title: Surface Papillary Epithelial Hyperplasia (Rough Mucosa) is a Helpful Clue for Identification of Polymorphous Low-Grade Adenocarcinoma.
abstract: The purpose of this study is to evaluate surface papillary epithelial hyperplasia, a microscopic finding that corresponds to the clinical finding of rough or stippled mucosa, as a predictor of polymorphous low-grade adenocarcinoma (PLGA). We conducted a retrospective review of minor salivary gland neoplasms submitted to our biopsy service from 1991 to 2013. Our review was limited to lesions involving the oral cavity/soft palate with the following diagnoses: PLGA, pleomorphic adenoma (PA), mucoepidermoid carcinoma (MEC), and adenoid cystic carcinoma (ACC). A total of 202 minor salivary gland neoplasms were included in the study. Among cases in which surface epithelium was present for evaluation (n = 112), surface papillary epithelial hyperplasia was evident in 30 % of PLGA and 1 % of non-PLGA (i.e., MEC, ACC, PA). The greater frequency of surface papillary epithelial hyperplasia in the PLGA versus non-PLGA cases and in the benign versus malignant cases was significant (p = .0001 and p = .041, respectively). The sensitivity and specificity of papillary epithelial hyperplasia for PLGA were 30 % (95 % confidence interval (CI) 11.97-54.27 %) and 99 % (95 % CI 94-99.82 %), respectively. The clinical presentation of PLGA appeared relatively nonspecific, with all analyzed tumor types exhibiting a predilection for females, middle-aged to older adults, palatal location, pink/tan/normal color, and firm consistency. In conclusion, papillary epithelial hyperplasia was evident in only a minority of PLGA. However, when present within the context of a palatal salivary gland neoplasm, it appears to indicate a high probability of PLGA. Accordingly, rough mucosa may be a useful clinical pearl for identification of PLGA.
authors.affiliation: Division of Oral Pathology, College of Dental Medicine, Medical University of South Carolina, 173 Ashley Ave., Charleston, SC, 29425, USA, chi@musc.edu.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Chi
authors.forename: Brad W
authors.initials: BW
authors.lastname: Neville
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology*; D008949:Adenoma, Pleomorphic / Q000175:diagnosis / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000175:diagnosis / Q000473:pathology; D018277:Carcinoma, Mucoepidermoid / Q000175:diagnosis / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult