Benign Salivary Gland Tumors Research Articles

Rare Sites and Presentations of Pleomorphic Adenoma – A Case Series

Abstract Pleomorphic adenoma is the most frequently occurring benign salivary gland neoplasm, commonly in the major salivary gland. Sometimes, it can also occur in the minor salivary glands, the common site being the palate, the lips, and the cheeks. Rarely, it can also be seen in locations such as on the tongue, floor of the mouth, pharynx, retromolar area, tonsil, and nasal cavity. We discuss some interesting cases of uncommon locations of pleomorphic adenoma involving minor salivary glands and its clinical, diagnostic, and treatment aspects. Here, we present four rare presentations of pleomorphic adenoma treated in our department. The patient details and clinical pictures were taken after informed consent.

Cystadenoma of the Tongue: A Case Report

Cystadenoma is a rare benign salivary gland neoplasm characterized by a predominantly multicystic growth pattern. The parotid gland is involved in about 45–50% of cystadenoma cases, with the minor glands of the lip and buccal mucosa being the next most common sites. The tongue is rarely involved. We report the case of a 56 year-old patient who presented a cystadenoma of the base of the tongue.

A Rare Synchronous Existence of Warthin’s Tumour and Oral Cancer

Oral squamous cell carcinoma (OSCC) is one of the most common malignancies worldwide while Warthin’s tumor (WT) is a common type of benign salivary gland neoplasm mostly seen in the parotid gland but rarely involves extra parotid tissues. Extra parotid WT is itself a rare entity and its synchronous occurrence with OSCC is an unusual phenomenon. It is vital to accurately identify the pathology as confusion may arise due to its rare occurrence and an intriguing presentation of resembling metastasis in lymph nodes. In the present review, a systematic literature search was performed and case reports and series in which synchronous existence of WT and OSCC were included. Total 13 papers have been included with 17 cases of synchronous WT and OSCC. Quality assessment for cases was done based on the CARE guidelines. The given results describe the histological features and site of WT in individuals who also had OSCC. Most of the studies described the histological findings of WT, which were seen involving the lymph nodes. More than 50% of the included cases had a history of tobacco chewing or smoking. The cases that have reported for follow up showed no evidence of any recurrence. WT with OSCC synchronous occurrence at a different site from the primary tumor can mimic a metastatic lesion from a primary lesion. It is a diagnostic challenge and could alter the management of these patients if not identified accurately. Awareness about this synchronous occurrence can avoid the overtreatment in such cases. Majority of the WTs described were seen in cervical lymph nodes.
 Keywords: Oral cancer; Warthin tumor; Benign Neoplasm; Mixed salivary gland tumor; Synchronous neoplasm; metastasis; Second malignancy; Prognosis.

Differentiation of salivary gland tumors using diffusion-weighted image-based virtual MR elastography: A pilot study.

Differentiation among benign salivary gland tumors, Warthin tumors, and malignant salivary gland tumors is crucial to treatment planning and predicting patient prognosis. However, differentiation of those tumors using imaging findings remains difficult. This study evaluated the usefulness of elasticity determined from Diffusion-weighted image (DWI)-based virtual MR elastography (MRE) compared with conventional MRI findings in differentiating the tumors. This study included 17 benign salivary gland tumors, six Warthin tumors, and 11 malignant salivary gland tumors scanned on neck MRI. The long and short diameters, T1 and T2 signal intensities, tumor margins, ADC values, and elasticity from DWI-based virtual MRE of the tumors were evaluated. The interobserver agreement in measuring tumor elasticity and the ROC curves were also assessed. The long and short diameters and the T1 and T2 signal intensities showed no significant difference among the three tumor groups. Tumor margins and the mean ADC values showed significant differences among some tumor groups. The elasticity from virtual MRE showed significant differences among all three tumor groups and the interobserver agreement was excellent. The area under the ROC curves of the elasticity were higher than those of tumor margins and mean ADC values. Elasticity values based on DWI-based virtual MRE of benign salivary gland tumors, Warthin tumors, and malignant salivary gland tumors were significantly different. The elasticity of Warthin tumors was the highest and that of benign tumors was the lowest. The elasticity from DWI-based virtual MRE may aid in the differential diagnosis of salivary gland tumors.

The risk of facial nerve palsy after benign parotidectomy. A quality project

Background Facial nerve palsy is a potential complication of parotidectomy for benign salivary gland tumours, necessitating a comprehensive understanding of its incidence and associated risk factors for improved patient counselling and preoperative planning. Aim/objectives This single-centre retrospective study aimed to assess the rate of facial nerve palsy following benign parotidectomy at a University Teaching Hospital. Material and methods Over a 3-year period, 160 patients undergoing parotid surgery for benign tumours were included. Data, encompassing sex, age, operation technique, tumour pathology, facial nerve function, and follow-up duration, were collected from medical records. Exclusion criteria comprised patients with prior parotid gland surgery or preoperative facial nerve palsy. Results The study revealed a 3.75% incidence of facial nerve palsy with no total paralysis post-parotidectomy for benign disease. Pleomorphic adenoma (50.6%) and Warthin’s tumour (44.4%) were the predominant tumour types. No significant differences were noted between groups with and without postoperative facial palsy based on obtained covariates. Conclusion and significance Our findings endorse partial superficial parotidectomy and extracapsular dissection as low-risk treatments for benign parotid tumours. However, prospective studies are warranted to elucidate recovery rates and long-term consequences of facial nerve palsy, contributing to refined surgical approaches and patient care in parotid surgery.

Never too young for a salivary gland carcinoma ex-pleomorphic adenoma

BackgroundCarcinoma ex-pleomorphic adenoma (CXPA) can either arise primarily as a de novo or from the malignant transformation of a benign pleomorphic adenoma (PA). CXPA mostly occurs in adults aged 50 to 70 years; hence, the occurrence of CXPA in younger ages is not common.Case presentationWe report a 27-year-old female who had a history of submandibulectomy for pleomorphic adenoma, and presented with recurrent left submandibular swelling for 4 months. The mass was rapidly increasing in size and was associated with occasional throbbing pain. Examination showed a multilobulated, firm left submandibular swelling with no overlying skin changes. FNAC was performed twice, by conventional and ultrasound-guided techniques, and both concluded as benign salivary gland tumours. CT scan and MRI revealed a well-demarcated tumour with an area of necrosis within, with no obvious invasion into surrounding soft tissue and no significant lymphadenopathy. Having high suspicion of a malignant transformation, the tumour was resected with a concurrent modified radical neck dissection. The histopathological examination confirmed a carcinoma ex-pleomorphic adenoma with the myoepithelial malignant component. The patient subsequently received adjuvant radiotherapy. This case demonstrated that CXPA, although rare, can occur in young adults. Pre-operative FNAC and radiological imaging may mimic a pleomorphic adenoma.ConclusionThe presence of recurrent tumours with rapid growth should alarm the clinician about a possible malignant transformation of a benign parotid tumour.

Successful Preservation of the Facial Nerve in Parotid Surgery for Huge Pleomorphic Adenoma of the Deep Lobe. A Case Report

Pleomorphic adenoma, also known as benign mixed salivary gland tumor, is the most common salivary gland tumor accounting for about 50-74 percent of all parotid neoplasms that has a slight female predilection in the 4th to 5th decade of life. The treatment of choice for this tumor is complete surgical removal. When the tumor arises from the superficial lobe of the parotid gland, superficial parotidectomy is recommended with facial nerve preservation and if the tumor involves the deep lobe, in that case, it may be necessary to perform total parotidectomy with identification and preservation of the facial nerve. Here we are presenting a case of parotid (deep lobe) pleomorphic adenoma where we successfully preserved and identified the facial nerve with the complete removal of the tumor.

Pleomorphic Adenoma of Palate: A Case Report

INTRODUCTION Pleomorphic adenoma is one of the most common benign salivary gland tumor affecting the major salivary glands mainly parotid gland of approx. 80% but infrequently the minor salivary glands of palate of approx. 7%. Salivary gland tumors are rare accounting only 2–3% of tumors occurring in head and neck region. The majority of minor salivary gland tumors are malignant in nature. The most common sites for minor salivary gland where pleomorphic adenoma arises are the palates followed by lips and cheek. This case report presents a case of pleomorphic adenoma of minor salivary gland of palate treated successfully by wide surgical excision with 1 cm healthy margin with uninvolved anatomical barrier under general anesthesia.

Title Expression of FOXO3 and MAPK1 Genes in Patients with Benign Salivary Gland Tumors.

Pleomorphic adenomas (PAs) and Warthin tumors (WTs) are the most common benign tumors that occur in the salivary gland. PA has a tendency towards malignant transformation. Thus, searching for new methods to diagnose salivary gland tumors and treatment is important. The members of the class O forehead box transcription factor (FOXO3) and mitogen-activated protein kinase 1 (MAPK1) genes participate in the cellular processes, including in cell proliferation. The aim of this study was to analyze these genes' expression in the salivary gland tissues and in salivary gland tumors. The study group consisted of 50 patients treated for salivary gland tumors. For genetic tests, fresh samples of tissue collected during the surgery were used. The expression levels of the FOXO3 and MAPK1 genes were statistically significantly lower in PA tissue than in normal salivary gland tissue and WT tissue. This research revealed that the FOXO3 and MAPK1 genes are present in benign salivary gland tumors and also indicated a role of these genes in the development of benign salivary gland tumors. The cause of the development of pleomorphic adenomas may be apoptotic disorder and the activation of the inflammatory process. The examined genes may have potential to be new therapeutic targets for the treatment of pleomorphic adenomas.

Vital Role of an Anaesthesiologist in Rendering Safe Anaesthesia in a Case of Parotid Tumor Resection with Obesity: A Case Report

Parotid pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. Slowly progressing asymptomatic swelling is the usual presentation of the tumor. Surgical excision of the tumor mass forms the mainstay of treatment, with utmost care taken to preserve the facial nerve. We describe here, a case of an obese male patient who was posted for parotid tumor resection under general anesthesia supplemented with superficial cervical plexus block whilst monitoring both muscle relaxation and nerve integrity.

Correlation of Clinical and Histopathological Features of Salivary Pleomorphic Adenoma.

Salivary gland tumors represent about 3% of the head and neck tumors. Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. This study was conducted to investigate and describe some clinical and histopathological aspects of salivary pleomorphic adenomas with special reference to the epithelial and mesenchymal components. In this retrospective study, one hundred tissue samples diagnosed as PA were sourced from archival tissue blocks between 2009 and 2019 in this retrospective study. Some clinical and demographic features, including age, sex, tumor size, and tumor location were recorded. This study included only samples taken by excisional biopsy. Then, the samples were histologically classified into three subtypes according to the proportion of epithelial and stromal components. The demographic and clinicopathological variables were statistically analyzed using Chi-square test or Fisher's exact test, considering a significance level of 5% (p< .05). In the present study, most cases (61%) were found in females, representing a female-male ratio of 1.6:1. The peak incidence was seen in the 4th and 5th decades of life. In 87% of cases, PA occurred in major salivary glands. There was a significant difference between the age of the patient and squamous metaplasia (p= 0.036). There was also a significant difference between the size of tumor and the amount of myxoid stroma (p= 0.021). Extensive myxoid stromawas mostly seen in tumors larger than 3.37cm (p= 0.001). In addition, there was a statistically significant difference between capsular invasion and the development of squamous metaplasia (p= 0.001). In this study, there was a significant correlation between the gland type and capsular features and between the size of tumor and rate of squamous metaplasia. A detailed clinical and histopathological analysis of PAs may provide a better insight to the pathophysiology of the lesion, tumor cell differentiation, and prognostic factors.

Pleomorphic Adenoma With Cystic Change, Extensive Squamous Metaplasia and Positive Block-Like p16 Staining Pattern: A Sheep In Wolf’s Clothing

Abstract Introduction/Objective Pleomorphic adenoma, the most common benign salivary gland neoplasm may show squamous metaplasia in up to 25% of cases, and less frequent cystic change. We report an unusual case of pleomorphic adenoma with cystic change, extensive squamous metaplasia and block-like p16 staining that was misdiagnosed as metastatic p16-positive squamous cell carcinoma in a limited core biopsy. Methods/Case Report A 78-year-old female with no history of malignancy presented with a right neck painless mass. PET-CT demonstrated a hypermetabolic ovoid mass adjacent to the right submandibular gland measuring 1.7 cm concerning for metastatic disease within a lymph node. Fine needle aspiration of lesion was hypocellular and showed cystic contents and rare atypical squamoid cells. Core biopsy of the lesion demonstrated sheets of squamoid cells with mild to moderate cytologic atypia in a hyalinized fibrotic stroma. Immunostain for p16 showed cytoplasmic and nuclear block-staining pattern. The biopsy was diagnosed as metastatic p16-positive squamous cell carcinoma. Subsequent human papilloma virus (HPV) in situ hybridization for low- and high-risk types was negative. The patient underwent right level 1B neck dissection revealing a pleomorphic adenoma arising at the periphery of the submandibular gland with cystic change and extensive central squamous metaplasia. Repeated p16 staining showed diffuse positivity in the area with squamous metaplasia and heterogenous staining in the non-metaplastic areas. Cobas HPV-PCR test covering 14 high-risk HPV subtypes was also negative. Results (if a Case Study enter NA) NA Conclusion We describe the unusual coexistence of extensive squamous metaplasia, cystic change and aberrant p16 staining pattern in an exophytic pleomorphic adenoma to raise awareness of how these changes individually, and more so in combination can mimic squamous cell carcinoma. The mechanism of p16 overexpression in metaplastic PAs appears to be independent of HPV infection.

Giant Pleomorphic Adenoma of Submandibular Gland.

Pleomorphic adenoma is a benign tumor of salivary glands which is relatively rare among head & neck neoplasms. Parotid gland is the most common site of occurrence whereas submandibular gland is rarely affected. We present a case of a giant pleomorphic adenoma of submandibular gland.

Epidemiological Profile of Salivary Gland Tumors in Southern Iranian Population: A Retrospective Study of 405 Cases.

Salivary gland tumors (SGTs) are a rare and diverse group of tumors that account for 3 to 10% of all head and neck malignancies. We aimed to conduct a comprehensive epidemiological analysis of SGTs in the south of Iran and compare the findings with previous reports from Iran and other parts of the world. Using a retrospective study, 405 patients diagnosed with SGTs were observed over an eight-year period between April 2013 and October 2021 in Shiraz, Iran. Patients' demographic and clinicopathological features were obtained from patients' records. Quantitative and descriptive data analysis was performed using SPSS software. There were 302 benign (74.5%) and 103 (25.4%) malignant SGTs. Pleomorphic adenoma and Warthin's tumors were the most common benign SGTs (70.5% and 21.5%, respectively). The most common malignant SGTs were mucoepidermoid carcinoma and adenoid cystic carcinoma (26.2% and 22.3%, respectively). There was a statistically significant association between tumor origin and its malignancy status (p < 0.001). In addition, the results indicated that benign tumors were most commonly detected in the parotid gland (p < 0.05). The benign tumors were more frequently observed among the younger population (p = 0.006). In summary, the findings of the current study were mainly consistent with the previous reports from Iran and the rest of the world. Benign tumors were the most prevalent type of SGTs, and the parotid gland was the most common site. While the majority of cases that developed from the major salivary glands were benign, all the minor SGTs were malignant. Older patients were more likely to develop malignant tumors compared to younger ones. This study provides insights into the prevalence, age-related incidence, gender distribution, and geographic variation of salivary gland tumors. This can be instrumental to develop a guideline for screening, diagnosis, and determining an optimal treatment.

Salivary gland tumor incidence in adult patients in a tertiary hospital in Mexico from 2008 to 2019.

To determine the incidence of salivary gland tumors in a population of a tertiary hospital in the State of Mexico, and to describe demographic variables. An observational, cross-sectional and retrospective study of salivary gland tumors reported in a tertiary hospital in the State of Mexico in the period 2008-2019 is presented. A prevalence of 0.049% was found. There was no difference between sex in the studied population. Benign salivary gland tumors were the most frequent (86.7%). The age range most affected was 51-60 years. The most frequently found tumor was the pleomorphic adenoma, followed by Warthin's tumor. There was 13.33% of sialolipomas, and one myoepithelioma. There were no cases of sublingual gland tumors or minor salivary glands. Tumors of the major salivary glands are infrequent tumors; population cases from a central Mexican state and their demographic characteristics are presented to contribute to the information found in local and international literature.

Diagnosis of Salivary Gland Tumors Using Transfer Learning with Fine-Tuning and Gradual Unfreezing.

Ultrasound is the primary tool for evaluating salivary gland tumors (SGTs); however, tumor diagnosis currently relies on subjective features. This study aimed to establish an objective ultrasound diagnostic method using deep learning. We collected 446 benign and 223 malignant SGT ultrasound images in the training/validation set and 119 benign and 44 malignant SGT ultrasound images in the testing set. We trained convolutional neural network (CNN) models from scratch and employed transfer learning (TL) with fine-tuning and gradual unfreezing to classify malignant and benign SGTs. The diagnostic performances of these models were compared. By utilizing the pretrained ResNet50V2 with fine-tuning and gradual unfreezing, we achieved a 5-fold average validation accuracy of 0.920. The diagnostic performance on the testing set demonstrated an accuracy of 89.0%, a sensitivity of 81.8%, a specificity of 91.6%, a positive predictive value of 78.3%, and a negative predictive value of 93.2%. This performance surpasses that of other models in our study. The corresponding Grad-CAM visualizations were also presented to provide explanations for the diagnosis. This study presents an effective and objective ultrasound method for distinguishing between malignant and benign SGTs, which could assist in preoperative evaluation.

Canalicualr adenoma in buccal space area : a case report

Introduction: Canalicular adenoma (CA) is considered a rare benign salivary gland neoplasm, although it was suggested that this lesion has a terminal duct origin. The most common location of this lesion is the upper lip which accounted for 80% of cases, followed by buccal mucosa and palatal area, it presented as a solitary lesion in middle age more in female patients. Case presentation: 75 years old, male, medically fit referred to the oral medicine and pathology clinic because he complaint of right cheek swelling for several years associated with discomfort but no associated pain or increase in the size of the lesion that presented in his cheek, the patient clinical examination revealed hard well-demarcated lesion in buccal area extended up to the zygomatic bone area, lesion can be palpable by using bi digest technique, CT x-ray was done for patient and shows two cystic lesions in right buccal space area, excisional biopsy done and histopathological evaluation revealed the diagnosis was Canalicular adenoma Conclusion: Canalicular adenoma is a benign salivary gland neoplasm that can be presented as solitary or multiple but solitary type more common, usually effect the upper lip and more in female patients with middle age, In our case the lesion presented in buccal mucosa area in male patient above 70 years old, clinical and histopathological evaluation is important to reach the diagnosis, clinical follow up is recommended in such lesion because there is a chance for recurrences

A rare case of pleomorphic adenoma of the nasal cavity

One of the most prevalent benign tumors of the main salivary glands is pleomorphic adenoma. They may also develop in the smaller salivary glands, which are common in the nasal cavity. The aim is to present this rare case which was diagnosed with tissue sampling and histopathological examination in conjunction with radiological findings. A 36-year-old woman's right nasal cavity was found to have a soft tissue mass that was seen protruding from the nasal septum. A detailed histological analysis led to the conclusion that the nasal cavity was home to a pleomorphic adenoma.In conclusion, pleomorphic adenomas in minor salivary glands are extremely uncommon, and they are much more uncommon in the nasal cavity, where they typically develop from the nasal septum. Due to the presence of lower stromal and higher epithelial components, it may be misdiagnosed at early stages. Resultant delayed detection leads to aggressive treatment.

Pleomorphic adenoma of the palate - A case series

ABSTRACT Rationale and Patient Concerns: This article highlights the case report of pleomorphic adenoma (PA) of the palate in a 37-year-old female patient and a 34-year-old male patient. Diagnosis and Investigations: Fine-needle aspiration cytology and computed tomography scan were performed to arrive at diagnosis. Interventions: Surgical excision was the most effective treatment plan. These tumors are mostly painless and are more common in the parotid gland, followed by the palate in case of minor salivary gland involvement. The tongue, tonsil, pharynx, floor of the mouth, lip, buccal mucosa, and retromolar region are other intraoral locations for this tumor. Lessons: PA is the most common benign salivary gland tumor, accounting for about 40%–70% of all major and minor salivary gland tumors. Palatal swellings are the most common complaints of patients; however, PA of the palate is a rare diagnosis. PA, also known as a benign mixed tumor, generally occurs in the parotid salivary gland and rarely in the minor salivary gland.

Oncocytoma: A Mystifying Parotid Gland Tumour

Oncocytoma is a rare salivary gland tumor consisting of oncocytes with many hyperplastic mitochondria. It usually occurs in the parotid gland. Very few cases of parotid oncocytoma have been reported in literature. Because of its rarity (&lt;1-2% of salivary gland tumors) and clinical presentation of the tumor. Clinical diagnosis is often challenging due to the likeness of oncocytoma to other benign and low-grade malignant salivary gland tumors there is a tendency among the clinicians to misdiagnose it as pleomorphic adenoma, hemangioma, or other forms of oncocytosis. Previously published articles had all agreed on the reality of this lesion occurring over the parotid gland. The paper aims to review previously published cases of oncoytoma to provide a better insight regarding demographic, clinicopathological, radiological and histological features of this rare tumor of parotid gland. A systemic review of English literature was performed after using a sensitive search strategy involving two different databases: google scholar and PubMed. A total number of 9 cases were included. The tumour is mostly presented in old age as a slowly growing tumour (mean duration 3.17 years) and showed a slightly higher female predominance (Female:Male=1.25:1). They were mostly located over superficial lobe,100%. Conventional histological variant has only been reported. Complete surgical excision was performed for all the cases without any reports of recurrence or malignant transformation. Imaging studies diagnosed the lesion as a benign tumor. Only histopathological examination can confirm it. Definitive histology examination concludes to oncocytoma. Furthermore, our aim is to bring to the forefront how these lesions require a comprehensive workup and how to choose the best treatment strategy. Mugda Med Coll J. 2023; 6(1): 30-36