Pleomorphic adenoma in the nasal cavity: a clinicopathological study of ten cases in Finland

Pediatric nasal septum pleomorphic adenoma: a case report

Pleomorphic adenoma (PA), the most common benign salivary gland tumor, is rarely found in the nasal cavity and paranasal sinuses, particularly in pediatric patients. This report presents a case of PA in the nasal septum of a 14-year-old girl who presented with unilateral epistaxis and progressive nasal obstruction. The tumor was excised from the left anterior nasal septum via endoscopic sinus surgery, and PA was confirmed through histopathological examination. This case emphasizes the importance of including PA in the differential diagnosis of pediatric sinonasal masses, despite its rarity, and underscores the necessity of meticulous surgical planning to prevent recurrence. Further studies are needed to better understand the long-term outcomes and optimal management strategies for this rare condition in children.

Diagnostic Challenges of Sinonasal Pleomorphic Adenoma

Pleomorphic adenomas (PAs) are benign tumors of the salivary glands. Rarely, they arise in the sinonasal cavity, presenting as well-defined, homogeneous soft tissue masses, causing expansive bony changes. The significance of PAs is the possibility of giving rise to malignant carcinoma - "carcinoma ex-pleomorphic adenoma" (CXPA).Here, we present the case of a 64-year-old female complaining of progressive unilateral congestion and external nose deformation, mostly along the left contour of the radix, with epiphora of the ipsilateral eye. Eventually, a tumor began protruding from the left naris. The computed tomography excluded osteolysis, while the surgical procedure discovered the inferior turbinate as the origin of the tumor. In addition, the ipsilateral maxillary sinus was found to have developed secondary sinusitis. After complete surgical excision, the histological result was sinonasal melanoma, but following no progression of the disease, a second pathologist with additional immunohistochemical markers (HMB-45 (human melanoma black 45) negative, Melan-A (melanoma antigen recognized by T-cells 1) negative, S100 (protein soluble in 100% ammonium sulfate at neutral pH) positive, panCK AE1/AE3 (pan cytokeratin antibodies AE1 and AE3) negative, p63 (tumor protein 63) negative, Ki-67 (marker of proliferation Kiel 67) 10%, CD68 (cluster of differentiation 68) negative, CK7 (cytokeratin 7) negative, and CDX2 (caudal-type homeobox 2) negative) placed the definitive diagnosis of PA.PA of the inferior turbinate is an extremely rare finding, with the clinical symptoms being unspecific. Sometimes, SOX-10 (SRY-box transcription factor 10) positivity can mislead to malignant melanoma, as in our case, which is why a broad panel of immunohistochemical markers is critical for the definitive diagnosis.

A Large Pleomorphic Adenoma in Nasal Cavity Misdiagnosed as Inverted Papilloma

Pleomorphic adenoma (PA) is a benign tumor characterized by slow-growing mixed tumors in the craniofacial area. It is relatively common in salivary glands; however, PA of the nasal cavity, which arises in the minor salivary glands, is rare. We present the case of a large PA in the nasal cavity of an adult immunocompetent woman with nasal obstruction and intermittent epistaxis. Based on preoperative radiologic examinations, she was misdiagnosed with an inverted papilloma. Endoscopic resection was performed under general anesthesia. Pathologically, the patient was confirmed to have PA, which has great cellularity and few stromal components. No complications or recurrences during the 1-year follow-up period were observed.

A Rare Case of Sinonasal Pleomorphic Adenoma

Pleomorphic adenoma (PA) is the most prevalent benign tumor of the salivary glands, characterized by both epithelial and mesenchymal differentiation. It primarily originates within the parotid and submandibular glands, with only rare occurrences in the minor salivary glands. PA in the sinonasal area is extremely rare. Herein, we present a case of a 61-year-old female with a large soft tissue mass in the paranasal sinus and nasal cavity, as evidenced by computed tomography imaging. The patient suffered from repeated nasal congestion for more than 6 months. Eventually, the mass was completely resected using an endoscopic endonasal prelacrimal approach under general anesthesia. Postoperative pathological examination revealed the presence of PA in the nasal sinus.

Endoscopic Endonasal Resection of Sinonasal and Nasopharyngeal Pleomorphic Adenomas: A Case Series

The aim of this study is to describe the clinicopathological characteristics of intranasal pleomorphic adenomas (PAs), as well as the role and outcomes of endoscopic endonasal resection. A retrospective review of the clinical data from patients with PA of the nasal cavity who were treated by the authors at three tertiary medical centers between June 1998 and December 2019. A total of five patients with PA were found. Three patients were male, two were female and their mean age was 62.2 years. All cases were resected "en bloc" with endoscopic endonasal approach. No evidence of disease was observed during a mean follow-up of 10.6 years. No case presented with malignant transformation into carcinoma ex-PA. PA of the sinonasal tract and the nasopharynx is difficult to diagnose due to nonspecific clinical and radiological findings. Endoscopic endonasal approaches can be considered the gold standard in the treatment of these tumors and provide excellent visual control of the surgical field and clear margins.

Pleomorphic Adenoma Presenting as an Atypical Nasal Mass in a 26-Year-Old Female

Pleomorphic adenoma (PA) is a salivary gland tumor that may rarely occur in the nasal cavity. It can be a clinical diagnostic dilemma in many instances due to many possible differential diagnoses. We report the case of a 26-year-old female who presented with a 3-year history of a right nasal growth associated with ipsilateral nasal blockage, nasal pain, and rhinorrhea. Radiological image showed a mild enhancing lesion in the right nasal cavity. The patient underwent a lateral rhinotomy with wide excision of the mass. Histopathological exam was consistent with PA. Nasal PA is a rare entity and should be suspected as a diagnosis for intranasal tumors.

Sinonasal/nasopharyngeal pleomorphic adenoma and carcinoma ex pleomorphic adenoma: a report of 17 surgical cases combined with a literature review

Objective: The aim of this study was to review demographic data, location, clinical symptoms, therapeutic methods, pathological features and relapse in sinonasal/nasopharyngeal pleomorphic adenoma (PA) and carcinoma ex pleomorphic adenoma (CXPA).

Methods: We conducted a retrospective analysis of 17 patients who were referred to our hospital during a 5-year period from 2013 to 2018.

Results: In this series, there were 7 males and 10 females. The tumors originated from the nasal septum in 4 cases, from the lateral wall of the nasal cavity in 2 cases, from the maxillary sinus in 1 case, and from the nasopharynx in 7 cases. The origin sites of 3 cases were not clear. The main symptoms were usually unilateral nasal congestion and epistaxis. All patients underwent endoscopic resection surgery. The postoperative period was uneventful. Ten patients were diagnosed with benign PA, and 7 patients were diagnosed with CXPA, including 5 cases of adenocarcinoma, 1 patient with mucoepidermoid carcinoma, and 1 patient with adenoid cystic carcinoma. After a mean follow-up period of 2.2 years (6 months–5.3 years), the recurrence rate of benign PA was 10% (1/10); the rate of malignant recurrence was 42.8% (3/7).

Conclusion: Sinonasal/nasopharyngeal PA and CXPA are rare neoplasms, and the most common primary site of PA and CXPA is the nasopharynx. As any salivary carcinoma type can arise in PA, these PA sites should be thoroughly sampled and closely examined to exclude the possibility of malignant transformation. Furthermore, PA and CXPA should be treated as soon as possible after definitive diagnosis, and endoscopic resection of tumor-negative margins may be helpful in preventing recurrence.

Sinonasal pleomorphic adenoma: A single institution case series combined with a comprehensive review of literatures

OBJECTIVE

This study aimed to reveal diagnosis, management, and treatment outcome characteristics of sinonasal pleomorphic adenoma and to identify predictors for disease recurrence.

METHODS

This study comprised a retrospective review of data from seven patients with sinonasal pleomorphic adenoma who were treated by the authors at a tertiary medical center between January 2005 and May 2017. In addition, the MEDLINE database was searched for literature published in English. A systematic review of the published articles was performed.

RESULTS

A total of 42 articles were eligible for review. Data from the seven treated patients and 101 patients described in the literature were included in the analysis. An endoscopic approach was employed in all cases treated at our institution, and recurrence was found in one patient with a large, 5.5-cm tumor. In reviewing prior publications, the mean age at surgery was 45.4 years, and the primary sign at diagnosis was nasal obstruction. The most common primary tumor site was the nasal septum (57.4%), and the mean tumor size was 3.6cm (range, 0.5-10cm) in 76 cases for which detailed information was available. Endoscopic endonasal resection achieved successful oncologic control in applied cases (25/25, 100%). Recurrence was found in eight of 101 patients. Multivariate analysis identified tumor origin of the paranasal sinus (adjusted OR 31.000, p=0.016) as being significantly associated with a high prevalence of recurrence.

CONCLUSION

Pleomorphic adenoma is a rare benign tumor of the sinonasal tract. Surgery that achieves clear margins is the treatment of choice. The tumor may be accessible via an endoscopic endonasal approach in most cases, although incomplete resection of the tumor stem may allow for tumor recurrence. In addition, our findings suggest that a tumor originating from the paranasal sinus is significantly associated with a high prevalence of recurrence.

Pedunculated carcinoma ex pleomorphic adenoma of the nasal cavity: A unique case report

BACKGROUND

A carcinoma ex pleomorphic adenoma (CXPA) is an epithelial malignancy arising in or from a benign pleomorphic salivary adenoma. The parotid gland is the most common location of CXPAs. Minor salivary gland CXPAs of the nasal cavity are exceedingly rare, with only 6 documented in the literature.

METHODS AND RESULT

We present a 7th case: an unusual pedunculated intranasal CXPA, which had a favorable outcome after a wide endoscopic excision and the longest follow-up period reported to date. The clinical features, immunohistochemical characteristics, treatment choices, and disease outcomes of the intranasal CXPAs reported in previous studies are also reviewed.

CONCLUSION

This case demonstrates the importance of considering the possibility of CXPA in the differential diagnosis of minor salivary gland malignancies in the nasal cavity.