1
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Petersson F. Sclerosing polycystic adenoma – A review. Ann Diagn Pathol 2022; 59:151949. [DOI: 10.1016/j.anndiagpath.2022.151949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
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2
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Wu L, Wang Y, Hu CY, Huang CM. Sclerosing polycystic adenosis of the submandibular gland: Two case reports. World J Clin Cases 2021; 9:2930-2936. [PMID: 33969079 PMCID: PMC8058660 DOI: 10.12998/wjcc.v9.i12.2930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Leng Wu
- Department of Stomatology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Ying Wang
- Department of Pathology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Chuan-Yu Hu
- Department of Stomatology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Chun-Ming Huang
- Department of Stomatology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
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3
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Das SN, Jyoti K, Rath R, Pattnaik B. Sclerosing polycystic adenosis of minor salivary glands: Report of a rare case with diagnostic approach and review of literature. J Oral Maxillofac Pathol 2021; 24:590. [PMID: 33967523 PMCID: PMC8083427 DOI: 10.4103/jomfp.jomfp_186_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/08/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Surya Narayan Das
- Department of Oral Pathology and Microbiology, S.C.B Dental College and Hospital, Cuttack, Odisha, India
| | - Kirti Jyoti
- Department of Oral Pathology and Microbiology, S.C.B Dental College and Hospital, Cuttack, Odisha, India
| | - Rachna Rath
- Department of Oral Pathology and Microbiology, S.C.B Dental College and Hospital, Cuttack, Odisha, India
| | - Bodhiswata Pattnaik
- Department of Oral Pathology and Microbiology, S.C.B Dental College and Hospital, Cuttack, Odisha, India
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4
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Kawai M, Inoue T, Yonaga T, Mochizuki K, Nakazawa T, Masuyama K, Kondo T. Juvenile sclerosing polycystic adenosis cytologically mimicking Warthin tumor. Diagn Cytopathol 2019; 47:1208-1212. [PMID: 31329351 DOI: 10.1002/dc.24283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/25/2019] [Accepted: 07/10/2019] [Indexed: 12/25/2022]
Abstract
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.
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MESH Headings
- Adenolymphoma/diagnostic imaging
- Adenolymphoma/metabolism
- Adenolymphoma/pathology
- Adenolymphoma/surgery
- Biopsy, Fine-Needle
- Child
- Diagnosis, Differential
- Humans
- Magnetic Resonance Imaging
- Male
- Salivary Gland Neoplasms/diagnostic imaging
- Salivary Gland Neoplasms/metabolism
- Salivary Gland Neoplasms/pathology
- Salivary Gland Neoplasms/surgery
- Scleroderma, Localized/diagnostic imaging
- Scleroderma, Localized/metabolism
- Scleroderma, Localized/pathology
- Scleroderma, Localized/surgery
- Scleroderma, Systemic/diagnostic imaging
- Scleroderma, Systemic/metabolism
- Scleroderma, Systemic/pathology
- Scleroderma, Systemic/surgery
- Ultrasonography
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Affiliation(s)
- Masataka Kawai
- Department of Pathology, University of Yamanashi, 1110 Shimokato, Chūō, Yamanashi, Japan
| | - Tomohiro Inoue
- Department of Pathology, University of Yamanashi, 1110 Shimokato, Chūō, Yamanashi, Japan
| | - Takaaki Yonaga
- Department of Otorhinolaryngology and Head & Neck Surgery, University of Yamanashi, 1110 Shimokato, Chūō, Yamanashi, Japan
| | - Kunio Mochizuki
- Department of Pathology, University of Yamanashi, 1110 Shimokato, Chūō, Yamanashi, Japan
| | - Tadao Nakazawa
- Department of Pathology, University of Yamanashi, 1110 Shimokato, Chūō, Yamanashi, Japan
| | - Keisuke Masuyama
- Department of Otorhinolaryngology and Head & Neck Surgery, University of Yamanashi, 1110 Shimokato, Chūō, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, 1110 Shimokato, Chūō, Yamanashi, Japan
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5
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Henrique Braz-Silva P, Motta do Canto A, Oliveira L, Martins F, Antônio Pereira da Costa A, Adolfo Costa Hanemann J. Sclerosing Polycystic Adenosis of Tongue. THE BULLETIN OF TOKYO DENTAL COLLEGE 2019; 59:121-125. [PMID: 29962419 DOI: 10.2209/tdcpublication.2017-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sclerosing polycystic adenosis (SPA) is a rare benign lesion of the salivary glands which appears histologically similar to sclerosing adenosis and fibrocystic disease of the mammary gland. To date, 67 cases of SPA have been reported in the literature, with the lesion arising in the minor salivary glands in only 9. The present report describes the 10th case of SPA. The patient was a 39-year-old Brazilian man who presented with an asymptomatic nodule on the ventral surface of the tongue. Based on a clinical diagnosis of benign salivary gland neoplasm, an excisional biopsy of the lesion was performed. Histopathological examination showed lobular proliferation of ductal and acinar elements surrounded by a fibrosclerotic stroma. Many of the ductal structures exhibited cystic dilatation and were surrounded by periductal fibrosis, which is consistent with SPA findings. No recurrence of the disease was observed after a 5-year follow-up. A literature review is also discussed, focusing on both the etiology of SPA and the treatment options available.
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Affiliation(s)
- Paulo Henrique Braz-Silva
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of São Paulo.,Laboratory of Virology, Institute of Tropical Medicine of São Paulo, University of São Paulo
| | - Alan Motta do Canto
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences
| | - Leticia Oliveira
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of São Paulo
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6
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Petersson F. Non-cystic Sclerosing Polycystic Adenosis: Diagnosis of a Hitherto Undescribed Pattern. Head Neck Pathol 2018; 13:681-685. [PMID: 30361835 PMCID: PMC6854348 DOI: 10.1007/s12105-018-0979-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/19/2018] [Indexed: 01/29/2023]
Abstract
A case of sclerosing polycystic adenosis without cysts is described. The lesion occurred as a painless slow growing superficial right parotid lump in a 47 years old woman. The tumor measured 14 × 10 mm and displayed extreme well circumscription, sclerotic stroma with scattered hyaline nodules, sprinkling of mononuclear inflammatory cells and islands of mature fat. The epithelial component was predominantly composed of tubules lined by low columnar to cuboidal epithelium with bland nuclear features. Only focal incomplete acinar differentiation with few cells containing small eosinophilic granules was present. The stroma contained a significant fibromyxoid component with increased cellularity. There was no recurrence on follow-up at 14 months.
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Affiliation(s)
- Fredrik Petersson
- grid.410759.e0000 0004 0451 6143Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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7
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Bag AK, Curé JK, Chapman PR, Singhal A, Haneef Mohamed AW. Imaging of Inflammatory Disorders of Salivary Glands. Neuroimaging Clin N Am 2018; 28:255-272. [PMID: 29622118 DOI: 10.1016/j.nic.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sialadenitis is among the most common conditions that affect the salivary glands. Inflammation of the salivary glands occurs as the end result of a variety of pathologic conditions, including infectious, autoimmune, and idiopathic causes. Clinically, inflammation of the salivary gland causes pain and localized swelling. The presentation may be acute or chronic, and can be recurrent. Because there is significant overlap of underlying disease mechanisms and clinical presentations, radiologic evaluation often plays a significant role in evaluation. This article is a brief review of sialadenitis, including disease mechanisms, causes, and the practical imaging of the salivary glands.
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Affiliation(s)
- Asim K Bag
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Joel K Curé
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
| | - Philip R Chapman
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
| | - Aparna Singhal
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
| | - Atif Wasim Haneef Mohamed
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
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8
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Mumtaz S, Ali A, Singh M. Sclerosing polycystic adenosis of the oral cavity. Br J Oral Maxillofac Surg 2018; 56:753-754. [PMID: 30054028 DOI: 10.1016/j.bjoms.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/10/2018] [Indexed: 11/25/2022]
Abstract
Minor salivary glands are ubiquitous in the oral cavity, and related diseases are often indolent and asymptomatic. We describe the unusual features of sclerosing polycystic adenosis, and its similarities to more sinister conditions of the minor salivary glands. Its importance is currently uncertain and research points to a pathogenesis that is neoplastic, which can create ambiguity. Sclerosing polycystic adenosis is a newly-discovered condition that merits further discussion and research to evaluate its full impact.
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Affiliation(s)
- S Mumtaz
- Oral and Maxillofacial Surgery Department, Mid Essex Hospitals Services Trust, Chelmsford, United Kingdom.
| | - A Ali
- Histopathology Department Mid Essex Hospitals Services Trust, Chelmsford, United Kingdom
| | - M Singh
- Oral and Maxillofacial Surgery Department, Mid Essex Hospitals Services Trust, Chelmsford, United Kingdom
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9
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Puranik RS, Shree VB, Puranik SR, Anigol PS. Sclerosing polycystic adenosis of lower lip: A new and rare salivary gland entity. J Oral Maxillofac Pathol 2018; 22:263-265. [PMID: 30158783 PMCID: PMC6097368 DOI: 10.4103/jomfp.jomfp_254_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sclerosing polycystic adenosis (SPA) was first described in 1996 by Smith et al. and was characterized by resemblance to epithelial proliferative lesions of the breast such as fibrocystic disease and sclerosing adenosis. Etiopathogenetically, it is generally believed to represent a nonneoplastic sclerosing and inflammatory process. The age range is broad (typically fourth decade), with a slight female predilection. The vast majority are parotid lesions, with very few in minor salivary glands. As of 2017, not more than 60 cases have been reported worldwide. Microscopically, it is characterized by a well-circumscribed to partially circumscribed tubulocystic proliferation of a gland within a sclerotic-fibrous stroma. Ductal epithelium showing variations such as foamy, mucous and apocrine are seen. We report a case of SPA of lower lip in a 70-year-old male.
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Affiliation(s)
- Rudrayya Shivanand Puranik
- Department of Oral and Maxillofacial Pathology, P.M.N.M Dental College and Hospital, Bagalkot, Karnataka, India
| | - Vg Bhagya Shree
- Department of Oral and Maxillofacial Pathology, P.M.N.M Dental College and Hospital, Bagalkot, Karnataka, India
| | - Surekha R Puranik
- Department of Oral and Maxillofacial Pathology, P.M.N.M Dental College and Hospital, Bagalkot, Karnataka, India
| | - Praveen S Anigol
- Department of Oral and Maxillofacial Pathology, P.M.N.M Dental College and Hospital, Bagalkot, Karnataka, India
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10
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Shilpi, Ahmad Ansari F, Bahadur S, Katyal A, Narula A, Nargotra N, Singh S. Sclerosing polycystic adenosis: A rare tumor misdiagnosed as retention cyst on fine needle aspiration cytology. Diagn Cytopathol 2017; 45:640-644. [DOI: 10.1002/dc.23701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/11/2017] [Accepted: 02/16/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Shilpi
- Department of Pathology; Hindu Rao Hospital; Delhi India
| | | | - Shalini Bahadur
- Department of Pathology; NDMC & Hindu Rao Hospital; Delhi India
| | - Akshi Katyal
- Department of Pathology; Hindu Rao Hospital; Delhi India
| | - Aastha Narula
- Department of Pathology; Hindu Rao Hospital; Delhi India
| | | | - Sompal Singh
- Department of Pathology; Hindu Rao Hospital; Delhi India
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11
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Skalova A, Michal M, Simpson RH. Newly described salivary gland tumors. Mod Pathol 2017; 30:S27-S43. [PMID: 28060365 DOI: 10.1038/modpathol.2016.167] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Alena Skalova
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Roderick Hw Simpson
- Department of Anatomical Pathology, Foothills Medical Centre, Calgary, Alberta, Canada
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12
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Abstract
Patients with salivary gland disease present with certain objective and/or subjective signs. An accurate diagnosis for these patients requires a range of techniques that includes the organized integration of information derived from their history, clinical examination, imaging, serology, and histopathology. This article highlights the signs and symptoms of the salivary gland disorders seen in the Salivary Gland Center, and emphasizes the methodology used to achieve a definitive diagnosis and therapy.
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Affiliation(s)
- Louis Mandel
- Department of Oral and Maxillofacial Surgery, Salivary Gland Center, Columbia University College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA.
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13
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Sclerosing polycystic adenosis of the retromolar pad area: a case report. Case Rep Pathol 2014; 2014:982432. [PMID: 24716068 PMCID: PMC3971555 DOI: 10.1155/2014/982432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/11/2013] [Indexed: 01/30/2023] Open
Abstract
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.
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Manojlović S, Virag M, Milenović A, Manojlović L, Salek Z, Skálová A. Sclerosing polycystic adenosis of parotid gland: a unique report of two cases occurring in two sisters. Pathol Res Pract 2014; 210:342-5. [PMID: 24636837 DOI: 10.1016/j.prp.2014.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/18/2013] [Accepted: 01/13/2014] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Spomenka Manojlović
- University of Zagreb School of Medicine, Department of Pathology, University Hospital Dubrava, Zagreb, Croatia.
| | - Mišo Virag
- University of Zagreb School of Medicine, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Aleksandar Milenović
- University of Zagreb School of Medicine, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | | | - Zrinko Salek
- University of Zagreb School of Medicine, Croatia
| | - Alena Skálová
- Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic
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15
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Petersson F. Sclerosing polycystic adenosis of salivary glands: a review with some emphasis on intraductal epithelial proliferations. Head Neck Pathol 2013; 7 Suppl 1:S97-106. [PMID: 23821217 PMCID: PMC3712090 DOI: 10.1007/s12105-013-0465-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/01/2013] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- Fredrik Petersson
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
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16
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A unique case of sclerosing polycystic adenosis of the sinonasal tract. Hum Pathol 2013; 44:1937-40. [PMID: 23465282 DOI: 10.1016/j.humpath.2013.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/20/2012] [Accepted: 01/07/2013] [Indexed: 01/30/2023]
Abstract
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.
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17
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Woo SB. Inflammatory Salivary Gland Disorders. ORAL PATHOLOGY 2012:264-285. [DOI: 10.1016/b978-1-4377-2226-0.00012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Sclerosing polycystic adenosis of the nasal septum: the risk of misdiagnosis. Clin Exp Otorhinolaryngol 2011; 6:107-9. [PMID: 23799170 PMCID: PMC3687059 DOI: 10.3342/ceo.2013.6.2.107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 08/13/2010] [Accepted: 09/07/2010] [Indexed: 12/01/2022] Open
Abstract
Sclerosing polycyctic adenosis (SPA) is a rare lesion of unknown etiology morphologically resembling fibrocystic changes of the breast. To date, approximately 41 cases of SPA have been reported. Most cases of SPA have originated in the parotid and submandibular glands, with a few cases of intra-oral minor salivary gland origin. This is the first reported case of sclerosing polycystic adenosis of nasal minor salivary gland origin. The differential diagnosis of SPA includes polycystic disease, sclerosing sialadenitis, and benign and malignant glandular neoplasias. Although atypia ranging from mild dysplasia to carcinoma in situ can occur in some cases, SPA has a favorable outcome. It is important to be familiar with SPA to avoid aggresive treatment that results from a misdiagnosis. We present a case of a 49-year-old man who had 1-year history of right nasal obstruction.
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Petersson F, Tan PH, Hwang JSG. Sclerosing polycystic adenosis of the parotid gland: report of a bifocal, paucicystic variant with ductal carcinoma in situ and pronounced stromal distortion mimicking invasive carcinoma. Head Neck Pathol 2011; 5:188-92. [PMID: 21286874 PMCID: PMC3098337 DOI: 10.1007/s12105-011-0242-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/12/2011] [Indexed: 01/11/2023]
Abstract
We present a case (female patient, age 45 years) with a bifocal, paucicystic variant of sclerosing polycystic adenosis of the parotid gland with cribriform ductal carcinoma in situ (DCIS) and pronounced stromal distortion affecting the in situ component to such an extent that it gave a distinct impression of intralesional invasive adenocarcinoma. P63-and calponin-positive myoepithelial cells were present in the periphery of the acini and ducts in the benign component, somewhat discontinuously in the DCIS-component, and even in the periphery of the small irregular atypical cell nests that appeared infiltrative on the haematoxylin and eosin stained sections. Strong cytoplasmic immunoreactivity for GCDFP-15 was detected in the benign component with a variable, patchy and mostly weak positivity in the DCIS. More than 90% of the cells in the DCIS component displayed strong nuclear immunoreactivity for androgen receptors and 10% of the benign ducts showed positivity. Weak to moderate nuclear immunoreactivity for estrogen receptors was seen in 30% of cells in the benign ductal component whereas the DCIS was negative. Occasional cells in the adenosis-component were weakly positive for PR. The proliferative activity (Mib-1/Ki-67) was low (1-2%) in the benign component whereas increased proliferation was seen in the DCIS and in the areas with pseudoinfiltration which also featured atypical mitoses.
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Affiliation(s)
- Fredrik Petersson
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
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Jeong BJ, Kim MR, Liang ZL, Koo BS, Kim JM. Sclerosing Polycystic Adenosis of the Parotid Gland - A Case Report -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.s1.s79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Byung-Joo Jeong
- Department of Pathology, Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
| | - Mi-Ran Kim
- Department of Pathology, Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
| | - Zhe Long Liang
- Department of Pathology, Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
| | - Bon-Seok Koo
- Department of Otolaryngology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin-Man Kim
- Department of Pathology, Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
- Daejeon Regional Cancer Center, Infection Signaling Network Research Center, Chungnam National University School of Medicine, Daejeon, Korea
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Fulciniti F, Losito NS, Ionna F, Longo F, Aversa C, Botti G, Foschini MP. Sclerosing polycystic adenosis of the parotid gland: report of one case diagnosed by fine-needle cytology with in situ malignant transformation. Diagn Cytopathol 2010; 38:368-73. [PMID: 19937766 DOI: 10.1002/dc.21228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Sclerosing polycystic adenosis (SPA) is a rare pathological condition affecting the salivary glands, first described by Smith etal. in 1996. Even though this lesion is being increasingly diagnosed, less than 50 cases have been published in the world literature to date. In line with numerous other pathological analogies between breast and salivary gland lesions, SPA shares with fibrocystic disease of the breast many histopathological features, i.e., fibrosis, oncocytic (apocrine) changes, hyperplasia of ductal and acinar epithelium, cystic dilation of ducts, and, often, atypical epithelial changes. Most of the described cases have followed a benign clinical course, despite the frequent possibility of atypical hyperplasia in more than 50% of the cases and of the more than occasional in situ malignant transformation. In this article, we introduce a new case occurring in the parotid gland of a 57-year-old male showing atypical epithelial hyperplasia and low-grade in situ mucoepidermoid carcinoma. Fine-needle cytology (FNC) was performed on the lesion and, when a diagnosis of SPA was prospected, the variegated cytological features of the obtained sample posed several differential diagnostic problems. The spectrum of pathological lesions entering differential diagnosis comprised sebaceous adenoma, Warthin's tumors with presence of sebaceous remnants, and low-grade mucoepidermoid carcinoma. Histopathological examination disclosed SCA with intraductal neoplastic transformation resembling noninvasive low-grade mucoepidermoid carcinoma. The cytological diagnosis of SPA should be entertained whenever a polymorphous picture is found on FNC samples comprising oncocytic/apocrine changes, sebaceous cells, cystic background, and epithelial hyperplasia with low-grade cytological atypias.
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Affiliation(s)
- Franco Fulciniti
- S.S.D. di Citopatologia, A.F. di Anatomia Patologica e Citopatologia, 80131 Naples, Italy.
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The pathogenic role of Epstein-Barr virus (EBV) in sclerosing polycystic adenosis. Pathol Res Pract 2010; 206:565-71. [PMID: 20400234 DOI: 10.1016/j.prp.2010.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 12/20/2009] [Accepted: 03/10/2010] [Indexed: 12/21/2022]
Abstract
Sclerosing polycystic adenosis (SPA) is a pathology of the salivary gland which occurs infrequently and has a controversial etiology. In this study, we investigated the possible roles of HPV and EBV in the pathogenesis of SPA. Archived cases of salivary gland lesions were retrieved, and their diagnoses were re-evaluated; cases that fit the diagnosis of SPA were selected and subjected to Alcian Blue-Periodic Acid Schiff's histochemical staining and immunohistochemical staining for HPV-1, EBV, S-100, and Bcl-2 proteins in addition to the proliferative marker Ki-67. In addition, RNA extracted from formalin-fixed, paraffin-embedded tissues was subjected to RT-PCR to confirm any positive immunohistochemical results. Co-localization of EBV and Bcl-2 in lesional cells was the most striking finding; Ki-67 was expressed in basal cells, while no expression was seen in the adjacent salivary gland cells. Our EBV (+) ve immunostaining results were confirmed by RT-PCR using RNA extracted from paraffin sections. Our results suggest a significant pathogenic role of EBV in SPA. Moreover, they provide new evidence on the neoplastic nature of SPA.
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Abstract
Sclerosing polycystic adenosis (SPA) is a rare lesion of salivary glands with a striking resemblance to fibrocystic disease of the breast. Most of the 47 reported cases have occurred within the parotid gland, with only a single case being described within the buccal mucosa. We report an additional case of SPA of the buccal mucosa. The exact nature of this entity is unknown, but has up until recently believed to be a pseudoneoplastic reactive and inflammatory sclerosing process. Even though SPA has satisfied the criteria for monoclonality, the debate as to whether SPA represents a true neoplasm or a pseudoneoplastic inflammatory sclerosing process, with low-grade neoplastic potential continues. Awareness of the occurrence of this lesion in both major and minor salivary glands is important to promote its differentiation from other more sinister salivary gland pathology. Cure is effected by localized surgical excision and all reported cases of SPA show an excellent prognosis with no true recurrence or metastasis.
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