Table 1

Differential diagnosis of juvenile pleomorphic adenoma of the cheek


Salient histological features

Carcinoma ex pleomorphic adenoma

Adenoid cystic carcinoma

- Cribriform and pseudoglandular patterns of basaloid cells with hyalinized stroma

- Frequent perineural invasion

- Minimal nuclear pleomorphism

- No squamous differentiation

- No high grade dysplasia or squamous carcinoma in situ, no extensive necrosis

Polymorphous low grade adenocarcinoma

- Uniform plump columnar cells with bland nuclei arranged in variable growth patterns (tubular, cribriform, papillary, solid, fascicular, microcystic, single file, pseudoadenoid cystic, strand-like, mixed)

- Perineural invasion common around small nerves

- Infiltrative borders

Basal cell adenoma

- Elongated and branching canaliculi separated by hyaline stroma

Acinic cell carcinoma

- Variable cell types (serous, clear, vacuolated, intercalated duct cells) arranged in solid, microcystic, papillary cystic and follicular patterns

- few mitotic figures

Clear cell carcinoma-hyalinizing type

-Trabeculae, cords, islands or nests of monomorphic clear cells surrounded by hyalinized bands with foci of myxohyaline stroma


- Invasive, cystic growth pattern, 75% had

- Conspicuous papillary component

- Composed of small cuboidal cells, large cuboidal cells, tall columnar cells or mixture

- Cystic spaces with hemorrhage and granulation tissue are frequent

Intraductal carcinoma

- intraductal neoplasm with micropapillary, cribriform, solid, comedo or clinging patterns, with preservation of myoepithelial cells surrounding intraductal tumor

Mucoepidermoid carcinoma

- Cords, sheets, clusters of mucous, squamous, intermediate and clear cells; low to high grade

Epithelial myoepithelial carcinoma

- Both epithelial and myoepithelial components seen

- Most tumor cells have myoepithelial features with clear cytoplasm or naked nuclei

- Focally, there are ducts or tubules with an outer rim of myoepithelial cells and inner, dark ductal cells with scant eosinophilic cytoplasm and round, bland nuclei

Dalati and Hussein Diagnostic Pathology 2009 4:32   doi:10.1186/1746-1596-4-32

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