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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.
basaloid salivary gland adenoma
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.
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.
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
BCAs present as well-circumscribed ,usually encapsulated nodules
measuring 0.2-5.5 cm. Except for the membranous type, which may be
On cut section, they are solid and homogeneous or partially cystic, with
a greyish-white to pinkish-red colour.
The tumours show a mixture of solid, trabecular, tubular, and membranous
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
The membranous pattern features prominent hyaline material , with
intercellular coalescing droplets within tumour nests.
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
• 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
• Tumor islands of membranous
• basal cell adenoma. Palisade
periph- eral cells and large pale
central cells. Thick and complete
basement mem- brane. HE×512.
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
• 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
• Basal cell adenoma
• SMA staining the preiphral
palisaded myoepithelial cells
• CK7 immunopositivity is
confined to the ductal cells.
• SMA immunoexpression is
typically localized in
peripheral tumour cells,
A few studies have reported frequent alterations at chromosomes 8p22, 19q
13.4 , and 16q 12-13.
Some BCAs occur in the setting of Brooke-Spiegler syndrome (multiple
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.
Canalicular adenoma is a benign salivary gland tumour composed of
monomorphous epithelial ductal cells arranged in anastomosing cords within
cell-poor vascular stroma.
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
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
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
Canalicular adenomas are well-circumscribed
brown to yellowish tumours
• 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
• 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.
• 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
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.
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
Basal cell adenoma
• Ductal cells: keratin, alpha-1-antichymotrypsin, CEA, S100 (alpha
• Basaloid cells: vimentin, actin, S100 (beta subunit)
• S100, AE1 / AE3, CK19, CK7, EMA, vimentin
• Distinctive linear immunoreactive pattern of GFAP among cells in
proximity to connective tissue interface
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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-
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.
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)