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Clinical Problem Solving: Pathology
September 2007

Pathology Quiz Case 2: Diagnosis

Author Affiliations

Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(9):949-950. doi:10.1001/archotol.133.9.949

Kleinsasser et al1 first described SDC in 1968. However, this pathologic entity was largely overlooked until the 1990s. In 1991, the World Health Organization included SDC in their salivary neoplasm classification.2 In recent years, numerous clinicopathologic studies have shed new light on this uncommon, high-grade salivary gland malignancy. Salivary duct carcinoma affects a preponderance of men (4:1), usually in the fourth to sixth decades of life. It has been described in both major and minor salivary glands, but more than 80% of cases occur in the parotid gland.3,4 Patients commonly present with a history of a painless, rapidly enlarging mass, although though 25% to 60% have facial palsy and as many as a third may have associated pain.3,4 While SDC usually begins de novo, studies suggest that it can arise as a component of carcinoma ex pleomorphic adenoma. This theory is supported by the fact that the most common histologic type of carcinoma arising in pleomorphic adenoma is ductal. Therefore, a minority of patients have a history of a long-standing, stable mass that has undergone recent rapid growth.3