Salivary Gland

With the exception of the pleomorphic adenoma, salivary gland neoplasms are rare, so you will not see many during residency training. To make matters worse, there is a great deal of morphologic overlap in some of the tumors, and immunostains are not usually helpful in distinguishing them. Your goal, early in your training, should be to recognize the more classic forms of the major tumors and also to be able to create a short differential diagnosis for any given tumor. In this organ, with all the mimics and variants, it is extremely important to approach a specimen with the question, “What else could this be?”

Biopsies of the salivary gland are occasionally performed in search of Sjögren’s syndrome; this is a complex diagnosis with specific criteria that must be met (see your favorite pathology textbook for that). Inflammatory lesions can also create a mass, such as chronic sialadenitis or a lymphoepithelial cyst.