Diagnosis and differential diagnosis of mucin-rich salivary gland tumors
10.12016/j.issn.2096-1456.202550434
- Author:
GUAN Weihang
1
;
LIU Cangwei
1
;
GUO Hao
1
;
LI Jinwei
1
;
WANG Dandan
1
;
QIAO Chunyan
1
;
NIE Mengdong
1
;
QU Ming
1
;
SHI Ce
1
Author Information
1. Department of Oral Pathology, Hospital of Stomatology, Jilin University & Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling
- Publication Type:Review
- Keywords:
salivary gland tumors;
mucus;
diagnosis;
mucinous adenocarcinoma;
mucinous cystadenoma;
pleomorphic adenoma;
mucoepidermoid carcinoma;
myoepithelioma;
immunohistochemistry;
pathology
- From:
Journal of Prevention and Treatment for Stomatological Diseases
2026;34(6):606-619
- CountryChina
- Language:Chinese
-
Abstract:
This paper systematically elaborates on the key points of diagnosis and differential diagnosis of salivary gland tumors characterized by a substantial amount of extracellular mucus as a main or prominent feature, and clarifies the core differential features. The term "mucus-rich" specifically denotes that mucus is a major component of the tumor, rather than a focal or minor one. This phenomenon is associated with distinct histogenetic mechanisms: it may result from specific genetic mutations (e.g., AKT1 E17K in mucinous adenocarcinoma) that drive ductal epithelial differentiation into mucus-secreting cells, or from myoepithelial cells secreting glycosaminoglycans that form a myxoid stroma. Salivary gland tumors with abundant extracellular mucus include mucinous cystadenoma, sialadenoma papilliferum-like intraductal papillary tumors, mucinous myoepithelioma, pleomorphic adenoma with mucin-rich stroma, mucinous adenocarcinoma, low-grade mucoepidermoid carcinoma, mucin-rich salivary duct carcinoma and intestinal-type adenocarcinoma. The diagnosis of these tumors is complicated by the dual nature of extracellular mucus: while it is a defining feature of some entities, it can also obscure key diagnostic architectural features in others, leading to histological overlap and inconspicuous diagnostic areas. Given the frequent histological morphological overlap among these tumors, immunohistochemical findings and molecular characteristics have emerged as crucial differential diagnostic criteria. Core differential diagnostic points include the following: histologically, there must be meticulous identification of typical structures obscured by mucin (such as squamoid cells in mucoepidermoid carcinoma and apocrine features in salivary duct carcinoma); in immunohistochemical staining, CK20 is useful for distinguishing intestinal-type adenocarcinoma (positive) from mucinous adenocarcinoma (negative), while androgen receptor aids in differentiating salivary duct carcinoma (positive) from mucoepidermoid carcinoma (negative); and molecular testing plays a critical role in definitive diagnosis (e.g., the AKT1 E17K mutation for mucinous adenocarcinoma, MAML2 rearrangement for mucoepidermoid carcinoma, and MEF2C::SS18 fusion for microsecretory adenocarcinoma). This paper systematically summarizes the core pathological features and differential diagnostic points of mucin-rich salivary gland tumors, aiming to provide a practical reference for clinical pathological diagnosis.
- Full text:2026060516154807216富含细胞外黏液的唾液腺肿瘤诊断及鉴别诊断.pdf
