Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report

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.

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.

Coblator-Assisted Endoscopic Transnasal Resection of a Large Nasopharyngeal Pleomorphic Adenoma

Background

Pleomorphic adenomas occurring in the adult nasopharynx are rare, with our literature search identifying only 11 previous English-language reports. We document the unusual case of a large nasopharyngeal pleomorphic adenoma that was resected using radiofrequency coblation via an endoscopic transnasal approach.

Methods

A 39-year-old male presented with worsening nasal congestion, intermittent otalgia, and a progressive change in voice. Flexible nasendoscopy showed a large homogeneous mass occupying the postnasal space, and computed tomography confirmed a 28 × 31 × 22 mm nasopharyngeal tumour. The biopsy-proven benign tumour was locally dissected using a coblator-assisted transnasal approach.

Results

Histology confirmed complete excision of a myoepithelial-rich pleomorphic adenoma. The patient was symptom-free postoperatively, and no signs of recurrence were seen at one-year follow-up.

Conclusions

This is a useful addition to the existing literature on surgical procedures used to treat benign pathology in the nasopharynx. The minimally invasive technique was well tolerated and had favourable patient outcomes.

Keratinizing pleomorphic adenoma: An unusual case report

Pleomorphic adenoma (PA) is the most common benign tumor of major or minor salivary glands. PA exhibits a great histological diversity, such as differentiation into oncocytic, sebaceous, mucinous, squamous, chondroid, osseous or adipose cells. Squamous metaplasia rarely results in the formation of extensive keratin-filled cyst lined by squamous epithelium. Extensive squamous metaplasia can be mistaken for malignancy, including mucoepidermoid carcinoma and squamous cell carcinoma. Here, we report a case of slowly enlarging PA with extensive squamous metaplasia and keratin cyst formations in a minor salivary gland in hard palate and discuss its microscopic features.

A benign salivary gland tumor of minor salivary gland mimicking an epithelial malignancy

Pleomorphic adenoma (PA) is the most common benign tumor of major or minor salivary glands. Microscopically, PA exhibits a great diversity of morphological aspects. Here, we present an unusual case of PA with extensive squamous metaplasia and keratin-filled cysts in the left retromolar region of a 50-year-old edentulous person whose microscopic finding may represent a diagnostic dilemma for pathologists.

Nasopharyngeal pleomorphic adenoma presenting as otitis media with effusion: case report and literature review

Most tumors arising in the nasopharynx are malignant and frequently develop otitis media with effusion (OME). On the contrary, benign nasopharyngeal tumors are very rare, and pleomorphic adenoma, which is a benign mixed tumor of the nasopharynx, is also rarely encountered. We herein report a case of nasopharyngeal pleomorphic adenoma which initially presented as OME. This tumor completely blocked the orifice of the Eustachian tube but was removed by a combination of transnasal and transoral endoscopic resection. A defect in the mucous membrane was covered with polyglycolic acid sheet and fibrin glue. Mucous membrane completely covered the exposed tubal cartilage without adhesion near the tubal orifice. OME and hearing loss completely subsided 3 months after the surgery. She was disease-free 2 years after the surgery. Use of polyglycolic acid sheet could be a feasible mesh for closure of surgical defect without scarring, and it also led to healing of OME.

Pleomorphic adenoma of the cervical heterotopic salivary gland: a case report

Introduction. Although pleomorphic adenoma is the most common neoplasm of the salivary glands, this tumor most commonly involves the minor salivary glands of palatal and rarely occurs in cervical region. Case Report. A 21-year-old female referred to our clinic due to painless mass of right upper region of neck. After paraclinical and pathologic evaluation, it was diagnosed as cervical pleomorphic adenoma. Conclusion. Pleomorphic adenoma may be rarely involving the neck. Although the prognosis is good, the choice treatment is the complete resection of the tumor.