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Polymorphous Adenocarcinoma: A Cytological Enigma Unveiled Through Uncommon Locations-A Case Study
Paruvathavarthini Thambiraj1, Debasis Gochhait1, Neelaiah Siddaraju1
1Department of Pathology, JIPMER, Puducherry, India.
Introduction:
Polymorphous adenocarcinoma (PAC) is a type encountered in minor salivary glands (49%-87%) PAC may occasionally occur in major salivary glands, in particular the parotid gland approximately 3% (range: 0%-9%) of cases. PAC has become a challenging entity for clinicians to diagnose because of the overlap of its clinical and microscopic features with other salivary gland tumours. Fine-needle aspiration (FNA) and core biopsy findings in these tumours are limited.
Aim:
The main objective is to study the cytomorphological aspects of this tumour and focus on uncommon locations.
Methods:
It was a retrospective single-institutional study from a time period of 4 years. A total of 11 cases (n = 11) were collected from archives. Papanicolaou (Pap) and May-Grunwald Giemsa (MGG) stained cytology slides were retrieved. All clinical details, types of procedure, cell block material, immunocytochemistry, follow-up biopsy/resection specimens and immunohistochemistry (IHC) status were analysed in detail.
Results:
Total 11 cases (n = 11) were collected; seven cases were located in major and four were located in minor salivary glands. Histopathological correlation was seen in eight cases (n = 8, 73%) remaining cases were lost for follow-up (n = 3). All aspirates showed similar cytomorphologic features, with hypercellular smears showing branching papillae, sheets and clusters composed of bland uniform cells with dispersed myxohyaline stroma seen. Five cases had lymph node metastasis and soft tissue infiltrative tumour deposits. Out of eight cases in histopathology, five cases were resection specimens and three cases were excision biopsy.
Conclusion:
Cytological evaluation of PAC, especially in uncommon anatomical sites, presents inherent challenges due to its morphological variability and overlap with other salivary gland neoplasms. However, with careful sampling, comprehensive assessment and integration of ancillary techniques, cytologists can contribute significantly to the accurate diagnosis and optimal management of PAC, thereby improving patient outcomes and enhancing our understanding of this rare malignancy.
