Pleomorphic adenoma of minor salivary glands of hard palate is a rare benign tumour. Surgery is the most common form of treatment for pleomorphic adenoma. Pleomorphic adenoma is the most common tumor of the. Pleomorphic adenoma is the most common benign salivary gland neoplasm.
Pleomorphic adenoma of the base of the tonguea case report. Pleomorphic adenoma is the most common type of tumor in salivary glands. The detection rate of the carcinoma component in the cytological specimens is not high and may be challenging in cytological examination. This article is from journal of surgical case reports, volume 20. Immunohistochemical pattern of pleomorphic adenoma.
Carcinoma ex pleomorphic adenoma of the lacrimal gland. Metastasizing pleomorphic salivary adenoma oncology. Carcinoma ex pleomorphic adenoma is typically an infiltrative neoplasm with features of cellular pleomorphism, high mitotic activity, perineural and vascular invasion. It progresses slowly and, left untreated, can produce signi. Metastasizing pleomorphic adenoma occurred on average 16 years following the initial treatment of a benign pleomorphic adenoma. Pleomorphic adenoma is the most common epithelial tumor of the lacrimalgland, and when this tumor is suspected, removal of the mass in its entiretywithout biopsy should be performed. Surgical management of pleomorphic adenoma of parotid gland in elderly patients. This theory suggests that the metastasis occurs as a result of incomplete excision or inadvertent disruption of the tumour with consequent spread through. Pleomorphic adenoma is the most common benign tumor affecting the major salivary glands and infrequently arises from the minor salivary glands. Pleomorphic adenoma of the minor salivary glands most commonly occurs in the palate 16. Cytological features of carcinoma ex pleomorphic adenoma of.
Although pleomorphic adenoma is the most common neoplasm of the salivary glands, this tumor most commonly involves the minor salivary glands of palatal and rarely occurs in cervical region. Imaging characteristics of recurrent pleomorphic adenoma. However, pa may also arise from the external auditory canal eac, although reports are very rare. Metastasizing pleomorphic salivary adenoma oncology jama. Pleomorphic adenoma is the most common of all salivary gland neoplasms, at almost 50% of tumors. The primary tumor arose most commonly from the parotid gland, followed by the minor salivary and submandibular glands. In this report, we present two cases of pleomorphic adenoma originating from minor salivary glands of the. Complete excision of the mass was done transorally under general anaesthesia.
In the parotid gland, the tumors are usually several centimeters in diameter but can reach much larger sizes if left untreated. Mostly, pa is located in the parotid glands 85%, minor salivary glands 10%, and the submandibular glands 5%. Cytological features of carcinoma ex pleomorphic adenoma. It derives its name from the architectural pleomorphism variable appearance seen by. In the majority of cases, tumors originate in the superficial lobe. Among minor salivary glands, palate is the most commonly affected site followed by lips, cheeks, gingiva, floor of the mouth, and tongue. Etiology and management of recurrent parotid pleomorphic. Lobulated lesions were observed in 49 pleomorphic adenomas and 36 warthins tumors. Pa of buccal minor salivary glands is a very rare occurrence both in adults and. Pleomorphic adenoma is the most common salivary gland neoplasm, constituting up to 60% of all benign salivary gland tumors, regardless of major or minor tumors. The difference in the clinical features between carcinoma. Malignant degeneration of an adenoma increases from 1.
Siegmar reinert, in maxillofacial surgery third edition, 2017. Pleomorphic adenoma surgery, symptoms, causes, treatment. The tumors presumably arise from ductular epithelium based on the ultrastructural. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial. Carcinoma ex pleomorphic adenoma cxpa of the salivary glands is a relatively rare carcinoma. Pleomorphic adenomas account for 7080% of benign salivary gland tumors and are especially common in the parotid gland see below 1,6 patients are typically middle aged and the incidence is slightly higher in females than males 2. Mixed tumor of the lacrimal gland pleomorphic adenoma definition. Pa of buccal minor salivary glands is a very rare occurrence both in adults and children. Pleomorphic adenoma of the lacrimal gland with extensive. Pdf pleomorphic adenoma pa is the most common salivary gland tumor, accounting for about 4070% of all major and minor salivary gland tumors. Differentiation of pleomorphic adenoma and warthins tumor. The objective of this study was to clarify the clinical presentation and treatment of pa of the eac.
The salivary glands give rise to a diversity of tumors that belies their small size. Pathologic examination identified a pleomorphic adenoma. We highlight the importance of keeping this rare tumor in mind and the early detection of symptoms because such a malignant transformation could occur in pleomorphic adenomas, with the. The hypothesis for recurrence of pleomorphic adenoma using this type of surgical approach is that microscopic portions of tumor perforate the capsule and are. Pleomorphic adenoma with bizarre myoepithelial cells. Pleomorphic adenoma is the most common tumor of salivary glands. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial nerve palsy. Pleomorphic adenoma is a common benign salivary gland tumor which presents as a painless swelling that gradually increases in size, if left untreated. The epidemiology of pleomorphic adenoma can cover all ages and both genders but is more prevalent among women from thirty to sixty years of age. Salivary gland tumours are uncommon, and the understanding of their behaviour relies chiefly on publications of large clinical series from individual institutes. Pleomorphic adenoma symptoms, causes, treatment, surgery. If the pleomorphic adenoma is in your parotid gland it can be a delicate surgery due to the closeness to your facial nerves and the potential for the surgery to cause damage to these facial nerves. Salivary gland tumours are uncommon, and the understanding of their behaviour relies chiefly on publications of large clinical series from individual institutes,, the recurrence potential of pleomorphic adenomas is well recognised, and the rate of 1. The presence of these different elements accounts for the name pleomorphic tumor or mixed one characteristic of a pleomorphic adenoma is the presence of microscopic projections of tumor outside of the.
It involves the parotid of the major salivary glands and the palate of the minor salivary glands. To the best of our knowledge, only 44 cases have been reported, 25 among which only 7 cases of pleomorphic adenoma were seen arising from main bronchus 4 cases arising from right main bronchus and 3 cases arising from left main. Pleomorphic adenomas in nasal cavity are unusual and may be misdiagnosed because they have predominant myoepithelial cellularity and fewer myxoid stromata compared with. Pleomorphic adenoma is the most common salivary gland neoplasm. Pleomorphic adenoma pa is the most common benign tumor affecting both major and minor salivary glands. The dominant tumor arising in the parotids is the benign pleomorphic adenoma, which is sometimes called. Between 70% and 85% of cases occur in the parotid gland. Pleomorphic adenoma benign mixed tumor is the most common neoplasm of the salivary glands. Pleomorphic adenoma an overview sciencedirect topics. Publication date 20171010 usage attributionnoderivatives 4. Recurrence and malignant transformation are concerns necessitating proper treatment. In such cases, it is critical to make a definite diagnosis as each of these tumors has an entirely different treatment protocol. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Pleomorphic adenomas are benign tumors that rarely involve nonsalivary glands.
Since 1951, when mark and rothberg published their first eac pleomorphic adenoma report, at least 35 similar cases have been reported 3. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Pleomorphic adenoma, also referred to as benign mixed tumors bmts, is a benign or a noncancerous growth in the salivary gland, the most commonly occurring parotid tumor. Treatment of recurrent pleomorphic adenoma must be individualized. The pleomorphic adenoma showed extensive degenerative changes including central cyst formation, stromal hyalinization and hemosiderin deposition. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Download fulltext pdf pleomorphic adenoma of the lacrimal gland article pdf available in british journal of ophthalmology 767. Pleomorphic adenoma is the most common salivary gland neoplasm and infrequently undergoes malignant transformation. Preferentially, 90% of these tumors occur in the parotid gland and the other 10% occur in the minor salivary glands.
Pleomorphic adenoma constitutes one of the common salivary gland tumors. This distribution corresponds with that of psas in general. Pdf clinical profile and management of pleomorphic adenoma of. Primary pleomorphic adenoma of the external auditory canal. On the basis of the combined light microscopic and immunohistochemical findings, there was no evidence to support a malignant change in the pleomorphic adenoma.
Surgical management of pleomorphic adenoma 50 years ago consisted predominantly of local excision or enucleation technique, a procedure that yields recurrence rates from 20% to 45%. Carcinoma ex pleomorphic adenoma is an epithelial malignant neoplasm arising from a primary or recurrent pleomorphic adenoma and is a diagnostic challenge for cytopathologists. Cystic areas within lesions were detected in 16 1677, 20. After paraclinical and pathologic evaluation, it was diagnosed as cervical. On the basis of the combined light microscopic and immunohistochemical findings, there was no evidence to support a malignant change in. The epithelial cells make up a trabecular pattern that is contained within a stroma. Pleomorphic adenoma pa is a benign tumour that mainly arises from salivary glands, and pa of the external auditory canal eac is very rare. Pleomorphic adenoma of the cervical heterotopic salivary. Carcinoma ex pleomorphic adenoma affects glandular structures, occurring mostly in major salivary glands and less commonly in the lacrimal gland. Pleomorphic adenoma pa is a benign tumour that mainly arises from the salivary glands. A 21yearold female referred to our clinic due to painless mass of right upper region of neck. The patient was followedup for 1 year without recurrence. This article presents a case of pleomorphic adenoma of the palatal minor salivary gland treated successfully by surgical excision. Pleomorphic adenoma remains one of the most interesting benign tumours encountered in head and neck surgery.
It is found mostly in the parotid gland in middleaged women. Surgical management of pleomorphic adenoma of parotid. Pleomorphic adenoma is the most common benign tumor of the salivary glands, mainly arising from major salivary glands such as parotis and submandibular gland. The goal of this research was to discuss the presentation, evaluation, and management of. It usually presents as slow growing submucosal mass on hard palate. Pdf pleomorphic adenoma of the palate researchgate. We report an interesting case of pleomorphic adenoma pa with extensive adenoid cystic carcinoma acc. Mostly, pa is located in the parotid glands 85%, minor salivary glands 10%, and the submandibular glands 5% 2.
The lobulated shape was observed more frequently in pleomorphic adenomas than in warthins tumors p 0. Carcinoma ex pleomorphic adenoma is a highgrade salivary gland carcinoma in which malignant transformation occurs in a previously benign pleomorphic adenoma. The goal of this research was to discuss the presentation, evaluation, and management of pediatric pleomorphic adenoma of the head and neck. This tumor most often develops in the parotid gland, where it represents 2% to 3% of all parotid neoplasms. About 80% of tumors occur within the parotid glands and most of the others in the submandibular glands. Carcinoma ex pleomorphic adenoma diagnostic histopathology. Volume 12, supplement 2, october 2014, pages s12s16.
Dec 26, 2014 the epithelial cells make up a trabecular pattern that is contained within a stroma. We highlight the importance of keeping this rare tumor in mind and the early detection of symptoms because such a malignant transformation could occur in pleomorphic adenomas, with the proportion. The most predominant site of pleomorphic adenoma is palate. Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. We report a case of a giant submandibular pleomorphic adenoma in a 75 years old female patient which measured 34. Carcinoma expleomorphic adenoma cxpa is a rare, aggressive, poorly understood malignancy of the salivary gland. Pleomorphic adenoma pa is the most common benign salivary gland tumor. Carcinoma ex pleomorphic adenoma may be asymptomatic 2 and has similar clinical presentations as benign pleomorphic adenoma.
Pleomorphic adenoma of breast, unusual in its location addeddate. Pleomorphic adenoma is the most common benign tumor of the major salivary glands, especially of the parotid gland. The diagnosis was a heterotopic pleomorphic adenoma in the postauricular area. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Pleomorphic adenoma of the salivary glands radiology. Pleomorphic adenoma, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms. Most of them are benign and pleomorphic adenoma is the commonest among them that involves both major 90% and minor 10% salivary glands.
Pleomorphic adenoma is the most common tumour of the salivary glands. Diagnosis requires that elements from the benign pleomorphic adenoma and the malignant component need to be seen. Aug 29, 2018 carcinoma ex pleomorphic adenoma is an epithelial malignant neoplasm arising from a primary or recurrent pleomorphic adenoma and is a diagnostic challenge for cytopathologists. The difference in the clinical features between carcinoma ex. Pleomorphic adenoma with extensive adenoid cystic carcinoma. The detection rate of the carcinoma component in the cytological specimens is not high.
During the surgery the part of the organ that is affected by the pleomorphic. Pleomorphic adenoma is the most common benign salivary gland neoplasm in children. The stroma may be chondroid, myxoid, osteoid, or fibroid. The dominant tumor arising in the parotids is the benign pleomorphic adenoma, which is sometimes called a. Carcinoma ex pleomorphic adenoma is the most common variety of mixed malignant tumor where carcinoma develops from the epithelial elements of a preexisting pleomorphic adenoma. Oct 30, 2012 pleomorphic adenoma of minor salivary glands of hard palate is a rare benign tumour. Pleomorphic adenoma of the head and neck in children. Surgical management of pleomorphic adenoma of parotid gland. Pleomorphic adenoma of the soft palate radiology jama. Pleomorphic adenoma pa, also known as benign mixed tumor, is the most common salivary tumor, constituting up to twothirds of all salivary gland neoplasms. Pleomorphic adenomas can vary in size, depending on the gland in which they are located. Pleomorphic adenomas are the most common benign salivary gland neoplasms. They originate from an uncommitted reserve cell of the intercalated duct which has the potential to differentiate into epithelial and myoepithelial cells 25.
More recently, subgroups of pleomorphic adenoma have been. Pleomorphic adenoma of the base of the tongue is a rare tumour. The purpose of this study was to collect observational data regarding age, size, symptoms, ct findings and treatment of pleomorphic adenoma of hard palate. Heterotopic pleomorphic adenoma in the postauricular area. Parotid gland is the most commonly affected major salivary gland. Most recurrent pleomorphic adenoma are multinodular. Etiology and management of recurrent parotid pleomorphic adenoma. Encapsulated mass with a welldefined margin was identified and excised from the posterior neck. Histologically, it is characterized by the presence of cellular pleomorphism and is composed of an epithelial and connective tissue component within a stroma of. However, pleomorphic adenoma has been reported to involve the minor salivary glands as well. Pleomorphic adenoma in the parotid gland mayo clinic proceedings.
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