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PLEOMORPHIC ADENOMA

Because of their remarkable histologic diversity, these neoplasms have also been called mixed tumors. They represent about 60% of tumors in the parotid, are less common in the

submandibular glands, and are relatively rare in the minor salivary glands. They are benign tumors that are derived from a mixture of ductal (epithelial) and myoepithelial cells, and

therefore they show both epithelial and mesenchymal differentiation. They also reveal epithelial elements dispersed throughout a matrix along with varying degrees of myxoid, hyaline,

chondroid (cartilaginous), and even osseous tissue. In some tumors, the epithelial elements predominate; in others, they are present only in widely dispersed foci.

Little is known about the origins of these neoplasms except that radiation exposure increases the risk. Equally uncertain is the histogenesis of the various components. A currently popular

view is that all neoplastic elements, including those that appear mesenchymal, are of either myoepithelial or ductal reserve cell origin (hence the designation pleomorphic adenoma).

Morphology.

Most pleomorphic adenomas present as rounded, well-demarcated masses rarely exceeding 6 cm in greatest dimension ( Fig. 16-16 ). Although they are encapsulated, in some locations

(particularly the palate) the capsule is not fully developed, and expansile growth produces tonguelike protrusions

Figure 16-16Pleomorphic adenoma. A, Slowly enlarging neoplasm in the parotid gland of many years duration. B, The bisected, sharply circumscribed, yellow-white tumor can be seen

surrounded by normal salivary gland tissue.

Figure 16-17Pleomorphic adenoma. A, Low-power view showing a well-demarcated tumor with adjacent normal salivary gland parenchyma. B, High-power view showing epithelial cells

as well as myoepithelial cells found within a chondroid matrix material.

Figure 16-18Warthin tumor. A, Low-power view showing epithelial and lymphoid elements. Note the follicular germinal center beneath the epithelium. B, Cystic spaces separate lobules

of neoplastic epithelium consisting of a double layer of eosinophilic epithelial cells based on a reactive lymphoid stroma.

Figure 16-19 A, Mucoepidermoid carcinoma showing islands having squamous cells as well as clear cells containing mucin. B, Mucicarmine stains the mucin reddish-pink. (Courtesy of

Dr. James Gulizia, Brigham and Women's Hospital, Boston.)

Figure 16-20Adenoid cystic carcinoma in a salivary gland. A, Low-power view. The tumor cells have created a cribriform pattern enclosing secretions. B, Perineural invasion by tumor

cells.

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