Pleomorphic Adenoma of Soft Palate: Unusual Occurrence of the Major Tumor in Minor Salivary Gland-A Case Report and Literature Review

Management of a giant pleomorphic adenoma of the soft palate: A case report

Key Clinical Message

Benign mixed salivary gland tumor is comprised of epithelial and myoepithelial cells and represents up to 80% of tumors of the parotid gland. It is relatively rare in the soft palate and in other minor salivary glands. Surgery is the standard care.

Abstract

Salivary gland tumors are relatively rare and morphologically diverse group of lesions. Pleomorphic adenoma (PA) is the most common salivary gland tumor, accounting for approximately 80% of all major and minor salivary gland tumors. PA usually affects the parotid gland. Huge PA occurring in soft palate is extremely rare. Patients with these tumors are usually between at the age of 40 and 60 years. The tumors exhibit pleomorphic nature microscopically that may pose diagnostic challenges to pathologists as may confuse PA histopathologically with other salivary gland tumors. Surgery is the standard treatment. The purpose of writing this case study is to describe unusual case of a giant PA of the soft palate found in a 44-year-old male successfully managed at our facility.

Surgical Treatment of a Huge Pleomorphic Adenoma in the Hard Palate of a Young Female Adult: A Case Report

Pleomorphic adenoma is the most common salivary gland tumor. This tumor mostly involves the parotid gland; however, if it occurs in the minor salivary glands, the palate would be the most common site. This lesion is more prevalent in patients with 40 to 60 years of age. Regarding the literature, the incidence of giant pleomorphic adenoma of the palate in young patients is considered a rare finding. Hereby, we present a rare case of pleomorphic adenoma of the palate, with an astonishing size, found in a 27-year-old patient. Furthermore, the surgical treatment of this lesion is described. This case was effectively treated with surgical curettage and tumor resection, emphasizing the significance of early detection in order to minimize complications. Surgical treatment, was beneficial to help the patient resume to normal life. Additionally, the clinical, radiological, and histopathological aspects and potential surgical treatments are discussed.

Computed tomographic features of adenoid cystic carcinoma in the palate

Background

To evaluate the computed tomographic features and create a prediction model for clinical diagnosis of adenoid cystic carcinoma (ACC) in the palate with intact mucosa.

Methods

From March 2016 to May 2018, 102 patients with palatal tumors and intact mucosa, including 28 patients with a pathological diagnosis of ACC after surgery, were enrolled in this study. The patients’ clinical symptoms, computed tomographic features and pathological diagnoses were recorded and analyzed. Independent predictors of ACC were determined by using univariate analysis and multivariate logistic regression, and the discrimination and calibration of the prediction model was evaluated, and internal validation was performed.

Results

Univariate analysis of patients showed that ACC patients were more likely than non-ACC patients to be older (P = 0.019); to have palatine bone destruction (P<0.001) and greater palatine foramen (GPF) enlargement (P<0.001); to have involvement of the pterygopalatine fossa (P<0.001), foramen rotundum (P<0.001), nasal cavity (P<0.001) and maxillary bone (P<0.001); and to have numbness (P = 0.007) and pain (P<0.001). Multivariate logistic analysis showed that age and GPF enlargement were independent predictors of ACC in palatal tumors. The diagnostic prediction model showed good discrimination and calibration, as evaluated by the area under the receiver operating characteristic curve (0.98) and the Hosmer-Lemeshow goodness-of-fit test (P = 0.927).

Conclusions

The palate ACC prediction model based on age and GPF enlargement shows excellent discrimination with no evidence of poor calibration. Older patients with palatal tumors and intact mucosa should be considered for ACC when they have GPF enlargement.

Electronic supplementary material

The online version of this article (10.1186/s40644-019-0190-z) contains supplementary material, which is available to authorized users.

Soft Palate Pleomorphic Adenoma of a Minor Salivary Gland: An Unusual Presentation

Approximately 10% of pleomorphic adenomas occur in the minor salivary glands with the palate being the most common site. Pleomorphic adenomas account for the majority of palatal tumours; however, minor salivary gland tumours have a higher risk of malignancy compared to tumours of the major salivary glands, so appropriate diagnostic evaluation should be prompt. We present a case of a 52-year-old man with a longstanding history of a soft palate pleomorphic adenoma which required excision under general anaesthetic via a mandibular swing approach. As well as the surgical approach to access this tumour; this case is unique as it is the largest soft palate pleomorphic adenoma reported in the literature. We discuss the appropriate preoperative investigations and airway considerations for this patient, as well as the factors to consider when planning operative management of palatal tumours.