Atypical features in pleomorphic adenoma—a clinicopathologic study and implications for management

Oral cavity salivary gland pleomorphic adenoma: a histomorphological case series

BACKGROUND

Pleomorphic adenoma (PA), the most common benign salivary gland epithelial lesion, has a biphasic epithelial-mesenchymal pattern and great histopathological diversity.

METHODS

This study's objective was to conduct a retrospective clinicopathological analysis, focusing on the histopathology characteristics of salivary gland PA.

RESULTS

There were ten cases of pleomorphic adenoma. The mean age was 33.5 years and no gender predilection was observed. All the patients presented with an asymptomatic mass and the duration of presentation was 31.2 ± 19.4 months. The cellular subtype (50 %) of PA was the most common. Capsular infiltration and incomplete capsules occurred in 20 % of cases. All the cases had round (100 %) and myxoid stroma. The cellular subtype was more common in the major salivary glands; showed capsular abnormalities (incomplete capsule, absent capsule, and tumor infiltration); and had more plasmacytoid, angular, spindled non-luminal cells as well as inflammation and cystic degeneration. The classic subtype had more clear and oncocytic cells along with sebaceous and squamous differentiation. The stroma-rich subtype had the shortest duration of complaints (three months) and showed giant cell reaction.

CONCLUSIONS

These findings confirm previous studies on the clinicopathological features of pleomorphic adenomas and highlight important morphologic characteristics like capsular invasion and squamous metaplasia, which can otherwise indicate malignancy.

MR Imaging Findings of Carcinoma Ex Pleomorphic Adenoma Related to Extracapsular Invasion and Prognosis

BACKGROUND AND PURPOSE

MR imaging can reflect the pathologic progression of carcinoma ex pleomorphic adenoma (CXPA). This study aimed to identify the imaging findings related to extracapsular invasion of CXPA. Additionally, the pathologic background of these findings was investigated.

MATERIALS AND METHODS

This retrospective study included 37 patients with histologically confirmed CXPA. Three radiologists independently evaluated whether the CXPA showed the following characteristic MR imaging findings: border, capsule, the corona sign on fat-saturated T2WI and contrast-enhanced fat-saturated T1WI, and the black ring sign. The corona sign appeared larger on fat-saturated and/or contrast-enhanced fat-saturated T1WI than on T1WI. The black ring sign was defined as an intratumoral nodule with a thick low-intensity rim on T2WI. Interreader agreement of the visual assessment was performed using κ analysis, and MR imaging and histopathologic findings were also correlated. Kaplan-Meier survival and the log-rank test were used to estimate the 3-year disease-free survival.

RESULTS

MR imaging findings, especially peritumoral findings, showed a significant difference between invasive and noninvasive CXPA. The reliability was poor for the border and capsule. In contrast, it was good for the corona sign on fat-saturated and contrast-enhanced fat-saturated T1WI and the black ring sign. Pathologically, the corona sign reflected the invasiveness of the tumor and inflammatory cells, while the black ring sign reflected hyalinization or fibrosis. The corona sign also showed a significant difference in the 3-year disease-free survival.

CONCLUSIONS

MR imaging findings, including the corona and black ring signs, reliably differentiated invasive and noninvasive CXPA. The corona sign can be used as a prognostic factor for CXPA.

The Milan System for Reporting Salivary Gland Cytopathology

OBJECTIVES

Our study assesses whether the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) offers any benefit over the original cytology classification, and measures interobserver agreement.

METHODS

Four cytopathologists retrospectively blindly classified preoperative cytology by MSRSGC from 101 resected salivary tumors. Consensus MSRSGC diagnoses were correlated with surgical pathology diagnoses and compared with the original cytology classification. Diagnostic parameters were calculated for both systems. Interobserver variability was assessed.

RESULTS

The original cytology classification vs MSRSGC had sensitivity, specificity, positive predictive value, and negative predictive value of 75.0% vs 78.3%, 97.1% vs 98.0%, 91.2% vs 94.7%, and 90.1% vs 90.0%, respectively. The original cytology classification risk of neoplasm (RON) was 91.7% for "negative for malignancy" and 100.0% for other categories. The MSRSGC RON was 71.4% in category II (nonneoplastic) and 100.0% in all other categories. The original cytology classification risk of malignancy (ROM) ranged from 0.0% for "atypical" to 100.0% for "positive for malignancy." The MSRSGC ROM ranged from 0.0% in categories I (nondiagnostic) and III (nonneoplastic) to 100.0% in category VI (malignant). Weighted agreement using the MSRSGC was 92% (Gwet AC1, 0.84); unweighted agreement was 69% (Gwet AC1, 0.64). MSRSGC category IVA (benign neoplasm) was most likely to show interobserver agreement, with complete agreement in 67% of cases.

CONCLUSIONS

The MSRSGC performs similarly to the original cytology classification and shows relatively high interobserver agreement.

Clinicopathologic Characteristics and Prognostic Factors of Primary and Recurrent Pleomorphic Adenoma: A Single Institution Retrospective Study of 705 Cases

Although pleomorphic adenoma (PA) is benign, it may recur and prompt further treatment with radiotherapy (RT). This study investigated the prognostic features of primary and recurrent PAs. A total of 705 PAs (613 primary and 92 recurrent) were analyzed. The following parameters: age, site and size, status of resection, histologic features, and clinical management were documented and correlated with recurrence-free survival. For primary PAs: The mean patient age was 50 years (female/male: 2/1), the median size was 2.1 cm (range: 0.5 to 9.0 cm), and the most common location was the parotid (92%). Tumors showed the following: complete encapsulation (25%), involvement of the surrounding salivary gland/fat (74%), hypercellularity (26%), ≥10 pseudopods (15%), squamous metaplasia (43%), mitoses (49%), intravascular tumor deposit (n=1), close proximity to nerves (n=2), positive margin (15%), and suboptimal resection (2%). The recurrence rate was 3.4% and malignant transformation was <1%. On univariate analysis, age below 30, mitosis ≥3/10 HPFs, squamous metaplasia, hypercellularity, and suboptimal resection correlated with recurrence-free survival. On multivariate analysis, only age below 30, mitosis ≥3/10 HPF and suboptimal resection predicted recurrence. For recurrent PAs: The resected primary PAs were fragmented in 58%. Forty-eight percent of patients had subsequent recurrences, mostly within 10 years, and 1 patient developed a subsequent malignant transformation. Forty-two percent of patients received RT. On univariate analysis, only RT was associated with better outcome (P=0.033). Young age, high mitoses, and specimen integrity predicted recurrence in primary PA. Recurrent PAs are difficult to eradicate, and 48% of these recurred for the second time, mostly within 10 years.

Salivary gland fine-needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6-year study

BACKGROUND

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. We presented our experience with fine-needle aspiration cytology (FNAC) for the diagnosis of salivary glands lesions by applying the MSRSGC categorization to the cytological diagnoses, and determined risk of malignancy (ROM) for each category.

METHODS

Fine-needle aspiration cytology of salivary gland lesions performed over a 6-year period was retrieved. FNAC results were retrospectively categorized according to the MSRSGC criteria, and correlated with corresponding histologic follow-up. ROM for each diagnostic category was calculated.

RESULTS

A total of 208 FNAC of salivary gland lesions were reviewed and retrospectively categorized as: non-diagnostic (ND) 23 (11%), non-neoplastic (NN) 54 (26%), atypia of undetermined significance (AUS) 10 (4.8%), benign neoplasms (BN) 77 (37%), salivary gland of uncertain malignant potential (SUMP) 13 (6.3%), suspicious for malignancy (SM) 7 (3.4%), and malignant (M) 24 (11.5%). Histopathological follow-up was available for 84 of 208 cases (40.4%). Overall concordance rate between FNAC and histology was 78.8%. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 93.3%, 94.6%, 82.4%, and 98.2%, respectively. Diagnostic accuracy to distinguish benign from malignant disease was 94.4%. ROM for each category was ND 0%, NN 0%, AUS 75%, BN 2.2%, SUMP 28.6%, SM 50%, and M 100%.

CONCLUSION

Fine-needle aspiration cytology continues to be an accurate diagnostic tool for most salivary gland neoplasms showing classical morphologic features. However, difficult cases with unusual or overlapping features will occur. In these situations, the use of MSRSGC risk-stratification could be helpful to define appropriate management.

Misinterpreted Myoepithelial Carcinoma of Salivary Gland: A Challenging and Potentially Significant Pitfall

Myoepithelial carcinoma (MECA) is an underrecognized challenging entity with a broad morphologic spectrum. Misinterpreting MECA is not uncommon as distinguishing it from its mimics, especially cellular myoepithelial-rich pleomorphic adenoma (PA), can be difficult. We described 21 histologically challenging cases of MECAs (16 MECA ex-PA and 5 MECA de novo). All MECAs ex-PA were intracapsular or minimally invasive except for 3 cases. Eighteen (86%) were initially misinterpreted as benign neoplasms, including PA (10), atypical PA (5), and myoepithelioma (3). The remaining 3 were initially diagnosed as malignant (MECA ex-PA) but were histologically challenging. Histologic features that were found most helpful in recognizing the malignant nature of MECA included: uniformly cellular myoepithelial proliferation with an expansile nodular lobulated pattern (all cases) and alternate hypocellular and hypercellular zonal distribution (76% of cases). Among the 16 MECA patients with follow-up, 14 (87.5%) progressed: 10 developed local recurrence and 5 distant metastases. In contrast, only one of 33 patients with cellular PA (control group) recurred locally. Ten of the 14 MECAs that progressed were MECA ex-PA, and 12 (85%) had an initial benign diagnosis. Two patients with MECA ex-PA died of their disease; one had an initial diagnosis of PA. MECA is a histologically challenging entity that closely mimics PA and seems to carry a significant risk of recurrence. Areas of clonal appearing cellular myoepithelial growth with an expansile nodular lobulated pattern and zonal cellular distribution distinguish the majority of MECAs and may serve as useful diagnostic histologic features to differentiate MECA from its benign mimics.

Carcinoma ex pleomorphic adenoma: a case report and review of literature

Background

Carcinoma ex pleomorphic adenoma (CA-ex-PA) is extremely unusual in minor salivary glands of oral cavity. CAex-PA is a carcinomatous change as a primary or as a recurrence of pleomorphic adenoma.

Objective

Due to resemblance of clinical symptoms of Ca ex PA and benign pleomorphic adenoma, it is mandatory for surgeons to keep high degree of clinical alertness, considering the peculiarity of this tumor.

Case Report

54-year-old male presented with swelling on left side in the pre-auricular region from the middle of zygomatic arch to mastoid process and from tragus of the ear up to angle of mandible. Fine needle aspiration cytology revealed a mixture of benign and malignant components. Total left parotidectomy with left radical neck dissection followed by reconstruction with cervicodeltopectoral flap was performed. Combination of chemotherapy and radiotherapy were given to patient. Histologic examination and pre-operative fine needle aspiration cytology confirmed the diagnosis of Carcinoma ex pleomorphic adenoma (CA-ex-PA). Two-year follow-up of patient showed no recurrence of the lesion.

Conclusion

Due to the similarity in the clinical symptoms of CA-ex-PA and benign pleomorphic adenoma, it is vital that clinicians maintain a high degree of clinical vigilance, considering the oddity of this malignancy.

Histopathological Findings of Intraoral Pleomorphic Adenomas: A Retrospective Study of a Case Series

The aim of this study was to describe the clinicopathological features of 21 cases of intraoral pleomorphic adenoma (PA), with emphasis on histopathological findings. Between 2000 and 2016, all patients diagnosed as intraoral PA were retrieved and histopathological slides stained with hematoxylin and eosin reviewed to confirm the diagnosis. All tumors were classified histologically according to Seifert et al (1980). The clinical and histopathological variables were analyzed using the Fisher's exact test, considering a significance level of 5% (P < .05). Plasmacytoid (85.7%), spindle (38.1%), and epithelioid (9.5%) myoepithelial cells were observed. Oncocytic (47.6%) and mucous (19%) cells were also found. The stroma was predominantly fibrous (95.2%), followed by myxoid (66.7%), hyaline (61.9%), and chondromyxoid (33.3%). Squamous (57.1%), adipose (47.6%), sebaceous (14.3%), and bone (14.3%) differentiations were found. Additionally, a group of tumors presented pleomorphism (23.8%), mitoses (14.3%), capsule infiltration (9.5%), and necrosis. The presence of cystic structures occurred significantly in patients older than 30 years (P = .04) and mitoses were more observed in PA from buccal mucosa (P = .026). All cases that presented plasmacytoid cells were smaller than 1.5 cm (P = .015). All tumors with up to 50% stroma area presented with size smaller than 2.0 cm (P = .013). Intraoral PA presents a large morphological spectrum and several microscopic features are associated with clinical findings.

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.

A Case Report of Rare Carcinoma Ex Pleomorphic Adenoma of Submandibular Gland and its Detailed Description

A 65-year-old female patient reported with a chief complaint of swelling in the left lower region of the jaw since two years. On clinical examination, the swelling was present on the mandibular left posterior region and measuring approximately 6.2 cm antero-posteriorly × 6.2 cm mediolaterally × 8.7 cm superioinferiorly. Initially, it was non tender but eventually it became tender. Fine needle aspiration was done to rule out any salivary gland pathology and report obtained was carcinoma ex pleomorphic adenoma. Then, excisional biopsy was taken and tissue sent for histopathology. Histopathological diagnosis was benign adenoma with carcinoma. Later serial sections of tissue were studied and came to the conclusion of carcinoma ex pleomorphic adenoma which was non invasive type and showed bizarre cells with neoplastic changes. Benign part was composed of myxomatous area with partial capsule. Neoplastic cells showed invasion into capsule and few necrotic areas were also present. Overall interpretation was favoured Non invasive carcinoma ex pleomorphic adenoma. So here, we reported a case of Carcinoma ex Pleomorphic Adenoma (CAEXPA) which is a deadly and rare variant of salivary gland malignancy.

Pleomorphic adenoma of the soft palate: major tumor in a minor gland

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.

Sperm associated antigen 9 (SPAG9) expression and humoral response in benign and malignant salivary gland tumors

Salivary gland cancers are highly aggressive epithelial tumor associated with metastatic potential and high mortality. The tumors are biologically diverse and are of various histotypes. Besides, the detection and diagnosis is a major problem of salivary gland cancer for available treatment modalities. In the present study, we have investigated the association of sperm associated antigen 9 (SPAG9) expression with salivary gland tumor (SGT). Clinical specimens of benign (n = 16) and malignant tumors (n = 86) were examined for the SPAG9 expression. In addition, the sera and adjacent non-cancerous tissues (n = 72) from available patients were obtained. Our in situ RNA hybridization and immunohistochemistry (IHC) analysis revealed significant difference (p = 0.0001) in SPAG9 gene and protein expression in benign (63%) and malignant tumor (84%) specimens. Further, significant association was also observed between SPAG9 expression and malignant tumors (P = 0.05). A cut-off value of >10% cells expressing SPAG9 protein designated as positive in IHC, predicted presence of malignant SGT with 83.72% sensitivity, 100% specificity, 100% PPV and 83.72% NPV. Humoral response against SPAG9 protein was generated in 68% of SGT patients. A cut-off value of 0.212 OD for anti-SPAG9 antibodies in ELISA predicted presence of malignant SGT with 69.23% sensitivity, 100% specificity, 100% PPV and 78.94% NPV. Collectively, our data suggests that the majority of SGT show significant difference and association among benign and malignant tumors for SPAG9 gene and protein expression and also exhibit humoral response against SPAG9 protein. Hence, SPAG9 may be developed as a biomarker for detection and diagnosis of salivary gland tumors.

Benign pleomorphic adenoma of minor salivary gland showing perineural invasion: a rare entity

Perineural invasion is a rare and sporadically reported histological finding in relation to benign lesions. We present a case of a benign pleomorphic adenoma of a minor salivary gland of the cheek, exhibiting perineural involvement. There have been no previously reported cases of minor salivary gland pleomorphic adenomas exhibiting this phenomenon. This is also the first report of this rare feature in surgical literature pertaining to the head and neck region.

Salivary gland tumors: a diagnostic dilemma!

Salivary gland tumors generate considerable interest because of their heterogeneous and variable histology, grade of malignancy, and clinical behavior. Fine needle aspiration cytology (FNAC) is considered the first diagnostic modality for salivary neoplasms due to its ready availability and ease of performance. However it cannot always be relied upon in isolation, and should be used in conjunction with other investigations like incisional biopsy. We present two cases, which highlight the drawbacks of relying on FNAC alone, which resulted in misdiagnosis of adenoid cystic carcinoma as pleomorphic adenoma.

A giant pleomorphic adenoma of the submandibular salivary gland: a case report

The most common benign salivary gland tumor is the pleomorphic adenoma (PA). They can attain grotesque proportions and weigh several kilograms. They can cause facial disfigurement and, if untreated, could lead to airway compromise. We report a case of a large PA arising from the left submandibular salivary gland in a 20-year-old black female. The lesion measured ∼16 × 15 × 12 cm.

Pleomorphic adenoma palate: Major tumor in a minor gland

Pleomorphic adenoma (PA) is the most common benign mixed salivary gland neoplasm that accounts for 60% of all benign salivary gland tumors. It has diverse histological presentation and occurs in both major and minor salivary glands. PA of minor salivary gland in the palate is a common entity. We report the case of a 45-year-old female who presented with a painless slow growing swelling of palate over the last 20 years. The mass was extending to oropharynx causing mechanical obstruction of airway. Magnetic resonance imaging (MRI) depicted an oval-shaped mass occupying oropharynx and displacing the tongue inferiorly. Fine needle aspiration cytology (FNAC) was suggestive of PA. The entire tumor mass was excised along with overlying mucosa. Histopathological examination confirmed diagnosis of PA of minor salivary gland. There has been no recurrence of the lesion since 1 year.

Radiotherapy for pleomorphic adenoma

PURPOSE

The aim of this study was to update our experience in treating pleomorphic adenoma with radiotherapy (RT).

MATERIALS AND METHODS

This is a retrospective analysis of 25 patients treated with RT alone (2 patients) or combined with surgery (23 patients), with follow-up ranging from 1.8 to 34.9 years (median, 10.5 years).

RESULTS

Local control was achieved in 13 (75%) of 16 patients with subclinical disease and 5 (56%) of 9 patients with gross disease. Overall local control was achieved in 18 (72%) of 25 patients. The 5-, 10-, and 15-year overall local control rates were 76 %, 76%, and 68%, respectively. Ten patients died of the following causes: recurrent disease, 2; malignant transformation, 2; and intercurrent disease, 6. At last follow-up, 14 patients were alive without evidence of disease, and 1 patient was alive with disease. Dental carries and transient facial nerve deficits were the most common complications. No patients developed severe complications subsequent to RT.

CONCLUSIONS

In patients at high risk for developing recurrent pleomorphic adenoma after surgery, RT is effective in controlling subclinical disease.

Pleomorphic adenoma of the salivary glands in children and adolescents

BACKGROUND

Pleomorphic adenomas (PAs) of the salivary glands are rare in children and adolescents. We reviewed the clinical manifestations, pathologic features, treatment, and prognosis of salivary gland PA in 90 children and adolescents.

METHODS

Clinical data including age, sex, location, symptoms, the period of evolution of the symptoms, pathologic type, and surgical treatment were evaluated.

RESULTS

The median age was 16.5 years old. There was a 1.43:1 female-to-male ratio. The parotid gland was the most commonly affected major gland (56.7%), and the palate, the most common site of minor salivary gland involvement. Ultrasonography and computed tomography were performed in most cases for diagnosis. Superficial parotidectomy or total parotidectomy with facial nerve dissection and preservation was the most common surgical procedure. Submandibular triangle dissection was applied to all submandibular PAs. Classic-type PA was the most common histologic subtype (43.3%).

CONCLUSIONS

Salivary gland PAs in children and adolescents have different characteristics compared with their adult counterparts in regard to histologic subtype and location. Surgical removal is the best treatment option for PAs in children and adolescents.

[Thirteen years' experience with superficial partial parotidectomy as treatment for benign parotid tumours]

INTRODUCTION

Most authors agree that surgery is the treatment of choice for benign tumours of the parotid gland. However, the best surgical technique and the extent of surgery remain controversial. This study attempts to establish whether the implementation of a partial superficial parotidectomy (PSP) is appropriate for the treatment of benign parotid gland tumours.

MATERIAL AND METHODS

We selected 63 patients with benign parotid gland surgery, of whom 43 had a pleomorphic adenoma and 20, a Warthin tumour. Of this group of 63 patients, 6 could not be included. We consequently studied 57 patients, 41 of them diagnosed as pleomorphic adenoma and 16, as Warthin tumours. In all of them, a PSP was performed without intraoperative monitoring of the facial nerve.

RESULTS

Transient facial nerve paralysis, 14 patients (24.5%). Ten cases were resolved within the first month after surgery and 4 before the third month, after indicating facial physiotherapy. One patient (1.7%) had a permanent difficulty in keeping one side of the lower lip aligned under pressure-mobility, without altering commissure mobility. None of the patients studied had a recurrence (control, 3-13 years).

CONCLUSIONS

Although PSP is a technique with a few complications, it has a recurrence rate comparable to or lower than other techniques used for the treatment of pleomorphic adenomas or Warthin parotid tumours. Intraoperative facial nerve monitoring can be helpful during surgery. The lack of monitoring would not be considered a contraindication for surgery.

Expression of hMLH1 and hMSH2 proteins in pleomorphic adenoma of minor salivary glands: relationship with clinical and histologic findings

OBJECTIVE

The aim was to examine the relationship between clinicopathological features and immunoexpression of hMLH1 and hMSH2 proteins in pleomorphic adenoma (PA) of minor salivary glands.

STUDY DESIGN

Paraffin-embedded samples of typically benign PA lesions (n = 35) were prepared for histologic and immunohistochemical assessment. Based on the clinicopathologic features, the samples were categorized into low- and high-risk subtypes for their estimated potential for malignant transformation.

RESULTS

Immunohistochemical analysis revealed strong correlations regarding the expression estimation and staining-intensity distribution (SID) scores between the two proteins. Although there was no relationship between marker immunoexpression and SID scores regarding clinical parameters, statistically significant variations for these parameters were evident regarding some histologic criteria or for risk stratification subtypes.

CONCLUSION

The findings of this study could suggest the relationship of a DNA mismatch repair deficiency with high-risk subtypes of PA and the implication of its role in the origin and progression of these subtypes.

[A case of giant pleomorphic adenoma of the parotid gland]

INTRODUCTION

A case of pleomorphic adenoma of the parotid gland was reported. Pleomorphic adenoma is the most common benign tumor of the major salivary glands. A review of the literature confirms that this kind of tumor is less common in the minor salivary glands. We described statistic population, types of the diagnostic, treatment and clinical course of pleomorphic adenoma of the parotid gland.

MATERIAL AND METHOD

We encountered such a tumor in a 55-year-old woman who was admitted to our Hospital. The only symptom was significant face deformation, growing for 30 years.

RESULTS

The tumor was located under the right side of the face and was removed surgically. No complications were observed in the postoperative course but paresis of the facial nerve occurred. The patient was discharged from the hospital with the recommendation of facial muscles rehabilitation. After the two months from the surgery, paresis was diminished. Afterwards contact with the patient got lost.

CONCLUSION

Pleomorphic adenoma is the most common benign tumor of the major salivary glands. Surgery is the main method of the treatment. The most common complication is paresis of the facial nerve.

Pleomorphic multicentric adenoma in the submandibular gland

Neoplasms of salivary glands represent a small group among the diseases involving the head and neck complex. In this group, the pleomorphic adenoma is the most frequent neoplasm, yet involves the submandibular gland in only 12.3% of cases. A patient presenting a swelling in the region of the submandibular gland was submitted to an incisional biopsy, where a fragment of the gland and one juxtaposed node were removed. Histologically they were defined as pleomorphic adenoma. Later, the patient was submitted to submandibulectomy and two other nodes were found close to the gland and removed. All specimens were histologically defined as pleomorphic adenoma. This multicentric finding is of great interest, perhaps explaining the recurrence rate of this neoplasm. The patient is in continuous follow-up and has not presented signs of recurrence.

Maintaining a high level of suspicion for recurrent malignant disease: report of a case with periapical involvement

AIM

To report the unusual endodontic presentation and radiographic features of a subgroup of pleomorphic adenoma called carcinoma ex pleomorphic adenoma and to stress the importance of maintaining a high level of suspicion in cases where primary or recurrent neoplasia is included in the differential diagnosis.

SUMMARY

This paper describes a case in which a patient with a previous history of malignant neoplasm presented with signs and symptoms similar to a dental infection. The pathology report however confirmed recurrence of the previous tumour in a malignant fashion. The importance of maintaining a high level of suspicion in early management of such disease is highlighted.

KEY LEARNING POINTS

*Pleomorphic adenomas, also known as benign mixed tumours, are common salivary gland tumours, which infrequently undergo malignant transformation, with potentially devastating consequences. *Malignant salivary gland tumours can present as dental swelling, dental pain and sudden loss of vitality of teeth so both general practitioners and specialists have the responsibility to evaluate such patients with a broad vision. *Radiographic differential diagnosis of periapical radiolucency should also include malignant salivary gland tumours. *This case highlights the need of vigilance at all times and emphasizes the benefits of biopsy and histological examination in the diagnosis of recurrent malignant salivary gland tumours.