Canalicular Adenoma

The canalicular adenoma is a benign tumor that has a significant predilection for the upper lip (Figure 10.4). In the past, this tumor was

Figure 10.4a. A freely moveable, indurated, submucosal mass of the upper lip in an elderly woman, highly suggestive of a canalicular adenoma.

more commonly referred to as a "monomorphic adenoma." Gardner recommended that the term monomorphic adenoma be used as a nosologic group of epithelial salivary gland tumors that are not pleomorphic adenomas (Gardner and Daley 1983). The canalicular adenoma and basal cell adenoma identify specific forms of monomorphic

Figure 10.4b. Based on this assumption, an incisional biopsy is not required. A pericapsular dissection and excision of this mass was performed in association with surrounding minor salivary gland tissue, thereby allowing for delivery of the specimen.

Figure 10.4c. The histopathology of the specimen confirms the clinical impression of canalicular adenoma. Reprinted with permission from Carlson ER, Schimmele SR. 1998. The management of minor salivary gland tumors of the oral cavity. In: Surgical Management of Salivary Gland Disease, The Atlas of the Oral and Maxillofacial Surgery Clinics of North America 6. Philadelphia: W.B. Saunders, pp. 75-98.

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Figure 10.5a. A freely moveable, indurated, submucosal mass of the buccal mucosa is noted in this patient.

Figure 10.5a. A freely moveable, indurated, submucosal mass of the buccal mucosa is noted in this patient.

adenomas (Daley, Gardner, and Smout 1984). The canalicular adenoma classically occurs in the upper lip in elderly women (Kratochvil 1991). In fact, canalicular adenomas typically affect an older population compared to pleomorphic adenomas (Ord 1994). The canalicular adenoma is typically an asymptomatic, slow-growing, and freely moveable mass that uncommonly exceeds 2 cm in widest diameter. It may resemble mucoceles, which are uncommonly located in the upper lip. Of the 121 canalicular adenomas in the AFIP files, 89 of them occurred in the upper lip. The second most common site was the buccal mucosa (Auclair, Ellis, and Gnepp et al. 1991). The tumor is encapsulated such that an excision of the tumor in any anatomic site in a pericapsular fashion represents a curative surgery provided that tumor spillage does not occur (Figure 10.5). The canalicular adenoma is multifocal in 20% of cases (Ord 1994). If recurrence is believed to have occurred, it might actually represent a new primary tumor (Melrose 1994).

Figures 10.5b and 10.5c. The CT scans show a well-circumscribed mass of this region.
Figure 10.5d. A benign neoplastic process occupies a high position on the differential diagnosis such that a mucosal-sparing excision of the mass with transoral access is able to be performed without first obtaining an incisional biopsy.

Figure 10.5e. A pericapsular dissection is performed.

Figures 10.5g and 10.5h. Histopathology identified canalicular adenoma (g) with an uninvolved capsule (h).

Figure 10.5f. This dissection permits delivery of the specimen. Stenson's duct was intimately attached to the tumor and therefore sacrificed with the tumor.

Figure 10.5i. The appearance of the site is noted to be well healed at 9 months postoperatively. Reprinted with permission from Carlson ER. 1995. Salivary gland pathology—clinical perspectives and differential diagnosis. In: The Comprehensive Management of Salivary Gland Pathology, Oral and Maxillofacial Surgery Clinics of North America 7. Philadelphia: W.B. Saunders, pp. 361-386.

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