Pleomorphic adenoma pathophysiology: Difference between revisions
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{{Pleomorphic adenoma}} | {{Pleomorphic adenoma}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{M.N}} | ||
==Overview== | ==Overview== | ||
The exact pathogenesis of pleomorphic adenoma is not fully understood. Chromosomal abnormalities involving 8q12 and 12q15 have been described. The gross features of pleomorphic adenoma are firm, well demarcated, encapsulated, and mobile. On [[microscopic]] [[histopathology]] they are a mixture of both [[epithelial cells]] and [[stromal]] [[matrix]]. The [[stromal]] [[matrix]] can be either hyaline, cartilaginous, myxoid. The epithelial components can be arranged into clumps, sheets or interlacing strands. On immunohistology these tumors are positive for [[S-100]], [[GFAP]], actin, keratin. | The exact [[pathogenesis]] of pleomorphic adenoma is not fully understood. [[Chromosomal abnormalities]] involving 8q12 and 12q15 have been described. The [[gross]] features of pleomorphic adenoma are firm, well demarcated, encapsulated, and mobile. On [[microscopic]] [[histopathology]] they are a mixture of both [[epithelial cells]] and [[stromal]] [[matrix]]. The [[stromal]] [[matrix]] can be either [[Hyaline cartilage|hyaline]], [[cartilaginous]], myxoid. The [[epithelial]] components can be arranged into clumps, sheets or interlacing strands. On immunohistology these [[tumors]] are positive for [[S-100]], [[GFAP]], [[actin]], [[keratin]]. | ||
==Pathophysiology== | ==Pathophysiology== | ||
===Pathogenesis=== | ===Pathogenesis=== | ||
*The exact pathogenesis of pleomorphic adenoma is not completely understood. | *The exact [[pathogenesis]] of pleomorphic adenoma is not completely understood. | ||
===Genetics=== | ===Genetics=== | ||
| Line 16: | Line 16: | ||
==Gross Pathology== | ==Gross Pathology== | ||
The gross pathological features of Pleomorphic adenoma are as follows: | {| align="right" | ||
|[[File:Pleomorphic adenoma.jpg|thumb|none|300px|Pleomorphic adenoma gross appearance [https://commons.wikimedia.org/wiki/File:Pleomorphic_adenoma.jpg Source:Department of Pathology,Calicut Medical College] ]] | |||
|} | |||
The [[gross]] [[pathological]] features of Pleomorphic adenoma are as follows<ref name="pmid27040584">{{cite journal |vauthors=Zhan KY, Khaja SF, Flack AB, Day TA |title=Benign Parotid Tumors |journal=Otolaryngol. Clin. North Am. |volume=49 |issue=2 |pages=327–42 |date=April 2016 |pmid=27040584 |doi=10.1016/j.otc.2015.10.005 |url=}}</ref>: | |||
*Firm | *Firm | ||
*Mobile | *Mobile | ||
*Well demarcated | *Well demarcated | ||
*Encapsulated(mostly, but the ''[[Myxoid]]'' and ''[[Stroma]]'' rich subtype sometimes show focal absences of capsule) | *Encapsulated(mostly, but the ''[[Myxoid]]'' and ''[[Stroma]]'' rich subtype sometimes show focal absences of [[capsule]]) | ||
*Tan-white in appearance | *Tan-white in appearance | ||
<br> | |||
<br> | |||
<br> | |||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
Pleomorphic adenoma has a highly variable appearance on microscopy, hence the name given. On microscopic histopathological analysis, the characteristic findings of pleomorphic adenoma are: | Pleomorphic adenoma has a highly variable appearance on [[microscopy]], hence the name given. On [[microscopic]] [[histopathological]] analysis, the characteristic findings of pleomorphic adenoma are:<ref name="ZhanKhaja2016">{{cite journal|last1=Zhan|first1=Kevin Y.|last2=Khaja|first2=Sobia F.|last3=Flack|first3=Allen B.|last4=Day|first4=Terry A.|title=Benign Parotid Tumors|journal=Otolaryngologic Clinics of North America|volume=49|issue=2|year=2016|pages=327–342|issn=00306665|doi=10.1016/j.otc.2015.10.005}}</ref> | ||
*The tumor is enclosed by a [[fibrous capsule]] of which may vary in thickness. | *The [[tumor]] is enclosed by a [[fibrous capsule]] of which may vary in thickness. | ||
* | *[[Stroma]]<nowiki/>l [[matrix]] mixed with [[polygonal epithelial]] and spindle-shaped [[myoepithelial cells]] constitutes majority of the [[tumor]] [[histopathology]]. | ||
*Depending upon the nature of the stroma adenomas can be: | *Depending upon the nature of the [[stroma]] adenomas can be: | ||
**[[epithelomucoid, myxoid,|Epithelomucoid]] | **[[epithelomucoid, myxoid,|Epithelomucoid]] | ||
**[[epithelomucoid, myxoid,|Myxoid]] | **[[epithelomucoid, myxoid,|Myxoid]] | ||
**[[Cartilaginous]] | **[[Cartilaginous]] | ||
**[[Hyaline]]. | **[[Hyaline]]. | ||
*Based upon which element predominates pleomorphic adenoma can be: | *Based upon which element predominates pleomorphic adenoma can be: | ||
**Cellular(either epithelial or [[Myoepithelial cells|myoepithelial]] cell rich) | **[[Cellular]](either [[epithelial]] or [[Myoepithelial cells|myoepithelial]] cell rich) | ||
**Stroma-rich | **[[Stroma]]-rich | ||
**Mixed type or classic | **Mixed type or classic | ||
*Epithelial components are usually of polygonal,spindle, or [[stellate shaped cells]] which may be arranged into various patterns: | *[[Epithelial]] components are usually of polygonal,spindle, or [[stellate shaped cells]] which may be arranged into various patterns:<ref name="pmid28613579">{{cite journal |vauthors=Bokhari MR, Greene J |title= |journal= |volume= |issue= |pages= |date= |pmid=28613579 |doi= |url=}}</ref> | ||
**Sheets | **Sheets | ||
**Clumps | **Clumps | ||
**Interlacing strands. | **Interlacing strands. | ||
**Duct-like structures | **[[Duct]]-like structures | ||
*The ducts and tubules that are present in pleomorphic adenoma consists of two cell types:<ref name="pmid28613579">{{cite journal |vauthors=Bokhari MR, Greene J |title= |journal= |volume= |issue= |pages= |date= |pmid=28613579 |doi= |url=}}</ref> | *The [[ducts]] and [[tubules]] that are present in pleomorphic adenoma consists of two cell types:<ref name="pmid28613579">{{cite journal |vauthors=Bokhari MR, Greene J |title= |journal= |volume= |issue= |pages= |date= |pmid=28613579 |doi= |url=}}</ref> | ||
**An outer [[myoepithelial]] layer | **An outer [[myoepithelial]] layer | ||
**Inner [[cuboidal epithelial cell]] layer | **Inner [[cuboidal epithelial cell]] layer | ||
*This particular outer myoepithelial cell layer is the one that blends into the surrounding stroma which contains scattered or clumped myoepithelial element cells.<ref name="pmid28613579">{{cite journal |vauthors=Bokhari MR, Greene J |title= |journal= |volume= |issue= |pages= |date= |pmid=28613579 |doi= |url=}}</ref> | *This particular outer [[Myoepithelial cell|myoepithelial]] cell layer is the one that blends into the surrounding [[stroma]] which contains scattered or clumped [[myoepithelial]] element cells.<ref name="pmid28613579">{{cite journal |vauthors=Bokhari MR, Greene J |title= |journal= |volume= |issue= |pages= |date= |pmid=28613579 |doi= |url=}}</ref> | ||
*Areas of [[squamous]] [[metaplasia]] and [[epithelial pearls]] are also seen.[[File:Pleomorphic adenoma - cell block -- high mag.jpg|thumb|none|Librepath [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons]] | *Areas of [[squamous]] [[metaplasia]] and [[epithelial pearls]] are also seen.[[File:Pleomorphic adenoma - cell block -- high mag.jpg|thumb|none|Librepath [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons]] | ||
====On immunohistochemical analysis, the positive stains of pleomorphic ademona include:==== | ====On immunohistochemical analysis, the positive stains of pleomorphic ademona include:==== | ||
*Positive [[S-100 protein]]<ref name="Furusede Sousa2016">{{cite journal|last1=Furuse|first1=Cristiane|last2=de Sousa|first2=Suzana O. Machado|last3=Nunes|first3=Fabio Daumas|last4=de Magalhaes|first4=Marina Helena Cury Gallottini|last5=de Arauijo|first5=Vera Cavalcanti|title=Myoepithelial Cell Markers in Salivary Gland Neoplasms|journal=International Journal of Surgical Pathology|volume=13|issue=1|year=2016|pages=57–65|issn=1066-8969|doi=10.1177/106689690501300108}}</ref> | *Positive [[S-100 protein]]<ref name="Furusede Sousa2016">{{cite journal|last1=Furuse|first1=Cristiane|last2=de Sousa|first2=Suzana O. Machado|last3=Nunes|first3=Fabio Daumas|last4=de Magalhaes|first4=Marina Helena Cury Gallottini|last5=de Arauijo|first5=Vera Cavalcanti|title=Myoepithelial Cell Markers in Salivary Gland Neoplasms|journal=International Journal of Surgical Pathology|volume=13|issue=1|year=2016|pages=57–65|issn=1066-8969|doi=10.1177/106689690501300108}}</ref> | ||
*Positive [[GFAP]] mainly in myxomatous and early chondromatous differentiation.<ref name="pmid1664847">{{cite journal |vauthors=Nishimura T, Furukawa M, Kawahara E, Miwa A |title=Differential diagnosis of pleomorphic adenoma by immunohistochemical means |journal=J Laryngol Otol |volume=105 |issue=12 |pages=1057–60 |date=December 1991 |pmid=1664847 |doi= |url=}}</ref> | *Positive [[GFAP]] mainly in [[myxomatous]] and early [[chondromatous]] [[differentiation]].<ref name="pmid1664847">{{cite journal |vauthors=Nishimura T, Furukawa M, Kawahara E, Miwa A |title=Differential diagnosis of pleomorphic adenoma by immunohistochemical means |journal=J Laryngol Otol |volume=105 |issue=12 |pages=1057–60 |date=December 1991 |pmid=1664847 |doi= |url=}}</ref> | ||
*[[Keratin]]<ref name="pmid2446294">{{cite journal |vauthors=Mori M, Tsukitani K, Ninomiya T, Okada Y |title=Various expressions of modified myoepithelial cells in salivary pleomorphic adenoma. Immunohistochemical studies |journal=Pathol. Res. Pract. |volume=182 |issue=5 |pages=632–46 |date=October 1987 |pmid=2446294 |doi= |url=}}</ref> | *[[Keratin]]<ref name="pmid2446294">{{cite journal |vauthors=Mori M, Tsukitani K, Ninomiya T, Okada Y |title=Various expressions of modified myoepithelial cells in salivary pleomorphic adenoma. Immunohistochemical studies |journal=Pathol. Res. Pract. |volume=182 |issue=5 |pages=632–46 |date=October 1987 |pmid=2446294 |doi= |url=}}</ref> | ||
*[[Actin]] | *[[Actin]] | ||
*[[Myosin]] | *[[Myosin]] | ||
*[[BMP-6]] protein overexpression.<ref name="pmid10632922">{{cite journal |vauthors=Kusafuka K, Yamaguchi A, Kayano T, Takemura T |title=Immunohistochemical localization of the bone morphogenetic protein-6 in salivary pleomorphic adenomas |journal=Pathol. Int. |volume=49 |issue=12 |pages=1023–7 |date=December 1999 |pmid=10632922 |doi= |url=}}</ref> | *[[BMP-6]] [[protein]] [[overexpression]].<ref name="pmid10632922">{{cite journal |vauthors=Kusafuka K, Yamaguchi A, Kayano T, Takemura T |title=Immunohistochemical localization of the bone morphogenetic protein-6 in salivary pleomorphic adenomas |journal=Pathol. Int. |volume=49 |issue=12 |pages=1023–7 |date=December 1999 |pmid=10632922 |doi= |url=}}</ref> | ||
==References== | ==References== | ||
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{{WS}} | {{WS}} | ||
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Latest revision as of 17:51, 15 February 2019
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Pleomorphic adenoma pathophysiology On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]
Overview
The exact pathogenesis of pleomorphic adenoma is not fully understood. Chromosomal abnormalities involving 8q12 and 12q15 have been described. The gross features of pleomorphic adenoma are firm, well demarcated, encapsulated, and mobile. On microscopic histopathology they are a mixture of both epithelial cells and stromal matrix. The stromal matrix can be either hyaline, cartilaginous, myxoid. The epithelial components can be arranged into clumps, sheets or interlacing strands. On immunohistology these tumors are positive for S-100, GFAP, actin, keratin.
Pathophysiology
Pathogenesis
- The exact pathogenesis of pleomorphic adenoma is not completely understood.
Genetics
- PLAG1 and HMGA2 chromosomal rearrangments are specific to pleomorphic adenoma.[1]
- Some clonal chromosomal abnormalities involving 8q12 and 12q15 have been noted.[2]
Gross Pathology
 |
The gross pathological features of Pleomorphic adenoma are as follows[3]:
- Firm
- Mobile
- Well demarcated
- Encapsulated(mostly, but the Myxoid and Stroma rich subtype sometimes show focal absences of capsule)
- Tan-white in appearance
Microscopic Pathology
Pleomorphic adenoma has a highly variable appearance on microscopy, hence the name given. On microscopic histopathological analysis, the characteristic findings of pleomorphic adenoma are:[4]
- The tumor is enclosed by a fibrous capsule of which may vary in thickness.
- Stromal matrix mixed with polygonal epithelial and spindle-shaped myoepithelial cells constitutes majority of the tumor histopathology.
- Depending upon the nature of the stroma adenomas can be:
- Based upon which element predominates pleomorphic adenoma can be:
- Cellular(either epithelial or myoepithelial cell rich)
- Stroma-rich
- Mixed type or classic
- Epithelial components are usually of polygonal,spindle, or stellate shaped cells which may be arranged into various patterns:[5]
- Sheets
- Clumps
- Interlacing strands.
- Duct-like structures
- The ducts and tubules that are present in pleomorphic adenoma consists of two cell types:[5]
- An outer myoepithelial layer
- Inner cuboidal epithelial cell layer
- This particular outer myoepithelial cell layer is the one that blends into the surrounding stroma which contains scattered or clumped myoepithelial element cells.[5]
- Areas of squamous metaplasia and epithelial pearls are also seen.
Librepath [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons
On immunohistochemical analysis, the positive stains of pleomorphic ademona include:
- Positive S-100 protein[6]
- Positive GFAP mainly in myxomatous and early chondromatous differentiation.[7]
- Keratin[8]
- Actin
- Myosin
- BMP-6 protein overexpression.[9]
References
- ↑ Mendoza, Pia R.; Jakobiec, Frederick A.; Krane, Jeffrey F. (2013). "Immunohistochemical Features of Lacrimal Gland Epithelial Tumors". American Journal of Ophthalmology. 156 (6): 1147–1158.e1. doi:10.1016/j.ajo.2013.06.034. ISSN 0002-9394.
- ↑ Debnath SC, Adhyapok AK (June 2010). "Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip". J Maxillofac Oral Surg. 9 (2): 205–8. doi:10.1007/s12663-010-0052-5. PMC 3244097. PMID 22190789.
- ↑ Zhan KY, Khaja SF, Flack AB, Day TA (April 2016). "Benign Parotid Tumors". Otolaryngol. Clin. North Am. 49 (2): 327–42. doi:10.1016/j.otc.2015.10.005. PMID 27040584.
- ↑ Zhan, Kevin Y.; Khaja, Sobia F.; Flack, Allen B.; Day, Terry A. (2016). "Benign Parotid Tumors". Otolaryngologic Clinics of North America. 49 (2): 327–342. doi:10.1016/j.otc.2015.10.005. ISSN 0030-6665.
- ↑ 5.0 5.1 5.2 Bokhari MR, Greene J. PMID 28613579. Missing or empty
|title=(help) - ↑ Furuse, Cristiane; de Sousa, Suzana O. Machado; Nunes, Fabio Daumas; de Magalhaes, Marina Helena Cury Gallottini; de Arauijo, Vera Cavalcanti (2016). "Myoepithelial Cell Markers in Salivary Gland Neoplasms". International Journal of Surgical Pathology. 13 (1): 57–65. doi:10.1177/106689690501300108. ISSN 1066-8969.
- ↑ Nishimura T, Furukawa M, Kawahara E, Miwa A (December 1991). "Differential diagnosis of pleomorphic adenoma by immunohistochemical means". J Laryngol Otol. 105 (12): 1057–60. PMID 1664847.
- ↑ Mori M, Tsukitani K, Ninomiya T, Okada Y (October 1987). "Various expressions of modified myoepithelial cells in salivary pleomorphic adenoma. Immunohistochemical studies". Pathol. Res. Pract. 182 (5): 632–46. PMID 2446294.
- ↑ Kusafuka K, Yamaguchi A, Kayano T, Takemura T (December 1999). "Immunohistochemical localization of the bone morphogenetic protein-6 in salivary pleomorphic adenomas". Pathol. Int. 49 (12): 1023–7. PMID 10632922.