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Int J Clin Exp Pathol 2011;4(4):336-348

Original Article
Morphological heterogeneity of oral salivary gland carcinomas: A clinicopathologic study
of 41 cases with long term follow-up emphasizing the overlapping spectrum of adenoid
cystic carcinoma and polymorphous low-grade adenocarcinoma

Stephan Schwarz, Maximilian Müller, Tobias Ettl, Philipp Stockmann, Johannes Zenk, Abbas Agaimy

Department of Pathology, University of Erlangen, Germany; Department of Oral and Maxillofacial Surgery, University of Regensburg, Germany;
Department of Oral and Maxillofacial Surgery, University of Erlangen, Germany; Department of Oto-Rhino-Laryngology, University of Erlangen,

Received April 1, 2011; accepted April 12, 2011; Epub April 18, 2011; published April 30, 2011

Abstract: We analyzed 41 oral salivary gland carcinomas from consecutive 290 salivary gland carcinoma database (14%) with emphasis on
the histological spectrum and clinical outcome of adenoid cystic carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA). The
cohort included 14 ACCs, 14 mucoepidermoid carcinomas (MECs), 8 PLGAs, 3 adenocarcinomas, not otherwise specified and 2 acinic cell
carcinomas. Mean age was 48, 58 and 61 yrs for ACC, MEC and PLGA, respectively. Eight patients (19.5%) died of tumor at a mean interval of
66.5 months. ACC and PLGA showed similar mean age, gender distribution, predominant palatal localization, nodal metastasis, perineural
invasion and MIB-1 index. However, ACC tended to show higher tumor stage and residual tumor (R1/R2) more frequently than PLGA, but this
was statistically not significant. ACC and PLGA showed overlapping architectural patterns. However, ACCs displayed well organized
basal-luminal differentiation, highlighted by CK5/CK7 immunostaining. In contrast, PLGA showed a disorganized histological and
immunohistological pattern. C-Kit expression (CD117) was common in ACC, generally mirroring that of CK7 and virtually lacking in PLGA.
Kaplan-Meier analysis demonstrated a similar clinical course for ACC and PLGA with 5 years survivals of 87% and 80%, respectively.
Fluorescence in situ hybridization (FISH) performed on all 290 salivary carcinomas confirmed the specificity of the translocation t(11;19) for
MEC and its absence in all other carcinomas including ACC and PLGA. Our results emphasize the diversity of oral salivary gland carcinomas
and the overlapping clinicopathological features of ACC and PLGA.  (IJCEP1104001).

Keywords: Oral salivary gland carcinoma; adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma; acinic cell carcinoma

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Address all correspondence to:
Abbas Agaimy, MD
Department of Pathology
University of Erlangen
Krankenhausstrasse 10
91054 Erlangen
Phone: +49-9131-8522288
Fax: +49-9131-8524745