Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. They originate from an uncommitted reserve cell of the intercalated duct which has the potential to differentiate into epithelial and myoepithelial cells 25. Hence, the final diagnosis was of giant pleomorphic adenoma with negative surgical margins. This article presents a case of pleomorphic adenoma of the palatal minor salivary gland treated successfully by surgical excision.
Ca ex pa has been named as carcinoma ex mixed tumour, carcinoma ex adenoma, and carcinoma ex benign pleomorphic adenoma. The prognosis is generally good after the surgical removal, however, there is an increased incidence of recurrence particularly if the parotid gland is affected. They may be broadly categorized into benign neoplasms, tumorlike conditions, and malignant neoplasms. The standard of treatment is nerveconserving, superficial parotidectomy. The treatment of pleomorphic adenoma is surgical excision. For tumors of deep lobe total parotidectomy is necessary. The risk of recurrence of pleomorphic adenoma is 3. Pleomorphic adenoma is the most common parotid neoplasm. Surgical treatment of recurrent pleomorphic adenoma of the. 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. A pleomorphic adenoma is a benign overgrowth arising from the salivary gland tissue and it is a painless hard, mobile, solitary mass.
The aim of this study was to determine whether adjuvant radiotherapy is more effective than surgical resection alone in patients with recurrent. A pleomorphic adenoma is a tumour of a gland that produces saliva in the mouth. Pleomorphic salivary adenoma in an adolescent british. Undifferentiated pleomorphic sarcoma diagnosis and. These cancerous transformations are known as carcinoma ex pleomorphic adenoma or malignant mixed tumor. Pleomorphic adenoma of the parotid gland in children. Most of them are benign and pleomorphic adenoma is the commonest among them that involves both major 90% and minor 10% salivary glands. Pleomorphic adenoma is a benign, slowgrowing neoplasm that most commonly affects the parotid gland. It has epithelial, myoepithelial, and stromal components.
Pleomorphic adenoma is the most common parotid gland tumor. It is found mostly in the parotid gland in middleaged women. 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. Management of pleomorphic adenoma of the parotid wiley online.
Salivary gland tumors are rare, comprising less than 3% of all neoplasia of the head and neck region. It accounts for 7080% of all benign parotid tumors. The results of surgical procedures for recurrence were determined with respect to tumor control and resultant facial nerve function. Pleomorphic adenoma pa is the commonest benign neoplasm of salivary glands. Of the six malignant pleomorphic adenoma, recurrence within the first ten years took place in four patients 66. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Primary pleomorphic adenoma of the external auditory canal. The tumor is almost always solitary and is usually found as a firm, mobile, painless slow growing mass.
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 biopsy should be conducted to exclude malignancy. Metastasizing pleomorphic salivary adenoma oncology. The role of adjuvant radiotherapy in its management is widely debated. Etiology and management of recurrent parotid pleomorphic. Parotid gland is affected from 80% to 90% of cases. Our goal was to investigate the prognosis of cxpa in the major salivary glands and factors influencing it. 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. For this reason, preoperative planning is necessary pleomorphic adenoma of the parotid, while rare in to ensure the appropriate surgical management of the pediatric population, provides a therapeutic the tumor. For pleomorphic adenomao of superficial lobe of parotid gland, superficial parotidectomy with preservation of facial nerve is done. Most recurrent pleomorphic adenoma are multinodular. Pictures of pleomorphic adenoma benign mixed tumor of.
Surgery is the most common form of treatment for pleomorphic adenoma. The role of adjuvant radiotherapy in management of. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Role of radiotherapy for pleomorphic adenoma request pdf. Pleomorphic adenoma of the parotid gland in children kimsey h. Prognostic factors affecting the clinical outcome of. It has a relatively high rate of recurrence after surgery. It progresses slowly and, left untreated, can produce significant morbidity and, rarely, death. If yes, where can i get it done and what is the expected cost of the surgery. Pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. Pleomorphic adenoma is the most common salivary gland tumor and accounts for approximately 80% of parotid tumors. Pleomorphic parotid adenoma benign tumor of the parotid. Pleomorphic adenoma is the most common benign tumor affecting the major salivary glands and infrequently arises from the minor salivary glands. The hypothesis for recurrence of pleomorphic adenoma using this type of surgical approach is that microscopic portions of tumor perforate the capsule and are.
Presently pleomorphic adenoma of the parotid gland is. Herein the presentation, radiography, histopathology, and treatment outcome of a rare case of lacrimal gland epithelialmyoepithelial carcinoma ex pleomorphic. These tumors occasionally undergo malignant transformation, with potentially devastating consequences. 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.
Nov, 2018 recurrent pleomorphic adenoma poses a significant treatment challenge, considering its propensity for further recurrence and potential for malignant transformation. The stroma may be chondroid, myxoid, osteoid, or fibroid. The current definition of ca ex pa became widely accepted in the second half of the. The management, pathology and treatment are discussed with emphasis on. Pleomorphic adenoma of the minor salivary glands most commonly occurs in the palate 16. The management, pathology and treatment are discussed with emphasis on the. Pdf clinical profile and management of pleomorphic adenoma of. Salivary gland pleomorphic adenoma in the netherlands rug. The use of radiation in t1 and t2 parotid gland tumors found that 5year diseasefree survival increased from 70% to 92% with postoperative radiation.
Surgical excision with adequate margins is the principle treatment of pleomorphic adenoma to avoid recurrence. Please remove adblock adverts are the main source of revenue for dovemed. Discussion pleomorphic adenoma pa is a benign salivary gland tumour. Pleomorphic adenoma develops as a lesion, which can slowly grow over the years. Pleomorphic adenoma is the most common type of all. Imaging features of recurrent parotid pleomorphic adenoma have been infrequently reported in the radiology literature. Many types of carcinoma are seen with adenocarcinoma being the most common. Malignant conversion developed in three 6% of 48 cases. Enucleation, enucleoresection and superficial or total parotidectomy with preservation of the facial nerve formed the mainstay of surgical treatment.
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. Recurrent pleomorphic adenoma of the parotid gland request pdf. Surgical management of pleomorphic adenoma of parotid gland. The patient presented excellent cosmetic and functional results, without signs of facial nerve palsy, damage or recurrence. Cns metastases of carcinoma ex pleomorphic adenoma of the. Pleomorphic adenoma pa is the most common benign salivary gland tumour, accounting for as many as 80% of all such tumours. Although pleomorphic adenomas most commonly occur in the parotid gland, it may also be encountered in the submandibular, lingual, and 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%. Chemotherapy is most often used to treat undifferentiated pleomorphic sarcoma that comes back after initial treatment or that spreads to other areas of the body. In the case of large tumors, the following symptoms may be experienced. Features are characteristic of a pleomorphic adenoma which was subsequently excised and confirmed histologically. The prognosis and treatment options will be explored. Wangthe pathologic basis of partial parotidectomy in parotid pleomorphic adenoma treatment. Pleomorphic adenoma pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. Giant presentation of pleomorphic adenoma in major. 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. Pdf pleomorphic adenoma of the parotid gland in children. The aim of this study was to update our experience in treating pleomorphic adenoma with radiotherapy rt.
The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the pleomorphic adenoma pa. Aggressiveness and extent of the tumor mass and its relation with the facial nerve form the important criteria which dictate the choice of treatment of pleomorphic adenoma of the parotid gland. Giant pleomorphic adenoma of the parotid gland med oral patol. Surgical management of pleomorphic adenoma of parotid gland in elderly patients. It involves the parotid of the major salivary glands and the palate of the minor salivary glands. It can be administered by pill or through a vein intravenously, or both. Conclusion reported to be 2045% with excisional biopsy 10. Pleomorphic adenoma pa is a benign tumour that mainly arises from salivary glands, and pa of the external auditory canal eac is very rare. Dec 26, 2014 the stroma may be chondroid, myxoid, osteoid, or fibroid. Management of the parotid pleomorphic adenoma, the problem of. Although pa most commonly occurs in the parotid gland 85% cases, it may involve submandibular 8%, lingual and minor salivary glands. Pleomorphic adenoma an overview sciencedirect topics. It progresses slowly and, left untreated, can produce sig.
A case report of 28 year old male patient diagnosed of pleomorphic adenoma of palate, is presented here. Rodrigueza, sara vargasb, caroline robsonc, antonio perezataydeb, robert shambergerd, trevor j. The role of adjuvant radiotherapy in management of recurrent. May 27, 2000 this case study illustrates an unusual condition in childhood, pleomorphic salivary adenoma in a 12yearold. Fortyeight cases of recurrent pleomorphic adenoma treated at the university of michigan, ann arbor, between 1935 and 1975 were retrospectively analyzed. Pleomorphic adenoma symptoms, causes, treatment, surgery. It is a benign tumour with a slow and continuous growth and without treatment can assume enormous dimensions. Although an mri may be sufficient for differentiating a pleomorphic adenoma from other growths, dual isotope imaging by a singlephoton emission ct spect may be preferred in this regard. The objective of treatment of a parotid pleomorphic adenoma is to remove all tumour cells with minimal short and longterm morbidity and minimal recurrence.
Surgical treatment of pleomorphic adenoma of the parotid gland. Sep 04, 2019 tumors of the salivary glands are uncommon and represent 24% of head and neck neoplasms. With correct surgical removal, the prognosis is excellent. This case report presents the clinical and radiographic features of a rare case of biopsy proved brain and spinal cord metastases arising from carcinoma ex pa of the parotid gland. The aim of this study is to report a case of an unusual minor salivary gland pleomorphic adenoma in the. Fortyeight cases of recurrent pleomorphic adenoma treated at the university of michigan, ann arbor.
Carcinoma ex pleomorphic adenoma of the lacrimal gland. Intraoral pleomorphic adenoma happens when a tumor affects the minor salivary gland. Surgical resection of the tumor or partoid gland usually partial is the mainstay of treatment. Pleomorphic adenomas are treated by complete surgical excision. This is a retrospective analysis of 25 patients treated. The pathology at this time was ill understood and the tumour was. Recurrent pleomorphic adenoma poses a significant treatment challenge, considering its propensity for further recurrence and potential for malignant transformation.
Tumors of the salivary glands are uncommon and represent 24% of head and neck neoplasms. Imaging characteristics of recurrent pleomorphic adenoma. Pleomorphic adenomas pas, also known as benign mixed tumors, are common tumors of the parotid gland. This case report presents the clinical and radiographic features of a rare case of biopsy proved brain and spinal cord metastases arising from carcinoma ex pa of the. Malignant transformation, though rare, has been reported. Carcinoma ex pleomorphic adenoma of the lacrimal gland with.
Presently pleomorphic adenoma of the parotid gland is treated. Surgical management of pleomorphic adenoma of parotid. Recurrent pleomorphic adenoma of the parotid gland. 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, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms. Pleomorphic adenoma of the cervical heterotopic salivary. Pleomorphic adenoma is the most common benign salivary gland neoplasm. 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. Pleomorphic adenoma, also known as benign mixed tumor is the most common tumor of the salivary gland accounting for 6080% of the benign variety. Surgical management of pleomorphic adenoma 50 years ago consisted predominantly of local excision or enucleation technique, a procedure that yields recurrence rates from 20% to 45%. The objective of this study was to clarify the clinical presentation and treatment of pa of the eac.
This case study illustrates an unusual condition in childhood, pleomorphic salivary adenoma in a 12yearold. Pleomorphic adenoma of buccal minor salivary gland. Eighty per cent of pleomorphic adenomas of this particular gland are benign, and 20 per cent are cancerous. Pleomorphic adenoma surgery, symptoms, causes, treatment.
The aim of this study was to determine whether adjuvant radiotherapy is more effective than surgical resection alone in patients with recurrent pleomorphic. The most predominant site of pleomorphic adenoma is palate. Pleomorphic adenoma benign mixed tumor is the most common neoplasm of the salivary glands. Following a negative systemic workup, the patient underwent radiation therapy and remains free of clinical or radiographic disease 24 months following surgery. Additionally, pa appears radiographically as a radiolucent defect with welldefined cortical margins. Carcinoma ex pleomorphic adenoma cxpa is an uncommon malignant tumor with highly aggressive biological behavior. Mar 18, 2019 the use of radiation in t1 and t2 parotid gland tumors found that 5year diseasefree survival increased from 70% to 92% with postoperative radiation. Treatment of recurrent pleomorphic adenoma must be individualized.
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