It is most commonly seen in postmenopausal women and is characterized by an admixture of epithelial and myoepithelial cells embedded in abundant myxomatous stroma. Pleomorphic adenoma of the salivary glands radiology. Pleomorphic adenoma arising from the epithelial rests of the salivary tissue in the lymph nodes of the parapharyngeal space is very rare. They contain both epithelial and myoepithelial mesenchymal tissues, with mixed histology. Pleomorphic salivary adenoma in an adolescent british. Metastasizing form of the pleomorphic adenoma is really rare but mortality is extremely high when detected as 22% 2. Pleomorphic adenoma pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. In cases of recurrent or longstanding pleomorphic adenomas, complementary radiologic studies to rule out metastasizing benign pleomophic adenoma are advised, such as a full body computed tomography ct scanning, magnetic resonance imaging mri andor positronemission tomography pet scanning. Pdf histopathological findings of pleomorphic adenoma of. Mostly, pa is located in the parotid glands 85%, minor salivary glands 10%, and the submandibular glands 5% 2.
Recurrent pleomorphic adenoma of submandibular region. Metastatic pleomorphic adenoma to the supraspinatus muscle. However, neoplasms in submandibular salivary glands were relatively uncommon. Pleomorphic adenoma pa is the most common benign mixed salivary gland neoplasm that accounts for 60% of all benign salivary gland tumors. Most of them are benign and pleomorphic adenoma is the commonest among them that involves both major 90% and minor 10% salivary glands. Carcinoma ex pleomorphic adenoma affects glandular structures, occurring mostly in major salivary glands and less commonly in the lacrimal gland. It progresses slowly and, left untreated, can produce signi. Pleomorphic adenoma of the lacrimal gland with extensive. Factors associated with pleomorphic adenoma can include chain smoking and radiation exposure. 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. This section of the tumor has a loose edematous appearance with cords and nests of cells interspersed. More importantly, they have a proven risk 515% of undergoing malignant transformation carcinoma ex pleomorphic adenoma, or malignant mixed tumor 3.
Pleomorphic adenoma pa, also known as benign mixed tumor, accounts for 45% to 74% of all major and minor salivary gland tumors and has been reported in other, less common sites such as the paranasal sinuses, larynx, palate, and nasal septum. Giant pleomorphic adenoma med oral patol oral cir bucal. In such cases, it is critical to make a definite diagnosis as each of these tumors has an entirely different treatment protocol. Mar 02, 2018 a carcinoma arising in a pleomorphic adenoma is referred to as a carcinoma ex pleomorphic adenoma caexpa or a malignant mixed tumor and conveys a poor prognosis. 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. Pleomorphic adenoma is the most common benign salivary gland neoplasm. During the surgery the part of the organ that is affected by the pleomorphic. Pleomorphic adenoma is the most common benign neoplasm of the salivary glands. Pleomorphic adenomas are seen rarely in children, with frequency rates of around 1.
Pleomorphic adenoma pa, the most common tumour of the salivary glands, mainly occurs in the parotid superficial lobe 85%, and less frequently in submandibular, lingual and minor salivary glands. Pleomorphic adenoma, abbreviated pa, is a very common benign salivary gland tumour. Pdf to describe the histopathological features of pleomorphic adenoma pa with. The risk of malignant transformation is only 5% of all cases.
Pleomorphic adenoma definition of pleomorphic adenoma by. Pleomorphic adenoma pa, also known as benign mixed tumor, is the most common salivary. Histopathology of pleomorphic adenoma in the parotid gland. May also occur in other major salivary glands submandibular and sublingual. However, pleomorphic adenoma has been reported to involve the minor salivary glands as well.
Extensive lipomatous involvement of the tumor is, however, a very rare finding. Pleomorphic adenoma an overview sciencedirect topics. Pleomorphic adenoma surgery, symptoms, causes, treatment. As a nuclear oncogene, plag1 encodes a developmentally regulated transcription factor and constitutes a subfamily of zinc finger proteins 2.
Carcinoma ex pleomorphic adenoma of the maxillary sinus. Seventyfive percent of pleomorphic adenomas transform into pleomorphic adenocarcinoma, while the rest transform into cystic carcinoma. Histopathological findings of pleomorphic adenomas of the salivary. Carcinoma ex pleomorphic adenoma diagnostic histopathology. Primary pleomorphic adenoma of the external auditory canal. We discuss the presentation, histopathologic picture, and management of this case. Pleomorphic adenoma, the most common salivary gland tumor. Functional histology of salivary gland pleomorphic adenoma. Pleomorphic adenoma pa is a benign tumour that mainly arises from the salivary glands. The term pleomorphic adenoma describes a being tumor with varied histologic appearances and consists of epithelial and mesenchymal tissues of possible myoepithelial lineage. Malignant transformation, though rare, has been reported. Also known as benign mixed tumours, pas comprise varying proportions of epithelial, myoepithelial and stromal components, and are encapsulated with a delicate pseudocapsule.
Pleomorphic adenoma pa, also known as benign mixed tumor, is the most common salivary tumor, constituting up to twothirds of all salivary gland neoplasms. The epithelial cells make up a trabecular pattern that is contained within a stroma. 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 10 pleomorphic adenoma incidence most common benign tumor clinical mass lesion 11 surgical treatment with margins pleomorphic adenoma gross bosselated chondroid histology. 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. 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. Pleomorphic adenoma symptoms, causes, treatment, surgery. The gross appearance of pleomorphic adenoma is that of a firm smooth mass within a pseudocapsule. Materials and methods fifty cases diagnosed as pleomorphic adenoma on fnac in which histopathology was available were retrieved from the archives of the pathology department.
Malignancy arising from a pleomorphic adenoma diagnosis either 1 or 2. Salivary gland tumors are relatively uncommon tumors, accounting approximately 310% of head and neck neoplasm. 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. Carcinoma ex pleomorphic adenoma arises from pleomorphic adenoma in a multistep process with genetic alterations of, for example, plag1, hmga2, or mdm2. Differential diagnosis of pleomorphic adenoma by immunohistochemical means volume 105 issue 12 toshiro nishimura, mitsuru furukawa, ei kawahara, atsuo miwa. Pleomorphic adenoma presents as a painless and slowly growing mass and also as exophthalmoses. Although pleomorphic adenomas most commonly occur in the parotid gland, it may also be encountered in the submandibular, lingual, and minor salivary glands. In this report, we present two cases of pleomorphic adenoma originating from minor salivary glands of the.
Koyama et al also recommended full body f18 fluorodeoxyglucose petct body. Histopathology of pleomorphic adenomas journal section. Histopathological findings of pleomorphic adenomas of the. Atlas of head and neck pathology pleomorphic adenoma table of contents previous next pleomorphic adenoma benign mixed tumor grossly, the tumor is freely movable, solid, sometimes lobulated and occasionally cystic. Pleomorphic adenoma is a common benign salivary gland tumor which presents as a painless swelling that gradually increases in size, if left untreated. Apr 15, 2020 a pleomorphic adenoma generally occurs in adults between 45 and 60 years old, and is diagnosed more often in females than in males. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial nerve palsy. Basic salivary gland pathology 1 basic salivary gland pathology jennifer l. Pleomorphic adenoma is the most common form of the salivary gland tumor.
Thus, complete surgical resection is the treatment of choice. The tumors presumably arise from ductular epithelium based on the ultrastructural. Icd03 seer sitehistology validation list june 18, 2019 4 lip c000c006,c008c009 mixed tumor, malignant, nos 894 89403 mixed tumor, malignant, nos 894 carcinoma in pleomorphic adenoma kaposi sarcoma 914 91403 kaposi sarcoma follic. Research histopathological findings of pleomorphic adenomas of the salivary glands fabio augusto ito, jacks jorge, pablo agustin vargas, marcio ajudarte lopes. History of a pleomorphic adenoma at the same site 25% of cases features of a pleomorphic adenoma and a carcinoma. Media in category histopathology of pleomorphic adenoma the following 18 files are in this category, out of 18 total. Conclusions almost all pleomorphic adenomas have focally thin capsules.
Even though they are rare in submandibular gland, they should be considered as differential diagnosis in case of submandibular mass lesions. Pdf pleomorphic adenoma of the palate researchgate. Since 1951, when mark and rothberg published their first eac pleomorphic adenoma report, at least 35 similar cases have been reported 3. Herein, a rare case of lipomatous pleomorphic adenoma arising in the parotid gland of a 14yearold japanese woman is presented. According to the literature, there are few cases reported up till now that have taken the origin from the minor salivary gland tissue of the pps 4, 5. Carcinoma ex pleomorphic adenoma itself is uncommon, and its origin in the maxillary sinus is very rare. Histologic localization of plag1 pleomorphic adenoma gene 1 in pleomorphic adenoma of the salivary gland. Surgery is the most common form of treatment for pleomorphic adenoma. Faculty of dental sciences, sri ramachandra university. 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. Other benign salivary gland tumours do not do this. A case of lipomatous pleomorphic adenoma in the parotid gland.
It has a diverse histological presentation and occurs in. A case of carcinoma ex pleomorphic adenoma arising from. The objective of this study was to clarify the clinical presentation and treatment of pa of the eac. Bosselated outer surface, often with tonguelike protrusions. Histopathological findings of pleomorphic adenoma of the salivary glands article pdf available in medicina oral, patologia oral y cirugia bucal 142. Semiology and oral pathology, dental school, university of. Pleomorphic adenoma of the breast archives of pathology.
Pleomorphic adenoma pleomorphic adenoma pa, or benign mixed tumor, is the most common salivary gland tumor and accounts for almost twothirds of all salivary gland tumors. Aug 29, 2018 carcinoma ex pleomorphic adenoma is an epithelial malignant neoplasm arising from a primary or recurrent pleomorphic adenoma and is a diagnostic challenge for cytopathologists. Dec 26, 2014 the epithelial cells make up a trabecular pattern that is contained within a stroma. 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. Features are characteristic of a pleomorphic adenoma which was subsequently excised and confirmed histologically.
Histologically, the lesion demonstrates both epithelial and mesenchymal elements. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial. It involves the parotid of the major salivary glands and the palate of the minor salivary glands. It is found mostly in the parotid gland in middleaged women. As the name suggests, pleomorphic adenomas are composed of a mixture of variable histology. Immunohistochemical pattern of pleomorphic adenoma. A carcinoma arising in a pleomorphic adenoma is referred to as a carcinoma ex pleomorphic adenoma caexpa or a malignant mixed tumor and conveys a poor prognosis. Pleomorphic adenoma is the most common benign tumor affecting the major salivary glands and infrequently arises from the minor salivary glands. Diagnosis requires that elements from the benign pleomorphic adenoma and the malignant component need to be seen. Salivary gland tumors comprise only 3% of all neoplasms of head and neck region and show diverse histology.
Pdf histopathological findings of pleomorphic adenoma of the. Pleomorphic adenoma is the most common neoplasia of the salivary glands. This article presents a case of pleomorphic adenoma of the palatal minor salivary gland treated successfully by surgical excision. Though it is classified as a benign tumor, pleomorphic adenomas have the capacity to grow to large proportions and may undergo malignant transformation, to form carcinoma ex pleomorphic adenoma, a risk that increases with time 9. A limited number of cases with lacrimal pleomorphic adenoma were reported. Pleomorphic adenoma pa, also known as benign mixed tumor, is.
A large pleomorphic adenoma can be disfiguring or exert mass effect on important structures. The histology reveals that a capsule is focally deficient in the. Pleomorphic adenoma pa is a benign tumour that mainly arises from salivary glands, and pa of the external auditory canal eac is very rare. Generally more than 80% of cases has a history of local recurence of pleomorphic adenoma before metastatic form. The stroma may be chondroid, myxoid, osteoid, or fibroid. Aug 09, 2017 benign epithelial tumor of the salivary glands with epithelial, myoepithelial, and mesenchyma differentiation. This is the sixth case of lipomatous pleomorphic adenoma in the english literature. Complete wide surgical excision is the treatment of choice. Histopathology of the salivary glands springerlink. Carcinoma ex pleomorphic adenoma of minor salivary glands with major epithelial. Most commonly affected site is the parotid gland 84% of cases.
The treatment of pleomorphic adenoma is surgical excision. Carcinoma ex pleomorphic adenoma of the lacrimal gland. Pleomorphic adenomas are also commonly found in the lacrimal glands where they account for approximately 50% of lacrimal gland tumors 7. Semiology and oral pathology, dental school, university of campinas.
Most often, however, it is due to the blockage of salivary ducts, which inhibits saliva drainage from the glands. However, pa may also arise from the external auditory canal eac, although reports are very rare. Pleomorphic adenoma of the breast is a rare, benign tumor accounting for 68 cases in the literature. Histopathology, pleomorphic adenoma, salivary gland neoplasms.
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