Pathology · patient case question
A swiss cheese or cribriform histological pattern is characteristic of which tumour?
Patient case: A lump behind the tonsil
demo: 56-year-old male
chief: A painless lump in the right side of the neck that he first noticed two months ago.
history: Never smoked. Modest alcohol intake. Reports multiple lifetime sexual partners.
meds: None.
findings: A firm, non-tender 3 cm level II cervical node on the right. Examination of the oropharynx shows an ulcerated, slightly raised lesion of the right tonsil. Elsewhere the mucosa is unremarkable.
Show answer and explanation
Correct answer: A. Adenoid cystic carcinoma
- A. Correct. Adenoid cystic carcinoma shows a cribriform pattern of basaloid cells surrounding pseudocystic spaces filled with basement membrane material, giving the swiss cheese appearance. Its defining behaviour is perineural invasion, which produces pain and facial numbness and accounts for its late distant recurrence.
- B. Pleomorphic adenoma is benign, the most common salivary tumour, showing epithelial and myoepithelial cells in a chondromyxoid stroma.
- C. Warthin tumour, or papillary cystadenoma lymphomatosum, has oncocytic bilayered epithelium over lymphoid stroma, occurs almost exclusively in the parotid, and is strongly linked to smoking.
- D. Mucoepidermoid carcinoma is a mix of mucous, epidermoid and intermediate cells and is the most common salivary malignancy overall, and the most common in children. It has no cribriform pattern.