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de Brito BS, Gaspar NG, Egal ESA, Sanchez-Romero C, Martins AS, Tincani ÁJ, de Oliveira Gondak R, de Almeida OP, Kowalski LP, Altemani A, Mariano FV. PLAG1 expression is maintained in recurrent pleomorphic adenoma. Virchows Arch 2016; 469:477-81. [PMID: 27381214 DOI: 10.1007/s00428-016-1980-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/25/2016] [Accepted: 06/27/2016] [Indexed: 11/26/2022]
Abstract
The proto-oncogene (pleomorphic adenoma gene 1 (PLAG1)) is immunohistochemically overexpressed in pleomorphic adenoma (PA). Its expression in recurrent pleomorphic adenoma (RPA), however, has not been investigated. Since complex mechanisms are involved in tumor recurrence, the aim of this study was to investigate whether PLAG1 overexpression occurs in RPA. We studied PLAG1 protein expression in 40 PAs and 36 RPAs by immunohistochemistry. Cases with immunopositive cells were classified into two categories, between 10 and 50 % and >50 %. In both groups, PLAG1 expression was observed in both epithelial and myoepithelial cells. Of PAs, 37 cases (93 %) were positive, while this was the case in 34 RPA cases (94 %). Our findings suggest that in addition to morphological similarity, PA and RPA express PLAG1, which might play a role in tumor recurrence. Furthermore, as for PA, expression of PLAG1 can be considered a valuable diagnostic marker for RPA.
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Affiliation(s)
- Beatriz Samara de Brito
- Pathology Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Natália Giovanelli Gaspar
- Pathology Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Erika Said Abu Egal
- Pathology Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Celeste Sanchez-Romero
- Oral Pathology Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Antonio Santos Martins
- Head and Neck Surgery Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Álfio José Tincani
- Head and Neck Surgery Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Oslei Paes de Almeida
- Oral Pathology Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Albina Altemani
- Pathology Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fernanda Viviane Mariano
- Pathology Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Av. Tessália Vieira de Camargo, 126 - Barão Geraldo, Cidade Universitária, Campinas, SP, 13083-887, Brazil.
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Affiliation(s)
- Pin-Zhir Chao
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
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Abstract
OBJECTIVE: To describe clinical and demographic characteristics of the parapharyngeal space tumors and assess surgical approaches used to treat them at our institution. METHODS: A retrospective and descriptive study of the parapharyngeal space tumors, excluding paragangliomas, treated from June 1991 to October 2002 in a cancer center. The study population included 21 patients, 8 men and 13 women, average age of 41 years (range, 20 to 70 years). Fine needle biopsy was done in 5 (24%) patients. Computed tomography (CT) was performed in all patients, and only a few required magnetic resonance image (MRI). RESULTS: Surgical approaches included transcervical alone or in combination with parotidectomy, transoral, or transmandibular (mandibular swing) approach. Laminectomy and segmentary approaches were also performed in 1 patient each. Sixteen (76%) patients had benign lesions and 5 (24%) had malignant tumors. Neurogenic tumors represented 57% of all tumors. Mean tumor size was of 6.7 cm (range, 3 to 11 cm). Six (29%) patients received adjuvant radiotherapy. Complications occurred in 6 (29%) patients, 4 (19%) of which were nervous injuries associated with peripheral nerve sheath tumors. Median disease-free follow-up survival was 33 months (range, 2 to 184 months) despite being an heterogeneous group of histologies. CONCLUSION: Parapharyngeal space is a rare location for head and neck tumors. Cervical approach should be the first choice for large tumors; transoral approach is reserved for tumors less than 3 cm. Conversion to mandibular swing approach when the cervical approach is not offering proper exposure for tumor resection is indicated. Preoperative histologic diagnosis is not required. Nevertheless, CT scan should always be performed in order to exclude paragangliomas, distinguish prestyloid from poststyloid lesions, and to assess the extension of the tumor as well as its relationship with adjacent structures.
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Affiliation(s)
- Kuauhyama Luna-Ortiz
- Department of Head and Neck Surgery, at the Instituto Nacional de Cancerología, Tlalpan, Mexico.
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Affiliation(s)
- Allen F Marshall
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill 27599-7070, USA.
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Abstract
Salivary gland tumors are a rare, histologically heterogeneous group of tumors which constitute approximately 4–6 % of all head and neck neoplasms. In 2/3 of cases they are benign, especially in the parotid gland. We report about a rare tumor of the parotid gland presenting as an extraskeletal chondroma. Histologically there were multiple S 100 protein-positive nests of chondrocytes. The externally completed cytology suspected a pleomorphic adenoma, nevertheless, the final histopathological findings showed another tumor entity.
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Li J, Bian D, Wang J. [Pleomorphic adenoma of the nasal septum: a case report]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:76-77. [PMID: 27197465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a rare case of pleomorphic adenoma arising from the nasal septum. A 37-year-old woman presented with a 1-year-history of right-sided occasional epistaxis. Computed tomographic scans revealed an oval mass in the right nasal cavity. The tumor was removed endoscopically with endonasal approach. The microscopic finding showed numbers of myoepithelial cells and duct-like structures consisting of loose myxoid stroma. This lesion had histological characteristics of a pleomorphic adenoma, and this was confirmed by immunohistochemical expression of cytokeratin, S-100 protein and SMA. Her post-operative course was uneventful, and she is currently free from the disease 1.5 years after surgery.
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Abstract
Salivary gland tumors are a relatively rare and morphologically diverse group of lesions. Pleomorphic adenoma is a benign tumor of the salivary gland that consists of a combination of epithelial and mesenchymal elements. The tumor most commonly arises from the parotid (60-70%) or submandibular glands. It develops less frequently in a minor salivary gland, presenting as an intraoral mass depend on the soft palate. We describe a case of benign pleomorphic adenoma of soft palate in a 45 year old female with computed tomography and histopathological findings. This patient presented in ENT department with history of gradually increasing mass lesion in the palatal region over a period of few months.
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Affiliation(s)
- Mounir Hmidi
- Department Otolaryngology and Neck Surgery, Military Hospital My Ismail Meknes, Morocco
| | - Hicham Aatifi
- Department Otolaryngology and Neck Surgery, Military Hospital My Ismail Meknes, Morocco
| | - Ali Boukhari
- Department Otolaryngology and Neck Surgery, Military Hospital My Ismail Meknes, Morocco
| | - Mohammed Zalagh
- Department Otolaryngology and Neck Surgery, Military Hospital My Ismail Meknes, Morocco
| | - Abdelhamid Messary
- Department Otolaryngology and Neck Surgery, Military Hospital My Ismail Meknes, Morocco
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Tauziède-Espariat A, Raffoul J, Sun SR, Monnin C, Lassabe C, Costes V. [A bilateral epithelial myoepithelial carcinoma of the parotid gland]. Ann Pathol 2015; 35:489-95. [PMID: 26586087 DOI: 10.1016/j.annpat.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/23/2015] [Accepted: 07/24/2015] [Indexed: 11/17/2022]
Abstract
We report the case of a 52-year-old man, who was admitted in the department of otorhinolaryngology for a mass of the right parotid gland. The radiological and clinical hypothesis was a squamous cell carcinoma. Histopathological examination revealed a biphasic proliferation composed of epithelial cells arranged in a tubular pattern stained with cytokeratins 5-6 and 7 and EMA surrounded by clear myoepithelial cells stained with smooth muscle actin and p63. Ki-67 labeling index was low. The diagnosis of epithelial myoepithelial carcinoma was proposed. One year after, the patient noticed a centimetric mass of the left parotid gland. The radiological hypothesis was the presence of an intraparotidian lymph node. Histopathological examination showed a second epithelial myoepithelial carcinoma. This is an uncommon neoplasm comprising approximately 1% of all salivary gland tumours, affecting mainly the parotid gland. It is occurring preferably in patients older than 60years old. This is a low-grade malignant tumour with tendency to local recurrence and lymph node metastatic potential. We describe an exceptional bilateral epithelial myoepithelial carcinoma of the parotid gland.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Service de pathologie, centre hospitalier de Montbéliard, 12, rue Docteur-Flamand, 25200 Montbéliard, France.
| | - Johnny Raffoul
- Service de pathologie, centre hospitalier de Montbéliard, 12, rue Docteur-Flamand, 25200 Montbéliard, France
| | - Shan Rong Sun
- Service de pathologie, centre hospitalier de Montbéliard, 12, rue Docteur-Flamand, 25200 Montbéliard, France
| | - Christine Monnin
- Service de pathologie, centre hospitalier de Montbéliard, 12, rue Docteur-Flamand, 25200 Montbéliard, France
| | - Catherine Lassabe
- Service de pathologie, centre hospitalier de Montbéliard, 12, rue Docteur-Flamand, 25200 Montbéliard, France
| | - Valérie Costes
- Service de pathologie, CHU Lapeyronie, 191, avenue du Doyen-Giraud, 34295 Montpellier, France
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Abstract
CONCLUSIONS Deep-lobe tumor parotidectomy decreases the incidence of parotidectomy post-surgical complications, preserves parotid function, and has a good esthetic appearance. OBJECTIVE The existing surgical technique in the parotidectomy of deep-lobe benign tumors can be improved. METHODS Fourteen surgical operations were performed (2004-2015) for selective deep lobe parotidectomy for patients with primary benign parotid tumors. The patients with deep-lobe benign tumors were operated on with the method of superficial lobe preservation, which included methylene blue staining of the gland and intra-operative facial nerve detection. RESULTS During follow-up, no cases of tumor recurrence, permanent facial nerve injury, postparotidectomy depression, or Frey's syndrome was found.
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Affiliation(s)
- Michael Vaiman
- a Department of Otolaryngology, Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Zerifin 70300, Israel
| | - Rani Abuita
- a Department of Otolaryngology, Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Zerifin 70300, Israel
| | - Basel Jabarin
- a Department of Otolaryngology, Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Zerifin 70300, Israel
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Casado A, Sánchez-Gutiérrez V, Barrancos C, Albandea A. [Atypical presentation of lacrimal gland pleomorphic adenoma with necrotic foci]. Arch Soc Esp Oftalmol 2015; 90:432-434. [PMID: 25843695 DOI: 10.1016/j.oftal.2015.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/14/2014] [Accepted: 02/25/2015] [Indexed: 06/04/2023]
Abstract
CLINICAL CASE The case is presented of 48 year-old male complaining of a painful left upper eyelid and swelling of the lacrimal gland, with a suspicion of dacryoadenitis. Removal was decided after dacriops suspicion. Histopathology diagnosed a pleomorphic adenoma of the lacrimal gland, with areas of necrosis. DISCUSSION Lacrimal gland pleomorphic adenoma usually presents as a slowly progressive painless mass. However, painful presentation in this case might be related with necrotic foci found in the histopathological examination. Although not described in lacrimal glands, pleomorphic adenomas have already been reported in the major and minor salivary glands, and these patients also presented with a painful mass.
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Affiliation(s)
- A Casado
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - V Sánchez-Gutiérrez
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Barrancos
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Albandea
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
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Sedassari BT, Rodrigues MFSD, Mariano FV, Altemani A, Nunes FD, Sousa S. The Stem Cell Marker Bmi-1 Is Sensitive in Identifying Early Lesions of Carcinoma ex Pleomorphic Adenoma. Medicine (Baltimore) 2015; 94:e1035. [PMID: 26166073 PMCID: PMC4504655 DOI: 10.1097/md.0000000000001035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In the present study, we evaluated and described the sensitivity of the stem cell marker B cell-specific moloney murine leukemia virus integration site 1 (Bmi-1) in identifying early lesions of carcinoma ex pleomorphic adenoma (CXPA). While invasive CXPAs are tumors with a prominent and easily recognizable malignant component, the identification of early carcinomatous changes in PA remains a diagnostic challenge due to the lack of objective morphological criteria. The immunohistochemical expression of Bmi-1 was assessed in both adenomatous and carcinomatous components of 9 CXPA cases at an early phase of histological progression (6 intracapsular and 3 minimally invasive) grouped according to the cellular differentiation as luminal (7 cases) or myoepithelial (2 cases). A selective nuclear expression of Bmi-1 was found exclusively in the malignant component of 8 cases (6 luminal type and 2 myoepithelial type), including intraductal carcinoma areas, except for 1 case in which scarce cells of the remnant PA were positive. Thus, Bmi-1 is expressed from the earliest morphologically detectable stages of PA malignant transformation. When faced with atypical features in PA, evaluation of Bmi-1 expression can provide more objective criteria for identification and diagnosis of early lesions of CXPA. This is applied to carcinomas with luminal or myoepithelial differentiation.
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Affiliation(s)
- Bruno Tavares Sedassari
- From the Department of Oral and Maxillofacial Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil (BTS, MFSDR, FDN, SS); and Department of Anatomic Pathology, School of Medicine, State University of Campinas, São Paulo, Brazil (FVM, AA)
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Fini G, Leonardi A, Mici E, Pellacchia V, D'Orazi V, Pasta V. Schwannoma of the parotid gland. Case report. Ann Ital Chir 2015; 86:S2239253X15019982. [PMID: 26108446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Schwannoma is encapsulated benign tumors arising from nerve cell. Of which ancient schwannoma is one of five variants. Intraparotid facial nerve schwannoma is been documented sporadical throught the medical literature, althought a few ancient schwannomas have been reported in different locations in the head and neck region. In this report, a 31 year old man patient with an misunderstanding tumor of the parotid gland is described and the histopathologic exam was performed to diagnosed the schwannoma.
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63
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Liu L, Yan Z, Tao S. [Pleomorphic adenoma of the trachea: a case report]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:425-426. [PMID: 26178060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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64
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Oral Pathology Quiz #88. Case number 1. Granular cell tumor. J N J Dent Assoc 2015; 86:14, 18. [PMID: 26495671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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65
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Luo H, Liu T. [A case report of surgical resection of giant pharyngeal pleomorphic adenoma and literature review]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:1997-1998. [PMID: 25895329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pleomorphic adenoma (PA) is a rare benign tumor in the pharynx. We presented a case with a huge PA in the pharynx. MRI displayed oropharyngeal mass, considering benign tumor. Preoperative fine-needle aspiration and cytology biopsy were important to confirm the diagnosis of PA preliminary. Extracapsular complete dissection for PA was performed under general anesthesia with tracheotomy subsequently. Postoperative histopathological examination confirmed the diagnosis of PA. The patient was discharged a week after operation and no recurrence was found in the following 8 months.
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Zaghi S, Hendizadeh L, Hung T, Farahvar S, Abemayor E, Sepahdari AR. MRI criteria for the diagnosis of pleomorphic adenoma: a validation study. Am J Otolaryngol 2014; 35:713-8. [PMID: 25128908 DOI: 10.1016/j.amjoto.2014.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 07/18/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To validate an MRI algorithm characteristic of pleomorphic adenoma (PA). STUDY DESIGN Cross-sectional analysis. SETTING Academic tertiary-care medical center. METHODS A radiologic algorithm for the MRI diagnosis of PA was developed on the basis of five "high probability" criteria that all must be fulfilled for the MRI to qualify as a positive test result: bright T2-signal, sharp margins, heterogeneous nodular enhancement, lobulated contours, T2-dark rim. We then identified MRI images from our institutional database to test the diagnostic accuracy of the proposed algorithm. RESULTS A total of 103 parotidectomy cases with adequate MRI studies were identified (pleomorphic adenoma n=41, mucoepidermoid carcinoma n=11, Warthin's tumor n=8, adenoid cystic carcinoma n=6, oncocytoma n=6, acinic cell carcinoma n=5, salivary duct carcinoma n=5, and other n=21). Eighteen of 21 cases that met all five "high probability" MRI criteria were consistent with PA on final histopathology; 3 were consistent with carcinoma. MRI had a specificity of 95.1% [95% confidence interval: 85.6-98.7%] and sensitivity of 43.9% [95% C.I.: 28.8-60.1%] for PA. The positive predictive value was 85.7% [95% C.I.: 70.4-100%] and the negative predictive value was 71.9% [95% C. I.: 62.0-81.9%]. The overall diagnostic accuracy was 74.8% [95% C.I.: 66.2-83.3%]. CONCLUSION A "high probability" MRI is about 95% specific for pleomorphic adenoma. A subset of patients with MRI imaging that is highly suggestive of PA may reliably avoid further workup. The value of MRI in this setting is especially useful if preoperative fine needle aspiration is not readily available. A significant proportion of PAs, however, have indeterminate imaging features that overlap considerably with other benign and malignant lesions.
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Affiliation(s)
- Soroush Zaghi
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Leenoy Hendizadeh
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tony Hung
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Salar Farahvar
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ali R Sepahdari
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Wollina U, Sturm U, Schönlebe J. Benign chondroid syringoma (mixed tumor of skin) on the flank with satellites: case report and literature review. Wien Med Wochenschr 2014; 164:377-80. [PMID: 25271109 DOI: 10.1007/s10354-014-0302-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mixed tumor of skin (chondroid syringoma) is a rare skin tumor. METHODS We report on the rare occasion of an atypical mixed tumor of skin (chondroid syringoma) in a 71-year old Caucasian male patient. RESULTS The tumor presented as a firm subcutaneous nodule on his flank. Histopathologic investigations revealed a focally increased proliferative activity and satellites in the adipose tissue. This is in accordance with the diagnosis of an atypical chondroid syringoma. The differential diagnosis to malignant chondroid syringoma is discussed. The tumor was removed by delayed Mohs surgery. CONCLUSIONS Atypical chondroid syringoma is a very rare subtype of mixed tumor of skin. It is an important differential diagnosis to malignant chondroid syringoma of skin.
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Affiliation(s)
- U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany,
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Abstract
PURPOSE To review indications and clinical outcomes in a series of orbitocranial tumors treated surgically through a transorbital extradural approach without craniotomy. METHODS In this retrospective case series, all patients who underwent surgery through a transorbital extradural approach without craniotomy for benign orbitocranial tumors involving the dura or extending into the anterior or middle cranial fossae were analyzed. RESULTS Twenty-seven patients (20 females and 7 males) were included. Median age was 47.0 years (range: 6-74 years) and median follow-up time was 43.5 months (range: 3-148 months). The median preoperative best-corrected visual acuity (logMAR) was improved from 0.35 (range: 0-2.6) to 0.1 (range: 0-2.6) at the last follow-up (p < 0.03). The mean ± SD preoperative exophthalmos significantly decreased from 20.4 ± 3.4 mm to 13.1 ± 3.5 mm at the last follow-up visit (p < 0.01). Four postoperative complications were noted and included one case each of ptosis, numbness, diplopia (transient for 6 months), and cranial nerve VI palsy (transient for 4 months). CONCLUSIONS The transorbital extradural approach provides access to the deep orbit and adjacent extradural cranial spaces. Benign orbital tumors that have eroded through the orbital roof, are located in the orbital apex abutting the anterior cavernous sinus and tumors requiring debulking are all processes that can be potentially approached through the transorbital extradural route. Compared to open craniotomy, the incision is smaller, the access more direct and specific risks of open craniotomy are reduced.
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Affiliation(s)
- Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University , Bundang-gu, Seongnam , South Korea and
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69
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Pokhrel SM, Badu BP, Lavaju P, Shrestha BG, Pant AR, Agarwal M. Unusual Presentation of Lacrimal Gland Pleomorphic Adenoma. JNMA J Nepal Med Assoc 2014; 52:949-951. [PMID: 26982673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
The pleomorphic adenoma of lacrimal gland presents as a painless, progressive, slowly growing supero-temporal swelling with variable proptosis. This tumor is usually found in adults and extremely rare in teenage. We report a case of a 15-year-old boy with pleomorphic adenoma of lacrimal gland which mimicked pseudotumor of orbit due to its presentation as an orbital inflammatory disease and the age distribution. Neuroimaging also suggested pseudotumor and oral steroid was started. But, there was no improvement on steroids and ultrasound guided Fine Needle Aspiration Cytology (FNAC) was performed which suggested Pleomorphic adenoma of the lacrimal gland. En-bloc excision of the mass through antero-lateral orbitotomy was done with satisfactory final outcome The histopathological evaluation was consistent with pleomorphic adenoma of the lacrimal gland.
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Affiliation(s)
- S M Pokhrel
- Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan
| | - B P Badu
- Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan
| | - P Lavaju
- Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
| | - B G Shrestha
- Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan
| | - A R Pant
- Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan
| | - M Agarwal
- Department of Pathology, B P Koirala Institute of Health Sciences, Dharan, Nepal
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Miladi S, Mestiri S, Kermani W, Ziadi S, Sriha B, Bouzouita K, Mokni M. Metastasizing pleomorphic adenoma of the submandibular gland: a case report. Pathologica 2014; 106:29-31. [PMID: 24897779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands. It is usually a benign, slow-growing and well-circumscribed tumour. However, PA may occasionally give rise to metastases that usually occur after a previous recurrence. These tumours display benign histological features in both primary tumours and metastases. Such tumours have been termed metastatic PA or metastatic mixed tumours. We report a case of metastatic PA of the submandibular gland with metastasis to the cervical lymph nodes.
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71
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Braich PS, Shetty S, Lingampally A, Ajemian MS, Bhaya MH. A rare cause of submandibular swelling in a 12-year-old child: pleomorphic adenoma. Ear Nose Throat J 2014; 93:35-37. [PMID: 24452892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Pleomorphic adenoma is rare in pediatric populations, where viral and congenital problems are the usual culprits responsible for submandibular masses. We report the case of a 12-year-old child who presented with a painless right submandibular mass that had developed over the course of 4 months. The patient denied fever, erythema, and edema. The mass was diagnosed as a branchial cleft cyst before complete excision was performed. The pattern and etiology of a pleomorphic adenoma in children differs from those in adults. In children, it requires prompt and correct diagnosis to keep morbidity and mortality at a minimum.
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Affiliation(s)
- Puneet S Braich
- Department of Ophthalmology, Virginia Commonwealth University, MCV Campus, Richmond, VA, USA
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72
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Oral pathology quiz #84. Case number 1. Pleomorphic adenoma. J N J Dent Assoc 2014; 85:12, 22. [PMID: 25291828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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73
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Cleceland DB, Rinaggio J, Schneider LC. Oral pathology quiz #83 Case number 1. Retrocuspid papilla of the mandible or B. Hirschfeld's papilla. J N J Dent Assoc 2014; 85:16-22. [PMID: 25141481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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74
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Ashrafi A, Oreadi D. Clinician's corner: a clinico-pathologic correlation. J Mass Dent Soc 2014; 63:40-43. [PMID: 24941551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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75
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Fruehwald-Pallamar J, Czerny C, Holzer-Fruehwald L, Nemec SF, Mueller-Mang C, Weber M, Mayerhoefer ME. Texture-based and diffusion-weighted discrimination of parotid gland lesions on MR images at 3.0 Tesla. NMR Biomed 2013; 26:1372-1379. [PMID: 23703801 DOI: 10.1002/nbm.2962] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate whether texture-based analysis of standard MRI sequences and diffusion-weighted imaging can help in the discrimination of parotid gland masses. The MR images of 38 patients with a biopsy- or surgery-proven parotid gland mass were retrospectively analyzed. All patients were examined on the same 3.0 Tesla MR unit, with one standard protocol. The ADC (apparent diffusion coefficient) values of the tumors were measured with three regions of interest (ROIs) covering the entire tumor. Texture-based analysis was performed with the texture analysis software MaZda (version 4.7), with ROI measurements covering the entire tumor in three slices. COC (co-occurrence matrix), RUN (run-length matrix), GRA (gradient), ARM (auto-regressive model), and WAV (wavelet transform) features were calculated for all ROIs. Three subsets of 10 texture features each were used for a linear discriminant analysis (LDA) in combination with k nearest neighbor classification (k-NN). Using histology as a standard of reference, benign tumors, including subtypes, and malignant tumors were compared with regard to ADC and texture-based values, with a one-way analysis of variance with post-hoc t-tests. Significant differences were found in the mean ADC values between Warthin tumors and pleomorphic adenomas, as well as between Warthin tumors and benign lesions. Contrast-enhanced T1-weighted images contained the most relevant textural information for the discrimination between benign and malignant parotid masses, and also for the discrimination between pleomorphic adenomas and Warthin tumors. STIR images contained the least relevant texture features, particularly for the discrimination between pleomorphic adenomas and Warthin tumors. Texture analysis proved to differentiate benign from malignant lesions, as well as pleomorphic adenomas from Warthin tumors, based on standard T(1w) sequences (without and with contrast). Of all benign parotid masses, Warthin tumors had significantly lower ADC values than the other entities.
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Affiliation(s)
- Julia Fruehwald-Pallamar
- Medical University of Vienna, Department of Radiology, Subdivision of Neuroradiology and Musculoskeletal Radiology, Vienna, Austria
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76
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Baron S, Koka V, El Chater P, Cucherousset J, Paoli C. Pleomorphic adenoma of the nasal septum. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 131:139-41. [PMID: 24139072 DOI: 10.1016/j.anorl.2013.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 03/22/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Pleomorphic adenoma is the most common benign tumour of the salivary glands. The major salivary glands are most commonly involved, or more rarely accessory salivary glands, especially the oral cavity. Other locations, such as the nasal cavity, paranasal sinuses or upper aerodigestive tract, are exceptional. CASE REPORT A 26-year-old female presented with right-sided nasal obstruction. Radiology found a lesion involving the anterior third of the nasal septum. The patient underwent complete surgical resection of the tumour via an endonasal approach. Histological examination found a mixed cellular component (epithelial and myoepithelial) and mesenchymatous tissue with chondromyxoid stroma, enabling diagnosis of a typical pleomorphic adenoma. DISCUSSION/CONCLUSION Pleomorphic adenoma is exceptional in the nasal cavity, with only a few cases reported in the literature. Although benign, the risk of local recurrence, malignant transformation and metastasis requires close long-term follow-up.
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Affiliation(s)
- S Baron
- Service ORL et chirurgie cervico-faciale, centre hospitalier intercommunal André-Grégoire, 56, boulevard de Boissière, 93130 Montreuil, France
| | - V Koka
- Service ORL et chirurgie cervico-faciale, centre hospitalier intercommunal André-Grégoire, 56, boulevard de Boissière, 93130 Montreuil, France.
| | - P El Chater
- Service ORL et chirurgie cervico-faciale, centre hospitalier intercommunal André-Grégoire, 56, boulevard de Boissière, 93130 Montreuil, France
| | - J Cucherousset
- Service de pathologie, groupe hospitalier intercommunal Le-Raincy-Montfermeil, 10, avenue du Général-Leclerc, 93370 Montfermeil, France
| | - C Paoli
- Service ORL et chirurgie cervico-faciale, centre hospitalier intercommunal André-Grégoire, 56, boulevard de Boissière, 93130 Montreuil, France
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77
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Ahn S, Kim Y, Oh YL. Fine needle aspiration cytology of benign salivary gland tumors with myoepithelial cell participation: an institutional experience of 575 cases. Acta Cytol 2013; 57:567-74. [PMID: 24107383 DOI: 10.1159/000354958] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/29/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic accuracy of fine needle aspiration (FNA) cytology of benign salivary gland tumors with myoepithelial cell participation, namely, pleomorphic adenoma, basal cell adenoma and myoepithelioma, at a single institution over a period of 10 years. STUDY DESIGN This study was based on 575 cytologic and matching histological samples (534 pleomorphic adenomas, 26 basal cell adenomas and 15 myoepitheliomas). RESULTS In most cases (393/534) of pleomorphic adenoma, a precise diagnosis was given. However, only 2 cases of basal cell adenoma and 1 case of myoepithelioma were diagnosed definitively. Descriptive diagnosis, instead of a definite diagnosis, was rendered in 16.9% of pleomorphic adenomas, 53.8% of basal cell adenomas and 40.0% of myoepitheliomas. Among all cases, the possibility of malignancy was raised in 5.2% of pleomorphic adenomas, 15.4% of basal cell adenomas and 20.0% of myoepitheliomas with a variable degree of suspicion. CONCLUSION In some cases, the distinction between these three neoplasms remains difficult in that all exhibit some degree of myoepithelial participation. However, FNA showed a high diagnostic accuracy in diagnosing benign salivary tumors with myoepithelial differentiation, and triage into this category provides sufficient information for clinicians to make treatment decisions.
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Affiliation(s)
- Soomin Ahn
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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78
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Stander S, Mulder-Van Staden S, Cheung TY, Dreyer WP, Mohamed N, Afrogheh A. Oral medicine case book 52: pleomorphic adenoma of the upper lip. SADJ 2013; 68:328-330. [PMID: 24133952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- S Stander
- Division of Oral Medicine and Periodontics, Faculty of Denristry, University of the Western Cape
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79
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Pallagatti S, Sheikh S, Gupta D, Das A, Singh R. Carcinoma ex pleomorphic adenoma. Case report. N Y State Dent J 2013; 79:52-54. [PMID: 24027900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Carcinoma ex pleomorphic adenoma (CXPA) is a rare and aggressive malignancy that usually develops in primary or recurrent pleomorphic adenoma. It occurs in 6% of all pleomorphic adenomas, of which only 7% of cases occur in minor salivary gland tumors. The rate of occurrence and malignant change increases with time if a case is left untreated. Intraorally, it is mostly seen in the palate, followed by the upper lip and buccal mucosa. CXPA of the hard palate typically presents as a painless, slow-growing swelling that frequently involves the periosteum and underlying palatal bone. Imaging of CXPA is usually noncontributory, leading to frequent misdiagnosis. Longstanding cases may extend up to the parapharyngeal space and cavernous sinus. We describe a rare case of CXPA of the palate with non-significant clinical and radiological findings. Early diagnosis for better prognosis is stressed.
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Affiliation(s)
- Shambulingappa Pallagatti
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences & Research, Mullane, Ambala, Haryana, India
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80
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Bovino BF, Sohn A, Winston D. Pleomorphic adenoma of the palate in a child. N Y State Dent J 2013; 79:44-47. [PMID: 24027898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Presented is a pleomorphic adenoma of the palate in a 12-year-old boy. Pleomorphic adenoma is usually found in adults and is rarely found in patients under 20 years of age. We present initial exam, diagnosis, treatment and a review of literature.
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Affiliation(s)
- Brian F Bovino
- Division of Oral &Maxillofacial Surgery, St. Luke's-Roosevelt Hospital Center, New York, NY, USA
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81
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Xiu Q, An L, Gao G. [Non Hodgkin's lymphoma misdiagnosed as mixed salivary gland tumor which located on hard palate one case]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 27:217-218. [PMID: 23631142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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82
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Rinna C, Reale G, Calvani F, Calafati V, Filiaci F, Riccardi E, Ramieri V, Cascino F, Cascone P, Ungari C. Pleomorphic adenoma of the lacrimal gland: two clinical cases. Eur Rev Med Pharmacol Sci 2012; 16 Suppl 4:90-94. [PMID: 23090819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Pleomorphic adenoma of the lacrimal gland is uncommon but it is the most common benign epithelial tumor of this gland. In the literature few cases have been reported in patients aged between 6 years and 80 years with a mean age of 39 years. A correct diagnosis and treatment is fundamental in order to avoid a relapse and sometimes their malignant transformation. An incisional biopsy is better to be avoided because it could injure the capsule, leading to dissemination of tumoral cells in the orbital tissues with a recurrence rate of 30% over 5 years. AIM This papers want to support the use of mini-invasive surgery for the treatment of orbital lesions when it is possible. MATERIALS AND METHODS We report two clinical cases of pleomorphic adenoma affecting the lacrimal gland treated with two different surgery approaches. The radiographic and photographic documentation of the patients was collected in the pre-and post-operatively. All patients underwent a CT scan and MRI. CONCLUSIONS This lesions requires a well-grounded clinical and therapeutic protocol to avoid the risk of malignant transformation or disease recurrence, very dangerous at this site. CT scan and MRI scan are very important to recognize different types of lesions involving the lacrimal gland and fossa. A mini-invasive surgery reduces hospitalization, risk of complications, surgical times and bleedings and guarantees an excellent functional and esthetic result when performed by a skilled surgeon.
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Affiliation(s)
- C Rinna
- Department of Maxillo-Facial Surgery, Sapienza University of Rome, Italy.
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83
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Skálová A, Andrle P, Hostička L, Michal M. [Pleomorphic adenoma of salivary glands: diagnostic pitfalls and mimickers of malignancy]. Cesk Patol 2012; 48:179-183. [PMID: 23121026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pleomorphic adenoma is the most common salivary gland tumor, characterized by a complex biphasic proliferation of epithelial and myoepithelial cells intermingled with a mezenchymal component with frequent metaplastic changes and protean histomorphology of the cells. This review describes several unusual histological findings in pleomorphic adenoma that may mimic malignancy, and therefore they represent a diagnostic pitfall. Intravascular invasion of tumor cells is generally suspicious of malignancy; however, intravascular tumor deposits may be rarely found within the capsule of clinically benign salivary pleomorphic adenomas. It is important not to render a malignant diagnosis in such neoplasms, in the absence of other evidence of malignancy. Pleomorphic adenomas, particularly of minor glands of palate, may contain large areas of squamous and mucinous metaplasia suspicious of mucoepidermoid carcinoma (MEC). In contrast to MEC, metaplastic pleomorphic adenomas do not harbour the distinctive translocations t(11;19) and t(11;15), they are not invasive, in contrast they reveal at least focally myxochondroid stroma. Cribriform structures in pleomorphic adenoma may mimic adenoid cystic carcinoma. Oncocytic metaplasia in cellular rich pleomorphic adenoma/myoepithelioma may be associated with significant nuclear polymorphism and hyperchromasia suspicious of malignancy. The most common pitfall in diagnosis of pleomorphic adenoma is so called "atypical PA" that must be distinguished from early malignant transformation to in situ-carcinoma ex pleomorphic adenoma.
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Affiliation(s)
- A Skálová
- Siklův ústav patologie, Univerzita Karlova v Praze, Lékarská fakulta v Plzni.
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84
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Stodulski D, Mikaszewski B, Stankiewicz C. Signs and symptoms of parotid gland carcinoma and their prognostic value. Int J Oral Maxillofac Surg 2012; 41:801-6. [PMID: 22542080 DOI: 10.1016/j.ijom.2011.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 10/12/2011] [Accepted: 12/07/2011] [Indexed: 01/02/2023]
Abstract
The aim of this study was to analyse signs and symptoms present in patients with parotid gland carcinoma and to assess their prognostic value. A retrospective study of data from 131 patients who were treated surgically was performed. Evaluation of prognostic factors was possible in 109 patients who completed a minimum 5 year follow up. The most common sign and symptoms were parotid mass (96.9%), pain (40.4%), enlarged cervical lymph nodes (32.0%), facial nerve palsy (20.6%) and overlying skin infiltration (19.8%). In 20% of all cases there were no symptoms of tumour malignancy. The average duration of symptoms suggesting malignancy was 4 months. In univariate analysis, the strongest prognostic value was found for facial nerve palsy; it reduced nearly tenfold (9.7) the 5-year disease-free survival. The subsequent poor prognostic factors were: skin infiltration, enlarged cervical lymph nodes, tumour fixation and tumour size (>4 cm). Pain and the dynamics of tumour growth were not statistically significant for survival rate. Significant difference in 5-year disease free survival rate was found between the groups of patients, according to the number of symptoms suggesting malignancy. The multivariate analysis showed that only facial nerve palsy and skin infiltration were independent prognostic factors.
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Affiliation(s)
- D Stodulski
- Department of Otolaryngology, Medical University of Gdansk, Poland.
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85
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Kini YK, Halli R, Mishra S, Kalburge JV. Comprehensive management of a rare carcinoma ex pleomorphic adenoma of the lacrimal gland with a modified lateral orbitotomy access osteotomy. A case report. Oral Maxillofac Surg 2012; 16:123-126. [PMID: 21445559 DOI: 10.1007/s10006-011-0269-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 03/02/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND Complete management of extraconal ocular tumors may require the joint efforts of a maxillofacial surgeon to provide access and an ophthalmic surgeon to completely excise the lesion. Pleomorphic adenoma is the most common benign tumor of the lacrimal glands, representing around 12% of the lacrimal fossa lesions. They may however undergo malignant changes. Carcinoma ex pleomorphic adenoma (CXPA), a type of malignant mixed tumor of the lacrimal gland has been rarely reported. CASE REPORT We report a case of CXPA of the lacrimal gland in a 35-year-old male. He was managed by a modified lateral orbitotomy access osteotomy with complete removal of the lesion and showed postoperative uneventful recovery. DISCUSSION Accurate clinical diagnosis of a neoplasm in the orbital cavity is important for correct therapeutic management. This paper emphasises on the comprehensive management of these lesions with a special emphasis on diagnosis and surgical technique.
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Affiliation(s)
- Yogesh K Kini
- Department of Oral and Maxillofacial Surgery, Rural Dental College, Loni, India.
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86
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Papadogeorgakis N, Kalfarentzos EF, Petsinis V, Parara E, Kopaka ME. Multinodular neck recurrence of parotid gland pleomorphic adenoma: a case report. Oral Maxillofac Surg 2012; 16:137-140. [PMID: 21660435 DOI: 10.1007/s10006-011-0279-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 05/27/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND Pleomorphic adenoma is the most common neoplasm of the parotid gland. It is a benign tumor composed of epithelial and myoepithelial cells arranged in various morphological patterns. The most common reasons contributing to a recurrent disease are obvious or underestimated tumor spillage, incomplete excision, and violation of the pseudocapsule of the tumor. CASE REPORT This article presents a case of gross multinodular recurrence of a parotid gland pleomorphic adenoma in a 38-year-old female patient. Upon clinical examination of the homolateral neck, multiple, painless, well-defined, palpable, nontender masses and subcutaneous nodules of the right parotid and homolateral neck region were revealed. The patient was treated with surgery and subsequent radiation therapy. Histologic examination of the resected specimen was suggestive of a recurrent pleomorphic adenoma disease. There were no signs of malignant transformation in the specimen. The diagnostic procedure followed, and management of the patient is outlined in the paper. DISCUSSION Pleomorphic adenoma is the most common tumor of the parotid gland. In spite of being a benign neoplasm, inadequate management of the lesion may lead to problems such as local recurrence or malignant transformation. Management of recurrent tumors is challenging because the probability of subsequent recurrence increases with each recurrent episode, thus making local control increasingly difficult and damage to the facial nerve more likely.
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MESH Headings
- Adenoma, Pleomorphic/diagnosis
- Adenoma, Pleomorphic/pathology
- Adenoma, Pleomorphic/radiotherapy
- Adenoma, Pleomorphic/surgery
- Adult
- Biopsy, Fine-Needle
- Combined Modality Therapy
- Female
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Magnetic Resonance Imaging
- Neck Dissection
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/radiotherapy
- Neoplasms, Multiple Primary/surgery
- Parotid Gland/pathology
- Parotid Gland/surgery
- Parotid Neoplasms/diagnosis
- Parotid Neoplasms/pathology
- Parotid Neoplasms/radiotherapy
- Parotid Neoplasms/surgery
- Radiotherapy, Adjuvant
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Affiliation(s)
- Nick Papadogeorgakis
- Department of Oral and Maxillofacial Surgery, Evangelismos General Hospital, University of Athens Dental School, 45-47 Ipsilantou Street, Athens 10676, Greece
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87
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Park JH, Do NY, Han SI, Lim SC. Usefulness of the melanoma antigen gene (MAGE) in making the differential diagnosis between pleomorphic adenoma and adenoid cystic carcinoma. J Otolaryngol Head Neck Surg 2012. [PMID: 22498264 DOI: 10.2310/7070.2011.110165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine the clinical usefulness of the melanoma antigen gene (MAGE) in making the differential diagnosis between pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC). In addition, using real-time reverse transcriptase polymerase chain reaction (RT-PCR), we examined which melanoma antigen gene was actually expressed in each tumour. MATERIALS AND METHOD Immunohistochemical staining was performed on samples of paraffin-embedded tissue specimens. Fifty-eight patients were diagnosed as PA (n = 31), ACC (n = 17), and nontumoral salivary tissue (n = 10) using MAGEA and MAGEA4. Using primers that could express MAGEA1, -A2, -A3, -A4, -A6, -A10, and -A12 subtypes, real-time RT-PCR was performed in three cases of PA and four cases of ACC that occurred in fresh tissues. RESULT We found no immunohistochemical expression of MAGEA or MAGEA4 in the nontumoral tissue. There was a mild degree of expression with no statistical significance in cases of PA. In ACC, however, in 17 cases (100%) and 16 cases (95%), there was a positive reaction to MAGEA and MAGEA4, respectively. In the RT-PCR analysis, PA showed no MAGE gene expression. However, both MAGEA3 and MAGEA4 were expressed in ACC. CONCLUSION These results suggest that MAGE could be used as a biologic marker in the differential diagnosis between PA and ACC. Our results also indicate that the expression of MAGE, as confirmed in the RT-PCR analysis, could be used as an alternative method for the early diagnosis of salivary gland tumours.
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MESH Headings
- Adenoma, Pleomorphic/diagnosis
- Adenoma, Pleomorphic/genetics
- Adenoma, Pleomorphic/metabolism
- Adult
- Aged
- Antigens, Neoplasm/biosynthesis
- Antigens, Neoplasm/genetics
- Biomarkers, Tumor/biosynthesis
- Biomarkers, Tumor/genetics
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/genetics
- Carcinoma, Adenoid Cystic/metabolism
- Diagnosis, Differential
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Salivary Gland Neoplasms/diagnosis
- Salivary Gland Neoplasms/genetics
- Salivary Gland Neoplasms/metabolism
- Young Adult
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Affiliation(s)
- Jun Hee Park
- Department of Otolaryngology-Head and Neck Surgery, University School of Medicine, Gwangju 501-759, Republic of Korea
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88
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Chen L, Ray N, He H, Hoschar A. Cytopathologic analysis of stroma-poor salivary gland epithelial/myoepithelial neoplasms on fine needle aspiration. Acta Cytol 2012; 56:25-33. [PMID: 22236742 DOI: 10.1159/000333563] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/20/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Fine needle aspiration (FNA) diagnosis of salivary gland neoplasms with epithelial/myoepithelial cells but rare or no stroma is usually difficult. Our aim was to study the cytomorphology of this cohort of FNA cases and evaluate the clinical follow-up. STUDY DESIGN The diagnostic terminology for this group of aspirates was 'favor an epithelial/myoepithelial neoplasm of the salivary gland'. The cytologic smears of 32 such cases were retrieved and showed cellular smears with bland-appearing or mildly atypical epithelial and myoepithelial cells without typical chondromyxoid stroma seen in pleomorphic adenoma (PA). RESULTS Twenty of the 32 cases had histologic follow-up. Ten of these 20 cases were PAs, including 8 cellular PAs. Two cases were basal cell adenomas, 1 case myoepithelioma and 1 case benign adenoma, not otherwise specified. Among the 6 malignant tumors on surgical resections, there were 3 epithelial-myoepithelial carcinomas, 1 myoepithelial carcinoma, 1 basal cell adenocarcinoma and 1 adenoid cystic carcinoma. CONCLUSIONS Although 14 of the 20 (70%) cases were benign neoplasms, a substantial amount of cases (30%) were malignant salivary gland neoplasms. The generic diagnostic terminology of 'epithelial/myoepithelial neoplasm of the salivary gland' and appropriate clinical follow-up are recommended for these cases.
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Affiliation(s)
- Longwen Chen
- Department of Anatomic Pathology, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
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89
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Dalampiras S, Andreadis D, Epivatianos A, Sakas L, Stanko P. Pleomorphic adenoma of the sublingual salivary gland: an unusual diagnostic challenge. Med Princ Pract 2012; 21:282-4. [PMID: 22222783 DOI: 10.1159/000334721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/26/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To describe a rare case of pleomorphic adenoma of the sublingual gland. CLINICAL PRESENTATION AND INTERVENTION An 80-year-old patient presented with a painless solid submucosal mass of 4 months' duration in the anterior floor of the mouth, appearing as a distinct homogeneous, radiolucent lesion in CT imaging. Histologic findings after complete removal were suggestive of a pleomorphic adenoma almost completely surrounded by a fibrous capsule. No recurrence was observed after a 12-month follow-up. CONCLUSION This case showed the possibility of sublingual salivary gland tumors and highlighted the need to consider them when making a differential diagnosis of masses located in the floor of the mouth.
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Affiliation(s)
- Stylianos Dalampiras
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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90
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Mulla O, Agada F, Dawson D, Sood S. Obstructive sleep apnoea and snoring - is examination necessary? Aust Fam Physician 2011; 40:886-888. [PMID: 22059218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article outlines two cases of snoring and obstructive sleep apnoea (OSA) secondary to parapharyngeal space tumours. Both patients were referred to a specialist sleep clinic where oropharyngeal masses were seen and biopsied. Both underwent surgery and this was curative of both their snoring and their OSA. Parapharyngeal space tumours are an extremely rare cause of OSA and snoring. However, all patients with OSA and snoring should have a full head and neck examination before referral; in rare cases this could enable early detection of a parapharyngeal space tumour.
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91
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Arunkumar KV, Kumar S, Bansal V, Saxena S, Elhence P. Pleomorphic adenoma--unusual presentation of a salivary gland tumor in the neck of a child. Quintessence Int 2011; 42:879-882. [PMID: 22026002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ectopic salivary gland tumors are rare in children. When salivary gland tumors do develop, they preferentially affect major salivary glands and then minor salivary glands. Pleomorphic adenoma, also referred to as a benign mixed tumor, is the most common tumor of the salivary glands. Approximately 90% of these tumors occur in the parotid gland, while the remaining 10% affect the minor salivary glands. However, it is uncommon to find them elsewhere in the head and neck region. We report a rare case of pleomorphic adenoma in the upper neck, an unusual site in an 8-year-old boy.
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Affiliation(s)
- K V Arunkumar
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India.
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92
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Yang S. Differential diagnosis of oncocytic pleomorphic adenoma. INDIAN J PATHOL MICR 2011; 54:853-4; author reply 854. [PMID: 22234139 DOI: 10.4103/0377-4929.91527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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93
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Shamim T. Pleomorphic adenoma of the palate. J Ayub Med Coll Abbottabad 2011; 23:159-160. [PMID: 23272462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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94
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Yan B, Li Y, Yang G, Wen ZN, Li ML, Li LJ. Discrimination of parotid neoplasms from the normal parotid gland by use of Raman spectroscopy and support vector machine. Oral Oncol 2011; 47:430-5. [PMID: 21439894 DOI: 10.1016/j.oraloncology.2011.02.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 02/13/2011] [Accepted: 02/23/2011] [Indexed: 11/17/2022]
Abstract
Preoperative diagnosis of neoplasms in the parotid gland is essential for successful surgical treatment. The purpose of this study is to apply Raman spectroscopy in order to distinguish the spectral differences between pleomorphic adenoma and Warthin tumor from that of normal parotid gland tissues. Furthermore we establish the diagnostic model of the Raman spectra of neoplasms in parotid gland by employing support vector machine (SVM) with Gaussian radial basis function. Firstly, Raman spectra from different histopathological tissues were obtained by near-infrared Raman microscope, SVM was then employed to analyze the different spectra and establish a discriminating model. As a result, the differences of peaks in the region 800-1800 cm(-1) demonstrated the biochemical molecular alterations between different histopathological tissues. Compared with normal parotid gland tissues, the content of proteins, lipids and DNA increased in pleomorphic adenoma. The content of DNA increased but proteins and lipids decreased in Warthin tumor. SVM displayed a powerful role in the classification of three different groups. The sensitivities and specificities of discrimination between different groups reached above 95% and 99%, respectively. Raman spectroscopy combined SVM algorithm could have great potential for providing a noninvasive, effective and accurate diagnostic technology for neoplasm diagnosis in the parotid gland.
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Affiliation(s)
- Bing Yan
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China
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95
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Brooks JK, Nikitakis NG. Rubbery palatal mass. Inflammatory myofibroblastic tumor. Gen Dent 2011; 59:153-155. [PMID: 21903528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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96
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Chen CP, Wang SJ, van Zante A, Yom SS. Stepwise regional and distant progression of recurrent pleomorphic adenoma. J Otolaryngol Head Neck Surg 2011; 40:E5-E10. [PMID: 21303593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Chien P Chen
- Department of Radiation Oncology, University of California-San Francisco, UCSF Comprehensive Cancer Center, 1600 Divisadero Street, San Francisco, CA 94115, USA
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97
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Chiang TY, Chen MK. Endoscope-assisted transoral excision of a huge parapharyngeal pleomorphic adenoma. B-ENT 2011; 7:143-146. [PMID: 21838102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
The treatment of choice for a parapharyngeal pleomorphic adenoma is total surgical resection. We describe an endoscope-assisted transoral excision of a huge parapharyngeal pleomorphic adenoma, and discuss the benefits of this type of operation.
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Affiliation(s)
- T Y Chiang
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
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98
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Mariano FV, Vidaurre EC, Bologna-Molina RE, Carlos-Bregni R, Paes de Almeida O. Histopathological and immunohistochemical analysis of oncocytic pleomorphic adenoma. INDIAN J PATHOL MICR 2011; 54:193-5. [PMID: 21393918 DOI: 10.4103/0377-4929.77403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Fernanda Viviane Mariano
- Department of Oral Pathology, Dental School, University of Campinas, Piracicaba-UNICAMP, Av. Limeira 901, Caixa Postal 52, CEP: 13414-903, Piracicaba-SP, Brazil.
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99
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Konan KE, N'Guessan ND, Anzouan KE, Assouan C, Edouma BG, Assa A. [Diagnostic and therapeutic aspects of parotid tumors in the Maxillofacial Surgery Department of the University Hospital Center in Treichville, Abidjan]. Odontostomatol Trop 2010; 33:11-17. [PMID: 21510354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Taking charge of parotid tumors in an African setting is difficult because of the weakness of the technical, delayed consultation, treatment of traditional healers, tumor volume, secondary infection and ulceration of some of them. OBJECTIVE Identify the epidemiological, clinical, evolutive and therapeutic in order to propose an adapted scheme to the management of these tumors in our African conditions. MATERIALS AND METHODS This is a retrospective study of 38 patients with parotid tumors operated and hospitalized in the department of stomatology and maxillofacial surgery university hospital of Treichville (Abidjan), during the period from January 2005 to December 2009 included, so a period of 5 years. RESULTS The study involved 21 (55.3%) men for 17 (44.7%) women aged between 8 and 75 years came to 76.31% for parotid tumor. In 55.26% patients consulted between 1 and 5 years. Clinically: general condition was preserved in 91.1%, tumor size ranged between 5 and 10 cm in 60.53%, they were in the form of nodules in 78.9%, were covered with healthy skin in 78.95%, appeared as isolated tumor in 72.06%. Ultrasound examination was the most paraclinical exam used (65.79%). The tumors were benign in 76.3% dominated by pleomorphic adenoma (63.2%). The most common malignant tumor was muco epidermoid carcinoma (7.9%). Exo-facial parotidectomy was the most common technique used (60.52%). The rate of patient follow-up at 2 years was 5.26%. CONCLUSION Social and cultural conditions of the management of tumors and lack of technical platform lead us to propose the total parotidectomy for a better cure rate of patients.
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Affiliation(s)
- K E Konan
- CHU Treichville Abidjan, Côte d'Ivoire
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100
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Takahama Junior A, Almeida OPD, Kowalski LP. Parotid neoplasms: analysis of 600 patients attended at a single institution. Braz J Otorhinolaryngol 2010; 75:497-501. [PMID: 19784416 PMCID: PMC9448922 DOI: 10.1016/s1808-8694(15)30486-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 04/10/2009] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Salivary gland tumors are rare, generally benign and affect mainly the parotid gland. AIM The purpose of this study was to retrospectively analyze all cases of parotid tumors treated at our institution from 1953 to 2003. METHODS All patients with primary parotid tumors were selected; clinical and histopathological data were analyzed and described. RESULTS 600 cases of parotid tumors were selected; 369 were benign and 231 were malignant. Pleomorphic adenoma was the most frequent benign tumor. The most common malignant tumor was the mucoepidermoid carcinoma. Therapy in most cases consisted of parotidectomy. Adjuvant therapy -- mainly radiotherapy -- was used in some cases with malignant tumors. The incidences of local, regional and distant recurrences of malignant tumors were 10%, 8% and 9%. CONCLUSION Patients with parotid tumors treated at our institution were mainly adults, with marginally more female patients. Benign tumors were mostly the pleomorphic adenoma, which were more frequent than malignancies. Most of the patients were treated by partial or total parotidectomy. Adjuvant therapy, mainly radiotherapy, was used in selected malignant cases.
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