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Basal cell Adenoma and Canalicular Adenoma

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Basal cell Adenoma and Canalicular Adenoma

  1. 1. Basal cell adenoma
  2. 2. Definition Basal cell adenoma ( BCA) is a benign salivary gland neoplasm composed of small basaloid cells, with occasional inner ductal epithelial cells forming nests and cords. Synonyms Monomorphic adenoma basaloid salivary gland adenoma Membranous adenoma
  3. 3. Epidemiology BCAs account for 1 -3.7% of all salivary gland tumours. They are most frequent in elderly adults the average patient age at presentation ranges from 57 years to > 70 years , with a slight female predilection. Localization Most BCAs arise in the major salivary glands. The parotid gland is the most common site (accounting for > 80% of cases) followed by the submandibular gland. extremely rare in the minor glands.
  4. 4. Clinical features The tumours are typically well-defined and movable solitary masses. The membranous type may present as multiple nodules and may coexist with dermal cylindromas or trichoepitheliomas Macroscopy BCAs present as well-circumscribed ,usually encapsulated nodules measuring 0.2-5.5 cm. Except for the membranous type, which may be multinodular. On cut section, they are solid and homogeneous or partially cystic, with a greyish-white to pinkish-red colour.
  5. 5. Histopathology The tumours show a mixture of solid, trabecular, tubular, and membranous patterns. They are composed of basaloid cells with scant cytoplasm, indistinct cell borders, and round to oval nuclei, and may show peripheral palisading. Large cells with paler-staining nuclei may be present in the centre of the basaloid nests. The membranous pattern features prominent hyaline material , with intercellular coalescing droplets within tumour nests.
  6. 6. Histologically 4 characteristic patterns have been described: solid, trabecular, tubular and membranous. It is characteristic the presence of a basaloid cellular layer with a stockade pattern and rounded by hyaline substance. The absence of myoepithelial cells!! present in benign mixed tumors and other salivary gland neoplasms, has been referred as characteristic of this tumour. However, other authors suggest the concurrence of myoepithelial cells, based in the presence presence of S-100 stromal fusiform cells
  7. 7. • The distinctive features are: 1. the thick, eosinophilic hyaline layer that surrounds the epithelial islands and separates them from one another. 2. This hyaline material is also often seen within the epithelial islands, appearing as hyaline droplets. • The hyaline materials stain positive for periodic acid-Schiff stain. membranous basal cell adenoma
  8. 8. • Tumor islands of membranous • basal cell adenoma. Palisade periph- eral cells and large pale central cells. Thick and complete basement mem- brane. HE×512.
  9. 9. Important features help to distinguish the membranous variant from the solid one: a thicker basement membrane-like structure, including a periepithelial sheath of hyaline materials surrounding the epithelial islands many extracellular hyaline droplets within those islands; encapsulated in less than half the cases
  10. 10. In summary: • Solid BCA are formed by small cells organized in a compact manner. • In the trabecular and tubular subtypes, they are disposed in narrow bands and ductal structures or in a combination of both. • Membranous subtype is constituted by external cells in a stockade pattern and by an intense hyalinized basal membrane. • Pancytokeratin staining is positive in all tumour cells but most intense in ductal cells.
  11. 11. • Tubular adenoma • Calponin highlighting periductal myoepithelial cells
  12. 12. • Trabecular adenoma • Calponin, peripheral palisaded myoepithelial cells
  13. 13. • Trabecular-tubular adenoma • Calponin-positive stromal-like spindled cells
  14. 14. • Basal cell adenoma • SMA staining the preiphral palisaded myoepithelial cells
  15. 15. • CK7 immunopositivity is confined to the ductal cells. • SMA immunoexpression is typically localized in peripheral tumour cells, indicating myoepithelial differentiation.
  16. 16. Genetic profile A few studies have reported frequent alterations at chromosomes 8p22, 19q 13.4 , and 16q 12-13. Genetic susceptibility Some BCAs occur in the setting of Brooke-Spiegler syndrome (multiple familial trichoepithelioma) Prognosis and predictive factors The prognosis is generally very good, with a very low recurrence rate; except for the membranous type, which has a recurrence rate of approximately 25% Basal cell carcinoma transformation of BCA occurs rarely.
  17. 17. Canalicular adenoma
  18. 18. Definition Canalicular adenoma is a benign salivary gland tumour composed of monomorphous epithelial ductal cells arranged in anastomosing cords within cell-poor vascular stroma. Epidemiology Canalicular adenomas occur in the fourth to seventh decades of life and rarely before the age of 50 years. Men are more often affected than women. In western countries, canalicular adenoma accounts for 0.5-12% of all minor salivary gland tumours
  19. 19. Localization Canalicular adenoma is a tumour of the minor salivary glands. Most cases (80%) occur in the upper lip. The buccal mucosa, and rarely the palate and other sites, may also be involved.
  20. 20. Clinical features Patients present with an asymptomatic, painless swelling, or the tumour is discovered incidentally during dental examination. In about 13% of cases, the tumours present multifocally (including bilaterally), typically in the upper lip and buccal region Macroscopy Canalicular adenomas are well-circumscribed brown to yellowish tumours
  21. 21. Histopathology • The tumours are well delineated and lobulated. Multiple small nodules can be found within the affected salivary gland. • Cyst formation can be present and may be accompanied by haemorrhage and haemosiderin macrophages. • The tumour cells are uniform columnar to cuboidal epithelial cells arranged in anastomosing, branching, or budding parallel cords, which are sometimes widely separated or sometimes join and form beaded edges. • The tumour cell nuclei are monomorphous, with finely dispersed chromatin and visible nucleoli. Mitoses are rare.
  22. 22. Immunohistochemical: • The cells are positive for cytokeratins. • S100 shows strong and consistent nuclear and cytoplasmic staining. • p63 is negative and KIT (CD117) is positive • The exclusive luminal differentiation of canalicular adenoma is a distinguishing feature from basal cell adenoma and adenoid cystic carcinoma.
  23. 23. In summary: strong and frequent staining for S100 protein represents the main characteristic of canalicular adenoma. The epithelial nature was determined by the high positivity for related cytokeratins and the absence of any reactivity for calponin rules-out a myoepithelial origin of this lesion. Prognosis The prognosis is excellent, and local excision is curative. Due to the multifocal growth of these tumours, it is difficult to ascertain whether a recurrence of canalicular adenoma is a true recurrence or a result of multinodularity.
  24. 24. IHC summary Basal cell adenoma • Ductal cells: keratin, alpha-1-antichymotrypsin, CEA, S100 (alpha subunit) • Basaloid cells: vimentin, actin, S100 (beta subunit) Canalicular adenoma • S100, AE1 / AE3, CK19, CK7, EMA, vimentin • Distinctive linear immunoreactive pattern of GFAP among cells in proximity to connective tissue interface
  25. 25. Reference 1. Pereira, M. C., Antônio, A., Pereira, C., Adolfo, J., & Hanemann, C. (2007). Immunohistochemical profile of canalicular adenoma of the upper lip : a case report, (Figure 2), 2–4. 2. Thompson, L. D. R., Bauer, J. L., Chiosea, S., & Mchugh, J. B. (2015). Canalicular Adenoma : A Clinicopathologic and Immunohistochemical Analysis of 67 Cases with a Review of the Literature, 181–195. https://doi.org/10.1007/s12105- 014-0560-6 3. Yu, G., Ubmüller, J., & Donath, K. (2009). Membranous Basal Cell Adenoma of the Salivary Gland : A Clinicopathologic Study of 12 Cases Membranous Basal Cell Adenoma of the Salivary Gland : A Clinicopathologic Study of 12 Cases, 6489. 4. Considerations, M. (2000). Salivary Gland Basal Cell and Canalicular Adenomas Immunohistochemical Demonstration of Myoepithelial Cell Participation and Morphogenetic Considerations, 124(March). 5. García, R. G., Cha, S. H. N., Guerra, M. F. M., & Amat, C. G. (2005). Basal cell adenoma of the parotid gland . Case report and review of the literature, 206–209. 6. Kawata, R., Yoshimura, K., & Lee, K. (2010). Basal cell adenoma of the parotid gland : a clinicopathological study of nine cases — basal cell adenoma versus pleomorphic adenoma and Warthin ’ s tumor, (September 1999), 779–783. https://doi.org/10.1007/s00405-009-1139-9 7. Sousa, S. O. M. De, Arau, N. S. De, Corre, L., Soubhia, A. M. P., & Arau, V. C. De. (2001). Immunohistochemical aspects of basal cell adenoma and canalicular adenoma of salivary glands, 37, 365–368. 8. WHO Classification of Head and Neck Tumours, 4ed, (2017)

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