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Basal Cell Adenoma

Synonyms: Monomorphic Adenoma

Definition

Benign neoplasm composed of basaloid cells with peripheral palisading.

Clinical Features

  • Usually adult
  • Slight predilection for females1
  • Usually in parotid:
    • occasionally within periparotid lymph nodes2
  • An extremely unusual congenital form described3
  • Malignant transformation:
    • rare
    • dermal analogue type particularly at risk4
    • of six cases:5
      • adenoid cystic carcinoma in 3
      • basal cell adenocarcinoma in 3

Gross Pathology

  • Encapsulated
  • Often cystic
  • Tend to be smaller than benign mixed tumors

Histopathology

  • Palisading at the periphery of epithelial nests:
    • results in ‘basaloid’ appearance
  • Pattern of growth:
    • may be predominantly:
      • tubular
      • trabecular, or
      • solid6–8
  • Foci of acinar differentiation:
  • Membranous or dermal analogue tumor:
    • solid variant
    • deposition of abundant basal lamina material around and within epithelial nests:
      • pattern nearly identical to that of eccrine dermal cylindroma10,11 (Fig. 1
        Basal cell adenoma of parotid gland. The appearance is reminiscent of that of a skin adnexal tumor.

        Fig. 1: Basal cell adenoma of parotid gland. The appearance is reminiscent of that of a skin adnexal tumor.

        )
  • Canalicular adenoma:
    • variant
    • bilayered strands or ribbons of columnar cells separated by a loose, well-vascularized stroma
    • increasingly regarded as entity separate from basal cell adenoma8,12 because greater tendency to arise from minor salivary glands:13
      • frequent occurrence of foci of basaloid cells and merging of canalicular and trabecular structures suggest sharp separation not always feasible14
    • Ultrastructurally:
      • like most other salivary gland tumors, appears to derive from intercalated portion of the duct, with minor participation of myoepithelial cells15–18 (Fig. 2 and Fig. 3
        Basal cell adenoma of parotid gland. Prominent reduplication of basal lamina is present. Cells are nondescript and are attached by numerous desmosomes. (×5065)

        Fig. 2: Basal cell adenoma of parotid gland. Prominent reduplication of basal lamina is present. Cells are nondescript and are attached by numerous desmosomes. (×5065)

        Basal cell adenoma of parotid gland. These epithelial cells contain numerous tonofilaments that are attached by desmosomes and form a true lumen. (× 16,850)

        Fig. 3: Basal cell adenoma of parotid gland. These epithelial cells contain numerous tonofilaments that are attached by desmosomes and form a true lumen. (× 16,850)

        )

Special Stains and Immunohistochemistry

  • Duct-lining cells in tubuloglandular and trabecular areas express:
    • keratins
    • α1-antichymotrypsin
    • CEA
    • α subunit of S-100 protein
  • Basaloid cells in trabecular and solid areas express:
    • vimentin
    • actin
    • β subunit of S-100 protein19,20

Differential Diagnosis

  • Basal cell adenocarcinoma
  • Benign mixed tumor
  • Adenoid cystic carcinoma21

Genetics

Management

  • Excision is curative

References

1 Batsakis JG, Brannon RB, Sciubba JJ. Monomorphic adenomas of major salivary glands. A histologic study of 96 tumours. Clin Otolaryngol. 1981;6:129–143.

2 Luna MA, Tortoledo ME, Allen M. Salivary dermal analogue tumors arising in lymph nodes. Cancer. 1987;59:1165–1169.

3 Seifert G, Donath K. The congenital basal cell adenoma of salivary glands. Contribution to the differential diagnosis of congenital salivary gland tumors. Virchows Arch. 1997;430:311–320.

4 Batsakis JG, Luna MA. Basaloid salivary carcinoma. Ann Otol Rhinol Laryngol. 1991;100(Pt 1):785–787.

5 Luna MA, Batsakis JG, Tortoledo ME, del Junco GW. Carcinomas ex monomorphic adenoma of salivary glands. J Laryngol Otol. 1989;103:756–759.

6 Crumpler C, Scharfenberg JC, Reed RJ. Monomorphic adenomas of salivary glands. Trabecular, tubular, canalicular, and basaloid variants. Cancer. 1976;38:193–200.

7 Dardick I, Lytwyn A, Bourne AJ, Byard RW. Trabecular and solid-cribriform types of basal cell adenoma. A morphologic study of two cases of an unusual variant of monomorphic adenoma. Oral Surg Oral Med Oral Pathol. 1992;73:75–83.

8 Gardner DG, Daley TD. The use of the terms monomorphic adenoma, basal cell adenoma, and canalicular adenoma as applied to salivary gland tumors. Oral Surg Oral Med Oral Pathol. 1983;56:608–615.

9 Pulitzer DR, Reed RJ, Megehee JA. Tubuloalveolar adenoma of salivary gland. Hum Pathol. 1985;16:641–644.

10 Batsakis JG. Basal cell adenoma of the parotid gland. Cancer. 1972;29:226–230.

11 Batsakis JG, Brannon RB. Dermal analogue tumours of major salivary glands. J Laryngol Otol. 1981;95:155–164.

12 Daley TD, Gardner DG, Smout MS. Canalicular adenoma. Not a basal cell adenoma. Oral Surg Oral Med Oral Pathol. 1984;57:181–188.

13 Suarez P, Hammond HL, Luna MA, Stimson PG. Palatal canalicular adenoma: report of 12 cases and review of the literature. Ann Diagn Pathol. 1998;2:224–228.

14 Zarbo RJ, Prasad AR, Regezi JA, Gown AM, Savera AT. Salivary gland basal cell and canalicular adenomas: immunohistochemical demonstration of myoepithelial cell participation and morphogenetic considerations. Arch Pathol Lab Med. 2000;124:401–405.

15 Chaudhry AP, Cutler LS, Satchidanand S, Labay G, Sunder Raj M. Ultrastructure of monomorphic adenoma (ductal type) of the minor salivary glands. Arch Otolaryngol. 1983;109:118–122.

16 Chaudhry AP, Cutler LS, Satchidanand S, Labay G, Sunder Raj M, Lin C-C. Monomorphic adenomas of the parotid glands. Their ultrastructure and histogenesis. Cancer. 1983;52:112–120.

17 Dardick I, Kahn HJ, van Nostrand AWP, Baumal R. Salivary gland monomorphic adenoma. Ultrastructural, immunoperoxidase, and histogenetic aspects. Am J Pathol. 1984;115:334–348.

18 Jao W, Keh PC, Swerdlow MA. Ultrastructure of the basal cell adenoma of parotid gland. Cancer. 1976;37:1322–1333.

19 Ferreiro JA. Immunohistochemistry of basal cell adenoma of the major salivary glands. Histopathology. 1994;24:539–542.

20 Takahashi H, Fujita S, Okabe H, Tsuda N, Tezuka F. Immunohistochemical characterization of basal cell adenomas of the salivary gland. Pathol Res Pract. 1991;187:145–156.

21 Nagao K, Matsuzaki O, Saiga H, Sugano I, Shigematsu H, Kaneko T, et al. Histopathologic studies of basal cell adenoma of the parotid gland. Cancer. 1982;50:736–745.

22 Batsakis JG, Luna MA, el-Naggar AK. Basaloid monomorphic adenomas. Ann Otol Rhinol Laryngol. 1991;100:687–690.

23 Herbst EW, Utz W. Multifocal dermal-type basal cell adenomas of parotid glands with co-existing dermal cylindromas. Virchows Arch [A]. 1984;403:95–102.

24 Reingold IM, Keasbey LE, Graham JH. Multicentric dermal-type cylindromas of the parotid glands in a patient with florid turban tumor. Cancer. 1977;40:1702–1710.

25 Choi HR, Batsakis JG, Callender DL, Prieto VG, Luna MA, El-Naggar AK. Molecular analysis of chromosome 16q regions in dermal analogue tumors of salivary glands: a genetic link to dermal cylindroma?. Am J Surg Pathol. 2002;26:778–783.

26 Bignell GR, Warren W, Seal S, et al.. Identification of the familial cylindromatosis tumour-suppressor gene. Nat Genet. 2000;25:160–165.

Last updated: 9 Jan 2006

Basal Cell Adenoma

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