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Quick Review #218 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental #adenocarcinoma #oralcancer
Polymorphous adenocarcinoma (PAC) is a low-grade malignant salivary gland tumor predominantly affecting the minor salivary glands of the oral cavity, particularly the palate.
Clinical Features:
- In the oral cavity, PAC commonly arises in the minor salivary glands, especially on the hard and soft palate, and can also occur on the buccal mucosa, upper lip, and retromolar area.
- It typically presents as a painless, slow-growing mass that is often firm and may become ulcerated if traumatized.
- PAC most frequently affects adults, with a slight female predominance, and is usually diagnosed in individuals around the sixth decade of life.
- When PAC occurs on the lip, it is generally found on the upper lip and presents as a slow-growing, painless mass, often smaller due to earlier detection.
Histopathological Features:
- PAC exhibits a variety of growth patterns, including lobular, papillary, cribriform, tubular, and solid structures, which is a hallmark of the disease.
- Despite this architectural diversity, the cells are relatively uniform, being small, bland, and round to ovoid with scant cytoplasm.
- The tumor often shows an infiltrative growth pattern, extending into surrounding tissues, and neural invasion is common, with perineural invasion being characteristic.
- The stroma can range from loose and myxoid to densely fibrous, and mucoid stromal material may be present.
- Immunohistochemically, PAC cells typically stain positive for cytokeratin, epithelial membrane antigen (EMA), S-100 protein, GFAP (glial fibrillary acidic protein), and p63.
Behavioral Patterns:
- PAC is generally slow-growing but can infiltrate locally into surrounding tissues.
- It has a low risk of metastasis, although regional lymph node involvement can occur, particularly in larger or recurrent lesions.
- Local recurrence is possible, especially if the tumor is not completely excised with adequate margins.
- Complete surgical excision is the treatment of choice to minimize recurrence risk.
- The overall prognosis for PAC is favorable, with a high survival rate, with long-term follow-up due to the potential for late recurrence.
References:
1. Fonseca, F. P., Brierley, D., Wright, J. M., Santos-Silva, A. R., Almeida, O. P., Rocha, A. C., Van Heerden, W. F., & Hunter, K. D. (2015). Polymorphous low-grade adenocarcinoma of the upper lip: 11 cases of an uncommon diagnosis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 119(5), 566-571
2. Simpson, R. H., Skálová, A., & Di Palma, S. (2016). Polymorphous low-grade adenocarcinoma. In A. Skálová, G. Gnepp, & J. A. Lewis (Eds.), Atlas of Salivary Gland Pathology (pp. 257–266)
3. Ellis, G. L., & Auclair, P. L. (2008). Tumors of the Salivary Glands (Vol. 9, 4th ed.). Armed Forces Institute of Pathology
4. ChatGPT.2024
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