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Sheereen S, Manva MZ, Sheereen S, Patil NN, Abdelrahim RK, Afroz MM. "Pleomorphic adenoma in salivary glands: Insights from a 100-patient analysis". J Oral Maxillofac Pathol 2024; 28:42-48. [PMID: 38800432 PMCID: PMC11126267 DOI: 10.4103/jomfp.jomfp_452_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 05/29/2024] Open
Abstract
Introduction Pleomorphic adenoma (PA) is a benign epithelial tumour originating from the salivary gland, specifically the parotid gland. This study aims to comprehensively analyse the clinical and pathological features of PA by examining the characteristics of the tumour, including its histological structure and immunohistochemical profile. Materials and Methods Over 8 years, beginning in October 2015 and ending in October 2023, an exhaustive retrospective study was conducted in the Department of Pathology, Kasturba Medical College, Mangalore, Manipal University, Karnataka, India. The research focused on 100 cases of pleomorphic adenoma and involved a meticulous examination of the clinical and pathological characteristics obtained by retrieving the pertinent files. Results Out of all the primary tumours, the majority (n = 70) was found in the parotid gland, followed by PA that developed from the minor salivary glands of the palate (n = 07), the submandibular gland (n = 17), and the lacrimal gland (n = 04). Only two cases had a primary tumour located in the lips. Females were more susceptible to these tumours than males. The parotid gland tumours showed a distinct trend in laterality, with 73 cases observed on the right side. In 85%, the initial symptom of the condition was painless swelling. Conclusion Salivary gland PA is typically a benign tumour. However, a subset of these tumours can exhibit a malignant phenotype. The preferred treatment is surgical excision with adequate margins.
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Affiliation(s)
- Shazima Sheereen
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | | | - Shamama Sheereen
- Department of Pedodontics and Preventive Dentistry, Maharaj Vinayak Global University, Jaipur, Rajasthan, India
| | - Namrata N. Patil
- Department of Oral Pathology and Microbiology, Saraswati Dhanwantari Dental College and Hospital, Post Graduation Research Centre, Parbhani, Maharashtra, India
| | - Rawa K. Abdelrahim
- Department of Preventive Dental Sciences, Dar Al Uloom University, Riyadh, KSA
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Kalwaniya DS, Meena R, Kumar D, Tolat A, Arya SV. A Review of the Current Literature on Pleomorphic Adenoma. Cureus 2023; 15:e42311. [PMID: 37614271 PMCID: PMC10442517 DOI: 10.7759/cureus.42311] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/25/2023] Open
Abstract
Pleomorphic adenomas (PA) are the most common benign salivary gland tumors. They arise from the major salivary glands, as well as the minor salivary glands. They may arise rarely from the palate, oral cavity, neck, and nasal cavity also. Yet, the fourth, fifth, and sixth decades of life are the most common for them to manifest. Forty percent of them occur in males and 60% in females. It is a benign mixed tumor, which has three components: an epithelial component, a myoepithelial cell component, and a mesenchymal component. A fibrous capsule separates these cells from the surrounding tissues. It generally presents as a slowly progressing painless swelling, which is well-delineated, nonsymptomatic, and not involving the facial nerve. Salivary gland tumors can be accurately diagnosed before surgery using fine-needle aspiration (FNA), ultrasonography (USG), and computed tomography (CT) scan. Calponin, cluster of differentiation 9 (CD9), glial fibrillary acidic protein (GFAP), Mcl-2, metastasis suppressor gene (NM23), p63, S-100, smooth muscle actin (SMA), and SRY-box transcription factor 10 (SOX10) exhibit the majority of the positive reactions in pleomorphic adenomas. The diagnostic marker pleomorphic adenoma gene 1 (PLAG1) is frequently employed since it is specific for pleomorphic adenoma. Although benign, these epithelial tumors have a propensity to recur and undergo malignant transformation if incompletely excised, leading to increased morbidity in these patients. A review of the consensus guidelines and literature was conducted, and the online literature on the subject from 2002 was included. This article is not a complete review of all the available literature; rather, it is a comprehensive review of the topic.
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Affiliation(s)
- Dheer S Kalwaniya
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Reena Meena
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Devender Kumar
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Aditya Tolat
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Satya V Arya
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Saripalli RRK, Alluri LSC, Jakkula A, Yadavilli SS. Extracapsular Dissection for Small Benign Tumors of Parotid Gland: A Case Report on Contemporary Technique. Cureus 2021; 13:e17007. [PMID: 34540408 PMCID: PMC8423323 DOI: 10.7759/cureus.17007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/30/2022] Open
Abstract
Salivary gland tumor looms as painless enlarging mass which may embrace in both major or minor glands. Pleomorphic adenoma (PA) accord about 40-70% of all salivary gland tumors, where Warthin tumor, basal cell adenoma (BCA), adenoid cystic carcinoma (ACC), and sebaceous tumors have a strong predilection for major salivary gland. However, polymorphous low-grade adenocarcinoma (PLGA) has a marked predilection for the minor salivary gland. We present a case of PA in a 26-year-old male patient that has been successfully managed by extracapsular dissection (ECD) without any post-operative complications.
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Affiliation(s)
| | | | - Ananthnag Jakkula
- Department of Oral and Maxillofacial Surgery, GSL Dental College & Hospital, Rajahmundry, IND
| | - Sai Sarat Yadavilli
- Department of Oral and Maxillofacial Surgery, St. Joseph Dental College, Eluru, IND
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Use of Propensity Score Matching to Compare Short Outcomes from Transoral and External Surgical Approaches in Patients with Deep-Lobe Parotid Pleomorphic Adenomas. ACTA ACUST UNITED AC 2021; 28:3115-3123. [PMID: 34436038 PMCID: PMC8395425 DOI: 10.3390/curroncol28040272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022]
Abstract
To compare the outcomes of patients who had deep-lobe parotid gland pleomorphic adenomas (PAs) that extended into the parapharyngeal space after surgical treatment, using a transoral approach or an external approach. One hundred and twelve eligible patients, with deep-lobe parotid gland PAs, were enrolled in this retrospective study. The surgical outcomes were compared for patients who received a transoral approach and an external approach, using 1:1 propensity score matching (PSM). The outcome measures were recurrence rate, facial nerve deficit, Frey’s syndrome, and hospitalization time. The median follow-up time was 4.8 years. After PSM, the transoral approach and external approach groups had no statistically significant difference in recurrence (10.3% vs. 3.4%; p = 0.201). The transoral approach group had no facial nerve deficit, but 5 of 29 patients (17.2%) in the external approach group had transient facial nerve paralysis (p = 0.052). The external approach group had a longer hospitalization time than the transoral approach group (5 vs. 4 days, p = 0.0017). The use of a transoral surgical approach to treat patients with deep-lobe parotid gland PAs led to low recurrence, shorter hospitalization times, and good functional and cosmetic outcomes.
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Hammed A, Alassaf A, Hammed S, Issa H. Complete resection of a huge parapharyngeal lesion without neurovascular injuries poses a big challenge. J Surg Case Rep 2021; 2021:rjab134. [PMID: 33927868 PMCID: PMC8062126 DOI: 10.1093/jscr/rjab134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
Abstract
Pleomorphic adenoma is the most common salivary gland neoplasm, accounting for 63% of all parotid gland tumors. Most tumors originate in the superficial lobe but, more rarely, these tumors may involve the deep lobe of the parotid gland, growing medially and occupying the parapharyngeal space (PPS). Our case presents a 48-year-old man with an extremely huge recurrent parapharyngeal lesion that bulging in the nasopharynx and the oropharynx and significantly comprised the airways. Surgery was planned to approach the deeper lobe of parotid gland and para-pharyngeal mass by transparotid, transmandibular swing approach. Histopathological examination revealed the features suggestive of pleomorphic adenoma. The patient was discharged after 9 days with no facial nerve deficit. Management of these tumors is more challenging due to the anatomical location of the para-pharyngeal space. Preoperative definitive diagnosis, with tumor typing, is less important, and incisional biopsy of any PPS mass should definitely be avoided, in order not to run the risk of a significantly higher rate of recurrence.
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Affiliation(s)
- Ali Hammed
- Department of Neurosurgery, Tishreen University Hospital, Lattakia, Syria
| | - Areeg Alassaf
- Otolaryngology-Head and Neck Surgery, Almouwasat University Hospital, Damascus, Syria
| | - Salah Hammed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Hala Issa
- Faculty of Medicine, Tishreen University, Lattakia, Syria
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Jain S, Hasan S, Vyas N, Shah N, Dalal S. Pleomorphic Adenoma of the Parotid Gland: Report of a Case With Review of Literature. Ethiop J Health Sci 2016; 25:189-94. [PMID: 26124628 PMCID: PMC4478272 DOI: 10.4314/ejhs.v25i2.13] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. The tumor has a female predilection between 30–50 years of age. Slowly progressing asymptomatic swelling is the usual presentation of the tumor. Surgical excision of the tumor mass forms the mainstay of treatment, with utmost care taken to preserve the facial nerve. Case Details This case report aims to throw light on an interesting case of pleomorphic adenoma of the parotid gland in a 50 years old female patient. The patient presented with a slowly progressing asymptomatic swelling on the left side of the face. There is also a special emphasis to a detailed review of literature. Conclusion Salivary gland neoplasms can occur at any site where salivary tissue is present. Pleomorphic adenoma is the commonest salivary gland tumor characterized by diverse histomorphological features. Early diagnosis and treatment plan entails thorough history taking, clinical examination, coupled with radiographic and histopathological findings.
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Affiliation(s)
- S Jain
- Department of Oral Surgery, Ahmedabad Dental College, Ahmedabad, Gujrat, India
| | - S Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - N Vyas
- Department of Oral Surgery, Ahmedabad Dental College, Ahmedabad, Gujrat, India
| | - N Shah
- Department of Oral Surgery, Ahmedabad Dental College, Ahmedabad, Gujrat, India
| | - S Dalal
- Department of Oral Surgery, Ahmedabad Dental College, Ahmedabad, Gujrat, India
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Datarkar AN, Deshpande A. Giant Parapharyngeal Space Pleomorphic Adenoma of the Deep Lobe of Parotid Presenting as Obstructive Sleep Apnoea: A Case Report & Review of the Diagnostic and Therapeutic Approaches. J Maxillofac Oral Surg 2014. [PMID: 26225040 DOI: 10.1007/s12663-014-0690-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Salivary gland tumours constitute about less than 4 % of all head and neck tumours. Pleomorphic adenoma, also called benign mixed tumour, is the most common tumour of the salivary glands. About 80-90 % of these tumours occur in the major salivary gland mainly parotid gland and 10 % of them occur in the minor salivary glands. AIMS AND METHODS Aim of this case report is to discuss the unique case of giant parotid pleomorphic adenomas arising in the deep lobe involving the parapharyngeal space and difficulty in respiration at sleep during nights repoted at this institute. The patient was undergoing treatment for obstructive sleep apnea syndrome when she reported at this institute for disturbed sleep. Diagnosis was based on computed tomography scan and magnetic resonance imaging and cytology by means of fine needle aspiration biopsy. CONCLUSION An exhaustive pre-operative diagnostic algorithm is mandatory before approaching such lesions involving parapharyngeal space. Fine needle aspiration biopsy is, in our opinion, mandatory to avoid histological surprises. The surgical approach varies according to the location of the tumour and should provide excellent visibility with wide surgical exposure to secure local neurovascular structures.
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Affiliation(s)
- Abhay N Datarkar
- Department of Craniofacial Surgery, Meditrina Institute of Medical Sciences, Nagpur, India
| | - Ajay Deshpande
- Department of Craniofacial Surgery, Meditrina Institute of Medical Sciences, Nagpur, India
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Akın İ, Karagöz T, Mutlu M, Şahan M, Önder E. Pleomorphic adenomas of the parapharyngeal space. Case Rep Otolaryngol 2014; 2014:168401. [PMID: 25140265 PMCID: PMC4129673 DOI: 10.1155/2014/168401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 07/01/2014] [Accepted: 07/10/2014] [Indexed: 11/23/2022] Open
Abstract
Background. Parapharyngeal space is one of potential facial planes for neoplasms and infections and represents less than 1% of all head and neck tumours. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. Case Presentation. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported. Extensive preoperative diagnostic workup was done in order to verify the nature and size of the tumour and the proximity to the large vessels. Review of the literature, clinical features, pathology, radiological findings, and treatment of these tumours are discussed. Conclusion. The excision of the tumor through submandibular transcervical approach, without cutting the mandible, turned out to be a safe and radical approach in all three cases.
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Affiliation(s)
- İstemihan Akın
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Tuğba Karagöz
- Department of Otorhinolaryngology and Head and Neck Surgery, Diskapi Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey
| | - Murad Mutlu
- Department of Otorhinolaryngology and Head and Neck Surgery, Diskapi Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey
| | - Mehmet Şahan
- Department of Otorhinolaryngology and Head and Neck Surgery, Diskapi Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey
| | - Evrim Önder
- Department of Pathology, Diskapi Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey
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Abstract
Pleomorphic adenoma is the most common tumor arising from the parotid salivary gland. In most instances, it involves the superficial part of the gland rarely affecting the deep part, which often presents as a swelling on the lateral pharyngeal wall. The neoplastic process involving the superficial and the deep part of the same gland is extremely unusual. We had a patient who presented to our clinic with a recurrent swelling of his left parotid gland with a diagnosis of pleomorphic adenoma. On a computed tomographic scan, it was found to involve both the superficial and deep parts of the gland. The gland was excised completely, preserving the facial nerve and all its branches. A histopathologic study of the specimen confirmed the diagnosis and extent of the disease.
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Ruiz-Laza L, Infante-Cossio P, Garcia-Perla A, Hernandez-Guisado JM, Gutierrez-Perez JL. Giant pleomorphic adenoma in the parapharyngeal space: report of 2 cases. J Oral Maxillofac Surg 2006; 64:519-23. [PMID: 16487817 DOI: 10.1016/j.joms.2005.11.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Luis Ruiz-Laza
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Seville, Spain
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Hernández Sandemetrio R, Armengot Carceller M, Alba García JR, Taleb C, Jiménez Roig JP, Frías Moya-Angeler S, Basterra Alegría J. Adenoma pleomorfo gigante de lóbulo profundo de la parótida: a propósito de un caso. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 57:56-8. [PMID: 16503035 DOI: 10.1016/s0001-6519(06)78664-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parapharyngeal space tumors are rare. Salivary neoplasms being the most frequent ones. The important volume they can reach, their silent character, and the complex anatomic relationships of this area makes their surgical resection difficult. This report describes a case of a pleomorphic adenoma in the deep lobe of the parotid gland presented like a parapharyngeal mass, and its diagnosis and treatment.
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Affiliation(s)
- R Hernández Sandemetrio
- Servicio de Otorrinolaringología, Hospital General Universitario, Facultad de Medicina, Valencia.
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Oliai BR, Sheth S, Burroughs FH, Ali SZ. ?Parapharyngeal space? tumors: A cytopathological study of 24 cases on fine-needle aspiration. Diagn Cytopathol 2004; 32:11-5. [PMID: 15584054 DOI: 10.1002/dc.20154] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The parapharyngeal space (PPS) is a well-defined anatomic zone of loose connective tissue lying deep to the tonsil and lateral to the pharynx. Neoplasms arising within the PPS are rare. We retrospectively reviewed 24 PPS fine-needle aspirations (FNAs) performed at The Johns Hopkins Hospital over the past 16 years (1987-2002). Patients presented with neck pain, dysphagia, and/or intraoral swelling of varying duration. Radiographic imaging disclosed PPS masses, varying in size from 2.5 to 8 cm. The most common clinicoradiographic suspicion was a nerve sheath tumor. Six cases had FNA performed using a 23-gauge needle via a transoral approach in the outpatient suite whereas the remainder were aspirated via a 22-gauge Franseen needle under CT guidance. Six of 24 cases (25%) were nondiagnostic due to lack of adequate cellular material. Of the 18 cases considered diagnostic, there were nine (50%) pleomorphic adenomas (PAs); three (17%) squamous-cell carcinomas (SCC); and one each of oncocytoma, adenocarcinoma, not otherwise specified (NOS), adenoid cystic carcinoma, lipoma, neurofibroma, and non-Hodgkin lymphoma, together comprising the remaining 33%. Four of the six cases deemed nondiagnostic (consisting predominantly of blood) on subsequent tissue follow-up revealed paraganglioma (two cases), SCC (one case), and schwannoma (one case). PPS is an uncommon target of an FNA procedure. PPS masses represent a heterogeneous group of neoplasms of which PA appears most common, representing 50% of our diagnostic cases. The rate of nondiagnostic FNA samples is moderately high due to excessive bleeding encountered in this location and other technical problems relating to adequately targeting the lesion in close vicinity of major neck vessels.
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Affiliation(s)
- Bahram R Oliai
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Panoussopoulos D, Yotakis J, Pararas B, Theodoropoulos G, Papadimitriou K. Giant pleomorphic adenoma of the parotid gland involving the parapharyngeal space treated by a totally extraoral transparotid approach. J Surg Oncol 2002; 81:155-7. [PMID: 12407730 DOI: 10.1002/jso.10165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- D Panoussopoulos
- First Department of Propaedeutic Surgery, Athens University Medical School, Hippocration Hospital, Athens, Greece. dpanouscc.uao.gr
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Rodríguez-Ciurana J, Rodado C, Sáez M, Bassas C. Giant parotid pleomorphic adenoma involving the parapharyngeal space: report of a case. J Oral Maxillofac Surg 2000; 58:1184-7. [PMID: 11021720 DOI: 10.1053/joms.2000.9587] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J Rodríguez-Ciurana
- Department of Oral and Maxillofacial Surgery, Vall d'Hebron Hospital, Barcelona, Spain.
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Bozzetti A, Biglioli F, Gianni AB, Brusati R. Mandibulotomy for access to benign deep lobe parotid tumors with parapharyngeal extension: report of four cases. J Oral Maxillofac Surg 1998; 56:272-6. [PMID: 9461160 DOI: 10.1016/s0278-2391(98)90884-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Bozzetti
- Department of Maxillofacial Surgery of the University of Milan, The San Paolo Biomedical Institute, Italy
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