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. Multiple primary pleomorphic adenomas in a single parotid gland. Pleomorphic adenoma is the most common benign parotid gland tumor. Here we are presenting a case of giant pleomorphic adenoma of the parotid, being the largest in size to be excised in pakistan in. It is a benign tumor with a slow and continuous growth that without treatment can reach an enormous size. Carcinoma ex pleomorphic adenoma cxpa is an uncommon malignant tumor with highly aggressive biological behavior. Pictures and imaging of parotid pleomorphic adenoma. Pleomorphic adenoma is the most common tumor of minor salivary glands, the palate being a. Usdj 2019 volume 3 issue 1 48 pleomorphic adenoma a diversified bizzare tumor bhardwaj n1, kaur s2 1pg student hids paonta sahib, 2 general dentist abstract pleomorphic adenoma is a lesion which accounts for the vast majority of all salivary tumors pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland. It has epithelial, myoepithelial, and stromal components. Family history of myh gene associated polyposis inherited condition causes high risk of.
Primary pulmonary pleomorphic adenoma is a very rare benign tumor that tends to arise in the large airways tumors tend to show small, branching, double layered ductules rather than ducts and less cartilaginous stroma as compared to pleomorphic adenomas arising in the salivary gland. Histogenesis of salivary gland pleomorphic adenoma mixed. It authorizes a categorization of these masses into benign and malignant ones with a good correlation to histopathology. Pleomorphic adenoma arising from heterotropic salivary. Pleomorphic adenoma, the most common salivary gland tumor, is also known as benign mixed tumors bmts, because of its dual origin from. The putative pleomorphic adenoma gene plag1 has been mapped to chromosome 8q12 neville et al. Dec 14, 2019 the etiology of metastasizing pleomorphic adenoma is not clearly understood, but a number of theories have been put forward. The patient presented excellent cosmetic and functional results, without signs of facial nerve palsy, damage or recurrence.
Some of the rarer subtypes of this tumor may have a misleading clinical presentation. Family history of high grade adenoma of colon diagnosed under age 60 in first degree relative. Pleomorphic adenoma is the most common salivary gland tumor and accounts for approximately 80% of parotid tumors. Pleomorphic adenoma, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms. Pdf pleomorphic adenoma of parotid in a young patient. The tumor can occur at any age but it is most common in young and middle aged adults between the ages of 30 60. Parotid gland pleomorphic adenoma with floretlike tyrosinerich. Pleomorphic adenoma of the cervical heterotopic salivary. Our goal was to investigate the prognosis of cxpa in the major salivary glands and factors influencing it. Histopathological findings of pleomorphic adenomas of the.
Cells with oncocytic change are a common finding in salivary glands and. Pleomorphic adenoma is considered the most common benign salivary gland tumor in this location. Pleomorphic adenomas of the nasal cavity were found to be extremely rare in this nationwide investigation. Pleomorphic adenoma definition of pleomorphic adenoma by. Pleomorphic adenoma is the most common amongst these, comprising 60 70% of all parotid tumours.
Department of otorhinolaryngology head and neck surger y, guys hospital, great maze pond road, london se1 9rt, united kingdom. Sox10 was highly and frequently expressed in tumors exhibiting similarities to acini and intercalated ducts eg, acinic cell carcinoma, adenoid cystic carcinoma, pleomorphic adenoma, epithelial. Recognition of these variants is important since longstanding pleomorphic adenomas. Histogenesis roughly 70% pleomorphic adenomas have cytogenetic alterations that likely play a central role in the tumourogenesis and can be stratified into 4 groups. One of the most common of these tumors in the parotid gland is a pleomorphic adenoma. Nose, nasal tumour, pleomorphic adenoma, diagnosis, histopathology. Oncocytic pleomorphic adenoma of the parotid gland oncocytic pleomorphic adenoma of the parotid gland pulitzer, donald r reitmeyer, william j.
Symptoms associated with pleomorphic adenoma parotid tumor. Pleomorphic adenoma pa, the most common salivary gland tumor, accounts for 54 to 65% of all salivary gland neoplasias and 80% of the benign salivary. An unusual variant of a common palatal salivary gland. Benign tumors in major salivary glands are frequently found in the parotid gland in 70% to 80% of cases. It is found mostly in the parotid gland in middleaged women. Clinical characteristics of pleomorphic adenoma of salivary glands among jordanian patients nemer alkhtoum, abed rabou qubilat, sulaiman alzaidaneen, mefleh al sarhan, ahmad alqudah abstract objective. Pleomorphic adenoma is the most common benign salivary gland tumor, accounting for almost threefourths of all such tumors. A case of pleomorphic adenoma of the parotid gland with. The prognosis is generally good after the surgical removal, however, there is an increased incidence of recurrence particularly if the parotid gland is affected.
Parotid gland tumors represent 23% of head and neck tumors and 0. Here we report a case of a young female 25 years old with pleomorphic adenoma of the parotid gland. Histogenesis of benign pleomorphic adenoma mixed tumor. Pleomorphic adenoma of salivary gland and synchronous. A case of lipomatous pleomorphic adenoma in the parotid gland. 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. A large duct passes out of parotid gland and carries saliva into the oral cavity. From our clinical data and previous reports of pleomorphic adenomas with focal oncocytosis, it is concluded that such changes likely do not alter prognosis in affected patients.
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. Recurrent pleomorphic adenoma of submandibular region. A 53yearold man had fine needle biopsy of a left parotid mass showing cellular components with mucoid material consistent with pleomorphic adenoma. Immunohistochemical pattern of pleomorphic adenoma. Pleomorphic adenoma is the most common benign salivary gland neoplasm. Pleomorphic adenoma benign mixed tumor of the salivary glands is a benign, slowly growing neoplasm that has a predilection to the parotid where 80% of these tumors arise. Lutfi kirdar kartal education and research hospital, ent department, istanbul, turkey. It constitute approximately 7080% of benign parotid gland tumors. The pleomorphic adenoma is the most frequent salivary gland tumour ellis, auclair, 1996. The overlapping histomorphologic structure of the basal cell adenoma variants with other recognized adenomas, such as pleomorphic adenoma and myoepithelioma, emphasizes relative differentiation toward 3 phenotypes, eg, ductal luminal, basal, and myoepithelial cells in varying proportions. Discussion pleomorphic adenoma appears as a painless slowly growing firm mass.
Dec 26, 2014 the epithelial cells make up a trabecular pattern that is contained within a stroma. Pleomorphic adenoma of the minor salivary glands most commonly occurs in the palate 16. Pleomorphic adenoma of the salivary glands radiology. Carcinoma ex pleomorphic adenoma ca ex pa is a type of cancer typically found in the parotid gland.
Differential diagnosis of pleomorphic adenoma by immunohistochemical means volume 105 issue 12 toshiro nishimura, mitsuru furukawa, ei kawahara, atsuo miwa. 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. Pleomorphic adenoma, the most common salivary gland tumor. Pleomorphic adenoma with extensive squamous metaplasia and. The stroma may be chondroid, myxoid, osteoid, or fibroid. Pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. Histopathological findings of pleomorphic adenomas of the salivary glands fabio augusto ito, jacks jorge, pablo agustin vargas, marcio ajudarte lopes semiology and oral pathology, dental school, university of campinas, piracicaba, sp, brazil. The aim of this study is to report a case of an unusual minor salivary gland pleomorphic adenoma in the hard palate, describing the most important aspects of this. A unique case of benign pleomorphic adenoma metastasizing to the thyroid gland and liver mufaddal moonim1, katherine wiles1, alia nasir2, ricard simo1 1. The pleomorphic adenoma is the most common tumour of glandular origin in the head and neck. Pleomorphic adenoma of the breast is a rare, benign tumor accounting for 68 cases in the literature. Oncocytic pleomorphic adenoma of the parotid gland. Pleomorphic adenoma 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. It is most commonly seen in postmenopausal women and is characterized by an admixture of epithelial and myoepithelial cells embedded in abundant myxomatous stroma.
About 90% of these tumors occur in the parotid gland and 10% in the minor salivary glands. Although pleomorphic adenomas most commonly occur in the parotid gland, it may also be encountered in the submandibular, lingual, and minor salivary glands. Pleomorphic adenoma surgery, symptoms, causes, treatment. Lam rmy 1984 an electron microscopic histochemical study of the histogenesis of major salivary gland pleomorphic adenoma. It is the most common salivary gland tumor, with a slight.
Pleomorphic adenoma pa is the most common type of all salivary gland tumors. Parotid pleomorphic adenoma is the most common slowgrowing benign neoplasm of the salivary glands. Pleomorphic adenomas are the commonest tumors of the salivary glands. Salivary gland tumors are relatively common in the junction of the hard and soft palate area of the oral cavity. Most often, however, it is due to the blockage of salivary ducts, which inhibits saliva drainage from the glands. Multiple primary pleomorphic adenomas in a single parotid. Mr imaging mri is the method of choice for the characterization of parotid gland tumors. On the 1 year followup there is no recurrence or complaint detected. Though it is classified as a benign tumorpleomorphic adenomas have the capacity to grow to large proportions and may undergo malignant transformation, to form carcinoma ex pleomorphic adenomaa risk that increases with time 9. Pleomorphic adenoma is the most common benign neoplasm of the salivary glands. Benign tumour polymorphous low grade adenocarcinoma plga rare lesion 23% of benign s.
Pleomorphic adenoma may show various architectural and cytologic features that resemble other salivary tumors identifying areas typical of pleomorphic adenoma with triphasic ductal, myoepithelial and stromal components is helpful to establish the diagnosis squamous cell carcinoma. The patient presented with a slowly progressing asymptomatic swelling on the left side of the face. You are advised to consult the publishers version publishers pdf if you wish to cite from it. If yes, where can i get it done and what is the expected cost of the surgery. Clinical characteristics of pleomorphic adenoma of. Plag1 gene alterations in salivary gland pleomorphic. A case presentation of pleomorphic adenoma authorstream. Metastasizing pleomorphic adenoma is the third type of malignant mixed tumor of salivary glands and is the rarest.
To evaluate the incidence of salivary gland pleomorphic adenoma in jordanian patients. A case report of 28 year old male patient diagnosed of pleomorphic adenoma of palate, is presented here. Figure 1 a,b serial sections showed the tumor was surrounded completely by lymphoid tissues similar to those of the cortex of lymph. Symptoms the pleomorphic adenoma starts creating facial symptoms in case of malignant tumors based on the place where its formed itself. Pleomorphic parotid adenoma benign tumor of the parotid. 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. The tumor developed within an ectopic parotidtype salivary gland. This is the sixth case of lipomatous pleomorphic adenoma in the english literature. Case report giant pleomorphic adenoma of the parotid gland with a. Immunohistochemistry stresses the similarity between pleomorphic adenoma of salivary gland and breast. It is often firm, nodular, painless and almost always unilateral. Pleomorphic adenoma, also called benign mixed tumor, is the most common tumor of the salivary glands. Pleomorphic adenoma benign mixed tumor is the most common neoplasm of the salivary glands.
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. A case of lipomatous pleomorphic adenoma in the parotid. In the early stages a pleomorphic adenoma is usually painless but as they start to grow larger these tumors can start to cause complication in your ears or mouth. Twentytwo benign pleomorphic adenomas of the major salivary glands were studied by transmission electron microscopy and immunohistochemical techniques three cases in order to characterize the cell types comprising the epithelial and socalled mesenchymal regions of the tumors. Pleomorphic adenoma symptoms, causes, treatment, surgery. Pleomorphic adenoma is a benign, slowgrowing neoplasm that most commonly affects the parotid gland. A unique case of benign pleomorphic adenoma metastasizing. Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by. Pleomorphic adenoma of breast, unusual in its location. Hence, the final diagnosis was of giant pleomorphic adenoma with negative surgical margins. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. They originate from an uncommitted reserve cell of the intercalated duct which has the potential to differentiate into epithelial and myoepithelial cells 25. Conclusion a large pleomorphic adenoma of the nasal septum may show characteristic ct and mr.
Oct 25, 2007 even though many hypotheses for recurrences of parotid gland pleomorphic adenoma have been advanced, including cell biological and genetic factors 2, 3, obvious or underestimated tumor spillage, incomplete excision, and violation of the pseudocapsule of the tumor are considered the only proven reasons contributing to recurrent disease. Surgical management of pleomorphic adenoma of parotid gland. Those with 8q12 rearrangements those with 12q15 rearrangements those with miscellaneous clonal changes those that are karyotypically normal. The possible significance of this lesion in regard to the histogenesis of salivary gland pleomorphic adenomas is discussed. What links here related changes upload file special pages permanent link page.
Although the pleomorphic adenoma is normally benign it does have the potential to become cancerous, also referred to as malignant. The specimen was then submitted for paraffin embedding. A common histogenesis of the two entities is also suggested. We observed an unusual and clinically unsuspected pleomorphic adenoma developing in the anterior midcervical region of a young man. Eighty per cent of pleomorphic adenomas of this particular gland are benign, and 20 per cent are cancerous. Prognostic factors affecting the clinical outcome of. Malignancy was strongly suspected in the light of radiologic features.
Although ulceration and pain sometimes hamper speech and swallowing in cases of benign salivary gland tumors, 8,9 our study of 60 cases of submandibular gland pas showed that these pas have few clinical signs or symptoms besides painless swelling. Pleomorphic adenoma in the nasal cavity university of helsinki. Health, general adenoma case studies cancer research mouth cancer parotid glands physiological aspects. Imaging characteristics of recurrent pleomorphic adenoma of. Mri through the left parotid gland demonstrates a sharply circumscribed solid mass in the superficial aspect of the gland. Patient was referred to general surgery department of govt medical college, where surgical excision was done. The wide range of morphologic expression evident in pleomorphic adenoma would appear to be the result of a number of factors. In such cases, it is critical to make a definite diagnosis as each of these tumors has an entirely different treatment protocol.
Factors associated with pleomorphic adenoma can include chain smoking and radiation exposure. Management and prognostic factors of recurrent pleomorphic. Herein, a rare case of lipomatous pleomorphic adenoma arising in the parotid gland. Pleomorphic adenomas can occur at any age, but most common in young and middle aged adults, between 30 to 60 years. Family history of adenoma benign tumor of the colon diagnosed before age 60. Pleomorphic adenoma is the most common benign tumor of the salivary glands. Salivary gland pleomorphic adenoma in the netherlands rug. It has marked histological diversity with epithelial, myoepithelial and mesenchymaltype cells arranged in a. Pleomorphic adenoma is the most common neoplasia of the salivary glands. There was a thin layer of lymphoid tissue at the periphery of the pleomorphic adenoma. In addition to carcinoma ex pleomorphic adenoma, true malignant mixed tumors of the salivary glands usually arise from preexisting pleomorphic adenomas 1,3. Discussion pleomorphic adenoma pa is a benign salivary gland tumour. Pleomorphic adenomas are benign and tend to increase in size slowly. Pleomorphic adenoma an overview sciencedirect topics.
Like any structure in the body, the parotid gland is prone to the formation of abnormal growths which may either be benign or malignant. Although its local recurrence rate is known to be high, the recurrence extending to the cervical region is rare. Most reported pa of parotid gland occur in the superficial lobe and present as a swelling on the ramus. It progresses slowly and, left untreated, can produce signi. Pleomorphic adenoma is a benign tumor in the salivary gland.
It arises from the benign tumour pleomorphic adenoma its prognosis depends on the stage. Herein, a rare case of lipomatous pleomorphic adenoma arising in the parotid gland of a 14yearold japanese woman is presented. Statistical data included by ear, nose and throat journal. In conclusion, we suggest to better investigate early genetic alterations that could underlie of the synchronous occurrence of these lesions. Recurrent pleomorphic adenoma of submandibular region aydin s1, demir mg2, akbulut s1, alt. It is isointense to muscle on t1 and strikingly hyperintense on t2.
They are benign except for a rare carcinoma ex pleomorphic adenoma but are not always completely encapsulated and show a definite tendency to recur after excision, in which case recurrence represents local growth because of incomplete excision and not malignancy. Thus, when a multilobular tumor of the nasal septum exhibiting curvilinear enhancement and small. Salivary glands represent the place of some tumoral localisations relatively rare as compared to other frequent localisations, affecting 34 people of 100. Pleomorphic adenoma of the breast archives of pathology. Get a printable copy pdf file of the complete article 4. Ultrastructural studies tllough it is clear that electron inicroscopic studies imve aided in elucidating tim types of cells involved in pleomorphic adenomas of salivary gland origin, the variety and proportion of cells noted in these tumors and tim interpretation of tlmir relative roles have undoubtedly caused diftculties in ap preciating the histogenesis of pleomorphic adenoma. Extensive lipomatous involvement of the tumor is, however, a very rare finding. Diagnostic value of mr imaging of parotid gland tumors. One hundred thirty pleomorphic adenomas were identified, and 6 of these contained. Effective chemotherapy for submandibular gland carcinoma ex pleomorphic adenoma with lung metastasis after radiotherapy. We present a case of a 37yearold man presenting with a 1. A pleomorphic adenoma generally occurs in adults between 45 and 60 years old, and is diagnosed more often in females than in males. 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 is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. Pleomorphic adenoma clinical features incidence of malignant transformation increases with duration of tumour 2% for tumours less than 5 years 10% for tumours more than 15 years duration usually adenocarcinoma or undifferentiated carcinoma tumours are very aggressive for a diagnosis of carcinoma ex pleomorphic adenoma, recognizable traces of. T rise within sg tissue, common parotid 78% composed of cellular elements oncocytes. Effective chemotherapy for submandibular gland carcinoma ex. A pleomorphic adenoma is a tumour of a gland that produces saliva in the mouth. Frequently, this appears in the front region of the parotid portion of the salivary glands and also begins damaging the facial nerves. It derives its name from the architectural pleomorphism variable appearance seen by. Squamous metaplasia in a pleomorphic adenoma pa has been reported, but rarely has it been documented as being extensive enough to cause significant misdiagnosis. Salivary gland basal cell and canalicular adenomas.
680 786 16 1172 488 371 632 1332 1266 214 1404 413 726 1304 211 975 1388 217 631 271 32 913 1376 639 378 1141 1209 1188 833 937