Abstractwe present a case of a 62yearold male patient with pleomorphic adenoma and. Pleomorphic adenoma pa is the most common benign salivary gland tumour, accounting for as many as 80% of all such tumours. Fortyeight cases of recurrent pleomorphic adenoma treated at the university of michigan, ann arbor. This article is from journal of surgical case reports, volume 20. Volume 12, supplement 2, october 2014, pages s12s16. World literature suggests parapharyngeal space lesions account for only 0. Carcinoma ex pleomorphic adenoma cxpa is an uncommon malignant tumor with highly aggressive biological behavior. The difference in the clinical features between carcinoma. Parotid pleomorphic adenoma is the most common slowgrowing benign neoplasm of the salivary glands. Eighty per cent of pleomorphic adenomas of this particular gland are benign, and 20 per cent are cancerous.
On histological examination, 36 tumours were classified as pleomorphic adenomas and 26 as nonpleomorphic adenomas. Pleomorphic adenoma surgery, symptoms, causes, treatment. The treatment of pleomorphic adenoma is surgical excision. 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. Surgical management of pleomorphic adenoma of parotid gland in. Minor salivary gland pas are mostly located in the hard and soft palates. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Parotid gland is the most commonly affected major salivary gland. Pa may very rarely be seen in minor salivary glands. Carcinoma expleomorphic adenoma cxpa is a rare, aggressive, poorly understood malignancy of the salivary gland. Doctor answers on symptoms, diagnosis, treatment, and more. Malignancy must be considered for cases with pain and. Mixed tumor of the lacrimal gland pleomorphic adenoma definition.
Pleomorphic adenoma an overview sciencedirect topics. Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland. Pleomorphic adenomas pas of salivary glands are the most. The patient underwent surgical treatment involving left subtotal parotidectomy. Pa of buccal minor salivary glands is a very rare occurrence both in. Tumor recurrence may lead to a need for multiple surgeries and more extensive therapies. It involves the parotid of the major salivary glands and the palate of the minor salivary glands. A second study investigated postresection radiotherapy for carcinoma ex pleomorphic adenoma and found a 26% improvement in 5year local control from 49% to 75%. It derives its name from the architectural pleomorphism variable. Molecular cytogenetic pilot study on pleomorphic adenomas of. Pleomorphic adenoma, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms.
Imaging characteristics of recurrent pleomorphic adenoma. Electrical stimulation treatment for facial palsy after. The objective of treatment of a parotid pleomorphic adenoma is to remove all tumour cells with minimal short and longterm morbidity and minimal recurrence. Pleomorphic salivary adenoma in an adolescent british.
Histopathology of pleomorphic adenoma in the parotid gland. Metastatic pleomorphic adenoma e195 authors such as czader 9 have described the metastatic mixed tumor as a link between a pleomorphic adenoma and a cepa and suggested that metastases of pleomorphic adenomas may be the first stage in the transformation of a tumor into a carcinoma, though this does not occur in. Primary pleomorphic adenoma of the external auditory canal. A complete surgical excision with clear or wide margins is the preferred mode of treatment of pleomorphic adenoma of salivary gland. A pleomorphic adenoma is a tumour of a gland that produces saliva in the mouth. A pleomorphic adenoma is a benign overgrowth arising from the salivary gland tissue and it is a painless hard, mobile, solitary mass. Surgery, radiotherapy, chemotherapyis the treatment of choice. In rare cases these tumors can sometimes become malignant carcinoma ex pleomorphic adenoma and will grow rapidly, cause pain and could become lifethreatening. This article presents a case of pleomorphic adenoma of the palatal minor salivary gland treated successfully by surgical excision. Although pa most commonly occurs in the parotid gland 85% cases, it may involve submandibular 8%, lingual and minor salivary glands. Surgical excision is the recognized treatment as around 16. Pleomorphic adenoma is the most common of all salivary gland neoplasms, at almost 50% of tumors.
Preferentially, 90% of these tumors occur in the parotid gland and the other 10% occur in the minor salivary glands. Morbidity increases due to the total displacement of the tumor without its capsule and incisional biopsy for the purpose of diagnosis. If yes, where can i get it done and what is the expected cost of the surgery. Some choose to leave them untreated but if not treated some of the pleomorphic adenoma can experience malignant changes because. Alternative treatments for pleomorphic adenoma answers. Which statement is most accurate about these tumors. Surgical management of pleomorphic adenoma of parotid. Friedlander on pathophysiology of pleomorphic adenoma. 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 capsule. It is found mostly in the parotid gland in middleaged women.
The surgical treatment of benign tumor of the parotid gland can consist of enucleation, extra capsular. Treatment of patients with recurrent pleomorphic adenoma of the parotid gland is a challenge for a surgeon due to frequent problems with complete resection of all tumour foci while preserving. A limited number of cases with lacrimal pleomorphic adenoma were reported. Recurrent pleomorphic adenoma of the parotid gland. Pdf clinical profile and management of pleomorphic adenoma of. Pleomorphic adenoma symptoms, causes, treatment, surgery.
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. The objective of this study was to clarify the clinical presentation and treatment of pa of the eac. 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. Pleomorphic adenoma of the lacrimal gland with extensive. 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. Treatment of the benign tumor is essential is preventing a malignant tumor from occurring. Malignant transformation, though rare, has been reported. Pleomorphic adenoma pa is the most common benign tumor affecting both major and minor salivary glands.
Surgical treatment of recurrent pleomorphic adenoma of the. Management and prognostic factors of recurrent pleomorphic. Immunohistochemical pattern of pleomorphic adenoma. The treatment is surgical and there are two main different surgical approaches. Mixed tumour of the salivary gland or the pleomorphic adenoma is a benign tumour, arising mainly in the major salivary glands 65%, especially in the parotid and, less frequently, in accessory salivary glands 35% 1. Pathophysiology of pleomorphic adenoma doctor answers. Carcinoma ex pleomorphic adenoma cxpa is defined as a carcinoma. Management of the parotid pleomorphic adenoma, the problem of. Pleomorphic adenoma presents as a painless and slowly growing mass and also as exophthalmoses. When tumors involve the parotid gland, a superficial parotidectomy is the treatment of choice. 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.
International journal of otorhinolaryngology and head and neck surgery november december. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Pleomorphic adenoma of lacrimal gland pdf paperity. Treatment of recurrent pleomorphic adenoma must be individualized. View large image view hires image download powerpoint. Pleomorphic adenoma must be considered for the patients whose clinical course lasts for 12 months.
Therefore, enucleation or local dissection of the pleomorphic adenoma is not a sufficient surgical treatment of this special tumor entity. The management, pathology and treatment are discussed with emphasis on the. Survey of opinions on the management of pleomorphic adenoma. Pleomorphic adenoma the name of this tumour attempts to describe the unusual histopatholgy but terms are not correct. Download fulltext pdf pleomorphic adenoma of the lacrimal gland article pdf available in british journal of ophthalmology 767. Pleomorphic adenoma is the most common benign salivary gland neoplasm. This case study illustrates an unusual condition in childhood, pleomorphic salivary adenoma in a 12yearold.
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. It is a benign tumour with a slow and continuous growth and without treatment can assume. Clinical significance of the tumour capsule in the treatment of parotid pleomorphic adenomas. Pleomorphic adenoma constitutes one of the common salivary gland tumors. Histologically, it is characterized by the presence of cellular pleomorphism and is composed of an epithelial and connective tissue.
Nasopharyngeal pa is very rare, and a total of 8 cases have been. Most recurrent pleomorphic adenoma are multinodular. Salivary gland tumors are rare among all head and neck tumors. The main difference is the higher risk of facial nerve damage in the former, with unexpected permanent facial nerve paralysis in more than 30% of cases 24. Prognostic factors affecting the clinical outcome of. On the basis of a statistical comparison, the third phase proved to be the most effective in the differential diagnosis between pleomorphic adenoma and nonpleomorphic adenomas, both for the assessment of the degree of. Giant presentation of pleomorphic adenoma in major. Pleomorphic adenoma in the parotid gland mayo clinic proceedings. Although basic pattern of the tumour is variable, individual cells are not pleomorphic. Eightyfive percent of salivary gland tumors of the parotid gland are pleomorphic adenomas. The stroma may be chondroid, myxoid, osteoid, or fibroid. Rare cases have been reported in the lip 2, the hard and soft palate 3, the lacrimal gland 4, and the external auditory canal 5. Pleomorphic adenoma pa is the most commonly seen subtype, and 85% of the cases are located in the parotid gland.
Friedlander on alternative treatments for pleomorphic adenoma. Our goal was to investigate the prognosis of cxpa in the major salivary glands and factors influencing it. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Primary pleomorphic adenoma of minor salivary gland in the. They cannot be cured but the side effects of each hyper or hypotension, hirsutism or virilization, etc can all be controlled by blocking the over or underactivity of the pathway steroids leading to. Surgical excision is the only treatment of pleomorphic adenoma. In such cases, it is critical to make a definite diagnosis as each of these tumors has an entirely different treatment protocol. Another big consideration is if the benign tumor has become malignant.
The parapharyngeal space is very rare site for this tumour. Etiology and management of recurrent parotid pleomorphic. Among minor salivary glands, palate is the most commonly affected site followed by lips, cheeks, gingiva, floor of the mouth, and tongue. The growth is usually mobile unless found in the palate and when found in the parotid tail, it is present as an eversion of the ear auricle. Complications of treatment of rpa are similar to those for primary surgery for parotid pleomorphic adenoma.
Fine needle aspiration biopsy confirmed pleomorphic adenoma. Pleomorphic adenoma is the most common tumor of salivary glands. Pdf pleomorphic adenoma is the most common neoplasm of the parotid gland this study was carried out to. Pleomorphic adenoma definition of pleomorphic adenoma by. Siegmar reinert, in maxillofacial surgery third edition, 2017. Surgical management includes total parotidectomy, superficial parotidectomy and extracapsular dissection. Surgical management of pleomorphic adenoma of parotid gland in elderly patients.
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