Difference between revisions of "Polymorphous adenocarcinoma"

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| 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        =
| IHC        = S-100 +ve, CK7 +ve, vimentin +ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
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| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  =
| Prevalence = rare
| Prevalence = uncommon (varies by study)
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
| Prognosis  =
| Prognosis  = good
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    =
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==General==
==General==
*Almost exclusively in the oral cavity.
**Classically found in the palate -- 60% of PLGAs in palate.
*Tumour of the minor salivary glands.
*Always a low-grade tumour - by definition.
*Female:male ~= 2:1.
*Female:male ~= 2:1.
*Older people ~50-70 years old.
*Older people ~50-70 years old.
*Large variably in the prevalence reported - suggests a lacking of reproducibility in the [[diagnosis]].<ref name=pmid23320410/>
*Slow growing - metastases rare - prognosis good.<ref name=pmid18327037>{{Cite journal  | last1 = Paleri | first1 = V. | last2 = Robinson | first2 = M. | last3 = Bradley | first3 = P. | title = Polymorphous low-grade adenocarcinoma of the head and neck. | journal = Curr Opin Otolaryngol Head Neck Surg | volume = 16 | issue = 2 | pages = 163-9 | month = Apr | year = 2008 | doi = 10.1097/MOO.0b013e3282f70441 | PMID = 18327037 }}</ref><ref name=pmid23618791>{{Cite journal  | last1 = Fife | first1 = TA. | last2 = Smith | first2 = B. | last3 = Sullivan | first3 = CA. | last4 = Browne | first4 = JD. | last5 = Waltonen | first5 = JD. | title = Polymorphous low-grade adenocarcinoma: a 17 patient case series. | journal = Am J Otolaryngol | volume = 34 | issue = 5 | pages = 445-8 | month =  | year =  | doi = 10.1016/j.amjoto.2013.03.012 | PMID = 23618791 }}</ref>
==Gross==
*Tumour of the minor [[salivary gland]]s.<ref name=pmid24021444>{{Cite journal  | last1 = Andreu-Barasoain | first1 = M. | last2 = Vicente-Martín | first2 = FJ. | last3 = Gómez de la Fuente | first3 = E. | last4 = Salamanca-Santamaría | first4 = J. | last5 = Pampín-Franco | first5 = A. | last6 = López-Estebaranz | first6 = JL. | title = Polymorphous low-grade adenocarcinoma in the upper lip: a well-described but infrequently recognized tumor. | journal = Dermatol Online J | volume = 19 | issue = 8 | pages = 19265 | month =  | year = 2013 | doi =  | PMID = 24021444 }}</ref>
*Almost exclusively in the [[oral cavity]] - usually palate.<ref name=pmid18327037/>


==Microscopic==
==Microscopic==
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**Cytoplasm: eosinophilic.  
**Cytoplasm: eosinophilic.  
*Indistinct cell borders.  
*Indistinct cell borders.  
Note:
*'''Always''' a low-grade tumour - by definition.


DDx:
DDx:
*[[Adenoid cystic carcinoma]].
*[[Adenoid cystic carcinoma]].
*[[Pleomorphic adenoma]].
*[[Pleomorphic adenoma]].
*Cribriform adenocarcinoma of the minor salivary gland.<ref name=pmid21716087>{{Cite journal  | last1 = Skalova | first1 = A. | last2 = Sima | first2 = R. | last3 = Kaspirkova-Nemcova | first3 = J. | last4 = Simpson | first4 = RH. | last5 = Elmberger | first5 = G. | last6 = Leivo | first6 = I. | last7 = Di Palma | first7 = S. | last8 = Jirasek | first8 = T. | last9 = Gnepp | first9 = DR. | title = Cribriform adenocarcinoma of minor salivary gland origin principally affecting the tongue: characterization of new entity. | journal = Am J Surg Pathol | volume = 35 | issue = 8 | pages = 1168-76 | month = Aug | year = 2011 | doi = 10.1097/PAS.0b013e31821e1f54 | PMID = 21716087 }}
*[[Cribriform adenocarcinoma of the minor salivary gland]].<ref name=pmid21716087>{{Cite journal  | last1 = Skalova | first1 = A. | last2 = Sima | first2 = R. | last3 = Kaspirkova-Nemcova | first3 = J. | last4 = Simpson | first4 = RH. | last5 = Elmberger | first5 = G. | last6 = Leivo | first6 = I. | last7 = Di Palma | first7 = S. | last8 = Jirasek | first8 = T. | last9 = Gnepp | first9 = DR. | title = Cribriform adenocarcinoma of minor salivary gland origin principally affecting the tongue: characterization of new entity. | journal = Am J Surg Pathol | volume = 35 | issue = 8 | pages = 1168-76 | month = Aug | year = 2011 | doi = 10.1097/PAS.0b013e31821e1f54 | PMID = 21716087 }}
</ref>
</ref>


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Image:Polymorphous_low-grade_adenocarcinoma_high_mag.jpg | PLGA - high mag. (WC/Nephron)
Image:Polymorphous_low-grade_adenocarcinoma_high_mag.jpg | PLGA - high mag. (WC/Nephron)
</gallery>
</gallery>
==IHC==
==IHC==
*S100 +ve, CK +ve, vimentin +ve.
Features:<ref name=pmid23320410>{{Cite journal  | last1 = de Araujo | first1 = VC. | last2 = Passador-Santos | first2 = F. | last3 = Turssi | first3 = C. | last4 = Soares | first4 = AB. | last5 = de Araujo | first5 = NS. | title = Polymorphous low-grade adenocarcinoma: an analysis of epidemiological studies and hints for pathologists. | journal = Diagn Pathol | volume = 8 | issue =  | pages = 6 | month =  | year = 2013 | doi = 10.1186/1746-1596-8-6 | PMID = 23320410 }}</ref>
*S-100 +ve.
*CK7 +ve.
*Vimentin +ve.
 
Others:
*GFAP +ve/-ve.
*GFAP +ve/-ve.
*BCL2 +ve/-ve.
*BCL2 +ve/-ve.

Revision as of 18:27, 18 March 2015

Polymorphous adenocarcinoma
Diagnosis in short

PLGA. H&E stain.

LM 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
LM DDx adenoid cystic carcinoma, pleomorphic adenoma, cribriform adenocarcinoma of the minor salivary gland
IHC S-100 +ve, CK7 +ve, vimentin +ve
Site oral cavity, salivary gland

Prevalence uncommon (varies by study)
Prognosis good

Polymorphous low-grade adenocarcinoma, abbreviated PLGA, is a rare malignant salivary gland tumour.

General

  • Female:male ~= 2:1.
  • Older people ~50-70 years old.
  • Large variably in the prevalence reported - suggests a lacking of reproducibility in the diagnosis.[1]
  • Slow growing - metastases rare - prognosis good.[2][3]

Gross

Microscopic

Features:[5]

  • Architecture: often small nests, may be targetoid.
    • Classically has whorling with eye-of-storm & single file.
  • Cytologically monotonous (uniform) with variable architecture - key feature.
  • Indistinct cell borders.

Note:

  • Always a low-grade tumour - by definition.

DDx:

Images

IHC

Features:[1]

  • S-100 +ve.
  • CK7 +ve.
  • Vimentin +ve.

Others:

  • GFAP +ve/-ve.
  • BCL2 +ve/-ve.
  • Generally negative for myoepithelial markers (calponin, actin) - useful if negative.

See also

References

  1. 1.0 1.1 de Araujo, VC.; Passador-Santos, F.; Turssi, C.; Soares, AB.; de Araujo, NS. (2013). "Polymorphous low-grade adenocarcinoma: an analysis of epidemiological studies and hints for pathologists.". Diagn Pathol 8: 6. doi:10.1186/1746-1596-8-6. PMID 23320410.
  2. 2.0 2.1 Paleri, V.; Robinson, M.; Bradley, P. (Apr 2008). "Polymorphous low-grade adenocarcinoma of the head and neck.". Curr Opin Otolaryngol Head Neck Surg 16 (2): 163-9. doi:10.1097/MOO.0b013e3282f70441. PMID 18327037.
  3. Fife, TA.; Smith, B.; Sullivan, CA.; Browne, JD.; Waltonen, JD.. "Polymorphous low-grade adenocarcinoma: a 17 patient case series.". Am J Otolaryngol 34 (5): 445-8. doi:10.1016/j.amjoto.2013.03.012. PMID 23618791.
  4. Andreu-Barasoain, M.; Vicente-Martín, FJ.; Gómez de la Fuente, E.; Salamanca-Santamaría, J.; Pampín-Franco, A.; López-Estebaranz, JL. (2013). "Polymorphous low-grade adenocarcinoma in the upper lip: a well-described but infrequently recognized tumor.". Dermatol Online J 19 (8): 19265. PMID 24021444.
  5. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 74. ISBN 978-0781765275.
  6. Skalova, A.; Sima, R.; Kaspirkova-Nemcova, J.; Simpson, RH.; Elmberger, G.; Leivo, I.; Di Palma, S.; Jirasek, T. et al. (Aug 2011). "Cribriform adenocarcinoma of minor salivary gland origin principally affecting the tongue: characterization of new entity.". Am J Surg Pathol 35 (8): 1168-76. doi:10.1097/PAS.0b013e31821e1f54. PMID 21716087.