The diagnosis of a pleomorphic adenoma was established by ultrasonography, head and neck ct or mri, and fnac fine needle aspiration cytology or. Pleomorphic adenomas of the salivary gland can occur at any site where salivary gland tissue is present. On the other hand, we have that80% of salivary tumors occur in the parotid, the 10 to 15% in the submandibular gland and between 5 and 10% in. The attenuation value of the mass is higher than that of the surrounding gland. It is a benign tumor composed of epithelial and myoepithelial cells arranged in various morphological patterns. The anatomy and description of the parotid tail is confusing as it is not a distinct anatomical entity. Sep 04, 2019 superficial parotidectomy remains the initial procedure of choice for benign parotid gland tumors. Hamilton et al define the tail of the parotid gland as inferior 2 cms of the superficial lobe of the gland.
Pleomorphic adenoma is a benign, slowgrowing neoplasm that most commonly affects the parotid gland. Basal cell adenoma versus pleomorphic adenoma of the. Siegmar reinert, in maxillofacial surgery third edition, 2017. Because of its propensity for invasion, pleomorphic adenoma of the parotid.
Pdf, epub, full text, audio unceasing customer service. Pleomorphic adenoma arising from the tail of the parotid. Like any structure in the body, the parotid gland is prone to the formation of abnormal growths which may either be benign or malignant. Parotid gland pleomorphic adenoma with floretlike tyrosinerich. Our series of primary surgery cases with standardised parotidectomy technique in a university hospital were evaluated. Hyalinizing clear cell carcinoma arising in recurrent pleomorphic adenoma of parotid gland.
Patients with a pleomorphic adenoma of the parotid gland treated between january 2003 and june 2012 were included in this retrospective cohort study. Bilayered strands or ribbons of columnar cells with loose, well vascularized stroma. Clinically, they usually present as a painless palpable mass, indistinguishable from other salivary gland tumors, including pleomorphic adenoma, the most. 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.
The adenoma presents as a small, mobile, slowly growing, painless mass of 26 cm. A 53yearold man had fine needle biopsy of a left parotid mass showing cellular components with mucoid material consistent with pleomorphic adenoma. It is the most common type of salivary gland tumor, which accounts for upto two thirds of all the salivary gland neoplasms. Husseinb a department of oral and maxillofacial surgery, poole general hospital, long. 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. Ct of parotid tumors american journal of neuroradiology. Pleomorphic adenoma is considered as the most common benign salivary gland neoplasm, comprising about 50%74% of all parotid tu mours6,7. Case discussion right parotid gland benign looking tumor, consistent with pleomorphic adenoma. An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. A modified blair incision see the image below is often used. Differential diagnosis of pleomorphic adenoma by immunohistochemical means volume 105 issue 12 toshiro nishimura, mitsuru furukawa, ei kawahara, atsuo miwa. Pleomorphic adenoma of the parotid gland with extensive bone.
Pleomorphic adenoma of the parotid gland with extensive. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Distinct monomorphic adenoma with bilayered strands or ribbons of columnar cells with pure luminal ductal epithelial differentiation and loose, well vascularized stroma oral surg oral med oral pathol 1983. Optimal surgical management of parotid pleomorphic adenoma is important because of a considerable risk of tumour recurrence and complications. It is a benign tumor consisting of cells capable of differentiating to epithelial ductal and nonductal cells and. Thinning or absence of the pseudocapsule and the presence of fingerlike projections of the tumor have been observed in all histologic subtypes of pleomorphic. Palatal pleomorphic adenoma in a pediatric patient. Depending on the type of the insertion base, adenoma may be. Dec 14, 2019 pathology of metastasizing pleomorphic adenoma. Histologically, it is characterized by the presence of cellular pleomorphism and is composed of an epithelial and connective tissue component within a stroma of.
We report an unusual case of a huge tumor that measured 9. Pleomorphic adenoma pa is the most common salivary gland tumor and represents 60% to 73% of the parotid gland tumors, 40% to 60% of the submandibular and mi. This type of tumor accounts for the vast majority of all parotid tumors. Accurate localisation of these lesions on imaging is essential to assist the clinical diagnosis, to prevent inadequateincomplete excision and. British journal of oral and maxillofacial surgery 45 2007 6567 short communication metastasising pleomorphic adenoma of the parotid gland t. Salivary gland tumors are rare, comprising less than 3% of all neoplasms of the head and neck region 1 and are known by their complex microscopical features.
Types of benign parotid tumors pleomorphic adenoma. In most series, it represents 4575% of all salivary gland neoplasms. Feb 27, 2018 pleomorphic adenoma of the parotid gland. Pleomorphic adenoma or benign mixed tumor is the most common salivary gland neoplasm. Abstract hyalinizing clear cell carcinoma hccc is a neoplasm that predominantly affects the oral cavity in. Recurrent pleomorphic adenoma of the parotid gland request pdf. Pleomorphic adenoma is the most common benign salivary gland neoplasm. Nov 23, 2018 a metastasizing pleomorphic adenoma of salivary gland is an extremely rare form of pleomorphic adenoma that presents metastasis spread to other parts of the body. Pleomorphic adenoma is the most common of all salivary gland neoplasms, at almost 50% of tumors. During the surgery the part of the organ that is affected by the pleomorphic adenoma is removed referred to as surgical resection. Lesions of the tail of the parotid gland are difficult to assess clinically and provide a diagnostic dilemma on imaging, especially in the axial plane. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland.
Pdf recurrent pleomorphic adenoma of the parotid gland. It appears as a firm, painless and slow growing mass that is commonly diagnosed long after the lesion has started 4. The prognosis is generally good after the surgical removal, however, there is an increased incidence of recurrence particularly if the parotid gland is affected. Pleomorphic adenoma a salivary gland tumor as nasal mass. Jul 22, 2003 optimal surgical management of parotid pleomorphic adenoma is important because of a considerable risk of tumour recurrence and complications. 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. The diagnosis of a pleomorphic adenoma was established by ultrasonography, head and neck ct or mri, and fnac fine needle aspiration cytology or fnab. Adenoma is a benign tumor of glandular tissue, such as the mucosa of stomach, small intestine, and colon, in which tumor cells form glands or gland like structures. Pleomorphic adenoma is the most common neoplasm of the parotid gland. Pleomorphic adenoma symptoms, causes, treatment, surgery. A large duct passes out of parotid gland and carries saliva into the oral cavity. Usually in parotid gland or intranodal parotid gland, ectopic salivary gland in lymph nodes periparotid, cervical, cancer 1987. In an attempt to elucidate the malignant behavior of.
Because pleomorphic adenomas tend to grow over time and may become. Often cystic change, apocrine, mucous or pigmented cells histopathology 1999. In hollow organs digestive tract, the adenoma grows into the lumen adenomatous polyp or polypoid adenoma. Within medical history he does not refer to anything of importance. It has epithelial, myoepithelial, and stromal components. The neck nodule manifested itself 3 years after resection unreported case. Metastasising pleomorphic adenoma of the parotid gland. Pleomorphic adenoma pa, also known as benign mixed tumor, is the most common salivary tumor, constituting up to twothirds of all salivary gland neoplasms. Although pleomorphic adenomas most commonly occur in the parotid gland, they may also affect the submandibular, lingual and minor salivary glands. Pleomorphic adenoma of the parotid gland radiology case. It is the most common benign salivary gland in children and adults. Pleomorphic adenoma, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms.
Management and prognostic factors of recurrent pleomorphic. It derives its name from the architectural pleomorphism variable appearance seen by. One of the most common of these tumors in the parotid gland is a pleomorphic adenoma. A 29 years old gentleman with progressive swelling in the left parotid gland region. Pleomorphic adenoma pa represents 4574% of all salivary gland tumors and 65% of them occur in the parotid gland. Imaging characteristics of recurrent pleomorphic adenoma of. Basal cell adenoma is a rare benign epithelial tumor of the salivary gland, accounting for 12% of all salivary gland epithelial tumors. Superficial parotidectomy remains the initial procedure of choice for benign parotid gland tumors. The parotid, submandibular glands, and the minor salivary glands of the palate are commonly involved, and the sublingual gland is rarely affected 1,2. This case report aims to throw light on an interesting case of pleomorphic adenoma of the parotid gland in a 50 years old female patient. Pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland. May infiltrate capsule and exhibit extracapsular tumor islands.
Mostly, pa is located in the parotid glands 85%, minor salivary glands 10%, and the submandibular glands 5%. Pleomorphic adenoma of parotid gland with extensive bone. Pleomorphic adenoma of the parotid gland in children article in international journal of pediatric otorhinolaryngology 7111. The armed forces institute of pathology data of,749 salivary gland tumors showed 6,880 cases of pleomorphic adenoma, of which 4,359 were located in the parotid gland and 1,277 were located in minor salivary gland tissue auclair, ellis, and gnepp et al. Pleomorphic adenoma pa is the most common type of benign tumor of the salivary gland 1 2 3. In the majority of cases, tumors originate in the superficial lobe. The morphological complexity, exists among the tumor between individuals and glands, and. The present paper reports a case of pleomorphic adenoma pa in submandibular gland that, after more than 30 years of initial treatment, recurred and metastasized to ipsilateral neck lymph nodes and parotid gland.
Pleomorphic adenoma or benign mixed tumor, occur most frequently 85% in the parotid glands 2, followed by the minor salivary glands in 10% of the cases, and then by the submandibular glands at 5% 2. Introduction salivary gland tumors are rare and make up about 3% of all neoplasms of the head and neck. When tumors involve the parotid gland, a superficial parotidectomy is the treatment of choice. The tumor was a wellcircumscribed mass that measured 20. Discusses the case report of a patient with giant pleomorphic adenoma of the parotid gland. 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.
Surgical management of 246 previously untreated pleomorphic adenomas of the parotid gland. Pleomorphic adenoma occurs most commonly in the major salivary glands, 63% arising in the parotid gland, and most of these are seen in. Recurrent pleomorphic adenoma of the parotid gland. Although pleomorphic adenomas most commonly occur in the parotid gland, it may also be encountered in the submandibular, lingual, and minor salivary glands. Histopathological findings of pleomorphic adenomas of the.
Discussion pleomorphic adenoma appears as a painless slowly growing firm mass. Pleomorphic adenoma occurs most commonly in the major salivary glands, 63% arising in the parotid gland, and most of these arise in the superficial lobe. The image shows metastasizing pleomorphic adenoma of the skin on the lower anterior neck of a patient who had previously undergone resection of a right parotid pleomorphic adenoma. The incision usually starts just anterior to the ear helix, extends inferiorly below the ear lobe, and then continues onto the neck, parallelingbut staying at least 2 cm belowthe. Pleomorphic adenoma of the parotid gland in children. A metastasizing pleomorphic adenoma of salivary gland is an extremely rare form of pleomorphic adenoma that presents metastasis spread to other parts of the body. Buenting, john e smith, timothy l holmes, douglas k. Pleomorphic adenoma is the most common type of all benign and malignant salivary gland tumors, involving more frequently the. Benign parotid tumors are found in 65 75% of patients. Pleomorphic adenoma surgery, symptoms, causes, treatment.
Pleomorphic adenoma of parotid gland something about. Oct 25, 2007 pleomorphic adenoma is the most common neoplasm of the parotid gland. Materials and methods eleven patients aged 18 years and under were treated atchildrens hospital, bostonfrom 1983 to 2005 for pleomorphic adenoma of the parotid gland. More than 80% of basal cell adenomas arise in the major salivary glands, mostly the parotid gland. Plain ct showed a circumscribed solid lesion in the left parotid gland with a focus of calcification. Giant pleomorphic adenoma of the parotid gland med oral patol. Some adenomas grow from epithelial tissue in nonglandular areas but express glandular tissue structure as can happen in familial polyposis coli. B, warthin tumor in superficial part of left parotid g land. Although parotid gland constitutes 60% of all pleomorphic adenomas, minor salivary glands constitute only 8% of them 1. A, pleomorphic adenoma with slightly irregular margin in posteroinferior part of left parotid gland. Imaging characteristics of recurrent pleomorphic adenoma. Metastasizing pleomorphic adenoma of salivary gland. Among salivary gland neoplasms, metastasizing pleomorphic adenoma mpa constitutes an extremely rare group of tumors.
A complete surgical excision with clear or wide margins is the preferred mode of treatment of pleomorphic adenoma of salivary gland. The patient presented with a slowly progressing asymptomatic swelling on the left side of the face. Pedunculated lesions of the tail of parotid can be mistaken for an extra parotid lesion. Pleomorphic adenoma of the accessory parotid gland. It progresses slowly and, left untreated, can produce signi. Multiple primary pleomorphic adenomas in a single parotid gland. Pleomorphic adenoma of the salivary glands radiology. It is found mostly in the parotid gland in middleaged women. The tumor can occur at any age but it is most common in young and middle aged adults between the ages of 30 60. Unfortunately, if the tumor is in contact with the facial nerve, even a total parotidectomy can not guarantee the. 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.
Coexisting facial nerve schwannoma and monomorphic adenoma. Tumors of salivary and lacrimal glands, nasal fossa and maxillary sinus. Pleomorphic adenoma is the most common type of all salivary gland tumors, involving more frequently the parotid gland. How is pleomorphic adenoma of salivary gland treated. Pleomorphic adenoma an overview sciencedirect topics. It is the most common salivary gland tumor, with a slight. Pleomorphic parotid adenoma benign tumor of the parotid gland. Pleomorphic adenoma is the most common type of salivary gland tumor and the most common tumor of the parotid gland.
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