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Table 1 Differential diagnosis of juvenile pleomorphic adenoma of the cheek

From: Juvenile pleomorphic adenoma of the cheek: a case report and review of literature

Tumor Salient histological features
Carcinoma ex pleomorphic adenoma  
Adenoid cystic carcinoma - Cribriform and pseudoglandular patterns of basaloid cells with hyalinized stroma - Frequent perineural invasion - Minimal nuclear pleomorphism - No squamous differentiation - No high grade dysplasia or squamous carcinoma in situ, no extensive necrosis
Polymorphous low grade adenocarcinoma - Uniform plump columnar cells with bland nuclei arranged in variable growth patterns (tubular, cribriform, papillary, solid, fascicular, microcystic, single file, pseudoadenoid cystic, strand-like, mixed) - Perineural invasion common around small nerves - Infiltrative borders
Basal cell adenoma - Elongated and branching canaliculi separated by hyaline stroma
Acinic cell carcinoma - Variable cell types (serous, clear, vacuolated, intercalated duct cells) arranged in solid, microcystic, papillary cystic and follicular patterns - few mitotic figures
Clear cell carcinoma-hyalinizing type -Trabeculae, cords, islands or nests of monomorphic clear cells surrounded by hyalinized bands with foci of myxohyaline stroma
Cystadenocarcinoma - Invasive, cystic growth pattern, 75% had - Conspicuous papillary component - Composed of small cuboidal cells, large cuboidal cells, tall columnar cells or mixture - Cystic spaces with hemorrhage and granulation tissue are frequent
Intraductal carcinoma - intraductal neoplasm with micropapillary, cribriform, solid, comedo or clinging patterns, with preservation of myoepithelial cells surrounding intraductal tumor
Mucoepidermoid carcinoma - Cords, sheets, clusters of mucous, squamous, intermediate and clear cells; low to high grade
Epithelial myoepithelial carcinoma - Both epithelial and myoepithelial components seen - Most tumor cells have myoepithelial features with clear cytoplasm or naked nuclei - Focally, there are ducts or tubules with an outer rim of myoepithelial cells and inner, dark ductal cells with scant eosinophilic cytoplasm and round, bland nuclei