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Clinical Problem Solving: Pathology
March 2009

Pathology Quiz Case 1: Diagnosis

Arch Otolaryngol Head Neck Surg. 2009;135(3):320-324. doi:10.1001/archoto.2008.547-b

Salivary gland anlage tumors are rare causes of nasal obstruction in neonates. Previously classified as a congenital pleomorphic adenoma by Har-El et al,1these lesions were definitively characterized by Dehner et al,2who described a series of 9 patients in 1994. A total of 23 cases have been reported in the literature to date.1-9The histologic appearance of SGAT is characterized by fusiform, epithelioid proliferations that merge with ductal and glandular structures that are often lined by cuboidal, “basaloid” cells. These internal structures are focally continuous with the squamous mucosa of the tumor's surface.4Similar structural organization and cellular composition are evident during the embryological development of salivary glands when the ectoderm or endoderm proliferates into the underlying mesenchyme.2Debate regarding whether SGAT is a hamartoma or a true neoplasm remains unresolved. However, its attempts to recapitulate salivary gland development, its midline location, and its benign nature tend to favor the notion that SGAT is a congenital hamartoma, derived from the minor salivary gland tissue found throughout the upper aerodigestive tract.2