Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours
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Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours Hellquist, Henrik; Paiva-Correia, António; Vander Poorten, Vincent; Quer, Miquel; Hernandez- Prera, Juan C; Andreasen, Simon; Zbären, Peter; Skalova, Alena; Rinaldo, Alessandra; Ferlito, Alfio Published in: Advances in Therapy DOI: 10.1007/s12325-019-01007-3 Publication date: 2019 Document version Publisher's PDF, also known as Version of record Document license: CC BY-NC Citation for published version (APA): Hellquist, H., Paiva-Correia, A., Vander Poorten, V., Quer, M., Hernandez-Prera, J. C., Andreasen, S., Zbären, P., Skalova, A., Rinaldo, A., & Ferlito, A. (2019). Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours. Advances in Therapy, 36(8), 1950-1974. https://doi.org/10.1007/s12325-019-01007-3 Download date: 01. okt.. 2021 Adv Ther (2019) 36:1950–1974 https://doi.org/10.1007/s12325-019-01007-3 ORIGINAL RESEARCH Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours Henrik Hellquist . Anto´nio Paiva-Correia . Vincent Vander Poorten . Miquel Quer . Juan C. Hernandez-Prera . Simon Andreasen . Peter Zba¨ren . Alena Skalova . Alessandra Rinaldo . Alfio Ferlito Received: May 2, 2019 / Published online: June 17, 2019 Ó The Author(s) 2019 ABSTRACT to investigate whether an accurate histological diagnosis of the 11 different types of benign Introduction: A vast increase in knowledge of epithelial salivary gland tumours is correlated to numerous aspects of malignant salivary gland any differences in their clinical behaviour. tumours has emerged during the last decade Methods: A search was performed for histolog- and, for several reasons, this has not been the ical classifications, recurrence rates and risks for case in benign epithelial salivary gland malignant transformation, treatment modali- tumours. We have performed a literature review ties, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO clas- Henrik Hellquist and Anto´nio Paiva-Correia contributed sifications since 1972, as well as numerous to the manuscript equally and are co-first authors. textbooks on salivary gland tumours/head and Enhanced Digital Features To view enhanced digital neck/pathology/oncology. A large number of features for this article go to https://doi.org/10.6084/ archival salivary tumours were also reviewed m9.figshare.8175251. histologically. Electronic Supplementary material The online Results: Pleomorphic adenomas carry a con- version of this article (https://doi.org/10.1007/s12325- siderable risk (5–15%) for malignant 019-01007-3) contains supplementary material, which is available to authorized users. V. Vander Poorten H. Hellquist Á A. Paiva-Correia Otorhinolaryngology-Head and Neck Surgery and Epigenetics and Human Disease Laboratory, Faro, Department of Oncology, Section Head and Neck Portugal Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium H. Hellquist Á A. Paiva-Correia Centre of Biomedical Research (CBMR) and Algarve V. Vander Poorten Á M. Quer Á P. Zba¨ren Á A. Skalova Biomedical Centre (ABC), Faro, Portugal Multidisciplinary Salivary Gland Society, Geneva, Switzerland H. Hellquist (&) Á A. Paiva-Correia Department of Biomedical Sciences and Medicine, M. Quer University of Algarve, Faro, Portugal Department of Otolaryngology, Hospital Santa Creu e-mail: [email protected] i Sant Pau, Barcelona, Spain A. Paiva-Correia J. C. Hernandez-Prera Histopathology Department, Wythenshawe Department of Anatomic Pathology, Moffitt Cancer Hospital, Manchester University NHS Foundation Center, Tampa, FL, USA Trust, Manchester, UK Adv Ther (2019) 36:1950–1974 1951 transformation but, albeit to a much lesser INTRODUCTION degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually An impressive increase in knowledge of the never develop into malignancy. Pleomorphic genetics, pathogenesis, diagnostic possibilities, adenoma has a rather high risk for recurrence clinical behavior, treatment modalities and while recurrence occurs only occasionally in prognosis of malignant salivary tumours has sialadenoma papilliferum, oncocytoma, emerged during the last decade. A similar canalicular adenoma, myoepithelioma and the development has not happened with regards to membranous type of basal cell adenoma. benign salivary neoplasms, in despite the fact Papillomas, lymphadenoma, sebaceous ade- that a few of these are precursors to the malig- noma, cystadenoma, basal cell adenoma (solid, nant variants. The current 4th World Health trabecular and tubular subtypes) very rarely, if Organization (WHO) classification of 2017 ever, recur. defines 11 different types of benign epithelial Conclusions: A correct histopathological diag- salivary tumours (some of them with subclassi- nosis of these tumours is necessary due to (1) fications), 4 non-neoplastic epithelial lesions (1 preventing confusion with malignant salivary of which future studies possibly may give evi- gland tumours; (2) only one (pleomorphic dence that it may be a neoplasm–sclerosing adenoma) has a considerable risk for malignant polycystic adenosis), 3 benign soft tissue transformation, but all four histological types lesions/tumours, and 22 carcinomas [1]. This is of basal cell adenoma can occasionally develop to be compared to the 1st WHO edition of 1972 into malignancy, as does Warthin tumour; (3) that comprised just two adenomas (pleomor- sialadenoma papilliferum, oncocytoma, phic and monomorphic adenoma), two canalicular adenoma, myoepithelioma and tumours (acinic cell tumour ad mucoepider- Warthin tumour only occasionally recur; while moid tumour) and five carcinomas [adenoid (4) intraductal and inverted papilloma, lym- cystic carcinoma, adenocarcinoma, epidermoid phadenoma, sebaceous adenoma, cystadenoma, carcinoma, undifferentiated carcinoma and basal cell adenoma (apart from the membra- carcinoma in pleomorphic adenoma (PA)] [2]. A nous type) virtually never recur. No biomarker modified classification was proposed by Seifert was found to be relevant for predicting recur- et al. in 1990 [3] that led to the publication of rence or potential malignant development. the 2nd WHO classification in 1991 by which Guidelines for appropriate treatment strategies time the two recognisable benign tumour enti- are given. ties had risen to nine (two of which had sub- classifications) [4]. With the continuous Keywords: Benign salivary gland tumours; increase of knowledge, and a wider use of Biomarkers; Malignant transformation; immunohistochemistry and molecular tech- PubMed; Recurrence; Salivary gland niques, the separate entities have been better neoplasms; Treatment modalities characterized and more widely accepted. Sali- vary gland tumours were included in the 3rd and 4th editions of WHO classifications of head S. Andreasen A. Skalova Department of Otorhinolaryngology Head and Neck Department of Pathology, Charles University, Surgery and Audiology, Rigshospitalet, Faculty of Medicine in Plzen, Plzenˇ, Czech Republic Copenhagen, Denmark A. Rinaldo S. Andreasen University of Udine School of Medicine, Udine, Italy Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, A. Ferlito Køge, Denmark Coordinator of the International Head and Neck Scientific Group, Padua, Italy P. Zba¨ren Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Bern, Switzerland 1952 Adv Ther (2019) 36:1950–1974 and neck tumours (2005 and 2017, respectively) Table 1 2017 WHO classification of benign epithelial instead of being published in separate books salivary gland tumours (from El-Naggar et al. [1]) [1, 5]. The histological identification of PA, Warthin tumour (WT) and, to a certain extent Pleomorphic adenoma myoepithelioma myoepithelioma (MYO), is usually relatively Basal cell adenoma (membranous, solid, trabecular and straightforward, but the classification of some tubular types; often mixtures thereof) Warthin of the other eight benign tumours can on tumour occasion be rather difficult, primarily due to their rareness in a routine pathology laboratory Oncocytoma set-up. Many may perhaps agree with Zarbo Lymphadenoma (sebaceous and non-sebaceous et al. in their statement related to less common lymphadenoma) cystadenoma benign salivary gland tumours ‘‘To wit, we believe it does not matter what these tumours Sialadenoma papilliferum are called as long as they are recognized and Ductal papilloma (intraductal and inverted ductal designated benign and the adequacy of excision papilloma) Sebaceous adenoma is noted’’ [6]. However, it appears that some of the benign salivary gland tumours do have a Canalicular adenoma tendency to recur, others have a very low ten- dency, while yet some others do not recur at all. Compliance with Ethics Guidelines A few are known to develop into malignant neoplasms, while in others malignant transfor- This article is based on previously conducted mation is extremely rare, or has not yet even studies and does not contain any studies with been reported. Therefore, the aims of this study human participants or animals performed by were to investigate via a search in the medical any of the authors. The studies involved fully literature, whether the study of any biomarker complied with the ethical standard of the hos- and a correct histological subclassification pitals involved and in accordance with the would detect the risk