Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables.

Pavel Dulguerov,Jelena Todic,Marc Pusztaszeri,Naif H Alotaibi

doi:10.3389/fsurg.2017.00026

Abstract

The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy. A systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data. Pathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage. Myxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences.

Highlights

Pleomorphic adenoma (PA) is the most common parotid gland neoplasm accounting for 50–60% of all parotid tumors [1, 2]
The PubMed database was searched in December 2016 with the terms “pleomorphic adenoma” AND “recurrence” AND “parotid gland” AND “pathology” as well as with the terms “pleomorphic adenoma” AND “recurrence” AND “parotid gland” AND “surgery”
A recent publication from a Dutch registry covering close to 5,500 patients followed for 15 years and treated with formal parotidectomy [3] puts the incidence of recurrent pleomorphic adenoma (PA) to 2.9% and the rate of malignant transformation to 3.3% [88]

Summary

Introduction

Pleomorphic adenoma (PA) is the most common parotid gland neoplasm accounting for 50–60% of all parotid tumors [1, 2]. We hypothesize here that the various reasons advanced for the recurrence of PA can be grouped into pathology-related (capsule thickness or lack of capsule, pseudopodia, satellite nodules, multi-centricity) and surgery-related (rupture of the tumor, spillage of tumor contents, insufficient margins of resection because of nerve branches, inadequate excision related to the type of surgery) factors. These clinicopathological and surgical features of PA are the basis for this review. The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy

Methods

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Discussion

Conclusion