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Pitfalls in the Biopsy Diagnosis of Intraoral Minor Salivary Gland Neoplasms: Diagnostic Considerations and Recommended Approach

Turk, Andrew T. MD*; Wenig, Bruce M. MD

Advances in Anatomic Pathology:
doi: 10.1097/PAP.0000000000000000
Review Articles
Abstract

Among the more common types of intraoral minor salivary gland neoplasms are pleomorphic adenoma, basal cell adenoma, polymorphous low-grade adenocarcinoma, and adenoid cystic carcinoma. These minor salivary gland neoplasms share similar morphologic features and to a large extent immunohistochemical findings. Differentiation between these benign and malignant neoplasms is often predicated on the presence or absence of invasion. As such, in the presence of limited tissue sampling that typifies the initial testing modalities, including fine needle aspiration biopsy and/or incisional biopsy, it often is not possible to differentiate a benign from malignant minor salivary gland neoplasm. The diagnostic difficulties arise from the absence in needle or incisional biopsy of the tumor’s periphery to determine whether infiltrative growth is or is not present. In this manuscript we discuss limitations and considerations associated with evaluation of incisional biopsies of intraoral minor salivary gland tumors. We offer a diagnostic approach to evaluating these biopsies, and suggest diagnostic terminology for biopsy specimens in which distinction between benignancy and malignancy is not feasible. The pathologist’s approach to this distinction is critical, as treatment of benign neoplasms is generally conservative, whereas malignant lesions may warrant more aggressive management.

Author Information

*Department of Pathology and Cell Biology, Columbia University

Department of Diagnostic Pathology and Laboratory Medicine, Beth Israel Medical Center, St Luke’s and Roosevelt Hospitals, New York, NY

All figures can be viewed online in color at http://www.anatomicpathology.com.

The authors have no funding or conflicts of interest to disclose.

Reprints: Bruce M. Wenig, MD, Department of Diagnostic Pathology and Laboratory Medicine, Beth Israel Medical Center, St Luke’s and Roosevelt Hospitals, New York, NY 10003 (e-mail: bwenig@chpnet.org).

© 2014 by Lippincott Williams & Wilkins.