Pleomorphic adenoma with extensive adenoid cystic carcinoma. The difference in the clinical features between carcinoma ex. This article presents a case of pleomorphic adenoma of the palatal minor salivary gland treated successfully by surgical excision. Recurrence and malignant transformation are concerns necessitating proper treatment.
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. Pleomorphic adenoma of the head and neck in children. 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 adenoma of the base of the tonguea case report. Abstractwe present a case of a 62yearold male patient with pleomorphic adenoma and. Pleomorphic adenoma is the most common salivary gland neoplasm and infrequently undergoes malignant transformation. Pleomorphic adenoma symptoms, causes, treatment, surgery. Pleomorphic adenoma in the parotid gland mayo clinic proceedings. The primary tumor arose most commonly from the parotid gland, followed by the minor salivary and submandibular glands. 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. 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. The stroma may be chondroid, myxoid, osteoid, or fibroid.
Pleomorphic adenomas are benign tumors that rarely involve nonsalivary glands. Pleomorphic adenoma is the most common benign salivary gland neoplasm in children. Pdf pleomorphic adenoma pa is the most common salivary gland tumor, accounting for about 4070% of all major and minor salivary gland tumors. Pleomorphic adenoma of minor salivary glands of hard palate is a rare benign tumour. Surgical management of pleomorphic adenoma of parotid. However, pleomorphic adenoma has been reported to involve the minor salivary glands as well. The difference in the clinical features between carcinoma. Carcinoma ex pleomorphic adenoma affects glandular structures, occurring mostly in major salivary glands and less commonly in the lacrimal gland. Encapsulated mass with a welldefined margin was identified and excised from the posterior neck. Most recurrent pleomorphic adenoma are multinodular.
Pleomorphic adenoma remains one of the most interesting benign tumours encountered in head and neck surgery. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. 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. In the parotid gland, the tumors are usually several centimeters in diameter but can reach much larger sizes if left untreated. This distribution corresponds with that of psas in general. Between 70% and 85% of cases occur in the parotid gland. Carcinoma ex pleomorphic adenoma of the lacrimal gland. Preferentially, 90% of these tumors occur in the parotid gland and the other 10% occur in the minor salivary glands. The detection rate of the carcinoma component in the cytological specimens is not high. Metastasizing pleomorphic salivary adenoma oncology jama. Pleomorphic adenoma is a common benign salivary gland tumor which presents as a painless swelling that gradually increases in size, if left untreated.
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. Most of them are benign and pleomorphic adenoma is the commonest among them that involves both major 90% and minor 10% salivary glands. During the surgery the part of the organ that is affected by the pleomorphic. 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. 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. Download fulltext pdf pleomorphic adenoma of the lacrimal gland article pdf available in british journal of ophthalmology 767. Pleomorphic adenoma is the most common tumor of the. 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. Among minor salivary glands, palate is the most commonly affected site followed by lips, cheeks, gingiva, floor of the mouth, and tongue. Pdf clinical profile and management of pleomorphic adenoma of. Mixed tumor of the lacrimal gland pleomorphic adenoma definition. The objective of this study was to clarify the clinical presentation and treatment of pa of the eac.
Histologically, it is characterized by the presence of cellular pleomorphism and is composed of an epithelial and connective tissue component within a stroma of. It usually presents as slow growing submucosal mass on hard palate. Pleomorphic adenoma of breast, unusual in its location addeddate. The detection rate of the carcinoma component in the cytological specimens is not high and may be challenging in cytological examination. Pathologic examination identified a pleomorphic adenoma. More recently, subgroups of pleomorphic adenoma have been. Cytological features of carcinoma ex pleomorphic adenoma of. Pleomorphic adenoma of the soft palate radiology jama. After paraclinical and pathologic evaluation, it was diagnosed as cervical.
We report a case of a giant submandibular pleomorphic adenoma in a 75 years old female patient which measured 34. Diagnosis requires that elements from the benign pleomorphic adenoma and the malignant component need to be seen. Pleomorphic adenoma of the minor salivary glands most commonly occurs in the palate 16. Carcinoma ex pleomorphic adenoma is typically an infiltrative neoplasm with features of cellular pleomorphism, high mitotic activity, perineural and vascular invasion. Pleomorphic adenoma in the parapharyngeal space joms. Pleomorphic adenoma benign mixed tumor is the most common neoplasm of the salivary glands. Pleomorphic adenoma of the salivary glands oral surgery, oral. Pa of buccal minor salivary glands is a very rare occurrence both in adults and. Pleomorphic adenoma, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms. It is found mostly in the parotid gland in middleaged women. Pa of buccal minor salivary glands is a very rare occurrence both in adults and children. The goal of this research was to discuss the presentation, evaluation, and management of pediatric pleomorphic adenoma of the head and neck. Cystic areas within lesions were detected in 16 1677, 20. Pleomorphic adenoma pa is a benign tumour that mainly arises from the salivary glands.
Pleomorphic adenoma an overview sciencedirect topics. 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. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Siegmar reinert, in maxillofacial surgery third edition, 2017. Imaging characteristics of recurrent pleomorphic adenoma. In such cases, it is critical to make a definite diagnosis as each of these tumors has an entirely different treatment protocol.
Pleomorphic adenoma of the lacrimal gland with extensive. This tumor most often develops in the parotid gland, where it represents 2% to 3% of all parotid neoplasms. Dec 26, 2014 the epithelial cells make up a trabecular pattern that is contained within a stroma. However, pa may also arise from the external auditory canal eac, although reports are very rare. Metastasizing pleomorphic salivary adenoma oncology.
Pleomorphic adenomas can vary in size, depending on the gland in which they are located. Pleomorphic adenoma is the most common benign tumor of the major salivary glands, especially of the parotid gland. Pleomorphic adenoma is the most common tumour of the salivary glands. The salivary glands give rise to a diversity of tumors that belies their small size. Pleomorphic adenoma is the most common type of tumor in salivary glands. Malignant degeneration of an adenoma increases from 1. Differentiation of pleomorphic adenoma and warthins tumor.
About 80% of tumors occur within the parotid glands and most of the others in the submandibular glands. Volume 12, supplement 2, october 2014, pages s12s16. They originate from an uncommitted reserve cell of the intercalated duct which has the potential to differentiate into epithelial and myoepithelial cells 25. Cytological features of carcinoma ex pleomorphic adenoma.
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 epithelial cells make up a trabecular pattern that is contained within a stroma. Pleomorphic adenoma pa is the most common benign tumor affecting both major and minor salivary glands. The most predominant site of pleomorphic adenoma is palate. Since 1951, when mark and rothberg published their first eac pleomorphic adenoma report, at least 35 similar cases have been reported 3. Pdf pleomorphic adenoma of the palate researchgate. The purpose of this study was to collect observational data regarding age, size, symptoms, ct findings and treatment of pleomorphic adenoma of hard palate. Pleomorphic adenoma of the salivary glands radiology. Treatment of recurrent pleomorphic adenoma must be individualized. It involves the parotid of the major salivary glands and the palate of the minor salivary glands. Primary pleomorphic adenoma of the external auditory canal. 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 hypothesis for recurrence of pleomorphic adenoma using this type of surgical approach is that microscopic portions of tumor perforate the capsule and are.
Carcinoma expleomorphic adenoma cxpa is a rare, aggressive, poorly understood malignancy of the salivary gland. Lobulated lesions were observed in 49 pleomorphic adenomas and 36 warthins tumors. Pleomorphic adenoma with bizarre myoepithelial cells. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial nerve palsy. 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 of the cervical heterotopic salivary. Pleomorphic adenoma is the most common benign tumor of the salivary glands, mainly arising from major salivary glands such as parotis and submandibular gland. Pleomorphic adenomas are the most common benign salivary gland neoplasms. 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.
Carcinoma ex pleomorphic adenoma diagnostic histopathology. In this report, we present two cases of pleomorphic adenoma originating from minor salivary glands of the. The pleomorphic adenoma showed extensive degenerative changes including central cyst formation, stromal hyalinization and hemosiderin deposition. Surgical management of pleomorphic adenoma of parotid gland. Pleomorphic adenoma is the most common benign salivary gland neoplasm. Mostly, pa is located in the parotid glands 85%, minor salivary glands 10%, and the submandibular glands 5% 2. Pleomorphic adenoma is the most common salivary gland neoplasm. Pleomorphic adenoma is the most common benign tumor affecting the major salivary glands and infrequently arises from the minor salivary glands.
It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Etiology and management of recurrent parotid pleomorphic. Carcinoma ex pleomorphic adenoma cxpa of the salivary glands is a relatively rare carcinoma. The patient was followedup for 1 year without recurrence. 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. We report an interesting case of pleomorphic adenoma pa with extensive adenoid cystic carcinoma acc. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial.
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 pa is a benign tumour that mainly arises from salivary glands, and pa of the external auditory canal eac is very rare. The dominant tumor arising in the parotids is the benign pleomorphic adenoma, which is sometimes called a. 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 dominant tumor arising in the parotids is the benign pleomorphic adenoma, which is sometimes called. Surgical management of pleomorphic adenoma of parotid gland in elderly patients. Etiology and management of recurrent parotid pleomorphic adenoma. The lobulated shape was observed more frequently in pleomorphic adenomas than in warthins tumors p 0. The tumors presumably arise from ductular epithelium based on the ultrastructural. Pleomorphic adenoma of the base of the tongue is a rare tumour. It derives its name from the architectural pleomorphism variable appearance seen by. Parotid gland is the most commonly affected major salivary gland. 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. Pleomorphic adenoma constitutes one of the common salivary gland tumors. The goal of this research was to discuss the presentation, evaluation, and management of. Pleomorphic adenoma surgery, symptoms, causes, treatment. It progresses slowly and, left untreated, can produce signi. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma.
Complete excision of the mass was done transorally under general anaesthesia. 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. In the majority of cases, tumors originate in the superficial lobe. Publication date 20171010 usage attributionnoderivatives 4. This article is from journal of surgical case reports, volume 20. Carcinoma ex pleomorphic adenoma is a highgrade salivary gland carcinoma in which malignant transformation occurs in a previously benign pleomorphic adenoma. Oct 30, 2012 pleomorphic adenoma of minor salivary glands of hard palate is a rare benign tumour. Mostly, pa is located in the parotid glands 85%, minor salivary glands 10%, and the submandibular glands 5%. Pleomorphic adenoma is the most common tumor of salivary glands. A 21yearold female referred to our clinic due to painless mass of right upper region of neck. Carcinoma ex pleomorphic adenoma may be asymptomatic 2 and has similar clinical presentations as benign pleomorphic adenoma.
Salivary gland tumours are uncommon, and the understanding of their behaviour relies chiefly on publications of large clinical series from individual institutes. On the basis of the combined light microscopic and immunohistochemical findings, there was no evidence to support a malignant change in the pleomorphic adenoma. Heterotopic pleomorphic adenoma in the postauricular area. Immunohistochemical pattern of pleomorphic adenoma. The incidence is even lower in the upper respiratory tract, such as the nasal cavity, maxillary sinus and nasopharynx 8 9. Metastasizing pleomorphic adenoma occurred on average 16 years following the initial treatment of a benign pleomorphic adenoma. The diagnosis was a heterotopic pleomorphic adenoma in the postauricular area. Surgery is the most common form of treatment for pleomorphic adenoma. Pleomorphic adenoma pa is the most common benign salivary gland tumor. 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%. Pleomorphic adenoma is the most common of all salivary gland neoplasms, at almost 50% of tumors.
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