Original ArticleLow-Grade Salivary Duct Carcinoma Description of 16 CasesBrandwein-Gensler, Margaret MD*; Hille, Jos DDS, MDent, FCPath (SA)*; Wang, Beverly Y MD*; Urken, Mark MD*; Gordon, Ronald PhD*; Wang, Li Juan MD, PhD†; Simpson, James R.M MB, MRCPath‡; Simpson, Roderick H.W MB CHB, FRCPath§; Gnepp, Douglas R MD†Author Information From the *Departments of Otolaryngology and Pathology, Mount Sinai School of Medicine, New York, NY; the †Department of Pathology, Rhode Island Hospital, Brown University, Providence, RI; ‡St. Richard’s Hospital, Chichester, Sussex, UK; and the §Royal Devon and Exeter Hospital, Exeter, UK. Jos Hille is a research fellow from the University of the Western Cape, Cape Town, South Africa Reprints: M. Brandwein-Gensler, MD, Box 1189, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10021 (e-mail: [email protected]). The American Journal of Surgical Pathology: August 2004 - Volume 28 - Issue 8 - p 1040-1044 doi: 10.1097/01.pas.0000128662.66321.be Buy Metrics Abstract Low-grade salivary duct carcinoma is a rare neoplasm. We report on 16 patients, with a median age of 64 years. All but one tumor arose from the parotid gland, including one tumor that arose in an intraparotid lymph node; one arose in the submandibular gland. Tumors consist of single to multiple dominant cysts, accompanied by adjacent intraductal proliferation. Cysts are lined by small, multilayered, proliferating, bland ductal cells with finely dispersed chromatin and small nucleoli. Separate, smaller ductal structures are variably filled by proliferating ductal epithelium with cribriform, micropapillary, and solid areas. The overall appearance is very similar to breast atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Foci of definitive stromal invasion were seen in four tumors. Two tumors demonstrated transition from low- to intermediate- or high-grade cytology, with scattered mitotic figures and focal necrosis. S-100 revealed diffuse strong expression in all 9 cases studied. Myoepithelial markers (calponin) highlighted supportive myoepithelial cells rimming the cystic spaces, confirming the intraductal nature of most, or all, of six tumors studied. Nine tumors studied for Her2-neu antigen were uniformly negative. Follow-up was obtained on 13 of our 16 patients. All patients were disease-free after surgery 6 to 132 months (median 30 months). Low-grade salivary duct carcinoma is a low-grade neoplasm with an excellent prognosis; it may be treated by conservative but complete resection. Its resemblance to atypical breast ductal hyperplasia, or micropapillary/cribriform intraductal carcinoma, distinguishes it from high-grade salivary duct carcinoma, papillocystic acinic cell carcinoma, and cystadenocarcinoma. © 2004 Lippincott Williams & Wilkins, Inc.