Salivary duct carcinoma
Citation, DOI & article data
Salivary duct carcinomas are a subtype of primary salivary gland tumor. Salivary duct carcinomas show high rates of metastasis and recurrence.
Salivary duct carcinomas represent 5-10% of salivary gland malignancies and can arise de novo or out of a pleomorphic adenoma 1,2. They typically arise in males during the 6th or 7th decades 3.
Clinical presentation can vary depending on disease severity, but patients most often present with a parotid or neck mass. While frequently painless, some patients presenting with salivary duct carcinoma have also reported pain. In advanced disease, patients may present with facial nerve involvement resulting in weakness or paralysis 4,5.
Metastatic spread affects 30% of patients at presentation and 50-60% patients following diagnosis. Metastatic disease can present as dyspnea (lung metastases), bone pain (bone metastases), or right upper quadrant pain (liver metastases) 6,7.
Although radiological and molecular studies are helpful, a definite diagnosis of salivary gland carcinoma requires histological studies.
Microscopically, salivary gland duct carcinomas resemble breast ductal carcinoma, containing ducts with comedonecrosis 8. Tumor cells have prominent nucleoli with moderate to abundant eosinophilic cytoplasm 8,9.
CT and MR studies prove beneficial in determining localization and severity of disease 5,16-20. These tumors most commonly appear as a solid mass with ill-defined borders and heterogenous enhancement patterns. Compared with other salivary gland malignancies, salivary gland carcinomas are associated with invasion into adjacent tissue, including fat, muscle, and skin 10.
Salivary duct carcinomas are highly 18F-FDG avid, thus, PET may provide clinically relevant information for neck node investigation and surgical planning 11,12. Notably, sensitivity and negative predictive values are significantly higher for 18F-FDG PET compared to CT 11.
Treatment and prognosis
Management of salivary duct carcinoma is based on retrospective studies. Surgical resection of the tumor followed by radiotherapy is a frequent therapeutic choice 2,13. Surgery including ipsilateral neck dissection has also been used in some patients 14, although less frequently than resection of the tumor alone.
Salivary duct carcinoma is an aggressive malignancy with a high rate of local recurrence. Median overall survival is 79 months, with a five-year disease-specific survival of 64% 3.
Due to the nonspecific radiological appearance of salivary duct carcinoma, the differential diagnosis should primary parotid neoplasms, metastatic intraparotid lymph nodes, and more common salivary tumors such as myoepithelial carcinoma 15. A heterogenous enhancement pattern with cribriform necrosis and invasion into adjacent tissue is more indicative of salivary duct carcinoma.
- 1. Adel K. El-Naggar, John K. C. Chan, Jennifer R. Grandis et al. WHO Classification of Head and Neck Tumours. (2017) ISBN: 9789283224389 - Google Books
- 2. Gilbert M, Sharma A, Schmitt N et al. A 20-Year Review of 75 Cases of Salivary Duct Carcinoma. JAMA Otolaryngol Head Neck Surg. 2016;142(5):489. doi:10.1001/jamaoto.2015.3930 - Pubmed
- 3. Jayaprakash V, Merzianu M, Warren G et al. Survival Rates and Prognostic Factors for Infiltrating Salivary Duct Carcinoma: Analysis of 228 Cases from the Surveillance, Epidemiology, and End Results Database. Head Neck. 2013;36(5):694-701. doi:10.1002/hed.23350 - Pubmed
- 4. Lewis J, McKinney B, Weiland L, Ferreiro J, Olsen K. Salivary Duct Carcinoma. Clinicopathologic and Immunohistochemical Review of 26 Cases. Cancer. 1996;77(2):223-30. doi:10.1002/(SICI)1097-0142(19960115)77:2<223::AID-CNCR1>3.0.CO;2-N - Pubmed
- 5. Weon Y, Park S, Kim H et al. Salivary Duct Carcinomas: Clinical and CT and MR Imaging Features in 20 Patients. Neuroradiology. 2012;54(6):631-40. doi:10.1007/s00234-012-1014-z - Pubmed
- 6. David J. Dabbs. Diagnostic Immunohistochemistry. (2018) ISBN: 9780323477321 - Google Books
- 7. Paul W. Flint, Bruce H. Haughey, Valerie J. Lund et al. Cummings Otolaryngology. (2020) ISBN: 9780323611794 - Google Books
- 8. Mlika M, Kourda N, Zidi Y et al. Salivary Duct Carcinoma of the Parotid Gland. J Oral Maxillofac Pathol. 2012;16(1):134. doi:10.4103/0973-029x.92992 - Pubmed
- 9. Simpson R. Salivary Duct Carcinoma: New Developments—Morphological Variants Including Pure In Situ High Grade Lesions; Proposed Molecular Classification. Head and Neck Pathol. 2013;7(S1):48-58. doi:10.1007/s12105-013-0456-x - Pubmed
- 10. Wu W, Wang C, Li D, Luo J, Ye J, Xu S. Multiphase Contrast-Enhanced Computed Tomography Imaging Features of Salivary Duct Carcinoma: Differentiation from Other Salivary Gland Malignancies. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2019;128(5):543-51. doi:10.1016/j.oooo.2019.05.011 - Pubmed
- 11. Kim J, Lee S, Kim J et al. Diagnostic Value of Neck Node Status Using 18F-FDG PET for Salivary Duct Carcinoma of the Major Salivary Glands. J Nucl Med. 2012;53(6):881-6. doi:10.2967/jnumed.111.098384<
- 12. Bertagna F, Nicolai P, Maroldi R, et al. Diagnostic Role of 18F-FDG-PET or PET/CT in Salivary Gland Tumors: A Systematic Review. Revista Española De Medicina Nuclear E Imagen Molecular. 2015;34(5):295-302. doi:10.1016/j.remn.2015.04.003
- 13. Guzzo M, Di Palma S, Grandi C, Molinari R. Salivary Duct Carcinoma: Clinical Characteristics and Treatment Strategies. Head Neck. 1997;19(2):126-33. doi:10.1002/(sici)1097-0347(199703)19:2<126::aid-hed7>3.0.co;2-6 - Pubmed
- 14. Beck A, Lohuis P, Al-Mamgani A, Smit L, Klop W. Salivary Duct Carcinoma: Evaluation of Treatment and Outcome in a Tertiary Referral Institute. Eur Arch Otorhinolaryngol. 2018;275(7):1885-92. doi:10.1007/s00405-018-5000-x - Pubmed
- 15. Williams L, Thompson L, Seethala R et al. Salivary Duct Carcinoma. Am J Surg Pathol. 2015;39(5):705-13. doi:10.1097/pas.0000000000000413 - Pubmed
- 16. Thoeny H. Imaging of Salivary Gland Tumours. Cancer Imaging. 2007;7(1):52-62. doi:10.1102/1470-7330.2007.0008 - Pubmed
- 17. Motoori K, Iida Y, Nagai Y et al. MR Imaging of Salivary Duct Carcinoma. AJNR Am J Neuroradiol. 2005;26(5):1201-6. PMC8158590 - Pubmed
- 18. Kashiwagi N, Takashima S, Tomita Y et al. Salivary Duct Carcinoma of the Parotid Gland: Clinical and MR Features in Six Patients. BJR. 2009;82(982):800-4. doi:10.1259/bjr/29600237 - Pubmed
- 19. Kato H, Kanematsu M, Watanabe H, Mizuta K, Aoki M. Salivary Gland Tumors of the Parotid Gland: CT and MR Imaging Findings with Emphasis on Intratumoral Cystic Components. Neuroradiology. 2014;56(9):789-95. doi:10.1007/s00234-014-1386-3 - Pubmed
- 20. Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H. MR Imaging of Parotid Tumors: Typical Lesion Characteristics in MR Imaging Improve Discrimination Between Benign and Malignant Disease. AJNR Am J Neuroradiol. 2011;32(7):1202-7. doi:10.3174/ajnr.A2520 - Pubmed