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Cellular Classification of Salivary Gland Cancer

    continued...

    Grading is used primarily for mucoepidermoid carcinomas, adenocarcinomas, not otherwise specified (NOS), adenoid cystic carcinomas, and squamous cell carcinomas.[1,3] Various other salivary gland carcinomas can also be categorized according to histologic grade as follows:[3,5,6,7,8]

    Low grade

    • Acinic cell carcinoma.
    • Basal cell adenocarcinoma.
    • Clear cell carcinoma.
    • Cystadenocarcinoma.
    • Epithelial-myoepithelial carcinoma.
    • Mucinous adenocarcinoma.
    • Polymorphous low-grade adenocarcinoma (PLGA).

    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]

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