P41. Carcinoma ex pleomorphic adenoma in a minor salivary gland of the upper lip

Abstract

Introduction: We present the first case report of carcinoma ex pleomorphic adenoma (CXPA) arising in a minor salivary gland of the upper lip.Methods: We present the case of a 55 year old female with CXPA in an unusual site and a literature review of the relevant issues.Results: A 55 year old female presented with a 30 year history of a painless lump in her upper left labial sulcus. An excisional biopsy revealed a yellow glistening mass that appeared to be well encapsulated. Histopathology review identified features of CXPA.A wide local excision and local flap repair was undertaken. Microscopically no residual tumor was identified. The case was discussed at the local head and neck multidisciplinary team meeting, and owing to the small volume of disease and wide margins, it was agreed that radiotherapy was not indicated. At 18 months the patient remained disease free.Discussion: Oral lumps are common and are often given low priority by patients, as demonstrated in this case. Unfortunately the longer a pleomorphic adenoma (PA) remains untreated, the greater the risk of malignanat transformation to CXPA. Johns and Goldsmith report a 1.6% incidence of malignant transformation in tumors of 5 years duration compared with 9.4% in tumors present for 15 years. This highlights the importance of early surgical review and definitive treatment of PAs.A wide surgical excision with adequate margins is essential for a favorable outcome in patients with malignant minor salivary gland tumors. Postoperative radiotherapy is reserved for patients with high grade tumor histology, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins, although clear-cut survival advantage has not been proven. Recurrence, especially regional and distant metastases, portends an extremely poor prognosis.Although this case had a favorable outcome, it highlights the need for early surgical review and management of oral lesions of uncertain and/or unpredictable nature. Patients with known or suspected PA should be encouraged to undergo definitive surgical treatment early in their disease to avoid malignant transformation to CXPA at a later date.