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And Maxillofacial Pathology Oral Med Pathol 12 (2008) 57 Proceedings of the 3rd Annual Meeting of the Asian Society of Oral and Maxillofacial Pathology Date: November 17-18, 2007 Venue: Howard International House, Taipei, the Republic of China Oraganizaing Committee: President: Chun-Pin Chiang, School of dentistry, College of Medicine, National Taiwan University Vice Presidents: Li-Min Lin, College of Dental Medicine kaohsiung Medical University, Ying-Tai Jin, National Cheng Kung University Secretary General: Ying-Tai Jin, Nationatl Cheng Kung University Organizers: Taiwan Academy of Oral Pathology and School of Dentistry of Medicine, National Taiwan University myoepithelial and/or basal cells, glycogen-rich clear cells, Special lecture squamous epithelial cells and oncocytic cells may also be found focally or extensively in different tumour types. 1. Classification and diagnosis of salivary gland Grading of malignancy: The presence of many low-grade tumors based on the revised WHO classification and intermediate-grade carcinomas, which show greater Hiromasa Nikai propensity for the indolent aggression, and the ability of Hiroshima University, Hiroshima, Japan long standing benign tumours to undergo malignant transformation are striking features of salivary carcinomas. (1) General remarks of salivary gland tumours Therefore, the most important work for pathologists at We oral pathologists often have difficulties and confuse diagnosis of salivary gland neoplasms is to distinguish these in diagnosis of salivary gland tumours. This will be low- or intermediate grade carcinomas from both benign and attributable to our lack of accumulated experience due to highly aggressive tumour types often bearing microscopic their overall rarity, comprising only about 1% of human resemblances for determining the choice of treatments. tumours and less than 5% of all head and neck tumours. Their extreme morphological diversity between different (2) Classification of salivary gland tumours tumour types also makes diagnosis difficult. Despite the The same classification is applied to major and minor rather small number of cases encountered in routine salivary gland tumours. The WHO classification (1991) histologic examination, there are so many tumour entities. revealed a great expansion in the histologic types recognized Histologic patterns and cell components are often shared compared with the 1976 classification. In addition to among a variety of salivary adenomas and carcinomas with the recognition of many new types during the past two different clinical behaviors and prognosis. decades, as the most attributable reason for this significant Anatomical sites: Some tumours occur exclusively or increase of named entities, a variety of carcinomas, which predominantly in the parotid gland, whereas some are had been lumped together under the common heading of essentially limited to the minor salivary glands. This “adenocarcinoma”, had been clarified to be specific entities knowledge may guide diagnosis. with distinct histology and biologic behaviors and these Histological features and cell components: Reflecting a were classified individually. normal histoarchitecture of the tissue of origin, many of the In the newly published WHO classification (2005), there salivary gland tumours show the biphasic structure composed are not so many significant changes when compared with the of inner luminal epithelial cells and outer non-luminal 1991 classification. The revised classification is almost same myoepithelial or basaloid cells. On the other hand, some to the classification described in the AFIP atlas (1995). tumours may be almost purely epithelial or myoepithelial in (1) Tumours are divided into two groups, malignant cellular composition. The histological diversity is often epithelial tumours and benign epithelial tumours. brought by the neoplastic myoepithelial cells, as an important (2) Clear cell carcinoma, not otherwise specified, low- morphologic modifier, which exhibit a wide spectrum of grade cribriform cystadenocarcinoma and sialo- phenotypic expression. These “modified” myoepithelial or blastoma are newly adopted in the malignant epithe- basaloid cells often produce glycosaminoglycans and basal lial tumour group. lamina materials that may form the cribriform pseudoluminae. (3) As minor changes in the malignant epithelial tumour Cribriform pattern may also be formed by true ductal spaces. group, adenocarcinoma is defined as adenocarci- Biphasic tubular and cribriform structures are shared by a noma, not otherwise specified. Cystadenocarci- variety of tumour types. In addition to the cell components noma includes not only papillary cystadenocarcinoma showing differentiation toward the acinar, ductal, but also non-papillary cystadenocarcinoma. Carci- 58 Proceedings of the 3rd Annual Meeting of the Asian Society of Oral and Maxillofacial Pathology noma ex pleomorphic adenoma, carcinosarcoma carcinoma, sialoblastoma, small cell carcinoma and and metastasizing pleomorphic adenoma are indi- some non-sialogenic tumours. Polymorphous low- vidually classified and their comprehensive heading grade adenocarcinoma is a distinctive carcinoma of “carcinoma in pleomorphic adenoma” (malignant with low metastatic potential nearly always mixed tumour) was excluded. Large cell carcinoma involving minor salivary glands, whereas salivary and lymphoepithelial carcinoma are also indepen- duct carcinoma is one of the most aggressive dently classified without their common heading of adeno carcinomas mainly involving the parotid. In “undifferentiated carcinoma” previously used. recent years, the presence of low-grade variant of (4) In the benign epithelial tumour group, sebaceous this carcinoma has been suggested. Low-grade and non-sebaceous lymphadenomas are classified cribriform cystadenocarcinoma may be regarded to under the heading of lymphadenoma. Cystadenoma represent low-grade salivary duct carcinoma. includes papillary cystadenoma and mucinous cysta- denoma both of which were previously listed up as 2. Human papillomavirus in oral lesions and DNA subclassification. vaccines (5) Various synonyms previously used, such as myoepi- Hatsuhiko Maeda thelial adenoma, adenolymphoma, oncocytic adenoma, Department of Pathology, School of Dentistry, Aichi-Gakuin terminal duct adenocarcinoma and malignant myo- University, Nagoya, Japan epithelioma are not used in the present classification. In the past 20 years, there has been an increasing interest in human papillomaviruses (HPV) because of (3) Differential diagnosis of salivary gland tumours their potential role in the pathogenesis of malignant Discussion will be focused in the differential diagnosis tumors and HPV infections have been demonstrated in of (1) tumours mainly composed of clear cells, (2) tumours several oral disorders. In a recent meta-analysis, HPV mainly composed of oncocytic cells, (3) tumours with basal/ was indeed confirmed as an independent risk factor for basaloid cells as essential component, and (4) tumours oral carcinoma. To date, totally more than 100 types of showing cribriform pattern in their histology. Diagnostic HPV have been identified. As in anogenital cancers, HPV approach to these tumour groups will be discussed. Concept type 16 is the most prevalent type in oral carcinomas. The and diagnostic criteria of the newly classified tumour benign oral lesions, associated with HPV infection, include types will be explained here. The presentation will also leukoplakia, papilloma, condyloma acuminatum, verruca highlight an update on the conceptual, histopathologic vulgaris, and focal epithelial hyperplasia (FEH). Papillomas and clinicopathologic aspects and, if possible, immuno- and condylomas are mostly caused by HPV type 6 or 11, histochemical and ultrastructural features of each tumour while oral verrucas are associated with the skin types 2 or entity included in these groups. 4. The FEH lesions are caused by HPV types 13 and 32, (1) Salivary clear cell tumours include clear cell only detected in oral epithelium. In immunocompromised oncocytoma, sebaceous adenoma/carcinoma, clear patients, benign HPV-induced lesions are characterized cell variants of myoepithelioma/myoepithelial carci- by atypical morphology and the simultaneous detection of noma, mucoepidermoid carcinoma and acinic cell multiple HPV types. Oral benign HPV lesions are mostly carcinoma, monomorphic variant of epithelial- asymptomatic, and may persist or regress spontaneously. myoepithelial carcinoma, and clear cell carcinoma, In a previous investigation, we developed a novel NOS (hyalinizing clear cell carcinoma). hamster oral papillomavirus (HOPV) associated carcino- (2) Oncocytic variants are also known to be present in genesis model by combining DMBA application with mucoepidermoid carcinoma, acinic cell carcinoma physical wounding of the hamster lingual mucosa. Using and myoepithelioma/myoepithelial carcinoma. Fea- this animal model, we demonstrated that immunization with tures of other oncocytic tumours such as oncocytoma/ L1, E6 and E7 DNA vaccines prevent development of oncocytic carcinoma, Warthin tumour and oncocytic papillomavirus-associated oral carcinoma. Recently it has cystadenoma/cystadenocarcinoma are also briefly become clear that more potent methods for DNA vaccine outlined. delivery need to be developed to enhance the efficacy of (3) Included in the basaloid cell tumour group are basal DNA vaccines. Using this HOPV hamster model to compare cell adenoma/adenocarcinoma, adenoid cystic carci- the anti-tumor effectiveness of different
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