Pleomorphic Adenoma Of Parotid Gland Research Articles

Granulomatous lymphadenopathy masquerading as pleomorphic adenoma: A clinical and diagnostic dilemma

Lymphadenopathy can masquerade as other pathological entities due to their proximity to many sites, thus clinical misjudgment can happen. Ours is such example where Granulomatous cervical lymphadenopathy is clinically thought of as Pleomorphic adenoma of Parotid gland. They need careful review, radiological correlation before committing for final impression.

Imaging findings of parapharyngeal space pleomorphic adenoma in comparison with parotid gland pleomorphic adenoma

The purpose of this study was to assess imaging findings of parapharyngeal space (PPS) pleomorphic adenoma (PA) in comparison with parotid gland (PG) PA retrospectively. Ten patients with PPS PAs and 66 with PG PAs were included. CT and MR images were reviewed for the size, presence of calcification or cystic degeneration, and MR signal intensity of solid components. The maximum diameter was greater in PPS PA (57.3 ± 11.4 mm) than in PG PA (28.7 ± 20.8 mm) (p < 0.01). The frequency of calcification was higher in PPS PA (50 %) than in PG PA (15 %) (p < 0.05). The frequency of cystic degeneration was marginally higher in PPS PA (60 %) than in PG PA (29 %) (p = 0.058). On T2-weighted images, solid components of PPS and PG PAs showed hyperintensity in 40 and 54 %, isointensity in 50 and 32 %, and hypointensity in 10 and 14 %, respectively. The size and the frequency of calcification or cystic degeneration were higher in PPS PAs than in PG PAs. Radiologists should recognize the difference in imaging features between PPS and PG PAs.

Low-grade malignant myoepithelioma arising in a pleomorphic adenoma: a rare case

Malignant myoepithelioma is a very rare salivary gland tumor that can arise de novo or within a pre-existing pleomorphic adenoma. We report a case of malignant myoepithelioma most probably arising in a pre-existing pleomorphic adenoma of the left parotid gland. The patient was a 60-year-old man who presented with a multinodular mass lesion over left side of the face and neck. He had undergone removal of a pleomorphic adenoma of the left parotid gland twice (8 and 22 years ago). Histological examination showed locally concentrated highly invasive myoepithelial cells with bland-looking morphology and no evidence of mitosis or necrosis. Immunohistochemistry confirmed the myoepithelial differentiation (S-100+, SMA+) and a low Ki-67 labeling index (<5%).

壊死を伴った耳下腺多形腺腫の 1 例

背景 : 壊死を伴う唾液腺多形腺腫の報告例はまれで, 悪性腫瘍と誤診断されやすい腫瘍の一つである. 今回, 壊死を伴う耳下腺多形腺腫の 1 例を経験したので報告する.症例 : 71 歳, 女性. 約 2.5 cm 大の左耳下腺腫瘍に対して穿刺吸引細胞診が施行された. 穿刺吸引細胞診では壊死や好中球主体の炎症細胞を背景に, 紡錘形細胞が結合性の乏しい集塊を形成しており, 核分裂像が散見された. 通常の多形腺腫にみられるシート状の筋上皮細胞の集塊や粘液様間質は認めず, 筋上皮腫あるいは非上皮性悪性腫瘍を考えた. 摘出された腫瘍の組織像では, 被膜下の腫瘍辺縁部を縁取るように少量の多形腺腫の腫瘍成分がみられるのみで, 腫瘍の大部分は壊死や肉芽組織であった.結論 : 多形腺腫でも壊死を伴うことがあり, 本症例のように穿刺吸引細胞診で腺腫部分の腫瘍成分がほとんど採取されていない場合, 悪性腫瘍との鑑別が問題となる. 画像所見, 臨床情報などを加味して総合的に判断する必要がある.

Pleomorphic Adenoma of Parotid Gland in The Elderly: Do We Always Need to Operate?

Introduction: Pleomorphic adenoma is the most common salivary gland tumor, which usually involves the parotid gland. It can seldom undergo malignant transformation. Therefore, the best treatment to avoid malignant transformation is to excise the tumor, which is a straightforward decision in young and fit patients. However, surgery under general anaesthesia can lead to a rapid postoperative cognitive impairment in the elderly patients. Also, some patients may be at a higher risk for a general anaesthetic due to their general health and associated medical conditions. Aim: To discuss the advantages and disadvantages of surgical versus non-surgical management of parotid pleomorphic adenomas in the elderly and medically compromised. Methods & Material: A review of English literature. Conclusion: A decision to excise a parotid pleomorphic adenoma, with no malignant pointers, in the elderly and in patients who are high risk for general anaesthesia should be taken cautiously and a non-surgical approach should be considered.

Deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space

Pleomorphic adenomas are slow growing, well-demarcated benign neoplasms that constitute more than 80% of benign parotid tumours. Deep lobe parotid pleomorphic adenomas are rare tumors that present a diagnostic and therapeutic challenge. Approximately 10-12% of pleomorphic adenomas of the parotid are thought to arise from the deep lobe of parotid. Due to anatomical relations and restrictive boundaries of the deep lobe, parapharyngeal extensions may remain asymptomatic until reaching a very large size. These tumors have a variety of distinct clinical presentations, most commonly arising from the portion of the gland deep to the facial nerve lateral to the mandible. We present a case of deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space in a 38 year old female.

Multinodular neck recurrence of parotid gland pleomorphic adenoma: a case report

Pleomorphic adenoma is the most common neoplasm of the parotid gland. It is a benign tumor composed of epithelial and myoepithelial cells arranged in various morphological patterns. The most common reasons contributing to a recurrent disease are obvious or underestimated tumor spillage, incomplete excision, and violation of the pseudocapsule of the tumor. This article presents a case of gross multinodular recurrence of a parotid gland pleomorphic adenoma in a 38-year-old female patient. Upon clinical examination of the homolateral neck, multiple, painless, well-defined, palpable, nontender masses and subcutaneous nodules of the right parotid and homolateral neck region were revealed. The patient was treated with surgery and subsequent radiation therapy. Histologic examination of the resected specimen was suggestive of a recurrent pleomorphic adenoma disease. There were no signs of malignant transformation in the specimen. The diagnostic procedure followed, and management of the patient is outlined in the paper. Pleomorphic adenoma is the most common tumor of the parotid gland. In spite of being a benign neoplasm, inadequate management of the lesion may lead to problems such as local recurrence or malignant transformation. Management of recurrent tumors is challenging because the probability of subsequent recurrence increases with each recurrent episode, thus making local control increasingly difficult and damage to the facial nerve more likely.

Progress in studies on the surgical margins for pleomorphic adenoma of parotid gland

Progress in studies on the surgical margins for pleomorphic adenoma of parotid gland

唾液腺腫瘍の外科療法

The salivary glands are divided into two groups : the major glands （parotid, submandibular, sublingual） and minor glands. All salivary glands may be involved by tumor. In our hospital, salivary gland tumors occur much more commonly in the minor glands （minor glands: 72 ％, major glands: 28 ％）（palate: 53 ％, buccal mucosa:15 ％, lip: 13 ％, gingiva: 9 ％, tongue: 5 ％, oral floor: 5 ％）. In the major salivary glands, the majority of tumors occur in the parotid gland （parotid: 52 ％, submandibular: 43 ％, sublingual: 5 ％）. The majority of salivary glands tumors are benign （benign: 78 ％, malignant: 22 ％）. The pleomorphic adenoma is the most common salivary gland benign tumor. The mucoepidermoid carcinoma is the most common malignant salivary gland tumor. The surgical approach adopted should remove the benign salivary gland tumor in its entirety with a surrounding cuff of normal tissue. In a superficial lobe pleomorphic adenoma of parotid gland, treatment is a superficial parotidectomy. In deep lobe case, a total parotidectomy is required. Benign submandibular gland tumor is excised with extracapsular dissection and excision of the submandibular gland. The malignant salivary gland tumor requires excision with wide margins and in continuity neck dissection. Most of patients who contract malignant salivary gland tumors need to have reconstructive operations （skin graft, local flap, free flap, nerve graft）.

Genomic changes in salivary gland pleomorphic adenomas detected by comparative genomic hybridization

The aim of this study was to investigate whether so far unknown chromosomal alterations in pleomorphic adenoma (PA) exist. To this end, tissue samples from 18 patients with parotid gland PA were studied by comparative genomic hybridization (CGH) using Phi-29-DNA-polymerase for DNA amplification. The most common aberrations were losses of chromosomal material of 19p (6/18), 9q, 16p, and 19q (in 3 out of 18 patients each). Additional losses were observed on 4p, 5q, and 17q (2 / 18 each). Gains involved chromosomes 2p, 4p, 6p, 17q, and 21q (2 / 18 each). Losses of 19p have been associated with inactivation of tumor-suppressor genes in carcinomas previously. As a result, pleomorphic adenomas show a considerable diversity of chromosomal gains and losses detected by CGH. The 19p arm, and particularly its 19p13 region, need be further studied to elucidate the potential impact of associated lost tumor suppressor genes on PA development.

Pleomorphic Adenoma Causing Facial Nerve Palsy

Facial nerve palsy due to the benign parotid tumor is extremely rare. The authors experienced a case of pleomorphic adenoma in parotid gland, showing retrograde extension to mastoid bone along the facial nerve, resulting facial nerve palsy. An 82-year-old woman with facial nerve palsy for six years was revealed to have a solid mass in the close proximity to mastoid tip with contrast enhancement on computed tomography (CT). The mass extended into the air cells of temporal bone at the exiting site of the facial nerve through stylomastoid foramen. Based on the CT findings and her facial nerve palsy, initial diagnosis was facial nerve schwannoma. Mass was removed via transmastoid approach. The pathology was pleomorphic adenoma and direct nerve invasion was not observed.

Pleomorphic adenoma of parotid gland: delayed enhancement on computed tomography

To assess the efficacy of multiphasic CT with 8 min delayed acquisition in the differential diagnosis between pleomorphic adenomas and other parotid neoplasias. Between January 2004 and April 2007, 62 patients with parotid enlargement were enrolled in this prospective study. The CT protocol applied included the following four acquisitions: without contrast medium and 30 s, 120 s and 8 min after intravenous injection of contrast medium. We considered the degree of the enhancement of the lesions (rated as "low", "moderate" and "strong") and the degree of enhancement homogeneity (rated as "not homogeneous", "mildly homogeneous" and "uniform"). These parameters were compared with Hounsfield values of the lesions computed in each phase. The diagnosis was confirmed in all patients after surgery. On histological examination, 36 tumours were classified as pleomorphic adenomas and 26 as non-pleomorphic adenomas. On the basis of a statistical comparison, the third phase proved to be the most effective in the differential diagnosis between pleomorphic adenoma and non-pleomorphic adenomas, both for the assessment of the degree of the enhancement (in this phase, strong enhancement showed a sensitivity of 61.11%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 53.33%) and, above all, for the homogeneity of the enhancement (in this phase, indeed, uniform enhancement showed sensitivity, specificity, PPV and NPV of 100%). Our results seem to indicate that multiphasic CT with 8 min delayed acquisition allows the differential diagnosis between pleomorphic adenomas and other parotid neoplasias.

Rak przewodowy gruczołów ślinowych (salivary duct carcinoma) – charakterystyka kliniczna i patologiczna 5 przypadków

The 5 cases of salivary duct carcinoma (SDC); very rare, but distinct group of highly malignant salivary gland tumor are presented, and difficulties with pathological and clinical diagnosis is discussed. The SDC developed in single cases in parotid salivary gland, submandibular salivary and in mucosa of maxillary sinus, pyriform fossa and oral cavity (check). In 3 cases the second malignant tumor was present--synchronously (SDC + pleomorphic adenoma in parotid gland; SDC + squamous cell carcinoma in hypopharynx) or metachroneously (squamous cell carcinoma of upper lip followed by SDC). In one case the high levels of PSA suggesting of metastases from unknown primary within the prostate gland, or PSA expression related to SDC was observed. The four patients received radical treatment - surgical resection followed by radiotherapy; in one case only palliative treatment was applied, due to patient's poor general condition and high advancement of the primary disease. The observation ranged from 10 to 77 months (average time--31 months). The one patient died 13 months after diagnosis and palliative treatment. The three patients are alive with distant metastases to the lung and bones (77, 38 and 18 months after primary treatment was completed). Only one patient with 10 months observation after treatment is living without symptoms of recurrence or metastases.

Extraordinarily High F-18 FDG Uptake Caused by a Pleomorphic Adenoma of the Parotid Gland

Abstract: A 53-year-old man received an FDG-PET scan as a follow-up study for previous colon polyps. The FDG-PET scan revealed an area of extraordinary high FDG uptake at the left parotid region. Computed tomography (CT) showed a 1.6-cm contrast-enhancing nodule in the left parotid gland and the nodule was surgically removed. The histopathologic report confirmed the lesion was a pleomorphic adenoma (benign mixed tumor) of the left parotid gland.

Spontaneous infarction of a pleomorphic adenoma in parotid gland: Diagnostic problems and review

Although infarction of parotid gland pleomorphic adenoma (PA) following fine-needle aspiration (FNA) has been well-documented, spontaneous infarction of PA has remained as an uncommon entity in the literature. To our knowledge, we report the second case of spontaneous infarction occurring in a parotid gland PA. A 44-yr-old man presented with a 2-yr history of slowly enlarging right parotid mass, which had become painful 1 mo before performing FNA biopsy. Smears revealed abundant necrotic debris, atypical squamous cells, and small cells with dark nuclei suggestive of a carcinoma. Histologic examination of the tissue fragments demonstrated degenerated clusters of cells and chondromyxoid matrix. The parotidectomy specimen had features consistent with those of an infarcted PA. Although appears to be rare, spontaneous infarction of PA should be considered in the differential diagnosis, since necrosis may mimic carcinoma and cause misinterpretation of necrosis as an indication of malignancy, in an otherwise benign salivary gland neoplasm.

Basal Cell Carcinoma Occurring in Scar Tissue Following Excision of a Parotid Gland Pleomorphic Adenoma

A 49-year-old patient presented with a basal cell carcinoma growing on scar tissue left following excision of a parotid gland pleomorphic adenoma. The objective was to determine whether the basal cell carcinoma had resulted from tumor spillage at the time of the pleomorphic adenoma excision. Substantial evidence is presented linking the two tumors. The basal cell carcinoma most likely occurred as the result of tumor spillage at the time of the parotid gland pleomorphic adenoma excision. Cutaneous connective tissue stroma plays a significant role in determining the differentiation of basal cell carcinomas.

Basal Cell Carcinoma Occurring in Scar Tissue Following Excision of a Parotid Gland Pleomorphic Adenoma

Basal Cell Carcinoma Occurring in Scar Tissue Following Excision of a Parotid Gland Pleomorphic Adenoma

Adenoma pleomórfico de parótida: aspectos clínicos, diagnósticos e terapêuticos

As neoplasias da glândula parótida constituem um grupo heterogêneo com mais de 30 tipos histológicos definidos, sendo o adenoma pleomórfico o tumor benigno mais comum. OBJETIVO: Neste trabalho apresentamos uma casuística de adenoma pleomórfico de glândula parótida, com o objetivo de discutir a apresentação clínica, o diagnóstico e as técnicas cirúrgicas mais adequadas no tratamento desta doença. MATERIAL E MÉTODO: Foi realizado estudo clínico retrospectivo de um grupo de 68 pacientes com diagnóstico histopatológico de adenoma pleomórfico de glândula parótida, operados no Serviço de Otorrinolaringologia do HSPE-FMO, de janeiro de 1982 a junho de 2002. Foram colhidos os dados referentes a idade, sexo, sintomas mais freqüentes, exames complementares, localização, tamanho, técnica cirúrgica empregada, complicações do tratamento e evolução. RESULTADOS: Nesta casuística observamos maior incidência no sexo feminino, e mais freqüente na 5ª década de vida. A apresentação clínica mais comum foi nódulo na região parotídea, sendo este sinal presente em 100% dos casos. A parotidectomia superficial com identificação e preservação do nervo facial foi a cirurgia mais realizada (91,2% dos casos). As complicações pós-operatórias mais freqüentes foram paresia (14,7%) e paralisia (7,3%) do nervo facial, seguida da síndrome de Frey (4,4%). CONCLUSÃO: O adenoma pleomórfico é a neoplasia benigna mais comum na glândula parótida, sendo mais freqüente no sexo feminino, a partir da 5ª década de vida. É uma neoplasia de diagnóstico clínico, com confirmação a partir do exame histopatológico. A parotidectomia superficial é procedimento mínimo para o diagnóstico e terapêutica, sendo baixa a taxa de recidiva com esta cirurgia.

Simian Virus 40 Sequences and Expression of the Viral Large T Antigen Oncoprotein in Human Pleomorphic Adenomas of Parotid Glands

Simian virus 40 (SV40) sequences of the early region coding for the large T antigen (Tag) oncoprotein were investigated in DNA samples from human pleomorphic adenoma (PA) of parotid glands. Specific SV40 sequences were detected, by PCR and filter hybridization with an internal oligoprobe, in 28 of 45 (62%) human PA specimens. None of the DNA samples from 11 normal salivary gland tissues was SV40-positive. DNA sequence analysis, carried out in all PCR amplified products from SV40-positive PA specimens, confirmed the SV40 specificity and indicated that PCR products had a sequence not distinguishable from SV40 DNA wild-type strain 776. SV40 Tag expression was revealed by immunohistochemistry with the specific monoclonal antibody Pab 101 in PA thin sections with a highly sensitive technical approach which retrieved the nuclear viral oncoprotein in 26 out of 28 (93%) samples previously found SV40-positive by PCR. Detection of SV40 sequences and Tag expression in human PA suggests that this oncogenic virus may play a role as a cofactor in the onset and/or progression of this benign neoplasm, or that SV40 DNA could replicate and express the Tag in PA cells.

神経移植を要した巨大耳下腺多形腺腫例

We report a case of giant pleomorphic adenoma of parotid gland. The patient was a 66-year-old female who first noticed the mass 30 years previously, although the mass had not been treated. The tumor gradually enlarged and on examination at our hospital on March the third 1999, the tumor was 13×11×9cm. The patient underwent total parotidectomy and since the tumor involved a facial nerve, the nerve was resected and we grafted the cervical sensory plexus. Midline mandibulotomy was performed because the tumor extended to the parapharyngeal space. Histopathologically, there was no evidence of malignancy. Facial palsy was gradually improved postoperatively and there has been no recurrence for two years.