 6.1 Sialolithiasis with secondary chronic sialadenitis. A large stone is blocking a major salivary duct Figure 6.2 Obstructive sialadenitis associated with submandibular gland sialolithiasis. The parenchyma is atrophic with mixed acute and chronic inflammation including intraluminal neutrophils Figure 6.3 Gross appearance of suppurative sialadenitis Figure 6.4 Sclerosing polycystic adenosis. Small tubules and epithelial nests composed of cells with apocrine cytology are present within a collagenous stroma. Note the eosinophilic cytoplasmic granules in the bottom left Figure 6.5 A, Lymphoepithelial cysts in parotid gland removed from an HIV-infected patient. The solid tan areas correspond to infiltration by lymphoid tissue. B, Lymphoepithelial cyst of parotid gland in an HIV-infected patient. Note the lymphocytic infiltration of the epithelium Figure 6.6 A, Gross appearance of lymphoepithelial sialadenitis (LESA) of parotid gland. There is a combination of solid areas resulting from infiltration by lymphocytes and small cystic formations representing dilated ductal lumina. B, Prominent proliferation of duct epithelium in a patient with LESA disease Figure 6.7 A-C, Gross appearance of three benign mixed tumors of parotid gland. Note the sharply outlined character and predominantly solid cut surface. The tumors shown in A and B have a glistening surface indicative of cartilaginous differentiation, whereas the tumor in C has a more myxoid or gelatinous appearance Figure 6.8 Microscopic appearance of benign mixed tumor. Epithelial and myoepithelial cells can be easily distinguished Figure 6.9 Benign mixed tumor. The myoepithelial cells are undergoing cartilaginous metaplasia and appear to "melt" into the chondromyxoid stroma they are producing Figure 6.10 Benign mixed tumor with a markedly hypercellular appearance Figure 6.11 Distribution of recurrent tumor nodules (shown as dots) as demonstrated by careful histologic study of reexcision of benign mixed tumor of parotid gland, which at time of first operation had apparently been enucleated. Surgical scar measured 3.5 cm. (Courtesy of Dr. F. Leidler, Houston.) Figure 6.12 Recurrent benign mixed tumors typically appear as multiple small tumors distributed in residual gland tissue, as well as periglandular soft tissue Figure 6.13 Benign mixed tumor with area of malignant transformation in the form of poorly differentiated carcinoma (upper right and bottom left). As with this tumor, the histology of the carcinoma is most often salivary duct carcinoma Figure 6.14 Gross appearance of oxyphilic adenoma. The tumor is well circumscribed, solid, and light brown. (Courtesy of Dr. F. Facchetti, Brescia, Italy.) Figure 6.15 Low-power microscopic view of oxyphilic adenoma. The pattern of growth is solid, with a suggestion of trabecular formations. The tumor cells have a uniform granular eosinophilic staining quality Figure 6.16 Electron micrograph of oxyphilic adenoma showing cytoplasm packed with mitochondria (arrow). A portion of the nucleus (N) is at bottom right. (x31,000.) Figure 6.17 Gross appearance of Warthin tumor of parotid gland. The presence of multiple large cystic spaces is characteristic of this lesion. (Courtesy of Dr. J. Carvalho, Ann Arbor, MI.) Figure 6.18 Low-power appearance of Warthin tumor. Germinal centers are very prominent Figure 6.19 A, High-power view of the lining of one of the cysts of Warthin tumor. The epithelium is tall and oxyphilic, with a discontinuous layer of small cells at the base. The stroma beneath contains a monotonous lymphocytic infiltrate. B, Infarcted Warthin tumor following fine-needle aspiration. Ghost outlines of necrotic epithelial papillae can be seen adjacent to necrotic lymphocytic stroma Figure 6.20 Positive immunostaining for antimitochondrial antibody in oncocytes. (Courtesy of Dr. F. Facchetti, Brescia, Italy.) Figure 6.21 Basal cell adenoma of parotid gland. The appearance is reminiscent of that of a skin adnexal tumor (cylindroma) Figure 6.22 Canalicular adenoma of the buccal minor salivary glands. A, Parallel rows of columnar epithelial cells appose each other in areas imparting a beaded or canalicular pattern. The stroma is scant and predominantly myxoid. B, The columnar cells are uniform and cytologically bland Figure 6.23 So-called sebaceous lymphadenoma. Ductal structures merge with well-differentiated sebaceous glands, which in turn are sur- rounded by a heavy lymphocytic infiltrate Figure 6.24 Spindle cell myoepithelioma of parotid gland. It would be very difficult to distinguish this tumor from a soft tissue neoplasm on purely morphologic grounds Figure 6.25 Electron micrograph of a myoepithelioma of parotid gland. Portion of a neoplastic myoepithelial cell illustrating (left to right) extracellular space with collagen fibrils and basement membrane, electron-dense attachment plaques on the cell membrane, linear arrays of 6-nm actin microfilaments, perinuclear bundles of tonofilaments (indicative of squamous metaplasia), and a portion of the nucleus. (x22,900.) (Courtesy of Dr. Robert A. Erlandson, Memorial Sloan-Kettering Cancer Center.) Figure 6.26 Myoepithelioma composed of so-called hyaline cells. (A, H&E; B, keratin; C, S-100 protein.) Figure 6.27 Epithelial-myoepithelial carcinoma. The myoepithelial component is represented by the cells with clear cytoplasm. Infiltrative growth was present in other areas of this tumor. Benign mixed tumors can have similar appearing areas, but they lack infiltrative growth Figure 6.28 Gross appearance of mucoepidermoid carcinoma. This particular tumor is entirely solid, without the cystic formations commonly seen in low-grade lesions Figure 6.29 Mucoepidermoid carcinoma. Mucous, squamous, and intermediate cells can be seen Figure 6.30 Low-grade mucoepidermoid carcinoma has a predominantly cystic areas as well as infiltrative growth Figure 6.31 Acinic cell carcinoma. The cells have an abundant cytoplasm filled with basophilic zymogen granules Figure 6.32 Mammary analogue secretory carcinoma of parotid gland. These low-grade infiltrative carcinomas are comprised of large nests with a microcystic appearance. The lumens are filled with eosinophilic to basophilic secretions Figure 6.33 Mammary analogue secretory carcinomas contain monoto- nous cells with an apocrine appearance and vacuolated cytoplasm Figure 6.34 Adenoid cystic carcinoma. Typical low-power appearance Figure 6.35 Adenoid cystic carcinoma. Numerous "cylinders" containing a homogeneous acidophilic material can be seen Figure 6.36 Ultrastructural appearance of adenoid cystic carcinoma of oral minor salivary gland. The tumor is made up of myoepithelial cells covered by reduplicated basal lamina. False lumina are thus formed. (x7450.) Figure 6.37 Adenoid cystic carcinoma with prominent perineurial invasion Figure 6.38 Adenoid cystic carcinoma combining tubular (left) and solid (right) features Figure 6.39 High-grade ductal-type carcinoma of parotid gland. There is some degree of cytoplasmic apocrine-like change Figure 6.40 Low-grade cribriform cystadenocarcinoma of parotid gland. A mixture of solid and cystic nodules is typical Figure 6.41 Low-grade cribriform cystadenocarcinomas resemble low- grade breast epithelial lesions, such as atypical ductal hyperplasia and low-grade ductal carcinoma in situ Figure 6.42 Papillary cystadenocarcinoma of parotid gland Figure 6.43 Collision between Warthin tumor (right) and small cell (Merkel cell) carcinoma (left) Figure 6.44 Infantile hemangiomas are composed of small capillary-sized blood vessels that infiltrate the glandular parenchyma Figure 6.45 A, Fine-needle aspiration specimen from a benign mixed tumor of parotid. Clusters of benign-appearing epithelial cells are seen against a bluish myxoid matrix. Tyrosine-rich crystals are also present. B, Fine-needle aspiration of mucoepidermoid carcinoma of parotid gland. Most of the cells are of the so-called third cell type, and some exhibit focal squamous differentiation. (A, Courtesy of Dr. Maureen Zakowski, Memorial Sloan-Kettering Cancer Center.) Figure 6.46 Typical appearance of adenoid cystic carcinoma on fine- needle aspiration. The nuclei are small and hyperchromatic. There is a pink amorphous basement membrane-like material, which corresponds to the "cylinders" seen in the histologic sections Figure 6.47 Survival rates in malignant salivary gland tumors. (From Eneroth CM, Hamberger CA. Principles of treatment of different types of parotid tumors. Laryngoscope. 1974;84:1732-1740)
