Salivary glands

Primary salivary gland neoplasms

Benign

Sclerosing polycystic adenoma


Editorial Board Member: Lisa Rooper, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Kim A. Ely, M.D.

Topic Completed: 13 August 2021

Minor changes: 13 August 2021

Copyright: 2019-2021, PathologyOutlines.com, Inc.

PubMed Search: Sclerosing polycystic adenoma[title] or adenosis salivary glands

Kim A. Ely, M.D.
Page views in 2021 to date: 2,146
Cite this page: Ely KA. Sclerosing polycystic adenoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/salivaryglandssclerosingpolycysticadenoma.html. Accessed November 29th, 2021.
Definition / general
Essential features
Terminology
  • Sclerosing polycystic adenosis
  • Sclerosing adenosis
  • Polycystic adenosis
  • Sclerosing polycystic sialadenopathy
ICD coding
  • ICD-10: K11.8 - Other diseases of salivary glands
Epidemiology
Sites
Pathophysiology
Etiology
  • Unknown
Clinical features
Diagnosis
  • Best made on histologic examination of excisional material
Radiology description
  • Limited published descriptions
  • T2 weighted MRI: small cystic areas show high signal intensity
  • Ultrasound: hypoechoic, well circumscribed with microcysts (Head Neck Pathol 2012;6:247)
Radiology images

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Parotid lesion

Prognostic factors
Case reports
Treatment
Clinical images

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Palate lesion

Gross description
Frozen section description
  • Well circumscribed proliferation of scattered dilated, variably sized ducts lined by hyperplastic epithelium in a vague nodular pattern
  • Foci of apocrine change
  • Dense stroma
  • Because a definitive diagnosis may not be possible at the time of frozen section, a descriptive interpretation such as "sclerotic fibrous material with benign appearing glandular elements" could be rendered (Pathology 2016;48:93)
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Jiancong Liang, M.D.

Preservation of lobular architecture

Variably sized ducts

Hyperplastic intraluminal epithelium

Acini with eosinophilic granules

Cytology description
  • Interpretation is challenging and frequently misdiagnosed
  • Cohesive sheets and aggregates of cells
  • Moderate to abundant finely granular eosinophilic cytoplasm
  • Round to oval nuclei
  • Evenly distributed chromatin with indistinct nucleoli (Diagn Cytopathol 2017;45:640)
Positive stains
Negative stains
Electron microscopy description
  • Cells have abundant cytoplasm filled by electron dense granules of various sizes consistent with zymogen granules (Virchows Arch 2002;440:29)
Molecular / cytogenetics description
Sample pathology report
  • Parotid, right, excision:
    • Sclerosing polycystic adenoma (see comment)
    • Comment: Sections show a well demarcated nodule of densely collagenized stroma intermingling among a proliferation of acini and tubules. The latter are lined by cells which vary from vacuolated to foamy to apocrine to mucinous. Some ducts possess a hyperplastic epithelium with atypia reminiscent of ductal carcinoma in situ. Acini are remarkable for prominent eosinophilic intracytoplasmic granules which are highlighted upon PAS stain. No invasive growth is recognized.
Differential diagnosis
Board review style question #1

A 50 year old woman presents with a slow growing parotid mass. Calponin and p63 immunostains highlighted a subset of the cells. Elsewhere in the lesion, acini containing large, brightly eosinophilic, periodic acid-Schiff positive, intracytoplasmic granules were identified. What is the most likely diagnosis?

  1. Acinic cell carcinoma
  2. Sclerosing polycystic adenoma
  3. Chronic sclerosing sialadenitis
  4. Pleomorphic adenoma
Board review style answer #1
B. Sclerosing polycystic adenoma

Comment Here

Reference: Sclerosing polycystic adenoma
Board review style question #2
Which of the following immunohistochemical patterns support a diagnosis of sclerosing polycystic adenoma?

  1. p63+ in epithelial and myoepithelial cells; HER2 / neu+ and PR- in epithelial cells
  2. p63+ in myoepithelial cells; HER2 / neu- and PR+ in epithelial cells
  3. p63+ in epithelial and myoepithelial cells; HER2 / neu- and PR-
  4. p63+ in myoepithelial cells; HER2 / neu+ and PR+ in epithelial cells
Board review style answer #2
B. p63+ in myoepithelial cells; HER2 / neu- and PR+ in epithelial cells

Comment Here

Reference: Sclerosing polycystic adenoma
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