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Difference between revisions of "Polymorphous adenocarcinoma"
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| Image = Polymorphous_low-grade_adenocarcinoma_high_mag.jpg | | Image = Polymorphous_low-grade_adenocarcinoma_high_mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Polymorphous adenocarcinoma. [[H&E stain]]. | ||
| Synonyms = polymorphmous low-grade adenocarcinoma (obsolete term) | |||
| Micro = low-grade cytology - nuclei ovoid & small, small nucleoli, powdery chromatin ([[papillary thyroid carcinoma]]-like appearance); eosinophilic cytoplasm; variable architecture - often small nests, classically has whorling ("eye-of-storm") pattern and single file pattern | | Micro = low-grade cytology - nuclei ovoid & small, small nucleoli, powdery chromatin ([[papillary thyroid carcinoma]]-like appearance); eosinophilic cytoplasm; variable architecture - often small nests, classically has whorling ("eye-of-storm") pattern and single file pattern | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[adenoid cystic carcinoma]], [[pleomorphic adenoma]], cribriform adenocarcinoma of the minor salivary gland | | LMDDx = [[adenoid cystic carcinoma]], [[pleomorphic adenoma]], [[cribriform adenocarcinoma of the minor salivary gland]] | ||
| Stains = | | Stains = | ||
| IHC = S-100 +ve, CK7 +ve, vimentin +ve | | IHC = S-100 +ve, CK7 +ve, p40 -ve, p63 +ve, vimentin +ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
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| ClinDDx = | | ClinDDx = | ||
}} | }} | ||
'''Polymorphous | '''Polymorphous adenocarcinoma''', abbreviated '''PAC''', is a rare malignant [[salivary gland]] tumour. | ||
It was previously known as '''polymorphous low-grade adenocarcinoma''', abbreviated '''PLGA'''.<ref name=pmid29761209>{{cite journal |authors=Vander Poorten V, Triantafyllou A, Skálová A, Stenman G, Bishop JA, Hauben E, Hunt JL, Hellquist H, Feys S, De Bree R, Mäkitie AA, Quer M, Strojan P, Guntinas-Lichius O, Rinaldo A, Ferlito A |title=Polymorphous adenocarcinoma of the salivary glands: reappraisal and update |journal=Eur Arch Otorhinolaryngol |volume=275 |issue=7 |pages=1681–1695 |date=July 2018 |pmid=29761209 |doi=10.1007/s00405-018-4985-5 |url=}}</ref> | |||
==General== | ==General== | ||
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Note: | Note: | ||
*'' | *''Pretty much always'' a low-grade tumour. | ||
DDx: | DDx: | ||
*[[Adenoid cystic carcinoma]]. | *[[Adenoid cystic carcinoma]]. | ||
*[[Pleomorphic adenoma]]. | *[[Pleomorphic adenoma]]. | ||
*[[Cribriform adenocarcinoma of the minor salivary gland]].<ref name= | *[[Cribriform adenocarcinoma of the minor salivary gland]] - if one considers it a separate diagnosis. | ||
</ref> | **The ''World Health Organization'' lumps ''[[cribriform adenocarcinoma of the minor salivary gland]]'' with ''polymorphous adenocarcinoma''.<ref name=pmid29761209>{{cite journal |authors=Vander Poorten V, Triantafyllou A, Skálová A, Stenman G, Bishop JA, Hauben E, Hunt JL, Hellquist H, Feys S, De Bree R, Mäkitie AA, Quer M, Strojan P, Guntinas-Lichius O, Rinaldo A, Ferlito A |title=Polymorphous adenocarcinoma of the salivary glands: reappraisal and update |journal=Eur Arch Otorhinolaryngol |volume=275 |issue=7 |pages=1681–1695 |date=July 2018 |pmid=29761209 |doi=10.1007/s00405-018-4985-5 |url=}}</ref> | ||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
| Line 70: | Line 72: | ||
*CK7 +ve. | *CK7 +ve. | ||
*Vimentin +ve. | *Vimentin +ve. | ||
*p63 +ve (22 of 23 cases<ref name=pmid31653135/>). | |||
*p40 -ve (22 of 23 cases<ref name=pmid31653135>{{cite journal |authors=Atiq A, Mushtaq S, Hassan U, Loya A, Hussain M, Akhter N |title=Utility of p63 and p40 in Distinguishing Polymorphous Adenocarcinoma and Adenoid Cystic Carcinoma |journal=Asian Pac J Cancer Prev |volume=20 |issue=10 |pages=2917–2921 |date=October 2019 |pmid=31653135 |pmc=6982655 |doi=10.31557/APJCP.2019.20.10.2917 |url=}}</ref>). | |||
**Useful to differentiate from [[adenoid cystic carcinoma]] (AdCC); AdCC is usually p63 +ve/p40 +ve (36 of 47 cases) or p63 -ve/p40 -ve (10 of 47 cases). | |||
***p63 +ve/p40 +ve is seen in pleomorphic adenoma and mucoepidermoid carcinoma (in addition to adenoid cystic carcinoma).<ref name=pmid34518135>{{cite journal |authors=Sivakumar N, Narwal A, Pandiar D, Devi A, Anand R, Bansal D, Kamboj M |title=Diagnostic utility of p63/p40 in the histologic differentiation of salivary gland tumors: A systematic review |journal=Oral Surg Oral Med Oral Pathol Oral Radiol |volume=133 |issue=2 |pages=189–198 |date=February 2022 |pmid=34518135 |doi=10.1016/j.oooo.2021.07.010 |url=}}</ref> | |||
Others: | Others: | ||
*GFAP +ve/-ve. | *GFAP +ve/-ve. | ||
**One study suggests GFAP cleanly separates the PLGA (-ve) from [[pleomorphic adenoma]] (+ve).<ref name=pmid11174597>{{Cite journal | last1 = Curran | first1 = AE. | last2 = White | first2 = DK. | last3 = Damm | first3 = DD. | last4 = Murrah | first4 = VA. | title = Polymorphous low-grade adenocarcinoma versus pleomorphic adenoma of minor salivary glands: resolution of a diagnostic dilemma by immunohistochemical analysis with glial fibrillary acidic protein. | journal = Oral Surg Oral Med Oral Pathol Oral Radiol Endod | volume = 91 | issue = 2 | pages = 194-9 | month = Feb | year = 2001 | doi = 10.1067/moe.2001.111306 | PMID = 11174597 }}</ref> | |||
*BCL2 +ve/-ve. | *BCL2 +ve/-ve. | ||
*Generally negative for myoepithelial markers (calponin, actin) - '''useful if negative'''. | *Generally negative for myoepithelial markers (calponin, actin) - '''useful if negative'''. | ||
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==References== | ==References== | ||
{{Reflist| | {{Reflist|2}} | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Salivary gland]] | [[Category:Salivary gland]] | ||