Sinonasal and skull base pleomorphic adenoma: a case series and literature review.

Abstract

Pleomorphic adenoma (PA) is the most common benign neoplasm of the major salivary glands. PA of the paranasal sinuses and skull base is an extremely rare pathologic entity. We report 3 cases of sinonasal and skull-base PA (including locoregionally advanced parotid disease) and review other cases in the literature, with special attention to clinical presentation, diagnosis, and management. Retrospective review of patients with PA of the sinuses and skull base treated at 2 tertiary academic medical centers between January 1, 1993 and July 1, 2014. The MEDLINE database was additionally searched for all case series or reports of sinonasal or skull-base PA. A total of 32 articles were identified for review. In combination with the authors' cases, a total of 39 patients were found to have sinonasal and/or skull-base PA. The most common primary sites were the nasal septum and lateral nasal wall. Endoscopic resection was employed in 66% of cases, which achieved oncologic control in more than 80% of cases at a mean follow-up of 2 years. PA of the sinonasal tract and skull base is a rare, benign tumor that often may be surgically accessible through an endonasal, endoscopic approach. Recurrent disease may behave more aggressively than PA found in the major salivary glands. Accurate tumor sampling is essential for surgical planning, because malignant transformation does occur. In certain cases of unresectable tumors, endoscopic debulking may improve patient symptoms and quality of life.