The differential diagnosis of lymphoepithelial lesion of the salivary gland

The WHO classification of salivary gland tumors has been revised every few years since its first edition in 1972, with the fifth edition being published in 20241. The number of epithelial salivary gland tumors has increased from only 9 in the first edition to 36 histological types (15 benign and 21 malignant) in the fifth edition. Among the various salivary gland lesions, the differential diagnosis of epithelial tumors with abundant lymphoid stroma, including benign and malignant tumors, is challenging. Some salivary gland tumors, such as mucoepidermoid carcinoma, acinic cell carcinoma, and secretory carcinoma, are frequently associated with abundant tumor-associated lymphoid proliferation (TALP)2. Some tumor entities, including Warthin tumor, lymphadenoma, lymphoepithelial carcinoma, and carcinoma showing thymus-like elements (CASTLE) arising in the salivary glands have epithelial and lymphoid stromal components by definition. These tumors may show similar histologic features, and their differentiation is not straightforward. In addition, there are intraparenchymal lymph nodes in the parotid gland and periglandular lymph nodes around the parotid and submandibular glands. The differential diagnosis of lymphoid tissue, lymphoproliferative disease, and lymphocytic sialadenitis can be problematic3.

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