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Diagnostics Histology, Training and education

Case of the Month

A 71-year-old female presented with an incidental osseous nasal septum mass. The mass was completely excised via endoscopic septectomy.

What is the diagnosis?

a. Chondroblastic osteosarcoma
b. Osteochondroma
c. Low-grade chondrosarcoma
d. Enchondroma

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We will reveal the answer next month.

Do you have an interesting case that you would like us to feature? Email it to [email protected].

The Case of the Month series is curated by Anamarija M. Perry, University of Michigan.

Answer to December’s Case of the Month

D. Sclerosing polycystic adenosis

Sclerosing polycystic adenosis (SPA) is a rare, benign lesion that typically involves the parotid gland and resembles sclerosing adenosis/fibrocystic change of the breast (1,2). The lesion is well circumscribed with a thick, fibrous capsule. There is an epithelial proliferation that contains a variety of structures including nests, ducts, acini, and cystic structures surrounded by fibrosis (1,2,3). The cytoplasm has characteristic PAS-positive eosinophilic granules (1,3). Differential diagnosis includes pleomorphic adenoma (PA), salivary duct carcinoma, and chronic sclerosing sialadenitis (3,4). In contrast to SPA, PA typically demonstrates a chondromyxoid matrix and lacks prominent cytoplasmic eosinophilic granules (4). Salivary duct carcinoma demonstrates cellular pleomorphism, mitoses, comedonecrosis, and an infiltrative growth pattern not seen in SPA (4). Chronic sclerosing sialadenitis does have a prominent fibrotic component, but lacks a cystic component and typically involves the submandibular gland with a prominent inflammatory component (3).

Submitted by Emily R. McMullen and Jonathan B. McHugh, University of Michigan, Ann Arbor, USA.

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  1. F Petersson, “Sclerosing polycystic adenosis of salivary glands: a review with some emphasis on intraductal epithelial proliferations”, Head Neck Pathol, 7, S97 (2013). PMID: 23821217.
  2. DR Gnepp, “Salivary gland tumor ‘wishes’ to add to the next WHO Tumor Classification: sclerosing polycystic adenosis, mammary analogue secretory carcinoma, cribriform adenocarcinoma of the tongue and other sites, and mucinous variant of myoepithelioma”, Head Neck Pathol, 8, 42 (2014). PMID: 24595421.
  3. CA Eliot et al., “Sclerosing polycystic adenosis”, Head Neck Pathol, 6, 247 (2012). PMID: 22183766.
  4. S Manojlović et al., “Sclerosing polycystic adenosis of parotid gland: a unique report of two cases occurring in two sisters”, Pathol Res Pract, 210, 342 (2014). PMID: 24636837.

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