BSND: An emerging immunohistochemical marker that reliably distinguishes benign from malignant oncocytic salivary gland tumors.

Pleomorphic adenoma is the most common tumor of the salivary glands, predominantly affecting the parotid gland. Its occurrence in the minor salivary glands of the hard palate is relatively rare. While oncocytic metaplasia is well-documented in various salivary gland tumors, it is exceptionally uncommon in pleomorphic adenomas. This report presents a rare case of pleomorphic adenoma of the hard palate with extensive oncocytic metaplasia, highlighting the diagnostic challenges and the importance of histopathological evaluation. A 46-year-old male presented with a painless, slow-growing palatal lesion. Clinical and imaging findings suggested a benign tumor, leading to complete surgical excision. Histopathological analysis confirmed pleomorphic adenoma with substantial oncocytic transformation, a feature rarely reported in the literature. The postoperative course was uneventful, and no recurrence was observed during an 8-month follow-up. Given its atypical histological features, oncocytic pleomorphic adenoma can pose significant diagnostic difficulties, particularly in preoperative cytological evaluations. This case underscores the necessity of thorough histopathological examination to avoid misdiagnosis and ensure appropriate patient management.

Abstract Aim: Diagnosing salivary gland lesions with oncocytic differentiation is challenging as it encompassing 21 reactive and neoplastic lesions. With the extensive differentiation, morphological overlapping is possible especially that some tumors can be purely oncocytic. We propose a diagnostic algorithm based on analyzing oncocytic detection in the salivary gland lesion in AS’ registry (501 out of 6383 SGL) to propose a differential diagnosis based on morphology, immunohistochemistry, and molecular findings. Methods: We developed a weighted probabilistic scoring algorithm incorporating dimensional reduction and hierarchical clustering analysis of morphological features, immunohistochemical profiles, and molecular labelling that represents the greatest weighted values. If molecular information is missing, the algorithm computes the values corresponding to morphology and immunohistochemical vectors respectively. The algorithm uses supervised machine learning with backpropagation for continuous refinement of classification boundaries. Results: Salivary gland lesions with oncocytic differentiation comprise malignant neoplasms (e.g., acinic cell carcinoma, salivary duct carcinoma, myoepithelial carcinoma), benign neoplasms (e.g., pleomorphic adenoma, Warthin tumor, oncocytoma), cystic lesions and reactive process (e.g. multifocal oncocytic metaplasia), with different extent of oncocytic differentiation, either extensive, focal, or wall-lining, in which oncocytes are positive for MIA. Principal component analysis revealed three distinct oncocytic architectural patterns with eigenvalues >1.0: extensive (λ1=2.84), focal (λ2=1.92), and wall-lining (λ3=1.37). Hierarchical clustering demonstrated discrete entity groupings with a cophenetic correlation coefficient of 0.89. The algorithm achieved a primary diagnostic accuracy of 92% (95% CI: 88.3-95.7%), while maintaining differential diagnostic sensitivity of 85% at a lower boundary condition of 0.3. Nevertheless, the algorithm is designed to propose a diagnosis for well-investigated cases only. Otherwise, the differentials are provided. A user-friendly interface will be made available at https://www.biopticka.cz/en/publications/tools/Oncocytic/ Conclusions: The algorithm demonstrates acceptable performance metrics in differential diagnosis generation. Although oncocytic differentiation can theoretically occur in any lesion, the inclusion of the salivary oncocytic lesions was confined to real data with adequate molecular investigation. Coverage could be expanded if reliable inputs show oncocytic differentiation, for example, in secretory carcinoma, polymorphous adenocarcinoma (and its cribriform subtype), microsecretory carcinoma, or palisading adenocarcinoma. Citation Format: Bacem Khalele, Alena Skalova. Diagnostic algorithm for salivary gland oncocytic lesions. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2492.

Pleomorphic adenoma (PA), the most prevalent salivary gland tumor, exhibits a diverse histological spectrum characterized by epithelial, myoepithelial, and mesenchymal patterns, and secretory products. However, a subset of PAs presents microscopic features suggestive of malignancy, leading to challenging and potentially significant diagnostic pitfalls. A comprehensive retrospective analysis was conducted on the Salivary Gland Tumor Registry, compiled by the authors. A total of 104 cases diagnosed between 1960 and 2023 were retrieved. Clinical findings, pathological features, and molecular genetic results were analyzed. In the study of 104 PA cases, 23 (22.1%) presented features suggestive of pseudoinvasion, with satellite nodules being the most common (43.5%) along with capsular penetration, irregular growth, pseudopodia, lipomatous changes, and vascular permeation. Features of pseudomalignant cytomorphology were found in 97 cases (93.3%), characterized by increased cellularity, cellular atypia, heightened proliferative activity, oncocytic metaplasia, and necrosis. Additionally, 30 cases (28.8%) displayed features resembling other defined malignant salivary gland tumors, particularly myoepithelial carcinoma, adenoid cystic carcinoma, and polymorphous adenocarcinoma. Despite PA's generally straightforward diagnosis, cases with these features may be mistakenly interpreted as malignant tumors. The shared morphocytological features underscore the complexity of anaccurate diagnosis, emphasizing the need for meticulous examination and a comprehensive assessment, incorporating morphological, molecular, and immunohistochemical analyses to differentiate between benign and malignant salivary gland tumors, in selected cases.

Pleomorphic adenoma (PA) is the most common salivary gland tumour. Pre-operative fine-needle aspiration (FNA) is currently one of the most widely used cytological examination techniques for the diagnosis of salivary gland tumours. Because PA exhibits characteristic cytological features, cytological diagnosis is straightforward in most cases. However, limitations have emerged in certain cases, specifically in cases of oncocytic metaplasia (rare in PA), characterised by rich eosinophilic granular cytoplasm and relatively large nuclei, which can make cytological diagnosis challenging. To date, only two cytological reports of oncocytic PA have been published. The present study retrospectively analysed patients with oncocytic PA of the salivary gland who underwent preoperative FNA to describe the clinicopathological features of oncocytic PA. In addition, the application of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was discussed. The study cohort included 3 patients with parotid gland tumours. The cytological specimens had small and/or large clusters of oncocytic cells containing rich granular cytoplasm, relatively large nuclei, and occasional nucleoli in a myxoid (2 patients) and clear (1 patient) background, with no necrotic material. A review of the cytological features of the presented cases, as well as previously reported cases, indicated that oncocytic PA may be overdiagnosed as carcinoma, especially carcinoma ex pleomorphic adenoma (CXPA) because these cells have relatively large nuclei. The cytological features of oncocytic cells in PA resemble those of salivary duct carcinoma, the most common carcinoma component of CXPA. The absence of necrotic material and high-grade nuclear atypia are important diagnostic features. Furthermore, cytological specimens with atypical oncocytic cells in the PA should be classified as salivary neoplasms in the uncertain malignant potential category of the MSRSGC.

A Case of Melanotic Oncocytic Metaplasia of the Nasopharynx

Oncocytic metaplasia can occur in various thyroid conditions. Individual cells, follicles, or groups of follicles may show signs of oncocytic metaplasia, such as in irradiated thyroid gland, nodular goiter, and chronic lymphocytic thyroiditis, as well as in long‑term autoimmune hyperthyroidism (Graves’ disease). Malignant nodes from oncocytic cells are even rarer. According to the world literature, the prevalence of oncocytic carcinoma (OC) among all thyroid cancers is from 3% to 5%. Among nodes that had oncocytic cells in the cytological sample, oncocytic carcinoma is detected in 5.0—49.1% of cases; and the overall prevalence of malignancy among such nodes (including papillary and follicular cancer, oncocytic variant and OC) is 35.8%. Objective — to establish a connection between the presence of oncocytes in punctate thyroid nodules and the detection of cancer on histopathological examination; to investigate the possibility of using the presence of oncocytes in the punctate as a predictor of the presence of cancer. Materials and methods. A monocentric retrospective study was conducted involving 487 patients who underwent primary surgery between January 2019 and December 2023 for nodular and multinodular goiter (TBSRTC III, IV, V). All patients underwent thyroidectomy or hemithyroidectomy, supplemented with neck dissection and lymphadenectomy. Results. Among 487 patients with thyroid nodules categorized as Bethesda III, IV, or V, malignancy was identified in 211 cases. Of these, 36 patients exhibited oncocytic changes in the punctate, while 175 patients did not. In the remaining 276 patients, cancer was not diagnosed, including 60 cases with detected oncocytic cells and 216 cases without such changes on cytological examination. The data were analyzed for each patient group according to the Bethesda classification. The highest test performance (specificity and overall efficiency) was observed in patients with Bethesda III, though sensitivity was zero. Similarly, in patients with Bethesda IV and V, sensitivity remained extremely low, resulting in low overall efficiency despite high specificity. Conclusions. The study did not establish a significant relationship between the presence of oncocytic cells in punctate thyroid nodules (Bethesda III, IV, V) and the subsequent diagnosis of thyroid cancer. Therefore, the presence of oncocytic cells in thyroid nodules cannot be considered a reliable predictor of malignancy. Additionally, the presence of oncocytes does not appear to be a negative prognostic factor for malignancy compared to their absence.

Recurrent gene fusions are common in salivary gland tumors including benign tumors, such as pleomorphic adenoma (PA) and myoepithelioma (ME). In cases where chromosomal rearrangement is identified in the pleomorphic adenoma gene 1 (PLAG1) gene, different gene partners are found. Oncocytic metaplasia, characterized by oncocytes with abundant eosinophilic granular cytoplasm and hyperchromatic nuclei, is a well-known phenomenon in salivary gland neoplasms. However, the pure oncocytic variant of PA/ME showed PLAG1 gene rearrangements involving various gene partners at the molecular level, without any recurrent fusion being found. Our study includes 20 cases of PA/ME, with 11 females and 9 males. The age of patients ranged from 37 to 96 years, with a median age of 62.8 years. Most tumors originate from the parotid gland. The median size of the tumor was 26.5 mm (range: 13 to 60 mm). Among the 20 cases, 14 were a pure oncocytic variant of PA/ME, whereas 6 cases showed focal oncocytic or oncocytic-like aspects. Molecular studies on 20 cases of PA/ME were conducted. A novel recurrent ZBTB47-AS1::PLAG1 fusion was identified in 6 of 12 cases with pure oncocytic metaplasia, whereas the other cases had PLAG1 gene fusion with different gene partners. The transcriptomic analysis of the cases harboring ZBTB47-AS1::PLAG1 fusion demonstrated that these tumors have a distinct molecular profile from conventional PA/ME. This study reveals a unique subset in the oncocytic PA/ME spectrum characterized by pure oncocytic morphology with larger oncocytic cells and recurrent ZBTB47-AS1::PLAG1 fusion. It also highlights the transcriptomic distinctness of salivary gland adenomas with pure oncocytic metaplasia in the spectrum of salivary gland neoplasms. Further studies are needed to better understand the oncocytic variant of PA/ME and to determine the true nature of oncocytic cells in PA/ME.

Despite the increasing recognition of PD-L1 as predictor of immunotherapeutic response in various malignancies, its role and prognostic significance in thyroid cancer remain underexplored and subject to debate. This study begins to address this gap by comprehensively analyzing PD-L1 expression in papillary thyroid carcinoma (PTC) and investigating its correlation with key clinicopathological variables. We conducted immunohistochemistry (IHC) to assess PD-L1 expression in whole-tissue sections from 121 primary papillary thyroid carcinoma (PTC) cases. We then analyzed the correlations between PD-L1 expression and various clinicopathological variables. PD-L1 expression was detected in 33.1% of papillary thyroid carcinomas (PTCs), predominantly exhibiting weak to moderate intensity. Notably, this study found no significant correlation between PD-L1 expression and various clinicopathological variables. The lack of association with traditional factors such as age, sex, histological subtype, and tumor size suggests the complex and multifaceted nature of PD-L1 regulation in PTC. Multivariate logistic regression analysis identified chronic lymphocytic thyroiditis with oncocytic metaplasia as the sole independent predictor of PD-L1 expression (P = 0.014), underlining the potential influence of the tumor microenvironment on immune checkpoint expression in PTC. Our study underscores the intricate interplay between chronic lymphocytic thyroiditis with oncocytic metaplasia and PD-L1 expression in papillary thyroid carcinoma. The observed link suggests a potential avenue for therapeutic intervention using anti-PD-1/PD-L1 therapies in surgery-refractory PTC. Understanding the dynamics of immune checkpoint regulation in the context of the tumor microenvironment is crucial for devising effective treatment strategies. Future research endeavors should delve deeper into the molecular mechanisms underlying this interaction and explore its implications for patient outcomes. As the field of immunotherapy continues to evolve, our findings contribute valuable insights into the complex immunological landscape of thyroid cancer.

Pleomorphic adenoma is the most common and well-studied salivary gland neoplasm. It is a benign tumor most commonly occurring in the parotid gland although it can be seen in other major and minor salivary glands. There is a variety of metaplasia seen in Pleomorphic adenoma most commonly squamous metaplasia, others noted are osseous metaplasia, oncocytic metaplasia, sebaceous metaplasia, and adipocytic metaplasia. Also, at times tyrosine crystalloids are seen. This study discusses a few of the metaplasia and the presence of tyrosine crystals in pleomorphic adenoma. Indeed, this tumor proves true to its name.

Oncocytes are a component of many metaplastic and neoplastic lesions throughout the head and neck area, primarily originating in salivary/seromucinous glands and the thyroid gland. In addition, other lesions can contain cells that mimic oncocytes (pseudo-oncocytes); these can be of epithelial or non-epithelial origin. Review article. Oncocytic metaplasia is common in seromucinous glands throughout the upper aerodigestive tract, most notable in the oral cavity, nasopharynx and larynx. The main oncocytic salivary gland neoplasms are Warthin tumor and oncocytoma. Infarction of Warthin tumor may lead to recognition difficulties. Oncocytic subtypes of mucoepidermoid carcinoma and intraductal carcinoma have morphologic and immunohistochemical features that allow distinction from major oncocytic entities. Oncocytic thyroid tumors include adenoma, carcinoma (follicular, papillary and medullary), along with poorly differentiated tumors. Oncocytic papillary sinonasal and middle ear tumors must be distinguished from low grade adenocarcinomas. Pseudo-oncocytic entities include paraganglioma, Langerhans cell histiocytosis, giant cell tumor, rhabdomyoma, and metastatic tumors. Correct diagnosis of oncocytic head and neck lesions requires a knowledge of the spectrum of possible entities, their characteristic sites of occurrence, architecture, histomorphology, and immunohistochemistry. Oncocytic subtypes of several newly described entities are now recognized. Both epithelial and non-epithelial mimics of oncocytes exist. The molecular features of oncocytic tumors can be helpful in their diagnosis and understanding their pathogenesis.

Melanotic oncocytic metaplasia (MOM) of the nasopharynx is an extremely rare benign lesion which is characterized by the presence of usually a small, pigmented lesion near the Eustachian tube opening, but never reported the form of cyst without pigmentation. A 76-year-old man who had a symptom with globus pharyngeus for 3 months was presented to otolaryngology clinic. The lesion was found as a rare form of cystic mass without pigmentation through endoscopic examination. Microscopically, there were well-formed glandular structured oncocytic cells with abundant eosinophilic granular cytoplasm. Scattered brown pigments were also noted, which were positive for S-100 and negative for HMB-45 in immunohistochemistry. He was diagnosed with MOM of the nasopharynx. MOM of the nasopharynx should be always taken into consideration about its various clinical forms as a benign mimicker of malignant melanoma.

Some thyroid nodules cytologically presenting as follicular neoplasm, Hürthle cell (Oncocytic) type (FNHCT), are not oncocytic tumors and represent autonomously functioning thyroid nodules (AFTNs) with TSHR, GNAS, and EZH1 mutations or oncocytic metaplasia. A to be defined subset of FNHCT harbors genome haploidisation-type DNA copy number alterations (GH-CNA). Molecular profiling of FNHCT may distinguish oncocytic neoplasms from its mimics. Consecutive fine-needle aspirates of 180 thyroid nodules over 37 months diagnosed as FNHCT and tested by ThyroSeq v3 were identified. Histologic follow-up was available for 79 of 180 nodules (44%). No molecular alterations were found in 76 of 180 nodules (42%), of which 15 were resected (oncocytic metaplasia, n = 7; follicular oncocytic adenoma, n = 8). Of nodules followed without surgery, 17 of 101 (17%) showed TSHR, EZH1, and GNAS mutations of AFTNs. Papillary thyroid carcinoma was identified by BRAF V600E (n = 2) and hyalinizing trabecular adenoma by PAX8-GLIS3 (n = 1). GH-CNA alone was detected in 42 of 180 FNHCT nodules (23%), of which 29 were resected and histologically diagnosed as follicular oncocytic neoplasms. All remaining resected nodules were histologically proven oncocytic neoplasms: 1) RAS-like alterations without GH-CNA (n = 25) and 2) TERT and/or TP53 mutations co-occurring with GH-CNA (n = 6), including anaplastic thyroid carcinoma arising from follicular oncocytic carcinoma with TP53, TERT mutations with GH-CNA (n = 2). A proportion of FNHCT nodules are AFTNs and oncocytic metaplasias, which can be suspected based on characteristic mutations or lack of alterations on molecular testing. Among resected FNHCTs, GH-CNAs characterize approximately half of histologically confirmed follicular oncocytic neoplasms.

Salivary gland intraductal carcinoma (IDC) is a complex ductal neoplasm surrounded by a layer of myoepithelial cells. Recent insights have shown that there are three different types: intercalated duct-like, with frequent NCOA4-RET fusions; apocrine, with salivary duct carcinoma-like mutations; and mixed intercalated duct-like/apocrine, with RET fusions, including TRIM27-RET. In addition, an oncocytic IDC has been described, but it remains unclear whether it represents a fourth variant or simply oncocytic metaplasia of another IDC type. Our aim was to more completely characterize oncocytic IDC. Six IDCs with oncocytic changes were retrieved from the authors' archives, from three men and three women ranging in age from 45 to 75years (mean, 63years). Five arose in the parotid gland, with one in an accessory parotid gland. Four patients with follow-up were free of disease after 1-23months. Several immunostains (S100, mammaglobin, androgen receptor, and p63/p40) and molecular tools (RNA sequencing, RET fluorescence in-situ hybridisation, BRAF V600E VE1 immunohistochemistry, and Sanger sequencing) were applied. Histologically, the tumours were variably cystic with solid intracystic nodules often difficult to recognise as intraductal. In all, tumour ducts were positive for S100 and mammaglobin, negative for androgen receptor, and completely surrounded by myoepithelial cells positive for p63/p40. Molecular analysis revealed TRIM33-RET in two of six cases, NCOA4-RET in one of six cases, and BRAF V600E in two of six cases. One case had no identifiable alterations. Oncocytic IDC shares similarities with intercalated duct-like IDC. Although additional verification is needed, the oncocytic variant appears to be sufficiently unique to be now regarded as the fourth distinct subtype of IDC. Because of its indolent nature, oncocytic IDC should be distinguished from histological mimics.

Lesions mimicking malignancies in the nasopharynx are frequently seen in adult patients. These include inflammatory, metaplastic, and cystic lesions. We aimed to draw attention to rare tumor-like lesions that can be confused with malignancies and cause diagnostic difficulties clinically and radiologically. A total of 538 patients who underwent nasopharyngeal biopsy in our center between January 2010 and June 2020 were evaluated. Patient information was obtained from patient files and evaluated retrospectively. A total of 19 of the 538 patients had tumor-like lesions that were included in the study. Granulomatous inflammation was present in seven cases, oncocytic metaplasia in four cases, benign cyst in five cases, fungal infection in two cases, and immunoglobulin G4-related disease in one case. The nasopharynx is a region where various lesions can be seen. Some lesions form tumor-mimicking mass effect, cause increased thickness, and lead to increased metabolic activity in positron emission tomography-computed tomography that create the illusion of a malignant tumor and histopathologic verification is crucial. We aimed to present these rare tumor-like lesions that should be kept in mind in the differential diagnosis.

Melanotic oncocytic metaplasia (MOM) in the nasopharyngeal space is a very rare entity. Only 35 cases have been reported in the English literature, and most patients were East Asian males between 60 and 70 years of age. MOM presents as a brown or black lesion with slight elevation of the mucosa. These lesions are benign and defined as cellular enlargement with eosinophilic granular melanin-pigmented cytoplasm caused by mitochondrial accumulation. However, such presentation can lead physicians to misjudge MOM as a malignant lesion. Recently, we experienced a case of MOM of the nasopharynx. A 58-year-old woman was admitted to the internal medicine department with small-volume hemoptysis and referred to the ENT department for evaluation. She was a regular smoker without any medical history. Sinus endoscopy showed black pigmented lesions on both the torus tubaris and left posterior tonsillar pillar, with low bleeding risk. Excisional biopsy of the lesion was performed, and oncocytic metaplasia was confirmed pathologically. Hemoptysis showed spontaneous remission and no recurrence or other symptoms over 12 months of follow up. Melanotic oncocytic metaplasia in the nasopharynx should be clinically recognized to avoid misdiagnosis as a malignancy like melanoma.

What is hiding behind S100 protein and SOX10 positive oncocytomas? Oncocytic pleomorphic adenoma and myoepithelioma with novel gene fusions in a subset of cases

Despite the interest of researchers in IgG4-related disease (IgG4-RD), many questions still remain unanswered regarding the thyroid gland. We aimed to clarify the relationship between IgG4-positive plasma cells and the histopathological pattern in the Hashimoto thyroiditis (HT) in a Finnish series. HT specimens (n=280) were retrieved from the Department of Pathology, Fimlab Laboratories. After re-evaluation, 82 (29%) cases (72 females and 10 males, 52±17years) with significant fibrosis were selected. CD38, IgG and IgG4 positivity in plasma cells was evaluated by immunohistochemistry. Adjusted IgG4-positive plasma cells per HPF>20 and IgG4- to IgG-positive plasma cell ratio>30% were adopted as threshold criteria and related to other morphological features. IgG4-positive HT group included 13 cases (15% from fibrotic HT, 4.6% from all HT, 50±15years, 11 females) with adjusted HPF count 30±5 (23-40) IgG4-positive cells. IgG4-positivity significantly correlated with the presence of lobulation, oncocytic metaplasia and certain type of fibrosis, fibrosis spread outside the gland, lymphocytes/plasma cells epithelial penetration, the predominance of microfollicles and follicular atrophy in the present study. Despite the persisting uncertainty whether HT is IgG4-RD, HT with IgG4-positive plasma cells is histopathologically distinct entity with some geographic variability.

Melanotic oncocytic metaplasia (MOM) of the nasopharynx is a rare lesion that occurs mostly in Asian men in their 60s to 70s who are heavy smokers. Although it is a benign lesion, it’s sometimes mistaken for malignant melanoma, nevus or early nasopharyngeal carcinoma. A 75 year-old male visited our outpatient clinic with hearing loss that occurred a week earlier. Otoscopic findings revealed left serous otitis media. A nasopharyngoscopic examination to rule out a malignant tumor in the nasopharynx revealed multiple black nodules in the left torus tubarius and left nasal floor. Under local anesthesia, some of nodules were excised for histopathology. The histological examination revealed oncocytic metaplasia of mucous glands and the presence of numerous brown-colored melanin pigments. Immunohistochemically, S 100-positive and HMB 45-negative dendritic melanocytes were identified. During 3 months of regular follow up, there was no recurrence at the excision site and no expansion of the remaining lesion. (J Clinical Otolaryngol 2020;31:88-93)

Stomatitis and Cheilitis Glandularis are inflammatory conditions of the minor salivary glands with uncertain aetiology, uncommon in clinical practice. Local factors and systemic comorbidities associated with hyposalivation could contribute to the onset of the disease. The aim of this study is to describe retrospectively a case series of Stomatitis and Cheilitis Glandularis from two Oral Medicine and Pathology Departments. Also, a review of the clinical and epidemiological variables and a discussion of the diagnostic criteria is presented. There were included cases of Stomatitis and Cheilitis Glandularis from two Oral Diagnosis Centres from Argentina and Brazil, according to Reiter et al criteria. Demographic and clinicopathological features were described. A concise review of current literature was performed discussing diagnostic criteria and possible etiological factors. There were included six cases sequentially retrieved from the last ten years. The patients included were 4 men and 2 women with an average age of 65.33 years old. The majority of the included cases showed comorbidities or were treated with drugs associated with hyposalivation or a decrease in salivary flow. Clinically, firm nodules and pus discharge was observed in minor salivary glands. Actinic damage was a poorly associated factor in this series. Histopathology revealed sialoadenitis, oncocytic metaplasia with different degrees of periductal inflammation in all cases. Stomatitis and Cheilitis Glandularis are challenging disorders of the oral cavity. Hyposalivation could be an early phenomenon in a multifactorial context. More studies are needed for a better understanding of these conditions.