Nasopharyngeal Pleomorphic Adenoma: A Rare Case Report and Review of the Literature

Pleomorphic Adenoma of Nasal Septum a Case Report

Introduction

Pleomorphic adenoma is a common benign tumor of large and small salivary glands. It mainly occurs in the parotid gland, followed by the submandibular gland, sublingual gland and small salivary gland in the oral cavity. It is very rare in the nasal septum.

Patient Concerns

A 27-year-old female patient attended our clinic with Nasal congestion and a diminished sense of smell.

Diagnoses

Endoscopic examination revealed a mass within the right nasal passage. A pathological biopsy revealed pleomorphic adenoma.

Interventions

The nasal septum pleomorphic adenoma was resected by endoscopic approach.

Outcomes

No recurrence was observed for over 41 months of follow-up.

Conclusion

To prevent recurrence, extensive local resection with clear histological margins and long-term endoscopic follow-up with an endoscope are necessary.

A Rare Case of a Nasopharyngeal Pleomorphic Adenoma Mimicking a Nasopharyngeal Carcinoma

Pleomorphic adenoma is the most common benign pathology of the major salivary gland but rare in the minor salivary gland, especially in the nasopharynx, with only a few cases reported in the literature. A 76-year-old lady presented with bilateral nasal blockage for one year secondary to a nasopharyngeal mass. Histopathological examination reported it to be nasopharyngeal carcinoma, but the mass persisted after a course of chemotherapy combined with radiotherapy. Upon repeat biopsy, the mass was found to be a pleomorphic adenoma. The patient underwent nasopharyngectomy without complications and no evidence of recurrence after 18 months of follow-up.

Nasopharyngeal carcinoma ex-pleomorphic adenoma (noninvasive): A report of a rare case

Pleomorphic adenoma (PA) is the most common type of benign tumors of minor salivary glands. A carcinoma ex-pleomorphic adenoma (CXPA) is a malignant epithelial neoplasm originating from either a primary or recurrent benign PA. The nasopharynx is an extremely uncommon location for this tumor. A 32-year-old male had complaints of nasal blockage. In noncontrast computed tomography, a soft-tissue mass was present in the nasopharynx. Histopathological and immunohistochemical examination of the endoscopically excised mass revealed features of CXPA, noninvasive in nature. Careful histopathological examination is the key to identify this uncommon entity. To the best of our knowledge, <20 cases have been published so far.

The tubarial salivary glands: A potential new organ at risk for radiotherapy

INTRODUCTION

The presence of previously unnoticed bilateral macroscopic salivary gland locations in the human nasopharynx was suspected after visualization by positron emission tomography/computed tomography with prostate-specific membrane antigen ligands (PSMA PET/CT). We aimed to elucidate the characteristics of this unknown entity and its potential clinical implications for radiotherapy.

MATERIALS AND METHODS

The presence and configuration of the PSMA-positive area was evaluated in a retrospective cohort of consecutively scanned patients with prostate or urethral gland cancer (n = 100). Morphological and histological characteristics were assessed in a human cadaver study (n = 2). The effect of radiotherapy (RT) on salivation and swallowing was retrospectively investigated using prospectively collected clinical data from a cohort of head-neck cancer patients (n = 723). With multivariable logistic regression analysis, the association between radiotherapy (RT) dose and xerostomia or dysphagia was evaluated.

RESULTS

All 100 patients demonstrated a demarcated bilateral PSMA-positive area (average length 4 cm). Histology and 3D reconstruction confirmed the presence of PSMA-expressing, predominantly mucous glands with multiple draining ducts, predominantly near the torus tubarius. In the head-neck cancer patients, the mean RT dose to the gland area was significantly associated with physician-rated post-treatment xerostomia and dysphagia ≥ grade 2 at 12 months (0.019/gy, 95%CI 0.005-0.033, p = .007; 0.016/gy, 95%CI 0.001-0.031, p = .036). Follow-up at 24 months had similar results.

CONCLUSION

The human body contains a pair of previously overlooked and clinically relevant macroscopic salivary gland locations, for which we propose the name tubarial glands. Sparing these glands in patients receiving RT may provide an opportunity to improve their quality of life.

Pleomorphic Adenoma: A Systematic Review

Background

Pleomorphic adenoma (PA) is a commonly occurring benign tumor originating in the salivary glands.

Objective

The aim was to carry out a systematic literature of reports on pleomorphic adenoma from 2000 to 2018 to determine patient's age spread, gender, anatomical location, capsular invasion, histopathology, treatment and patient outcome.

Materials and methods

A PubMed search was conducted with the following key words: adenoma, pleomorphic adenoma, and mixed salivary tumor.

Results

Twenty-two articles in English were read in full after fulfilling the eligibility criteria. The mean age of PA occurrence was 44.14 years with a definite female predilection (M:F ratio = 13:8). It most commonly occurred in the facial region (42.85%), and surgical approach is the preferred intervention.

Conclusion

Pleomorphic adenomas are benign salivary gland neoplasms that can grow into extensive sizes if left untreated and hence need to be diagnosed early. Complete excision of the tumor is the definitive treatment, as enucleation can result in recurrence. Facial nerve has to be preserved if PA occurs in the parotid gland.

How to cite this article

Almeslet AS. Pleomorphic Adenoma: A Systematic Review. Int J Clin Pediatr Dent 2020;13(3):284-287.