Pleomorphic adenoma palate: Major tumor in a minor gland

Life-Threatening Bleeding in Atypical Pleomorphic Adenoma of the Soft Palate

Introduction

Atypical pleomorphic adenoma (PA) is an uncommon tumor, more frequent in submandibular and parotid glands. PA is classified as atypical when it presents hypercellularity, necrosis or hyalinization, dysplasia, capsular violation or distant metastases.

Case Report

We described a case of a 39-year-old female presented with a slowly growing mass involving the soft palate. A life-threatening bleeding from PA with hemorrhagic shock occurred and required ligation of the external carotid artery with tracheotomy. A transoral en-bloc excision of the mass (70 x 50 x 40 mm) was performed. Pathological exam demonstrated an atypical PA, with hypercellular fields and myoepithelial and squamous differentiation.

Conclusion

An appropriate diagnostic evaluation and a prompt intervention are essential to avoid dangerous complications, even for benign neoplasms.

Pleomorphic adenoma of the tonsillar cavity

INTRODUCTION AND IMPORTANCE

The tonsillar location of pleomorphic adenomas is rare in histological diagnosis. The elimination of other essentially lymphomatous diagnoses is essential.

CASE PRESENTATION

We present a case of a 15-year-old child who consults for a feeling of pharyngeal discomfort and difficulty eating solid foods for 6 months. Clinical examination and radiology (MRI) showed the presence of a mass in the tonsillar region. A biopsy revealed a pleomorphic adenoma. The tumor was removed transorally with good progress.

CLINICAL DISCUSSION

Pleomorphic adenoma of the tonsillar region is rare. Only histological examination can confirm this. Resection of the tumor must be complete in order to limit the risk of recurrence.

CONCLUSION

The pleomorphic adenoma of the tonsillar region has a non-specific clinical presentation. MRI helps guide the diagnosis. Its treatment is surgical requiring complete excision.

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.

Immunohistochemical expression of OCT4 and CD44 in major and minor salivary gland neoplasms

The aim of this study was to identify tumor parenchyma cells exhibiting immunohistochemical profile of stem cells by evaluating the immunoreactivity of OCT4 and CD44 in a number of cases of salivary gland neoplasms. The sample consisted of 20 pleomorphic adenomas, 20 mucoepidermoid carcinomas, and 20 adenoid cystic carcinomas located in major and minor salivary glands. The expression of OCT4 and CD44 was evaluated by the percentage of positive cells and the intensity of expression. All studied cases showed positive expression of OCT4 and CD44 and higher values than the control groups. For OCT4, luminal and non-luminal cells were immunostained in the case of pleomorphic adenomas and adenoid cystic carcinomas. Moreover, the immunoreactivity of CD44 was particularly evident in the non-luminal cells of these lesions. In mucoepidermoid carcinomas, there was immunoreactivity for both markers in squamous and intermediate cells and absence of staining in mucous cells. For both markers, a significantly higher immunostaining was verified in neoplasms located in the major salivary glands compared with lesions in minor salivary glands (p<0.001). In the total sample and in minor salivary glands, malignant neoplasms exhibited higher immunoreactivity for OCT4 than pleomorphic adenoma. A significant moderate positive correlation (r = 0.444 and p ≤ 0.001) was found between OCT4 and CD44 immunoexpression in the total sample. The high expression of OCT4 and CD44 may indicate that these proteins play an important role in identifying tumor stem cells.

Pleomorphic Adenoma of the Palate: A Case Report

Pleomorphic adenoma is the most common benign tumor affecting the major salivary glands and infrequently arises from the minor salivary glands. It involves the parotid of the major salivary glands and the palate of the minor salivary glands. This article presents a case of pleomorphic adenoma of the palatal minor salivary gland treated successfully by surgical excision.

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.

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

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 glands mainly parotid gland and 10 % of them occur in the minor salivary glands. The most common site for pleomorphic adenoma of the minor salivary glands is the palate, followed by the lips and the cheeks. Other rare sites include the floor of the mouth, tongue, tonsil, pharynx, retromolar area and the nasal cavity. Here, we are reporting a case of pleomorphic adenoma of the minor salivary glands of the soft palate in a 36-year-old Indian female. The mass was removed by wide local excision with adequate margins under general anesthesia. There was no recurrence seen after a follow-up period of 1 year.

The Le Fort I osteotomy as surgical approach of an extensive pleomorphic adenoma of the palate

Pleomorphic adenoma (PA) is the most common benign mixed salivary gland tumor. We describe here a peculiar case of a 72-year-old woman with a PA of the palate resected with palatal approach combined with Le Fort I osteotomy, adding to the currently limited scientific literature on intraoral approach for removal of extensive tumors of the midface. The Le Fort I osteotomy approach allows direct visualization of the tumor and ensures a wide excision, increasing safety and minimizing the possibility of recurrence.