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Salivary Gland Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Cellular Classification of Salivary Gland Cancer

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Low grade, intermediate grade, and high grade

Intermediate grade and high grade

  • Myoepithelial carcinoma.

High grade

  • Anaplastic small cell carcinoma.
  • Carcinosarcoma.
  • Large cell undifferentiated carcinoma.
  • Small cell undifferentiated carcinoma.
  • Salivary duct carcinoma.

*Some investigators consider mucoepidermoid carcinoma to be of only two grades: low grade and high grade.[5]

Salivary gland carcinomas and mixed tumors

  1. Mucoepidermoid carcinoma.
  2. Adenoid cystic carcinoma.
  3. Adenocarcinomas.
    1. Acinic cell carcinoma.
    2. PLGA.
    3. Adenocarcinoma, NOS.
    4. Rare adenocarcinomas.
      1. Basal cell adenocarcinoma.
      2. Clear cell carcinoma.
      3. Cystadenocarcinoma.
      4. Sebaceous adenocarcinoma.
      5. Sebaceous lymphadenocarcinoma.
      6. Oncocytic carcinoma.
      7. Salivary duct carcinoma.
      8. Mucinous adenocarcinoma.
  4. Malignant mixed tumors.
    1. Carcinoma ex pleomorphic adenoma.
    2. Carcinosarcoma.
    3. Metastasizing mixed tumor.
  5. Rare carcinomas.
    1. Primary squamous cell carcinoma.
    2. Epithelial-myoepithelial carcinoma.
    3. Anaplastic small cell carcinoma.
    4. Undifferentiated carcinomas.
      1. Small cell undifferentiated carcinoma.
      2. Large cell undifferentiated carcinoma.
      3. Lymphoepithelial carcinoma.
    5. Myoepithelial carcinoma.
    6. Adenosquamous carcinoma.

Mucoepidermoid carcinoma

Mucoepidermoid carcinoma is a malignant epithelial tumor that is composed of various proportions of mucous, epidermoid (e.g., squamous), intermediate, columnar, and clear cells and often demonstrates prominent cystic growth. It is the most common malignant neoplasm observed in the major and minor salivary glands.[1,9] Mucoepidermoid carcinoma represents 29% to 34% of malignant tumors originating in both major and minor salivary glands.[3,5,10,11] In two large retrospective series, 84% to 93% of cases originated in the parotid gland.[12,13] With regard to malignant tumors of the minor salivary glands, mucoepidermoid carcinoma shows a strong predilection for the lower lip.[3,14] In an AFIP review of civilian cases, the mean age of patients was 47 years, with an age range of 8 years to 92 years.[3] Prior exposure to ionizing radiation appears to substantially increase the risk of developing malignant neoplasms of the major salivary glands, particularly mucoepidermoid carcinoma.[3,13]

Most patients are asymptomatic and present with solitary, painless masses. Symptoms include pain, drainage from the ipsilateral ear, dysphagia, trismus, and facial paralysis.[3] (Refer to the PDQ summary on Pain for more information.)

Microscopic grading of mucoepidermoid carcinoma is important to determine the prognosis.[1,12,15] Mucoepidermoid carcinomas are graded as low grade, intermediate grade, and high grade. Grading parameters with point values include the following:

  • Intracystic component (+2).
  • Neural invasion present (+2).
  • Necrosis present (+3).
  • Mitosis (≥4 per 10 high-power field [+3]).
  • Anaplasia present (+4).

Total point scores are 0 to 4 for low grade, 5 to 6 for intermediate grade, and 7 to 14 for high grade.

In a retrospective review of 243 cases of mucoepidermoid carcinoma of the major salivary glands, a statistically significant correlation was shown between this point-based grading system and outcome for parotid tumors but not for submandibular tumors.[12] Another retrospective study that used this histologic grading system indicated that tumor grade correlated well with prognosis for mucoepidermoid carcinoma of the major salivary glands, excluding submandibular tumors, and minor salivary glands.[13] A modification of this grading system placed more emphasis on features of tumor invasion.[16] Nonetheless, though tumor grade may be useful, stage appears to be a better indicator of prognosis.[3,16]

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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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