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 [disease name] is not fully understood.
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]].
 
OR
 
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Pathophysiology==
==Pathophysiology==
===Physiology===
The normal physiology of [name of process] can be understood as follows:
===Pathogenesis===
===Pathogenesis===
*The exact pathogenesis of [disease name] is not completely understood.
*The exact [[pathogenesis]] of pleomorphic adenoma is not completely understood.
OR
*It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
*Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
*[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
*The progression to [disease name] usually involves the [molecular pathway].
*The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Genetics==
===Genetics===
*PLAG1 expression is specific to Pleomorphic adenoma.
*[[PLAG1]] and [[HMGA2]] [[chromosomal]] rearrangments are specific to pleomorphic adenoma.<ref name="MendozaJakobiec2013">{{cite journal|last1=Mendoza|first1=Pia R.|last2=Jakobiec|first2=Frederick A.|last3=Krane|first3=Jeffrey F.|title=Immunohistochemical Features of Lacrimal Gland Epithelial Tumors|journal=American Journal of Ophthalmology|volume=156|issue=6|year=2013|pages=1147–1158.e1|issn=00029394|doi=10.1016/j.ajo.2013.06.034}}</ref>
*Some clonal chromosomal abnormalities involving 8q12 and 12q15 have also been described.<ref name="pmid22190789">{{cite journal |vauthors=Debnath SC, Adhyapok AK |title=Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip |journal=J Maxillofac Oral Surg |volume=9 |issue=2 |pages=205–8 |date=June 2010 |pmid=22190789 |pmc=3244097 |doi=10.1007/s12663-010-0052-5 |url=}}</ref>


==Associated Conditions==
*Some clonal [[Chromosomal abnormality|chromosomal abnormalities]] involving 8q12 and 12q15 have been noted.<ref name="pmid22190789">{{cite journal |vauthors=Debnath SC, Adhyapok AK |title=Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip |journal=J Maxillofac Oral Surg |volume=9 |issue=2 |pages=205–8 |date=June 2010 |pmid=22190789 |pmc=3244097 |doi=10.1007/s12663-010-0052-5 |url=}}</ref>
Conditions associated with [disease name] include:


*[Condition 1]
==Gross Pathology==
*[Condition 2]
{| align="right"
*[Condition 3]
|[[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] ]]
|}


==Gross Pathology==
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>:
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*Firm
*Mobile
*Well demarcated
*Encapsulated(mostly, but the ''[[Myxoid]]'' and ''[[Stroma]]'' rich subtype sometimes show focal absences of [[capsule]])
*Tan-white in appearance
 
<br>
<br>
<br>


==Microscopic Pathology==
==Microscopic Pathology==
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
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.
*[[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:
**[[epithelomucoid, myxoid,|Epithelomucoid]]
**[[epithelomucoid, myxoid,|Myxoid]]
**[[Cartilaginous]]
**[[Hyaline]].
*Based upon which element predominates pleomorphic adenoma can be:
**[[Cellular]](either [[epithelial]] or [[Myoepithelial cells|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:<ref name="pmid28613579">{{cite journal |vauthors=Bokhari MR, Greene J |title= |journal= |volume= |issue= |pages= |date= |pmid=28613579 |doi= |url=}}</ref>
**Sheets
**Clumps
**Interlacing strands.
**[[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>
**An outer [[myoepithelial]] layer
**Inner [[cuboidal epithelial cell]] layer
*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]]
 
====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 [[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>
*[[Actin]]
*[[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>


==References==
==References==
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[[Category: Otolaryngology]]
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Latest revision as of 17:51, 15 February 2019

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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

Gross Pathology

Pleomorphic adenoma gross appearance Source:Department of Pathology,Calicut Medical College

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]

On immunohistochemical analysis, the positive stains of pleomorphic ademona include:

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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. ↑ 5.0 5.1 5.2 Bokhari MR, Greene J. PMID 28613579. Missing or empty |title= (help)
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.

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