Tohoku J. Exp. Med.

, 1990, 161, 111-128

Intraoral Minor Salivary Gland

Tumors : A Demographic and Histologic
Study of 200 Cases

HIROSHITAKAHASHI,
SHUICHIFUJITA, NOBUo TSUDA,*
FUMIAKITEZUKA
j and HARUOOKABE
Department of Oral Pathology, Nagasaki University School
of Dentistry, *Pathology Division of Central Diagnostic
Laboratory, Nagasaki University Hospital, Nagasaki 852,
and tDepartment of Pathology, the Research Institute for
Tuberculosisand Cancer, Tohoku University, Sendai 980

TAKAHASHI, H., FUJITA,S., TSUDA,N., TEZUKA,F. and OKABE,H. Intraoral

Minor Salivary Gland Tumors : A Demographic and Histologic Study of 200
Cases. Tohoku J. Exp. Med., 1990, 161(2), 111-128 In a demographic and
histologic study of 200 intraoral minor salivary gland tumors seen in Japan
(Nagasaki and Miyagi prefectures), 127 cases (63.5%) were classified as benign,
comprising 124 pleomorphic adenomas and 3 monomorphic adenomas. The other
73 cases (36.5%) were malignant tumors, represented by 33 adenoid cystic car-
cinomas, 16 mucoepidermoid carcinomas, 10 carcinoma in pleomorphic adenomas,
6 acinic cell carcinomas, 5 adenocarcinomas, one polymorphous low-grade
adenocarcinoma, one undifferentiated carcinoma and one clear cell carcinoma.
There was an overall female preponderance (1.78/1). The mean age for females
was 47.2 years and for males was 50.6 years. The mean age for patients with
malignant tumors was 10 years greater than for patients with benign tumors and
was statistically significant. The palate was the most common site for intraoral
minor salivary gland tumors followed by the lip and buccal mucosa. These three
sites accounted for 83° of all cases. Tumors arising in these three sites were
predominantly benign. In contrast, those located in the gingiva, floor of the
mouth and tongue were predominantly malignant. The results of this study were
compared with other recent studies. - minor salivary gland ; tumors ;
histology ; age and sex ; Japanese

Neoplasms of minor salivary gland origin occur much less commonly than
those arising from major salivary glands (Gorlin and Chaudhry 1957; Richardson
et al. 1975; Main et al. 1976; Shrikhande and Talvalker 1978; DelBalso 1979;
Perzin and LiVolsi 1979; Brocheriou et al. 1980; Eveson and Cawson 1985b).
In spite of their relative infrequency in terms of the total number of cases
accessioned in most oral or hospital surgical pathology services (Regezi et al.

Received March 24, 1990; revision accepted for publication May 25, 1990.
Mailing address : Dr. H. Takahashi, Department of Oral Pathology, Nagasaki Univer-
sity School of Dentistry, 7-1 Sakamoto-machi, Nagasaki 852, Japan.
111
 112 H. Takahashi et al.

1985), minor salivary gland tumors continue to generate considerable interest.

Several studies (Chaudhry et al. 1961; Eneroth 1971; Eneroth and Hjert-
man 1972; Isacsson and Shear 1983; Eveson and Cawson 1985a, b ; Regezi et al.
1985) have documented the distribution of series of minor salivary gland tumors
seen in some countries. Reports from various parts of the world indicate that
there are differences in the frequency of particular histologic types and in the
frequency with which minor salivary glands are involved. However, there has
been little information published about their occurrence in the Japanese popula-
tion. Racial and geographic variations in the frequency and distribution of
salivary gland neoplasms do exist. For example, Davies et al. (1964)have shown
a higher proportion of salivary gland tumors in the submandibular gland and
palate in Uganda compared to non-African cases.
The purpose of this study is to determine the relative frequency and distribu-
tion of the various types of minor salivary gland neoplasms in Japan and to
provide data for comparison with other epidemiological findings in different
geographic locations.

MATERIALS AND METHODS

The 200 minor salivary gland tumors that make up this study were obtained from the
following sources : 84 cases from the files of the Pathology Division, Central Diagnostic
Laboratory, Nagasaki University Hospital, 84 cases from the Department of Pathology,
Tohoku University Hospital, and 32 cases from the Department of Oral Pathology, Nagasaki
University School of Dentistry. Information with respect to patient age and gender, and
anatomic location of the tumor was available in all the cases. Slides stained with hematox-
ylin and eosin (H & E) were available for review in every case. Special stains such as
alcian blue and periodic acid-Schiff were available in the most of cases.
The histological classification used is that proposed by the World Health Organization
(Thackray and Sobin 1972), with two alterations, namely the separation of polymorphous
low-grade adenocarcinoma from adenocarcinoma and the addition of clear cell carcinoma.
These two terms are not listed in the WHO classification. The pleomorphic and monomor-
phic adenomas were regarded as benign for purpose in this study ; the mucoepidermoid
carcinoma, acinic cell carcinoma, adenoid cystic carcinoma, adenocarcinoma, polymorphous
low-grade adenocarcinoma, clear cell carcinoma, epidermoid carcinoma, undifferentiated
carcinoma and carcinoma in pleomorphic adenoma as malignant.
Histologically, pleomorphic adenoma consisted of cartilagenous and hyalinous tissues,
myxomatous areas, and epithelial elements. Basically, the tumor cells showing active
growth were epithelial cells producing a glandular lumen, which was surrounded by
myoepithelial cells. Mutinous materials were often seen to remain in the glandular lumen.
Monomorphic adenoma, basal cell type is composed almost exclusively of solid masses, cords,
and occasional trabeculae of epithelial cells. The periphery of the clusters was lined by a
palisading row of tumor cells. Intercellular stroma was scant. The tumor cells were
essentially isomorphic with deep basophilic round-to-oval nuclei. Cytoplasm was baso-
philic and occasionally scant (Fig. 1). The tumor cells of oxyphilic cell adenoma were
arranged in sheets, cords and alveolar-like clusters. The cells were polygonal and uniform
in size. The cytoplasm was deeply eosinophilic and granular. The nuclei were round or
oval, some showing definite pyknotic changes (Fig. 2). Microscopically, mucoepidermoid
carcinoma was characterized by mucus-secreting cells, cells of epidermoid type, and an
intermediate cell variety in various proportions. Glandular and cystic structures, solid
 Intraoral Minor Salivary Gland Tumors 113

nests of tumor cells, or a variety of these growth patterns were evident (Fig. 3). Acinic cell
carcinoma consists of solid epithelial sheets interspersed with microcystic spaces which may
give rise to cribriform appearance. Glandular structures may be seen in some areas. The
cells are usually polygonal and show abundant granular cytoplasm which is basophilic in
most cases (Fig. 4). Adenoid cystic carcinoma contained rounded or ovoid cells forming
clusters and strands in a myxomatous or hyalinous connective tissue matrix. The islands
and strands of tumor cells interconnect to enclose characteristic cystic spaces, presenting a
cribriform pattern of growth (Fig. 5). The microscopic patterns of adenocarcinoma varied
from trabecular, tubular, solid, papillary or mucus-secreting varieties without epidermoid
traits to glandular carcinomas with partial sebaceous gland differentiation. In the present
study, the term polymorphous low-grade adenocarcinoma (Evans and Batsakis 1984;
Gnepp et al. 1988) was used as a designation for the neoplasm that has recently been
classified as lobular (Freedman and Lumerman 1983), terminal duct (Batsakis et al. 1983)
or trabecular (Stone and Stromme-Koppang 1978) adenocarcinoma. These tumors are
characterized by cytological uniformity and histological diversity. The neoplastic cells
were small to medium-sized, regular, and have ample cytoplasm that exhibits a varying
appearance. Sometimes it is homogeneously eosinophilic or basophilic ; it may also be
clear, although a coarse granular eosinophilic appearance was also noted in a few areas.
Mitotic figures were few. Tumor necrosis was not seen. In contrast to this constant
cellular blandness, there was considerable histologic variety. The spectrum of growth
patterns included solid nests and trabeculae, tubules, papillae, cysts, cribriform or
pseudoadenoid cystic formations, strands, and fascicles (Figs. 6 and 7). Clear cell car-
cinoma was composed of neoplastic epithelium disposed in solid sheets, clumps, and small
nests surrounded by thin vascular connective tissue stroma. Neoplastic epithelial cells were
polyhedral to cuboidal in shape with well-defined cell boundaries, clear cytoplasm, and
cellular pleomorphism (Fig. 8) (Mohamed 1976; Batsakis 1979). Undifferentiated car-
cinoma is a malignant tumor of epithelial structure that is too poorly differentiated to be
placed in any of the other groups of carcinoma. There is no attempt at tubule formation
and keratinization in this malignant epithelial tumor. To be included in the group of
carcinoma in pleomorphic adenoma, a tumor had to contain some areas with histologic
characteristics typical of benign pleomorphic adenoma and other areas that were clearly
carcinoma (Figs. 9 and 10). Epidermoid carcinoma showed intracellular keratinization,
intercellular bridging, and keratin pearl formation without mucus production. None
showed evidence of origin in the overlying oral mucosa.
The mean age is presented in terms of mean + s.D.. Differences between the mean ages
were evaluated by the method of Student's t-test and the differences were judged to be
significant when p values were less than 0.05.

RESULTS
General features
In the present study, pleomorphic and monomorphic adenomas were consid-
ered to be benign salivary gland tumors. The remaining tumors were classified as
malignant.
The distribution of the 200 tumors, according to histologic type, is shown in
Table 1. Benign salivary gland tumors account for 63.5% of the cases in this
series. Tumors classified as malignant accounted for 36.5% of the series.

Age and sex distribution

The patients of minor salivary gland tumors ranged in age from 10 to 85 years.
 114 H. Takahash 1 et al.

TABLE 1. Histologic cl assification of 200 intraoral manor salivary

gland tumors

The peak incidence was in the sixth and seventh decades for males and in the
fourth, fifth and sixth decades for females (Table 2) but varied according to
whether the tumors were benign or malignant. Thus the peak incidence of benign
tumors was in the fourth and fifth decades but the peak incidence of malignant
tumors was in the seventh decade. There is an overall female predominance

TABLE 2. Age and sex distribution of intraoral manor salivary

gland tumors
 Intraoral Minor Salivary Gland Tumors 115

TABLE 3. Age distribution of 200 patients with benign and ma lignant intraoral minor
salivary gland tumors

(female-to-male ratio, 1.8: 1), which was maximum in the fourth decade (5: 1).
The mean age for female patients was 47.2 years + 16.2, and the mean age for male
patients was 50.6 years + 17.3. The ratio of benign to malignant tumors also
appeared to decrease with age after the first two decades (Table 3). It was
maximum in the third decade when nearly 82% of tumors were benign. In the
seventh, eighth and ninth decades 48% of total tumors were benign. The mean
ages of patients with tumors of the benign group were compared with the mean
ages of patients with tumors of the malignant group. The mean age for patients
with benign tumors was 44.8 years + 17.3, and for patients with malignant tumors
was 54.8 years + 13.3. It was found that patients in the malignant group were

TABLE 4. Primary site of intraoral minor salivary gland tumors, and percentage of
malignant and benign tumors
 116 H. Takahashi et al.

significantly older than those in the benign group, and this sig nificance was more

pronounced in females than in males (p <0.01).

Site distribution
The percentage of the frequency of minor salivary gland tumors in various
sites is illustrated in Table 4. The palate was the most common site of involve-
ment (66% of all cases), followed by the lip (11.5% of all cases) and the buccal
mucosa (8.5% of all cases). These three sites were the location of 86% of the
tumors in this study. There were striking differences in the ratio of benign to
malignant tumors in differing sites. For example, in the palate, lip and buccal
mucosa only 29% of tumors were malignant. In the minor glands of other sites,
however, 82% of the tumors were malignant (Table 5).

Individual tumors
The distribution of the 200 tumors, according to histologic type, is shown in
Table 5. The criteria used for diagnosis are currently widely used and accepted.
Pleomorphic adenoma. The pleomorphic adenoma was the most common
neoplasm in this study. One hundred twenty-four tumors were classified as

TABLE5. Histologic classification and anatomic distribution of 200 intraoral minor

salivary gland tumors
 Intraoral Minor Salivary Gland Tumors 117

pleomorphic adenomas, accounting for 62% of all minor salivary gland tumors
and 98% of the benign tumors in this study. The age range was from 10 to 82
years, with a mean of 44.4. The mean age of the males was 42.3± 18.3 and of the
females 45.3+ 16.7 years. There was no difference in the mean age at initial
consultation for men and women. The sex of 124 patients has been recorded : 36
were males (29%) and 88 females (71%). The female-to-male ratio was 2.4 :1.
Monomorphic adenoma. Monomorphic adenomas were uncommon in the
minor salivary gland with only three examples (1.5%). The ages of the three
patients (two males, one female) with monomorphic adenoma were 50, 53 and 85
years. Subclassification on a histological basis revealed 2 cases of the basal call
type of monomorphic adenoma, one example of oxyphilic cell adenoma.
Mucoepidermoid carcinoma. Mucoepidermoid carcinoma was the second most
common malignant lesion noted in this study.. Sixteen tumors were diagnosed as
mucoepidermoid carcinoma, accounting for 8% of all tumors and 22% of the
malignant lesions. There were 7 male and 9 female patients. The female-to-
male ratio was 1.3 :1. The age of the 16 patients with a mucoepidermoid car-
cinoma ranged from 36 to 80 years with a mean of 57.0+9.3 for males and 56.0+
12.6 for females. Althouth the palate was the most frequent site for mucoepider-
moid carcinoma (37.5%), tumors were frequently found in the gingiva (18.8%),
the floor of the mouth (18.8%), the buccal mucosa (12.5%), the lip (6.2%), and the
tongue (6.2%).
Acinic cell carcinoma. Acinic cell carcinoma is a relatively rare tumor in
minor salivary gland. Six examples, accounting for 8.2% of malignant tumors
and 3% of all tumors, were found in this study. The patients ranged in age from
26 to 60 years, and the mean age at diagnosis was 50.2 years + 12.9. Four of the
five patients were female. Three tumors arose in the palate, and one each in the
lip, tongue, and gingiva.
Adenoid cystic carcinoma. Adenoid cystic carcinoma was the most common
malignant tumor in this study. This tumor represented 16.5% of all minor
salivaly gland tumors and 45% of the malignant salivary lesions. The ages of the
33 patients (19 males, 14 females) ranged from 20 to 77 years with a mean of 57.6
(+ 11.8) years for males and 51.2 (± 12.5) for females. The palate was the most
common location, accounting for 52% of adenoid cystic carcinomas. Tumors
were also found in the gingiva, six cases (18%) ; the tongue, three cases (9%) ; the
lip, three cases (9%) ; and the floor of the mouth, and the buccal mucosa, two
cases each.
Adenocarcinoma. Adenocarcinomas accounted for 6.9% of the malignant
tumors and for 2.5% of all tumors. The ages of the five patients with adenocar-
cinoma were 22, 22, 62, 62 and 70 years. There were 3 males and 2 females.
Primay site of the 4 cases showed a palatal location and one case was seen in the
buccal mucosa.
Microscopically, all cases showed a predominantly tubular pattern. How-
 118 H. Takahashi et al.

ever, two cases showed the papillary variant and one case showed mucus produc-
ing adenocarcinoma.
Polymorphous low-grade adenocarcinoma. One tumor of this type was seen in
this series in a male aged 51 years. The lesion occurred in the glands of the
tongue.
Clear cell carcinoma. One lesion in this series was designated as clear cell
carcinoma. This case was a palatal tumor in a 62-year-old man. Neither tumor
showed evidence of glandular differentiation nor any other features that would
permit a more specific diagnosis, i.e., mucoepidermoid carcinoma, acinic cell
carcinoma, or epithelial-myoepithelial carcinoma. For the purpose of this review,
this lesion was classified as clear cell carcinoma.
Undifferentiated carcinoma. One tumor was poorly differentiated malignant
epithelial lesion that could not be further classified. This was located on the
maxillary gingiva of a 48-year-old woman.
Carcinoma in pleomorphic adenoma. Ten tumors in the present study were
considered to be examples of carcinoma in pleomorphic adenoma. The ages of the
10 patients ranged from 37 to 82 years with a mean of 68.0 ( ± 19.8) for males and
55.9 ( + 16.1) for females. There were 2 males and 8 females. Seven tumors were
located on the palate, one in the buccal mucosa, one in the floor of the mouth, and
one in the lip. Ten tumors showed focal areas of epithelium typical of benign
pleomorphic adenoma, in addition to the carcinomatous component. A
malignant-appearing epithelial component showed undifferentiated carcinoma in
5 cases, epidermoid carcinoma in two, and mucoepidermoid carcinoma, adenoid
cystic carcinoma and adenocarcinoma in one each.
No case of adenolymphoma and epidermoid carcinoma occurred in this series.

DISCUSSION
Comparison of clinicopathologic characteristics of the Japanese cases with
those of the literature reveals some similarities and some differences.
Most studies in the literature indicate that minor salivary gland tumors are
somewhat more common in females than in males with female-to-male ratios
varying from 1.2: 1 to 1.5: 1. The Japanese cases examined in this study showed
1.2: 1 for benign and 2.3: 1 for malignant neoplasms. We are unable to explain
the apparent female sex predilection for malignant tumors.
The age range of patients with intraoral minor salivary gland neoplasms in
our series was 10-85 years. The present study indicated a statistically significant
difference (p <0.01) in the ages of both males and females with benign tumors
(mean, 44.8 years + 17.3) when compared with the age of patients with malignant
tumors (mean, 54.8 years + 13.3). This is in keeping with the findings of most
other studies (Evans and Cruickshank 1970).
In the present study of 200 intraoral salivary gland tumors, the palatal glands
are more frequently involved than any of the other sites of minor salivary glands.
 Intraoral Minor Salivary Gland Tumors 119

TABLE 6. Reported frequency of intraoral minor salivary gland tumors at the most
common primary sites

Our figure of 66% is higher than the series in the United States (Spiro et al. 1973;
Chaudhry et al. 1984; Regezi et al. 1985) but appears to be almost the same as in
Australia (Chau and Radden 1986) (Table 6).
In the present sample, intraoral pleomorphic adenoma was found over a wide
age distribution with a peak frequency in the fourth and fifth decades which was
particularly prominent in females. Waldron et al. (1988),however, reported peak
frequency in the sixth decade. Our study showed that the mean age for males
was 42.3 (+ 18.3)years and for females 45.3 (± 16.7)years, somewhat similar to the
mean age of 46 years reported by Chaudhry et al. (1961). A slight females
preponderance (57% and 56%, each) for intraoral pleomorphic adenomas was
reported by Lucas (1976),and Isacsson and Shear (1983). On the other hand, the
results of the present study showed prominence in females (70%).
As can be seen in Table 7, there are some interesting and not completely
explainable differencesin the reported relative frequency of the various histologic
types. The frequency of pleomorphic adenoma in most series is quite similar with
the exception of the 70% incidence reported by Isacsson and Shear (1983) and the
low 15.8% incidence in Spiro's series (Spiro et al. 1973). The high frequency of
pleomorphic adenoma in the investigation of Isacsson and Shear (1983) might
result from the relatively higher number of black than white patients with
pleomorphic adenoma. Our figure of 62% showed the number between the
Australian cases (Chau and Radden 1986) and the African cases (Isacsson and
Shear 1983).
The group defined as monomorphic adenomas according to the WHO
classification comprised only 1.5% of the intraoral minor salivary gland tumors of
the present study. This is lower than the 4% reported by Main et al. (1976)but
is in striking contrast to the observations of Eneroth and Hjertman (1972) who
registered monomorphic adenoma in 34 (20%) of 170 palatal salivary gland
tumors.
120 H. Takahashi et al.
 Intraoral Minor Salivary Gland Tumors 121

Except in Spiro's report (1973), mucoepidermoid carcinoma is the most

frequent type of malignant intraoral salivary gland tumors in studies originating
in the United States, accounting for 15% to 34% of all minor salivary gland
tumors. The reports from South Africa (Isacsson and Shear 1983) and Britain
(Eveson and Cawson 1985a) showed a lesser frequency of mucoepidermoid car-
cinoma. In the present study, mucoepidermoid carcinoma is the second most
frequent type of malignant neoplasms, and the relative incidence of this neoplasm
was similar to the study of Britain. There were 33 cases of adenoid cystic
carcinoma in our series of 73 malignant tumors (45%). Although the relative
frequency of adenoid cystic carcinoma is also quite similar to the reports from
Britain (Eveson and Cawson 1985a) and Australia (Chau and Radden 1986), our
data were different from others (Spiro et al. 1973 ; Isacsson and Shear 1983;
Chaudhry et al. 1984 ; Regezi et al. 1985 ; Waldron et al. 1988).
The adenocarcinoma may occur in the intraoral sites with preference for the
palate. In the series of Chaudhry et al. (1961) adenocarcinoma comprised 33% of
the malignant intraoral salivary gland tumors, while Stene and Stromme-Koppang
(1981) reported a frequency of 45%. In the present study, 5 of 73 malignant
tumors were adenocarcinomas.
Polymorphous low-grade adenocarcinoma was found in only one lesion (0.5%
of all tumors and 1.4% of malignant tumors) of our study. This is in contrast
with Waldron's report (1988) (Table 7), which designated this carcinoma the
second most common type of intraoral minor salivary gland tumors. Comparison
of the incidence of the lesion designated in the present and Waldron's descriptions
(1988) as polymorphous low-grade adenocarcinoma with that reported in other
similar studies is difficult. Because application of this subtype of salivary gland
carcinoma is fairly recent, and there is scant information available as to its
frequency in relation to other types of salivary gland tumors.
Carcinoma in pleomorphic adenomas are uncommon in the oral minor sali-
vary glands and in most reports account for less than 2% of all cases. Exceptions
to this are the findings of Eveson and Cawson (1985b), who reported that 7.1% of
336 minor salivary gland tumors were carcinoma in pleomorphic adenomas, and
Spiro's report (1986) of a 6.4% incidence in 420 cases. Carcinoma in pleomorphic
adenoma of intraoral salivary gland origin is rare, other than in the palate
(Chaudhry et al. 1961). Seven out of 10 cases in the present series occurred in the
palate but the remaining three examples were found in the buccal mucosa.
Frequency in our study was 10 compared with 124 benign pleomorphic adenomas
(1:12.4), while in the series of intraoral minor salivary gland tumors reported by
Isacsson and Shear (1983), the ratio was 1: 28.
The acinic cell carcinoma rarely involves intraoral minor salivary glands.
Only one example was recorded in each of the series of Chaudhry et al. (1961) and
Main et al. (1976) and there were 2 cases in each of the studies of Eneroth (1971)
and Spiro et al. (1973). The 3% incidence among all minor salivary gland tumors
 122 H. Takahashi et al.

in our study is slightly higher than that reported in other investigations except
Waldron's study (1988). In their report of 29 acinic cell tumors of intraoral
salivary gland origin, Abrams and Melrose (1978) reported that the palate, tongue
and floor of the mouth were the sites most commonly involved, whereas lips and
buccal mucosa were the most frequent locations in the series of 19 cases reported
by Chen et al. (1978).
The adenolymphoma and epidermoid carcinoma are a rare intraoral tumor
(Fantasia and Miller 1981) and no example occurred in the present study.
This study investigated geographical differences of intraoral minor salivary
gland tumors by histologic type, to further evaluate the descriptive epidemiology
of these tumors. We cannot explain why the ratio of benign to malignant tumors
in Japan is fairly similar to those of Australian (Chau and Radden 1986) and a
part of American (Regezi et al. 1985) people (Table 7). Recently, an association
between the HLA-DR antigens and susceptibility of salivary gland neoplasms was
reported (Zarbo et al. 1987). Numerous benign and malignant salivary gland
tumors expressed HLA-DR antigens. There has been reported that the mean gene
frequencies of the HL-A antigens are markedly lower in Negro than in Caucasian
populations (Bodmer and Bodmer 1973). Whether the clinicopathologic similar-
ity of intraoral minor salivary gland tumors between the Japanese and other two
series (Regezi et al. 1985; Chau and Radden 1986) is genetically determined,
related to a particular combination of HLA-DR antigens, or is a result of socio-
economic and nutritional factors should be disclosed.

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Fig. 1. Monomorphic adenoma, basal cell type.

Note the solid proliferation of spindle-shaped neoplastic cells. H & E, x 132.
Fig. 2. Monomorphic adenoma, oxyphilic cell type.
The tumor cells are arranged in broad parallel columns or solid rounded acinar
groups, and tubular formation. Compact area of tumor shows the large, pale
cells with granular cytoplasm. H & E, x 66.
Fig. 3. Mucoepidermoid carcinoma.
Columnar epithelial cells producing mucin show glandular formation.
Squamous epithelium in the basal area proliferates so as to push the columnar
epithelial cells toward the lumen. H & E, x 33.
Fig. 4. Acinic cell carcinoma.
This tumor is characterized by mixture of well-differentiated acinic cells and
intercalated duct type cells. H & E, x 66.
Intraoral Minor Salivary Gland Tumors 125
126 H. Takahashi et al.

Fig 5. Adenoid cystic carcinoma.

In this characteristic field from an adenoid cystic carcinoma, tumor cells form
multiple cystic spaces. H & E, x 66.
Fig 6. Polymorphous low-grade adenocarcinoma.
Note lack of cellular pleomorphism and varying patterns of tumor growth with
cribriform and solid patterns. H & E, x 50.
Fig 7. Polymorphous low-grade adenocarcinoma.
There are well-formed tubules with solid nests. H & E, x 50.
Fig . 8. Clear cell carcinoma.
The solid pattern of growth and the voluminous clear cells are demonstrated.
H & E, x40.
Intraoral Minor Salivary Gland Tumors 127
128 H. Takahashi et al.

Fig . 9. Carcinoma in pleomorphic adenoma.

The neoplastic cells of pleomorphic adenoma show a partially glandular
structure. The myxomatous matrix is seen in part of the tumor tissue. H &
E, x66.
Fig 10. Carcinoma in pleomorphic adenoma.
An area of , malignant tumor shows epidermoid carcinoma with marked ker-
atinization. H & E, x 66.