Although pleomorphic adenomas most commonly occur in the parotid gland, it may also be encountered in the submandibular, lingual, and minor salivary glands. 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 adenoma, also known as benign mixed tumor is the most common tumor of the salivary gland accounting for 6080% of the benign variety. The treatment of pleomorphic adenoma is surgical excision. The patient presented with a slowly progressing asymptomatic swelling on the left side of the face. Pleomorphic adenoma is the most common salivary gland tumor and accounts for approximately 80% of parotid tumors. Ballance wa, ro jy, elnaggar ak, grignon dj, ayala ag, romsdahl mg.
Tumors of the salivary glands, though uncommon, are not that rare and constitute an important field in oral maxillofacial pathology. Metastasizing pleomorphic adenoma is the third type of malignant mixed tumor of salivary glands and is the rarest. Though much less likely to occur than pleomorphic adenoma, warthins tumor is the second most common benign parotid tumor. It accounts for 4045% or more of minor salivary gland tumors. 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.
Histologically, within a fibrous capsule, the pleomorphic adenoma is composed of an extremely variable mixture of epithelial and myoepithelial elements. Benign mixed tumors bmts, is a benign or a noncancerous growth in the salivary gland. Events related to secretion of macromolecules and absorption, responses to the altered microenvironment and controversies concerning epithelialmesenchymal transition versus modified myoepithelial differentiation are explored. Marginal mandibular nerve weakness ramus mandibularis level i neck dissection extended recurrent pleomorphic adenoma. Case example deep lobe parotid tumor parapharyngeal space pleomorphic adenoma. Lutfi kirdar kartal education and research hospital, ent department, istanbul, turkey. Histologically, the tumors were characterized by cystic spaces, tumor cords with beading, tubule formation, and by the presence of luminal. Salivary gland tumors comprise only 3% of all neoplasms of head and neck region and show diverse histology. The epithelial cells make up a trabecular pattern that is contained within a stroma. It progresses slowly and, left untreated, can produce signi.
The malignant component can be of any histologic type, but salivary duct carcinoma is the most common histologic type seen. Warthins tumor is highly unlikely to become malignant. 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. Printable pleomorphic adenoma of the breast surgical. The gland most likely affected is the parotid gland. Salivary gland tumors are rare, comprising less than 3% of all neoplasia of the head and neck region.
Pleomorphic adenoma of the breast surgical pathology. The stroma may be chondroid, myxoid, osteoid, or fibroid. In addition to carcinoma ex pleomorphic adenoma, true malignant mixed tumors of the salivary glands usually arise from preexisting pleomorphic adenomas 1,3. Histologically, the lesion demonstrates both epithelial and mesenchymal elements. Pleomorphic adenomas are benign and tend to increase in size slowly. The term pleomorphic adenoma describes a being tumor with varied histologic appearances and consists of epithelial and mesenchymal tissues of possible myoepithelial lineage.
We present 4 cases of carcinoma ex pleomorphic adenoma of the parotid gland. May 30, 2012 within the background of pleomorphic adenoma, the carcinoma cells sometimes replaced ductal luminal cells while retaining an intactlike myoepithelial layer. Pdf fine needle aspiration cytology of pleomorphic adenoma. They occur over a wide age range but the peak incidence is in 6th to 7th decades with a slight female predominance. Histopathology of pleomorphic adenoma in the parotid gland. Received is a single container consists of a rubbery nodule weighing 26 g and measuring 5 x 4. However, there is evidence to support the more conservative approach of. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported.
Pleomorphic adenoma definition of pleomorphic adenoma by. It is the most common salivary gland tumor, with a slight. Pleomorphic adenoma is the most common amongst these, comprising 60 70% of all parotid tumours. Pleomorphic adenoma of the breast definition rare breast neoplasm with epithelial, myoepithelial and chondromyxoid components identical in appearance to pleomorphic adenoma of the salivary gland. It is found mostly in the parotid gland in middleaged women. Pleomorphic adenoma of the salivary glands radiology. Invasive salivary duct carcinoma ex pleomorphic adenoma of. Pleomorphic adenoma benign mixed tumor of the breast. Carcinoma ex pleomorphic adenoma is a malignant salivary gland tumor that arises in association with pleomorphic adenoma. Pleomorphic adenoma is by far the most common salivary gland tumors comprising 50%60% of all salivary gland neoplasm and approximately 60%80% of parotid gland neoplasm. Dec 14, 2019 the etiology of metastasizing pleomorphic adenoma is not clearly understood, but a number of theories have been put forward. Malignant transformation, though rare, has been reported.
On the 1 year followup there is no recurrence or complaint detected. Recurrent pleomorphic adenoma of submandibular region aydin s1, demir mg2, akbulut s1, alt. Monomorphic adenoma definition of monomorphic adenoma by. Pleomorphic adenoma pa, also known as benign mixed tumor, is the most common salivary. Department of oral and maxillofacial pathology, school of dentistry. Histopathological findings of pleomorphic adenomas of the salivary. Functional histology of salivary gland pleomorphic adenoma. Histology residual pleomorphic adenoma carcinoma component specific salivary carcinoma any type ad i nos 68 adenocarcinoma, nos ihc specific to type of carcinoma carcinoma ex pleomorphic adenoma 69. Histologically, isomorphic cells in nests and interlaced trabecules with a prominent basal membrane are observed. Here we are presenting a case of giant pleomorphic adenoma of the parotid, being the largest in size to be excised in pakistan in. Pleomorphic adenoma an overview sciencedirect topics. Pleomorphic adenoma, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms. The tumor can occur at any age but it is most common in young and middle aged adults between the ages of 30 60.
Carcinoma ex pleomorphic adenoma of the parotid gland. In fact, it is the only tumor virtually restricted to the parotid gland. Semiology and oral pathology, dental school, university of. Panorama of pleomorphic adenoma in a series of patients. Benign neoplasms of salivary glands i webpathology. Pleomorphic adenoma is the most common benign salivary gland neoplasm.
Imaging characteristics of recurrent pleomorphic adenoma of. The gross appearance of pleomorphic adenoma is that of a firm smooth mass within a pseudocapsule. 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. 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. Pleomorphic adenoma benign mixed tumour of the salivary glands. Salivary gland tumours are a relatively rare entity. To assess the value of fine needle aspiration cytology fnac in the diagnosis of pleomorphic adenoma and to determine the cytologic variations responsible for diagnostic errors.
Therefore, we finally made a diagnosis of invasive salivary duct carcinoma ex pleomorphic adenoma. These cancerous transformations are known as carcinoma ex pleomorphic adenoma or malignant mixed tumor. Some choose to leave them untreated but if not treated some of the pleomorphic adenoma can experience malignant changes because of them recurrence. Histopathology, pleomorphic adenoma, salivary gland neoplasms. Recurrent pleomorphic adenoma of submandibular region. Pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. Pdf histopathological findings of pleomorphic adenoma of. Clinical features pleomorphic adenoma in the minor salivary glands presents as an asymptomatic, slowgrowing, firm swelling, 23 cm in size fig. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. Conclusions almost all pleomorphic adenomas have focally thin capsules. Surgery is the most common form of treatment for pleomorphic adenoma. An appraisal article in head and neck pathology 93 november 2014 with 60 reads how we measure reads.
Discussion pleomorphic adenoma appears as a painless slowly growing firm mass. Pleomorphic adenoma surgery, symptoms, causes, treatment. The complex microstructure of salivary gland pleomorphic adenoma is examined in relation to function. Pleomorphic adenoma symptoms, causes, treatment, surgery.
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