Year : 2005 | Volume
: 16 | Issue : 4 | Page : 167--70
Salivary duct carcinoma of the palate
I Ponniah1, GM Murali2, P SureshKumar3, MG Kumaran4, A Shaheen5,
1 Oral and Maxillofacial pathology, TN Gov't. Dental College and Hospital, Chennai, India
2 Oral Medicine and Radiology, TN Gov't. Dental College and Hospital, Chennai, India
3 Oral and Maxillofacial Surgery, TN Gov't. Dental College and Hospital, Chennai, India
4 TN Gov't. Dental College and Hospital, Chennai, India
5 Oral and Marillo facial Pathology, TN Gov't. Dental College and Hospital, Chennai, India
TN Gov«SQ»t. Dental College and Hospital, Chennai
Salivary duct carcinoma is a rare high-grade neoplasm that more frequently affects the parotid gland. Though neoplasms of this type are infrequent in minor salivary glands, they are less aggressive and may lead to early diagnosis before distant metastases could occur. Salivary duct carcinoma is also the most frequent epithelial component of carcinosarcoma. The present article reports a case of SDC of the palate in a 26-year-old male and discusses SDC as a malignant epithelial component in carcinosarcoma.
|How to cite this article:|
Ponniah I, Murali G M, SureshKumar P, Kumaran M G, Shaheen A. Salivary duct carcinoma of the palate.Indian J Dent Res 2005;16:167-70
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Ponniah I, Murali G M, SureshKumar P, Kumaran M G, Shaheen A. Salivary duct carcinoma of the palate. Indian J Dent Res [serial online] 2005 [cited 2021 Feb 25 ];16:167-70
Available from: https://www.ijdr.in/text.asp?2005/16/4/167/29902
Salivary duct carcinoma (SDC) is a rare, typically high-grade malignant epithelial neoplasm composed of structures that resemble expanded salivary gland ducts. Kleinsasser and Klein first applied the term in 1968  to describe a malignant neoplasm of salivary gland having resemblance to the ductal carcinoma of breast. Other terms include infiltrating salivary duct carcinoma, cribriform salivary carcinoma of excretory duct . and low grade salivary duct carcinoma . Recently, a variant of SDC sarcomatoid salivary duct carcinoma has been proposed . Over 80 % of the tumors are found in the parotid gland more commonly in elderly men, with peak in the sixth decade. ,, ,,,, Although it was first described over three decades ago, reports of SDC involving minor salivary glands of the oral cavity is rare, with only fewer than 20 such tumors described in the literature ,,,,,,,,,,,,. We report a case of SDC involving the palate in a 26-yearold male. In addition, we discuss SDC as a malignant epithelial component in carcino sarcoma.
In January 2001, a 26-year-old male patient presented with the chief complaint of swelling in the roof of his mouth on the right side for the past 1 year. History revealed that the swelling started as a small one and gradually progressed to the present size. On his account, the swelling was painless initially and reported that he developed pain only in the last few weeks. He stated that the pain was localized, continuous and gnawing in nature. There was no history of nasal obstruction or discharge. His past medical and dental history was unremarkable.
On physical examination, there was no palpable lymph node. hitra orally, a single lobulated swelling was noted on the right side of the hard palate, measuring 3 cm x 2cm in size, irregular in shape. The lesion extended anteriorly to the 14 region, posteriorly to the junction of hard and soft palate and medially crossing the midline to the left side of the palate [Figure 1] a. The mucosa over the swelling appeared smooth but showed slight bluish tinge with a bluish black discoloration on the posterior aspect. Few engorged blood vessels were also seen over the swelling.
On palpation, the lesion was firm, tender and slightly compressible. Aspiration was attempted but did not yield any positive results. Occlusal radiograph of maxilla showed widening of periodontal ligament space in relation to 11, which also showed extrusion. There was also loss of trabecular pattern and ill-defined radiolucency indicating bone destruction [Figure 1]b. The lesion was provisionally diagnosed as an adenoma of the palate. An incisional biopsy was performed and subjected to histopathological examination.
Histopathological examination showed beneath a non-dysplastic surface epithelium, variably sized circumscribed nests of dysplastic epithelium with prominent central comedonecrosis and intraductal papillary projections [Figure 2]a and b. The nests of epithelium also exhibited solid and cribriform growth patterns [Figure 2]c. The stroma was predominantly fibro vascular and characteristically showed vascular invasion in many regions of the section [Figure 2]d. The histomorphology of the lesion was consistent with salivary duct carcinoma.
The lesion was excised completely free of margins, as observed by the study of surgical specimen. There was no evidence of local recurrence or distant metastasis during the 4 years of follow-up.
Review of the literature showed that SDC of the oral cavity is more common in the palate ,,,, ,,and is similar to its counterpart in the parotid gland with respect to age and gender. Most of the reported cases occurred in patients over 50 yeas of age and is uncommon before the third decade, only one case had been reported previously in a 23 year old patient , ours being the second case to the best of our knowledge.
SDC is considered to be a high-grade carcinoma with dismal short term prognosis , death eventually occurring within the first 3 years after diagnosis ,,,. In contrast, others believe that there exist different sub types, one of which is characteristically aggressive, whereas the other less invasive purely intraductal, perhaps representing pre-invasive phase of high-grade SDC ,,. SDC is characterized microscopically by intraductal tumor cell islands with papillary, cribriform or solid configurations of cells, often with central comedonecrosis .
Combination of different patterns are frequently found in the same tumor ,, as observed in our case. Perineural and vascular invasion as well as intralymphatic emboli may also be seen.
Delgado et al , suggested that cribriform growth pattern and comedonecrosis are more frequently encountered in high-grade than in low-grade SDC. Progression is evidenced by the acquisition of higher cytologic grades such as, monomorphous cellular composition, well defined cytoplasmic borders and rigid cellular arrangement , In our case, cribriform growth pattern and comedonecrosis were prominent and also higher cytologic grades were observed. However this lesion is found to be less aggressive similar to most other reports of SDC of oral cavity , ,,,,,,,,,,.
To make a definitive diagnosis of SDC, Garland et al , require circumscribed epithelial nest with central comedonecrosis. Interestingly, in most cases of carcinosarcoma, a rare biphasic tumor consisting of carcinomatous and sarcomatous features  the malignant epithelial component is that of SDC.,,, Furthermore, both SDC,,,,, and carcinosarcoma may arise from pre-existing pleomorphic adenoma , ,,. Does the presence of residual pleomorphic areas have any significance to the prognosis? The fact is that the presence of pre-existent pleomorphic adenorna does not have a significant prognostic factor in SDC,. Similarly, the degree of lethality is also not dependent on the histological type of carcinoma in carcinosarcoma.
Immunohistochemical findings in carcinosarcoma suggest that both epithelial and mesenchymal component have a common precursor cell, possibly myoepithelial cell with a spectrum of differentiation ,,. In contrast Alvarez-Canas and Rodilla  concluded that the malignant epithelial component resembling similar to SDC in carcinosarcoma, is composed entirely of ductal cells without evidence of myoepithelial differentiation.
Recently, sarcomatoid SDC has been described in an attempt to define those carcinosarcomas that manifest SDC microscopically, as a variant of SDC rather than carcinosarcoma ,. The concept of sarcomatoid SDC was based on the immunohistochemical expression pattern of epithelial specific markers ,. Further evidence for this concept is the ultra structural observation of interdigitating cytoplasmic process and scattered junctional complexes in addition to the lack of tonofilaments or intracellular lumina in the sarcomatoid component . Therefore, it is likely that both carcinomatous and sarcornatous component share a common histogenetic pathway . It is appropriate that the use of the term carcinosarcoma be restricted to those carcinosarcomas in which the malignant epithelial component does not resemble SDC.
In conclusion, although these terminologies for closely related neoplasm in terms of prognosis may generate academic interest, it is difficult to predict any difference in their biologic behaviour. It is important that more cases of this neoplasm should be reported to understand any significant biologic differences that would help to establish a definite conclusion about their nature. Until more is known about their nature, it is widely believed that both SDC and SDC in carcinosarcoma are rare high-grade carcinomas capable of distant metastases with a poorer outcome in major salivary glands,, ,,, ,,. In contrast SDC of minor salivary gland origin arerelatively less aggressive and carries a better prognosis , ,,,,,,,,,,.
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