What are the possible complications of pleomorphic adenoma of salivary gland. Only 70 cases have been reported in the world literature. Carcinoma ex pleomorphic adenoma affects glandular structures, occurring mostly in major salivary glands and less commonly in the lacrimal gland. 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. Siegmar reinert, in maxillofacial surgery third edition, 2017. Download as ppt, pdf, txt or read online from scribd.
This article presents a case of pleomorphic adenoma of the palatal minor salivary gland treated successfully by surgical excision. In the parotid gland, the tumors are usually several centimeters in diameter but can reach much larger sizes if left untreated. This is an interesting case not only for rarity but also for the sudden onset presentation of the lesion and unusual diagnosis in underlying jaw and dental disease figure 1. Ductal adenocarcinoma ex pleomorphic adenoma of the. Pleomorphic adenoma of the lacrimal gland with extensive. Diffusionweighted images demonstrated well complex tissue. However, pleomorphic adenoma has been reported to involve the minor salivary glands as well. Among salivary gland tumors, cxpa is unique and interesting because it is histologically diverse and contains both benign pleomorphic adenoma and carcinomatous components. 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 is the most common benign tumor affecting the major salivary glands and infrequently arises from the minor salivary glands. About 90% of these tumors occur in the parotid gland and 10% in the minor salivary glands.
Histological examination of the second recurrence showed a malignant. Although rare, this condition has been reported to be responsible for 4. We present 4 cases of carcinoma ex pleomorphic adenoma of the parotid gland. It derives its name from the architectural pleomorphism variable appearance seen by.
Pleomorphic adenoma mixed tumor, a benign tumor of salivary gland type containing epithelial, myoepithelial, and stromal components, is the most commonly diagnosed lesion of the salivary glands. One of the most common of these tumors in the parotid gland is a pleomorphic adenoma. Carcinoma ex pleomorphic adenoma of the lacrimal gland. A large pleomorphic adenoma can be disfiguring or exert mass effect on important structures. Pleomorphic definition of pleomorphic by the free dictionary. A free application to browse and search the journals content is now available for mobiles and devices. The specimen was then submitted for paraffin embedding. A 21yearold female referred to our clinic due to painless mass of right upper region of neck. Pleomorphic adenoma is a benign tumor in the salivary gland. Pleomorphic parotid adenoma benign tumor of the parotid.
Pleomorphic adenoma is a common benign salivary gland tumor which presents as a painless swelling that gradually increases in size, if left untreated. Surgical management of pleomorphic adenoma of parotid. Pleomorphic adenoma of parotid gland with extensive bone. Jan 21, 2016 pleomorphic adenomas, also known as benign mixed tumors, are the most common tumors of glandular origin in the head and neck and although they are generally benign they can undergo malignant transformation. Pleomorphic adenomas can vary in size, depending on the gland in which they are located. Most common presentation is recurrent epistaxis and nasal obstruction. Carcinoma ex pleomorphic adenoma is typically an infiltrative neoplasm with features of cellular pleomorphism, high mitotic activity, perineural and vascular invasion. Pleomorphic adenoma, abbreviated pa, is a very common benign salivary gland tumour. Metastasizing form of the pleomorphic adenoma is really rare but mortality is extremely high when detected as 22% 2. Carcinoma ex pleomorphic adenoma of the parotid gland. 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 ex pleomorphic adenoma ca ex pa is a type of cancer typically found in the parotid gland. Pleomorphic adenoma, also known as benign mixed tumor is the most common tumor of the salivary gland accounting for 6080% of the benign variety. The submental nodule was found to be a lipoma on histopathological analysis. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. Other benign salivary gland tumours do not do this. 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. Radiographic surveillance of abdominal free fat graft in complex parotid pleomorphic adenomas. Pleomorphic adenoma pa, also known as benign mixed tumor, is the most common salivary tumor, constituting up to twothirds of all salivary gland neoplasms. Cns metastases of carcinoma ex pleomorphic adenoma of the. Salivary gland ppt free download as powerpoint presentation.
Pleomorphic adenoma an overview sciencedirect topics. Our goal was to investigate the prognosis of cxpa in the major salivary glands and factors influencing it. Clinical features pleomorphic adenoma in the minor salivary glands presents as an asymptomatic, slowgrowing, firm swelling, 23 cm in size fig. Imaging revealed a lytic lesion over the left orbital wall with soft tissue extension suggestive of malignancy. Maspin expression in carcinoma ex pleomorphic adenoma. Seventy one of the 78 patients in this series were referred without previous surgery, and, on clinical or radiological evidence, 63 89% tumours were correctly diagnosed and totally excised, with preservation of a margin of the surrounding. Feb 27, 2018 osseous pleomorphic adenoma tumor with bone formation many clinical conditions may have similar signs and symptoms. The signs and symptoms are similar to other malignant salivary gland tumours. In the 1991 who classification of tumours of the salivary glands, the term malignant mixed tumour comprises three different pathologies. Recently, we encountered a case of pleomorphic adenoma of the breast and thus present here the mammographic and ultrasonographic findings with the pathology of this rare breast tumor. These pathologies, which should not be confused, are the carcinoma ex pleomorphic adenoma.
Carcinoma ex pleomorphic adenoma of the salivary glands. Pleomorphic adenomas, also known as benign mixed tumors, are the most common tumors of glandular origin in the head and neck and although they are generally benign they can undergo malignant transformation. Pleomorphic adenoma pa is the most common salivary gland tumor, accounting for about 4070% of all major and minor salivary gland tumors. It accounts for 4045% or more of minor salivary gland tumors. One of the malignant forms of pleomorphic adenomas pa is carcinoma ex pleomorphic adenoma caexpa. Although pleomorphic adenomas most commonly occur in the parotid gland, it may also be encountered in the submandibular, lingual, and minor salivary glands. He underwent an en bloc resection of the mass with orbital.
This article is from journal of surgical case reports, volume 20. After paraclinical and pathologic evaluation, it was diagnosed as. Pleomorphic adenoma of breast, unusual in its location. This case report presents the clinical and radiographic features of a rare case of biopsy proved brain and spinal cord metastases arising from carcinoma ex pa of the parotid gland. Carcinoma ex pleomorphic adenoma ca ex pa is a rare malignant transformation of a benign primary pleomorphic adenoma pa. Northern blot analysis using this est detected a 7. More recently, subgroups of pleomorphic adenoma have been.
In a compilation of 60 individual studies, gnepp reported that the average rate of malignant change was 6. Pdf pleomorphic adenoma in ectopic salivary gland tissue in. Like any structure in the body, the parotid gland is prone to the formation of abnormal growths which may either be benign or malignant. Though it is classified as a benign tumorpleomorphic adenomas have the capacity to grow to large proportions adenoja may undergo malignant transformation, to form carcinoma ex pleomorphic adenomaa risk that increases with time 9. Pleomorphic adenoma of the minor salivary glands is commonly found in the palate. Immunohistochemical pattern of pleomorphic adenoma. Dec 26, 2014 the epithelial cells make up a trabecular pattern that is contained within a stroma.
A myoepithelial carcinoma, a rare malignant salivary gland neoplasm, arose in a pleomorphic adenoma of the parotid gland. Pleomorphic adenoma surgery recovery doctor answers. Myoepithelial carcinoma malignant myoepithelioma of the. Pleomorphic adenoma surgery, symptoms, causes, treatment. To reduce the risk of recurrence and malignant transformation, pleomorphic adenomas of the lacrimal gland should be removed intact, without prior biopsy. Pdf pleomorphic adenoma is a benign epithelial tumor of adenoid structure preferentially arising. This is the first case in the literature describing overlapping.
Pleomorphic adenoma of the submandibular gland jama network. Pulmonary salivary glandtype tumors with features of. The mass was surgically removed and confirmed to be a pleomorphic adenoma on histopathological analysis. Histologic grade is a significant predictor of outcome in salivary gland carcinomas. Giant parapharyngeal space pleomorphic adenoma causing acute. Recurrent pleomorphic adenomas of the parotid gland warrant consideration because of the potential for facial nerve injury occurring with surgical treatment and the risk of malignant conversion. Pdf pleomorphic adenoma of the palate researchgate. Pdf basal cell adenoma of the salivary glands is an uncommon type of monomorphous adenoma. Pleomorphic adenoma is the most common type of all salivary gland tumors. Patient presented with a lump in the left parotid gland. The difference in the clinical features between carcinoma.
We report the case of a 62yearold male who presented with a swelling over his left temple. Carcinoma ex pleomorphic adenoma cxpa is an uncommon malignant tumor with highly aggressive biological behavior. On palpation it was non tender, hard in consistency, the skin over the swelling was free. The submandibular gland is involved in only 5% to 10% of the salivary gland tumors, and pleomorphic adenoma pa is the most common tumor affecting it. Pleomorphic adenoma, warthins tumor and neuroma of the facial nerve nerve sheath tumor were considered as the most probable differential diagnosis. A pleomorphic adenoma is a tumour of a gland that produces saliva in the mouth. Pleomorphism is a term used in histology and cytopathology to describe variability in the size, shape and staining of cells andor their nuclei. Fortyeight cases of recurrent pleomorphic adenoma treated at the university of michigan, ann arbor. Publication date 20171010 usage attributionnoderivatives 4. Prognostic factors affecting the clinical outcome of. If yes, where can i get it done and what is the expected cost of the surgery. Pleomorphic adenoma has a rather high risk for recurrence while.
Pleomorphic adenomas in nasal cavity are unusual and may be misdiagnosed because they have predominant myoepithelial cellularity and fewer myxoid stromata compared with those. Finding of a solid lesion in superficial lobe of right parotid gland, which was later proven to be pleomorphic adenoma by fnac study. In such cases, it is critical to make a definite diagnosis as each of these tumors has an entirely different treatment protocol. As our knowledge base has evolved, it is clear that carcinoma ex pleomorphic adenoma is not automatically a high grade tumor as is traditionally suggested. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported.
Pleomorphic adenoma is a very rare benign tumor of the breast. Pleomorphic adenoma pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. However, the sheer variety of tumor type and the rarity of these tumors pose challenges to devising highly predictive grading schemes. In this report, we present two cases of pleomorphic adenoma originating from minor salivary glands of the. Pleomorphic adenoma, also called benign mixed tumor, is the most common tumor of the salivary glands. Giant primary pleomorphic adenoma of the lung presenting as a. Objectiveshypothesis histopathological characteristics of pleomorphic adenomas, especially of capsular alterations such as thin capsule areas, capsule. Benign tumors pleomorphic adenoma warthins tumor oncocytoma lymphangioma haemangioma pleomorphic adenoma. The commonest sites for intraoral pa are palate, buccal. There was no tumor recurrence during the oneyear postoperative followup.
Ultrasound demonstrated a well demarcated, hypoechoic lesion of a solid, vascular appearance within the superficial gland. During the surgery the part of the organ that is affected by the pleomorphic. Carcinoma ex pleomorphic adenoma cxpa is a rare and poorly understood malignancy that develops from either a longstanding primary or a recurrent pleomorphic adenoma pa. Surgery is the most common form of treatment for pleomorphic adenoma. Warthins tumor is usually seen in elderly males with a history of smoking, does not cause eversion of the ear lobe, located in the lower portion of the parotid near angle of mandible, and 10. More importantly, they have a proven risk 515% of undergoing malignant transformation carcinoma ex pleomorphic adenoma, or malignant mixed tumor 3. Surgical treatment of recurrent pleomorphic adenoma of the. Basic salivary gland pathology 1 basic salivary gland pathology jennifer l. 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 of nasal septum is a rare, benign, minor salivary gland tumour arising from the nasal septum. Pleomorphic adenoma pa is the most common benign salivary gland tumor. By searching sequence databases with sequence tagged sites stss located within a 300kb region on chromosome 8 associated with recurrent translocation breakpoints in pleomorphic adenomas see 181030 and cytogenetics, kas et al. Histopathology images of pleomorphic adenoma by pathpedia. Downloaded from the university of groningenumcg research database pure.
Several key determinants of cell and nuclear size, like ploidy and the regulation of cellular metabolism, are commonly disrupted in tumors. Giant primary pleomorphic adenoma of the lung presenting. Photomicrograph showing ductal pattern and myxoid pattern. It arises from the benign tumour pleomorphic adenoma. Pleomorphic adenoma of the soft palate radiology case. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. The initial tumour was a pleomorphic adenoma with epithelial and myoepithelial elements. This is the first case in the literature describing. Recurrent pleomorphic adenoma of submandibular region. The patient remained diseasefree on oneyear followup. The pleomorphic adenoma is the most common tumour of glandular origin in the head and neck 1. Abstractwe present a case of a 62yearold male patient with pleomorphic adenoma and.
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. Transsphenoidal approach has become the surgery of choice for pituitary adenomas. Pdf pleomorphic adenoma pa is the most common salivary gland tumor, accounting for about 4070% of all. In the majority of cases, tumors originate in the superficial lobe. Core needle biopsy can also be done in outpatient setting.
In 3 of the 4 cases, diffusionweighted and apparent diffusion coefficient adc mapping images clearly revealed carcinoma as a hypercellular area with low adc values and pleomorphic adenoma as a hypocellular area with high adc values. The most common benign tumour of the major salivary glands is the pleomorphic adenoma. Pleomorphic adenoma synonyms, pleomorphic adenoma pronunciation, pleomorphic adenoma translation, english dictionary definition of pleomorphic adenoma. They are seen rarely in the minor salivary glands, usually in hard palate, soft palate and nasopharynx. The stroma may be chondroid, myxoid, osteoid, or fibroid. 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. Pleomorphic adenoma pa, the most frequent tumour in salivary glands, can undergo malignant transformation. Pleomorphic adenoma is the most common salivary gland neoplasm and infrequently undergoes malignant transformation. Carcinoma ex pleomorphic adenoma is an uncommon malignant tumor with high aggressive behavior and poor prognosis. Multiple or bilateral pleomorphic adenomas are rare. Salivary gland pleomorphic adenoma in the netherlands rug. Subsequently the tumour recurred twice and was characterised by invasion of the mandible.
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. We report a case of a giant submandibular pleomorphic adenoma in a 75. Recurrencefree survival in patients who develop a recurrence, reflecting a. 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. 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. We observed an unusual and clinically unsuspected pleomorphic adenoma developing in the anterior midcervical region of a young man. Around 7080 percent of pleomorphic adenoma occur in the superficial lobe of the parotid gland, although the lesion may occur in any area of the parotid gland. Pleomorphic adenoma of breast, unusual in its location frozen section was reported as benign breast tumor with possibility of 1 fibroadenoma with chondroid and osseous metaplasia 2 benign mixed tumor pleomorphic adenoma. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. However, there are a few studies in this topic in the recent. Mostly, pa is located in the parotid glands 85%, minor salivary glands 10%, and the submandibular glands 5%.
Primary pleomorphic adenomas of the lung are extremely rare tumors with less than 40 cases reported in the literature by now. A large duct passes out of parotid gland and carries saliva into the oral cavity. Pleomorphic adenoma is the most common of all salivary gland neoplasms, at almost 50% of tumors. Pleomorphic adenoma of the cervical heterotopic salivary. The tumor is almost always solitary and is usually found as a firm, mobile, painless slow growing mass. Analysis of the clinical relevance of histological classification of. Generally more than 80% of cases has a history of local recurence of pleomorphic adenoma before metastatic form. Pleomorphic adenomas are benign tumors that rarely involve nonsalivary glands. Eighty per cent of pleomorphic adenomas of this particular gland are benign, and 20 per cent are cancerous. The term pleomorphic adenoma describes a being tumor with varied histologic appearances and consists of epithelial and mesenchymal tissues of possible myoepithelial lineage.
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