The pathogenic role of Epstein-Barr virus (EBV) in sclerosing polycystic adenosis. Pathol Res Pract. 2010;206:565-571. [PMID: 20400234 DOI: 10.1016/j.prp.2010.03.003]

A challenging case of sclerosing polycystic adenoma of the parotid gland: a case report and brief review of the latest updates

Sclerosing polycystic adenoma (SPA) is a rare neoplastic salivary gland lesion with only about 100 cases reported worldwide so far. The lesion is confused with several malignant and other benign tumors such as apocrine intraductal carcinoma (IC), salivary duct carcinoma (SDC), chronic sclerosing sialadenitis, polycystic dysgenetic disease (PDD), pleomorphic adenoma (PA), acinic cell carcinoma (ACC), and mucoepidermoid carcinoma (MEC). We present a case of SPA for a 23-year-old male patient presenting with a slowly growing parotid mass. Fine needle aspiration (FNA) followed by total excision of the tumor was performed and the picture was consistent with SPA. We discuss the findings of the case and briefly review the literature on SPA.

A Case of Sclerosing Polycystic Adenoma of the Parotid Gland

Sclerosing polycystic adenoma (SPA) is a rare salivary gland tumor with about 100 cases reported in the literature. We describe a case of SPA in the parotid gland and review the diagnostic tools used for identifying SPA. A 24-year-old male with a two-year history of right-sided face mass, initially thought to be pleomorphic adenoma of the parotid gland after fine needle aspiration (FNA). Following superficial parotidectomy, histologic features were consistent with SPA. This case illustrates the challenge of pre-operative assessment for SPA. Recent study has suggested SPA is a neoplasm and definitive treatment is surgical excision.

Sclerosing polycystic adenosis of the submandibular gland: Two case reports

BACKGROUND

Sclerosing polycystic adenosis (SPA) is a rare disease of salivary glands, similar to fibrocystic disease of the breast. It occurs over a wide age range and exhibits a slight female preference. Most SPA cases have occurred in the parotid gland. The exact nature of SPA is unclear, but its tumor nature has recently been proposed. Although SPA has a good prognosis after adequate surgery, atypical lesions might occur, ranging from mild dysplasia to carcinoma in situ in some cases. To the best of our knowledge, only five cases of SPA in the submandibular gland have been reported to date. Here, we present two new cases of SPA involving the submandibular gland.

CASE SUMMARY

A 50-year-old woman and a 52-year-old woman were referred to Tongji Hospital in Wuhan, China, with complaints of moderate pain, recurrent swelling, and a mass in the submandibular area. After admission, the two cases of the submandibular mass were examined physically. The boundary of the submandibular tumor was clear, and the range of motion was good. After preoperative examinations, surgery was performed on a selective basis. Postoperative histopathological examination revealed a well-defined mass with acinar structures, ducts, or cystic dilated glands of various sizes scattered in a large number of proliferative sclerosing stroma. There were flat and cuboidal cells, and eosinophils in the duct epithelium. There was also a eosinophilic substance in the lumen of dilated cysts. No atypical epithelial hyperplasia, invasive growth, or carcinoma in situ was found. Based on the above findings, the mass was diagnosed as SPA. Both patients have remained asymptomatic and no recurrence or distant metastasis had occurred by the 7-mo and 5-year follow-up, respectively.

CONCLUSION

SPA is a rare disease of the salivary gland. Even though it has a good prognosis after adequate surgery, atypical lesions may occur from mild dysplasia to carcinoma in situ. However, no recurrence, distant metastasis, or mortality has been reported for submandibular gland SPA. Clinicians and pathologists should be familiar with the characteristics of SPA in the submandibular gland to avoid misdiagnosis and overtreatment.

Sclerosing polycystic adenosis of minor salivary glands: Report of a rare case with diagnostic approach and review of literature

Sclerosing polycystic adenosis (SPA) is an uncommon entity occurring in the salivary glands, with majority of the cases reported in major salivary glands reminiscent of fibrocystic disease of the breast. SPA arising in minor salivary glands of the oral cavity constitutes an exceedingly rare phenomenon. Here, we report a case of SPA that presented as a solitary, submucosal mass on the left lower labial mucosa in a 19-year-old male. The pathology features and a clinicopathologic diagnostic approach highlighting key features are discussed here. Similar cases published in the English literature are reviewed.

Juvenile sclerosing polycystic adenosis cytologically mimicking Warthin tumor

Sclerosing polycystic adenosis (SPA) is a rare salivary gland disease. Histologically it resembles a low-grade ductal carcinoma in situ or sclerosing adenosis of the breast, characterized by lobular proliferation of ducts with apocrine cellular features surrounded by fibrosclerotic stroma. Although SPA is typically benign, recurrence is not uncommon, and cases with a malignant component have been documented. Thus, complete excision is desirable but preoperative diagnosis is challenging. A 12-year-old boy presented with a painless mass in the right neck. We identified a well-demarcated mass in the right parotid region measuring approximately 2 cm using cervical echography and magnetic resonance (MR) imaging. Fine-needle aspiration (FNA) revealed two cell types. There were loosely cohesive clusters of polymorphic epithelioid cells with irregular nuclei and abundant vacuolated cytoplasm containing zymogen granules. Some of these cells were binuclear. The other cell types represented normal ductal cells. The original cytological diagnosis was Warthin tumor. Right parotidectomy was performed. Histologically, we observed proliferation of ducts with granular, vacuolated, zymogen granules, and apocrine-like features in the cytoplasm with hyalinizing sclerotic stroma and some binuclear cells. Four years after parotidectomy, there has been no recurrence or malignant transformation.Cytological diagnosis of SPA is challenging on FNA specimens since SPA is a very rare entity of the salivary gland that can mimic other salivary gland neoplasms. A mixture of apocrine-like cells and sebaceous-like cells, nuclear pleomorphism, and zymogen granules can help to diagnose this rare lesion during the initial cytological diagnosis.

Sclerosing Polycystic Adenosis of Hard Palate: A Rare Entity in Salivary Glands

Sclerosing polycystic adenosis (SPA) is a rare neoplasm of salivary glands, with a striking resemblance to the benign fibrocystic disease of the breast. The most common site of occurrence is the parotid gland. However, submandibular gland, minor salivary glands, and buccal mucosa may also be affected. It shows a slight female predilection and occurs over a wide age range. The exact nature of the disease is unknown but is postulated to be a neoplasm recently. The treatment is effective by localized surgical excision, and recurrence is rare. To the best of our knowledge, there is only one case report of SPA involving palate. Here, we describe an additional case report of SPA occurring in the palatal region of a 49-year-old male patient.

Newly described salivary gland tumors

This review concentrates on three salivary gland tumors that have been accepted in the recent literature as new neoplastic entities: mammary analog secretory carcinoma (MASC), sclerosing polycystic adenoma (SPA) and cribriform adenocarcinoma of tongue and other minor salivary glands (CAMSGs). MASC is a distinctive low-grade malignant salivary cancer that harbors a characteristic chromosomal translocation, t(12;15) (p13;q25) resulting in an ETV6-NTRK3 fusion. SPA is a rare lesion often mistaken histologically for low-grade salivary carcinoma. Previously thought to be a reactive fibroinflammatory process, but recent evidence of clonality, recurrences in up 30%, and dysplastic foci suggest it may be truly neoplastic. CAMSG is a distinct tumor entity that differs from polymorphous low-grade adenocarcinoma (PLGA) by location (ie, most often arising on the tongue), by prominent nuclear clearing, alterations of the PRKD gene family and clinical behavior with frequent metastases at the time of presentation of the primary tumor. Early metastatic disease seen in most cases of CAMSG associated with indolent behavior makes it a unique neoplasm among all low-grade salivary gland tumors. Salivary glands may give rise to a wide spectrum of different tumors. They are often diagnostically challenging as morphological features often overlap between different entities. Although conventional morphology in combination with immunohistochemical findings still provide the most important clues for diagnosis, recent advances in molecular pathology offer new diagnostic tools in investigating the differential diagnosis, as well as providing potentially valuable prognostic indicators. In the last two decades, several new salivary gland tumor entities have been described, namely MASC, SPA and CAMSGs.

Sclerosing Polycystic Adenosis of the Parotid Gland: A Systematic Review and Report of 2 New Cases

PURPOSE

We sought to evaluate clinical-epidemiologic aspects, pathologic characteristics, and treatment of sclerosing polycystic adenosis (SPA) of the parotid gland and to report 2 new cases.

MATERIALS AND METHODS

We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies published in or before June 2016. The inclusion criteria were as follows: final diagnosis of SPA affecting the parotid gland and articles published in Spanish or English. The exclusion criteria were as follows: unclear diagnosis after pathologic analysis and patients affected by other conditions in the major salivary glands. We added 2 new cases.

RESULTS

Our review ultimately included 21 articles and 45 cases. The mean patient age was 41 years (range, 7-84 years). The female-to-male ratio was 2:1. In all patients the tumor showed progressive growth. The evolution range was 7 days to 11 years. In 17.7% of cases, the tumor was associated with pain. The average tumor size was 30.3 mm (range, 12-60 mm). Fine needle aspiration biopsy (FNAB) was unable to diagnose 30 cases. Benign tumors comprised 58% of tumors (18), whereas malignancy was present in 25.8% (8). Thirty-five tumors were well circumscribed. There were 8 multinodular or lobed cases. The tumor was described as encapsulated in 1 case, partially encapsulated or pseudo-encapsulated in 16, and not encapsulated in 12. Five cases showed different degrees of degenerative changes, ranging from dysplasia to invasive carcinoma. All cases underwent surgical treatment. Superficial parotidectomy with preservation of the facial nerve was performed in 22 cases (61.1%), total parotidectomy in 8 (22.2%), and tumor enucleation in 6 (16.6%). The mean follow-up period was 51.5 months (range, 5-276 months). Of documented cases, 74.2% had 2 or more years of follow-up. Recurrences occurred in 6 cases (16.6%).

CONCLUSIONS

We consider SPA a benign tumor with progressive growth, which is occasionally painful. It occurs around age 40 years and occurs more often in female patients. Fine needle aspiration biopsy does not provide an adequate preoperative diagnosis. Recurrences are infrequent. Follow-up should be customized according to the pathologic findings. Malignant transformation may occur. Superficial parotidectomy with facial nerve preservation is the treatment of choice.

Salivary gland tumor "wishes" to add to the next WHO Tumor Classification: sclerosing polycystic adenosis, mammary analogue secretory carcinoma, cribriform adenocarcinoma of the tongue and other sites, and mucinous variant of myoepithelioma

This review is a continuation of suggested tumor additions to the next WHO Tumor Classification. The author will focus on four salivary gland entities that have recently become accepted in the literature as new neoplastic entities: sclerosing polycystic adenosis, mammary analogue secretory carcinoma, cribriform adenocarcinoma of the tongue and other sites, and mucinous variant of myoepithelioma.

Sclerosing polycystic adenosis of the retromolar pad area: a case report

Sclerosing polycystic adenosis is a rare pathological lesion that affects salivary glands. The majority of cases involve the parotid and its occurrence in minor glands is exceedingly rare. Here, we report the first case of this lesion in the retromolar pad area and discuss its histological features and immunohistochemical reactivity with αSMA and Ki67 markers. A review of the literature on its immunohistochemical profile is also provided. Sclerosing polycystic adenosis has a diverse histomorphology and should be differentiated from other more important pathologic lesions.

Sclerosing polycystic adenosis of parotid gland: a unique report of two cases occurring in two sisters

Sclerosing polycystic adenosis (SPA) of salivary glands is a tumorous lesion of salivary glands, with clinical presentation of a slow-growing mass characterized by a combination of histological features, some of which are reminiscent of mammary fibrocystic disease. SPA is mostly unifocal, but rarely may be multifocal and/or bilateral. Recurrences have been reported in up to 19% of cases. Although originally considered pseudoneoplastic, the occurrence of "dysplasia" and carcinoma in situ of ductal epithelium, and recent evidence of clonality suggest a possible neoplastic nature. Herein we describe, for the first time, two cases of SPA in two sisters (7 and 33 years old). The younger patient experienced multiple recurrences. This is the first report of familial occurrence of SPA, suggesting a possible genetic background.

Sclerosing polycystic adenosis of salivary glands: a review with some emphasis on intraductal epithelial proliferations

Sclerosing polycystic adenosis (SPA) is a rare condition of salivary glands. The most common site is the parotid gland (80 % of cases). SPA shows no gender predilection and occurs over a wide age spectrum (9-84 years). SPA is mostly unifocal, but may rarely be multifocal. Histologically, SPA are sharply circumscribed mostly unencapsulated lesions composed of acinar and ductal components with variable cytomorphological characteristics, including foamy, vacuolated, apocrine, mucous, clear/ballooned, squamous, columnar and oncocyte-like cells. Characteristic for SPA is the presence of large acinar cells with abundant eosinophilic cytoplasmic granules. The stroma is densely collagenized, frequently harbouring a variably intense chronic inflammatory infiltrate and may contain fat. Rarely the stroma is myxoid. Some degree of intraductal epithelial proliferations have been reported in at least 50 % of cases. The proportion of cases with epithelial proliferations that fulfill criteria for high-grade ductal carcinoma in-situ is <10 %. Immunohistochemically, both ductal and acinar cells are positive for broad spectrum cytokeratins. There is variable immunoreactivity for epithelial membrane antigen and S-100 protein. CEA, p53 and HER2 is reportedly negative. Gross cystic disease fluid protein-15 is strongly expressed in the acinar component. There is consistent but variable expression of estrogen and progesterone receptors. The proliferative index (Ki-67) is low (1-2 %) in the benign (acinar and ductal) components. Using HUMARA methodology (non-random inactivation of X-chromosomes), six cases with atypical epithelial proliferations have been shown to be clonal processes. Recurrences have been reported in up to 19 % of cases.

A unique case of sclerosing polycystic adenosis of the sinonasal tract

Sclerosing polycystic adenosis is an extremely uncommon, recently described, sclerosing lesion of the salivary glands that appears histologically similar to fibrocystic changes of the breast. The key histopathologic features of sclerosing polycystic adenosis include lobular proliferation of ductal and acinar elements, cystically dilated ducts exhibiting frequent apocrine and sebaceous metaplasia, eosinophilic intracytoplasmic granules within some acinar-type cells, intraductal epithelial hyperplasia, and dense fibrosis. Most described cases have occurred in the major salivary glands, particularly the parotid gland. Although most authorities consider sclerosing polycystic adenosis to be a pseudoneoplastic process, the occurrence of dysplasia and carcinoma in situ of ductal epithelium reported recurrence rates of up to 30%, and recent evidence of clonality suggests a possible neoplastic etiology. However, there have been no cases of metastasis. Herein, we report the first case of sclerosing polycystic adenosis of the sinonasal tract in a 79-year-old woman presenting with a sinonasal mass.

Sclerosing polycystic adenosis of the parotid gland

Sclerosing polycystic adenosis (SPA) is an uncommon salivary gland lesion similar to fibrocystic disease and adenosis of the mammary glands. To our knowledge, 51 cases of SPA have been reported in the literature to date. Sclerosing polycystic adenosis is well circumscribed, yet not encapsulated, and has sclerotic and irregularly defined lobules composed of abundant hyalinized collagen with ductal, acinar hyperplasia and areas of apocrine metaplasia. Focal cystic spaces within a dense fibrotic stroma are also characteristic features of this lesion. Most of the known cases occurred mainly in the parotid gland. In this article, we describe a case of SPA occurring in the parotid gland of a 47-year-old male patient.

Sclerosing polycystic adenosis

A 25-year-old female presented with a well-defined, painless mass of 1 year's duration in the right parotid gland. MR imaging revealed a relatively well-circumscribed lesion involving the deep and superficial lobes of the right parotid gland. Histologic examination of the resection resulted in a diagnosis of sclerosing polycystic adenosis, a rare benign salivary gland entity of presumed non-neoplastic origin. The clinical, radiographic, and morphologic features of sclerosing polycystic adenosis are discussed.

[Sclerosing polycystic adenosis of the submandibular gland]

Sclerosing polycystic adenosis (SPA) is a rare, newly-reported lesion of the salivary glands. Most cases occurred within mayor salivary glands and were frequently confused with other salivary gland carcinomas such as acinar cell carcinoma. We report a case of SPA within the submandibular gland in a 63-year-old woman.