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

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.

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

“…On gross exam, tumors are firm, rubbery, well circumscribed and frequently are embedded in normal salivary gland. Occasional tumors are multinodular; one patient presented with two separate masses [6]. Tumors range from a few millimeters to 7 cm in greatest dimension at initial presentation.…”

“…To date, there are 63 cases reported [1][2][3][4][5][6][7][8][9][10][11][12][13]. Patients range in age from 9 to 84 years with a male to female ratio of 27:36.…”

Fat-Containing Salivary Gland Tumors: A Review

“…The latter represents a clonal disease associated with variable sclerosis, acinar cell hyperplasia and cystic ductal changes that have been likened to fibrocystic disease of the breast [24,25]. In sharp contrast to the bland histology of sialolipoma, sclerosing polycystic disease may on occasion feature clear-cut epithelial dysplasia indistinguishable from in situ carcinoma of the breast [25,26]. The term sialolipoma seems more appropriate for this variant and is in line with the nomenclature used for similar lesions in other organs, such as thymolipoma and thyrolipoma.…”

Apocrine Hidrocystoma of the Lower Lip: A Case Report and Literature Review

“…(2) Morphologically, apocrine -HCs have a double lining of epithelium (inner layer, tall columnar or cuboidal cells) with decapitation secretion and an outer side consisting of myoepithelial cells, whereas eccrine -HCs are lined by flat epithelium without myoepithelial cells [3,12]. (3) Immunohistochemically, apocrine -HCs are positive for human milk fat globules, GCDFP-15, CK7 and CK18 in the inner layer of epithelium, and also positive for a-SMA in the outer myoepithelial cells, whereas eccrine -HCs are negative for all of these [3,4,14,15]. Therefore, the most compatible pathological diagnosis in the present case was apocrine -HC.…”

“…The differential diagnosis includes cystic pleomorphic adenoma (CPA), Warthin tumor (WT), cystadenoma (CA), cystadenocarcinoma (CAC), mucoepidermoid carcinoma (MEC), salivary duct carcinoma (SDC), mucous retention cyst, salivary duct cyst, and sclerosing polycystic adenosis (SPA). Apocrine-HC lacks the myxoid to chondroid component and myoepithelial proliferation of CPA, and CPA lacks the apocrine-like secretory epithelium that [15], nodular sclerosis, xanthomatous infiltrate, acinar-type cells, and foamy degeneration of cyst-lining epithel cells, however, apocrine -HC essentially lacks nodular sclerosis ''scar-like hyalinized fibrous stroma'' and these feature except for apocrine-like epithelium (GCDFP-15 positive). Furthermore, in our case is found to be a cystic lesion rather than a tumor by low positive rate of ki-67.…”