Pleomorphic Adenoma Of Parotid Gland Research Articles

Patient-derived parotid gland pleomorphic adenoma organoid model and its preliminary histological and functional characterization

Objective: To establish patient-derived organoid models of pleomorphic adenomas (PAs) of the parotid gland and preliminarily characterize their histology, related biomarkers and functions. Methods: Fresh tumor tissue specimens were collected from surgical procedures of Oral and Maxillofacial Department. The harvested tissues were processed and cultured in a head and neck tumor organoid culture system, resulting in the successful establishment of organoid models from four cases of parotid gland pleomorphic adenomas. The in vitro growth of PA organoids was recorded by light microscopy. The successfully established organoids were passaged and cryopreserved, and the cryopreserved PA organoids were revived and re-cultured to observe their viability and organoid regeneration ability. Histological characterization, as well as characterization and detection of related markers and functional proteins, were performed on the organoids, comparing them with the patient-derived tissues. Results: The constructed organoid model of pleomorphic adenoma exhibited a dense and compact three-dimensional spherical structure. Hematoxylin and eosin staining indicated morphological similarities between the organoid and its tissue of origin. Immunohistochemistry showed positive cytoplasmic staining for Calponin, CK7, and EMA in both the organoid and the source tumor tissue, suggesting consistent histopathological characteristics between the organoid and its tissue of origin. Periodic acid-Schiff staining of the organoid showed positive staining for glycogen, with positive staining located in the interior and periphery of the organoid, indicating that the organoid possessed secretory functions like the salivary gland. Conclusion: We successfully constructed organoids of pleomorphic adenoma derived from patient samples. This model faithfully replicates the tissue morphology and biomarkers of the source tissue and exhibits biological functions associated with mucus secretion. It serves as a valuable in vitro model for studying the development and progression of salivary gland tumors.

Parotid gland pleomorphic adenoma re-operations with regard to patient and surgeon satisfaction: what can be improved?

Background Surgery, the treatment of choice for parotid pleomorphic adenoma (PA), is associated with facial nerve palsy and decreased quality of life. Re-operation for PA recurrence (rPA) significantly increases these risks and constitutes a dilemma for both patient and surgeon. Factors influencing the success of re-operation, as well as the self-reported satisfaction of both sides, have yet to be addressed in the literature. This study aims to improve upon the decision-making schedule in PA re-operations, based on patient expectations, imaging, and concordance with the first operative report (FOpR). Methods Seventy-two rPAs treated in a single tertiary center were collected and analyzed. The FOpRs and pre-operative imaging were divided according to defined criteria into accurate and non-accurate categories. The re-operative field and course were categorized as anticipated or unanticipated. The re-operation was categorized as satisfactory or unsatisfactory for both the patient and the surgeon. Results The accuracy of FOpRs and pre-operative imaging was 36.1% and 69.4%, respectively. Re-operative courses were: 36.1% anticipated and 63.9% unanticipated. The most frequently omitted data were: presence of satellite tumors (9.7%), and amount of removed parenchyma (9.7%). Variables that most commonly affected FOpR non-accuracy were: tumor size (Chi2(1)=59.92; p < 0.001) and capsule condition (Chi2(1)=29.11; p < 0.001). There was no significant relationship between FOpR accuracy and re-operative course (Chi2(1)=1.14; p = 0.286), patient satisfaction (Chi2(1)=1.94; p = 0.164) or surgeon satisfaction (Chi2(1)=0.04; p = 0.837). Pre-operative imaging (Chi2(1)=36.73; p < 0.001) had the greatest impact on surgeon satisfaction. Conclusion Accurate pre-operative imaging impacted surgeon satisfaction. The impact of the FOpR on re-operation technicalities and patient satisfaction was minor. Imaging precision should be improved to streamline the decision-making process of PA re-operation. This article proposes suggestions for a future decision-making algorithm as a starting point for a prospective study. Key messages Accurate pre-operative imaging impacts both surgeon and patient satisfaction. There is no significant relationship between the accuracy of the first operative report and surgeon and patient satisfaction. There is a statistically significant relationship between patient and surgeon satisfaction.

A Rare Case of Paediatric Pleomorphic Adenoma of the Parotid Gland

Pleomorphic adenomas are benign salivary gland tumours, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumour can be explained on the basis of its epithelial and connective tissue origin. The tumour has a female predilection between 30-50 years of age. Slowly progressing asymptomatic swelling is the usual presentation of the tumour. Surgical excision of the tumour mass forms the mainstay of treatment, with utmost care taken to preserve the facial nerve. This case report aims to throw light on an interesting case of pleomorphic adenoma of the parotid gland in a 10 years old female patient. The patient presented with a slowly progressing asymptomatic swelling on the right side of the face, which was diagnosed to be pleomorphic adenoma of right parotid gland. The aim of the study is to discuss how to proceed regarding the further management.

Conservative Surgical Approach to Pleomorphic Adenoma in Parotid Gland: Case Report

AbstractPleomorphic adenoma is a benign neoplasm of the salivary glands that affects most frequently females in the fourth and sixth decade of life. As it is usually an asymptomatic lesion, it is diagnosed upon routine physical examination. Treatment consists in surgical removal with partial or total involvement of the parotid gland. Conservative enucleation is the least invasive surgical option for this type of lesion. The present work aimed to report a case of pleomorphic adenoma of the parotid gland with eight years of evolution. The tumor was treated conservatively. Patient has been followed for sixth months, and no sensory alterations, fistulae, clinical signs of recurrence, nor any other alteration have been observed so far. Due to the benign nature of the lesion, an evolution with favorable prognosis is expected. Keywords: Adenoma. Benign Neoplasia. Tumor ResumoO Adenoma pleomórfico é uma neoplasia benigna de glândulas salivares, que acomete com maior frequência pessoas do sexo feminino entre a quarta e sexta década de vida. Por se tratar de uma lesão muitas vezes assintomática, geralmente é descoberta através do exame físico de rotina. O seu tratamento consiste em remoção cirúrgica podendo envolver ou não a glândula parótida de maneira parcial ou total. A enucleação conservadora é a modalidade cirúrgica menos invasiva para este tipo de lesão. O presente trabalho tem por objetivo relatar um caso de adenoma pleomórfico em glândula parótida com oito anos de evolução. O tumor foi tratado de maneira conservadora. A paciente está sendo acompanhada há 6 meses e não foram observados até momento alterações sensoriais, fistulas, indícios clínicos de recidiva ou qualquer outra alteração. Devido ao caráter benigno da lesão, espera-se evolução com prognóstico favorável. Palavras-chave: Adenoma. Neoplasia Benigna. Tumor.

Conservative Surgical Approach to Pleomorphic Adenoma in Parotid Gland: Case Report

Abstract Pleomorphic adenoma is a benign neoplasm of the salivary glands that affects most frequently females in the fourth and sixth decade of life. As it is usually an asymptomatic lesion, it is diagnosed upon routine physical examination. Treatment consists of surgical removal with partial or total involvement of the parotid gland. Conservative enucleation is the least invasive surgical option for this type of lesion. The present work aimed at reporting a case of pleomorphic adenoma of the parotid gland with eight years of evolution. The tumor was treated conservatively. Patient has been followed for sixth months, and no sensory alterations, fistulae, clinical signs of recurrence, nor any other alterations have been observed so far. Due to the lesion benign nature, an evolution with favorable prognosis is expected. Keywords: Adenoma. Neoplasms. Salivary Glands. Resumo O Adenoma pleomórfico é uma neoplasia benigna de glândulas salivares, que acomete com maior frequência pessoas do sexo feminino entre a quarta e sexta década de vida. Por se tratar de uma lesão muitas vezes assintomática, geralmente é descoberta através do exame físico de rotina. O seu tratamento consiste em remoção cirúrgica podendo envolver ou não a glândula parótida de maneira parcial ou total. A enucleação conservadora é a modalidade cirúrgica menos invasiva para este tipo de lesão. O presente trabalho tem por objetivo relatar um caso de adenoma pleomórfico em glândula parótida com oito anos de evolução. O tumor foi tratado de maneira conservadora. A paciente está sendo acompanhada há 6 meses e não foram observados até momento alterações sensoriais, fistulas, indícios clínicos de recidiva ou qualquer outra alteração. Devido ao caráter benigno da lesão, espera-se evolução com prognóstico favorável. Palavras-chave: Adenoma. Neoplasias. Glândulas Salivares.

Giant Pleomorphic Adenomas of Parotid Gland: a Case Series.

The parotid gland is the largest salivary gland in the body. Pleomorphic adenomas (PA) are most common benign tumors of parotid gland. If left untreated, they can gradually attain the size which can weigh several kilograms. This paper highlights a case series of 15 cases diagnosed as giant pleomorphic adenoma arising in the parotid gland along with their management. A hospital based, observational study of 15 patients of PA of the parotid gland, > 10cm in its widest dimension considered as giant, done at tertiary care ENT hospital over period of 9years. The age of the patients ranged from 30 to 81years with mean age 50.33 ± 15.30years. There were 5(33.33%) males and 10(66.67%) females. The time duration of having tumor ranged from 5 to 20years with mean duration of 10.4 ± 4.17years and the largest tumor was 25cm in its largest diameter. Mean weight of tumors was 2.72 ± 0.52kg. One out of fifteen cases was detected as malignant in nature. All cases were treated by surgical excision without any complications. Pleomorphic adenoma of parotid gland can assume a giant proportion when timely surgical intervention is not done. We can build up confidence and hope for life in patients after complete surgical excision of giant PA.

Clinicopathologic Features and Prognostic Factors of Widely Invasive Carcinoma Ex Pleomorphic Adenoma of Parotid Gland: A Clinicopathologic Analysis of 126 Cases in a Chinese Population

Salivary intracapsular carcinoma ex pleomorphic adenoma (ICCXPA) and minimally invasive CXPA (MICXPA) generally have favorable outcomes. In contrast, widely invasive CXPA (WICXPA) frequently results in disease-related death. The aims of the present study were to analyze the differences in the clinicopathologic features between parotid gland ICCXPA or MICXPA and WICXPA and the prognostic factors for WICXPA. We performed a retrospective cohort study. The clinicopathologic parameters of patients with primary CXPA of the parotid gland from our 2001 to 2012 cohort were reviewed. The predictor variable was a set of heterogeneous factors grouped into demographic, clinical, and pathologic features. The primary outcome variable was the tumor diagnosis, grouped into 3 categories: ICCXPA, MICXPA, and WICXPA. For statistical analysis, ICCXPA and MICXPA were combined into 1 group, with WICXPA analyzed separately. The differences in the clinicopathologic parameters between the 2 groups (ICCXPA plus MICXPA vs WICXPA) were evaluated using the χ2 test or t test. The secondary outcome variable was disease-specific survival (DSS) of those with WICXPA. The survival data for WICXPA were statistically analyzed using the Kaplan-Meier method and Cox regression. A total of 241 cases of CXPA had been diagnosed, including 63 cases of ICCXPA, 52 cases of MICXPA, and 126 cases of WICXPA. The patients with WICXPA were older than were those with ICCXPA/MICXPA (59.6 vs 51.4years; P<.001) and had a larger tumor diameter (3.9 vs 3.3cm; P=.040). The proportion of histologic high-grade tumor (P<.001), proportion of carcinoma more than 50% (P<.001), and proportion of lymph node involvement (P<.001) was greater in those with WICXPA. Cox regression analysis indicated that age, T stage, and N stage were independent prognostic factors of DSS for those with WICXPA. Older age, later T stage, a greater proportion of carcinoma, histologic high-grade findings, and lymph node involvement were associated with parotid gland WICXPA. Age, T stage, and N stage were the important independent factors for predicting the prognosis of patients with parotid gland WICXPA.

Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size &amp;lt;4 cm), 2 suffered facial paresis and out of 11 patients (size &amp;gt;4 cm), 5 suffered same. Out of 59 patients with depth of tumor &amp;lt;2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth &amp;gt;2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.&lt;/p&gt;

Expression of CD44v6 and COX-2 in pleomorphic adenomas and carcinomas of parotid gland

To investigate the correlation between CD44v6 and cyclooxygenase-2(COX-2) expression and recurrence and deterioration of pleomorphic adenoma of parotid gland. Immunohistochemistry was used to detect the expression of CD44v6 and COX-2 in 19 normal parotid tissues, 25 primary pleomorphic adenomas, 15 first recurrent pleomorphic adenoma, 15 second recurrent pleomorphic adenoma and 13 cancer in pleomorphic adenomas. The correlation between CD44v6 and COX-2 and the recurrence and deterioration of pleomorphic adenomas was evaluated using SPSS 15.0 software package. The positive expression rate of CD44v6 in normal parotid gland, primary pleomorphic adenoma, first recurrent pleomorphic adenoma, second recurrent pleomorphic adenoma and cancer was 5.26%, 44.00%, 60.00%, 93.37% and 100.00%, respectively;and the positive expression rate of COX-2 was 10.53%, 40.00%, 63.33%, 93.37% and 100.00%, respectively. There was significant difference in the positive expression intensity of CD44v6 and COX-2 among the groups (P<0.05). The positive expression rate and intensity of CD44v6 and COX-2 in normal parotid gland tissue were significantly lower than those in other groups (P<0.05). There was no significant difference in the positive expression rate and intensity of CD44v6 between primary pleomorphic adenoma and first recurrent pleomorphic adenoma (P>0.05). There was no significant difference in the expression intensity of COX-2 between the two groups (P>0.05), but the positive expression rate of COX-2 between the two groups was not significant(P>0.05). The positive expression rate and intensity of CD44v6 and COX-2 in the second recurrent pleomorphic adenoma were significantly higher than those in the first recurrent pleomorphic adenoma(P<0.05), but there was no significant difference between the two groups(P>0.05). CD44v6 in the second recurrent pleomorphic adenoma and cancer was significantly higher than that in the first recurrent pleomorphic adenoma(P<0.05). There was no significant difference in the expression rate and intensity of COX-2 (P>0.05). CD44v6 and COX-2 may play an important role in promoting occurrence, invasion, recurrence and deterioration of pleomorphic adenoma through synergistic action.

Novice's Sojourn to Parotid Surgery.

Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenoma is the most common salivary gland tumor, accounting for 60-80% of benign tumors of salivary glands, 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. Usually they are found as solitary unilateral, firm and mobile, painless, slow growing mass. The tumor has a female predilection between 30 and 50years of age. Utmost care is to be taken to preserve the facial nerve while performing superficial or total parotidectomy. We present 10 cases of pleomorphic adenoma of parotid gland over period of 2years, highlighting the prognosis following surgical management.

Correlation between computed tomography imaging and histopathology in pleomorphic adenoma of parotid gland

ObjectiveThe purpose of this study was to correlate the CT imaging features and histopathological findings of pleomorphic adenomas (PA), and also try to identify its clinical significance. MethodsTotally 262 PAs in the parotid gland including 18 recurrent cases were retrospectively reviewed with preoperative CT and pathologic slides. Each pathologic slide was reviewed by two pathologists to calculate mean value of epithelial/mesenchymal component, and the results were correlated with features of CT scans. ResultsPAs showing high contrast enhancement were correlated with high proportion of epithelial components in histopathologic findings. PAs with smooth border tend to have high proportion of epithelial components. The margin on CT imaging did not consisted with pathologic margin of resected specimens. In recurrent PAs, there was a significant difference on CT contrast enhancement, not in proportion of epithelial component. ConclusionThe histopathology and CT imaging features of PAs were variable, but we can find the correlation of epithelial component and CT contrast enhancement. Further large scale study would be expected to identify the clinical significance of CT imaging features and histopathologic findings of PAs.

Proteomics analysis of pleomorphic adenoma of the human parotid gland.

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Diffusion-weighted MRI for differentiation between sialadenitis and pleomorphic adenoma.

The aim of this study was to compare apparent diffusion coefficient (ADC) values from diffusion-weighted MRI (DWI) among normal salivary glands, cases with sialadenitis and cases with pleomorphic adenoma of major salivary glands. 22 patients (totalling 44 major salivary glands) diagnosed with either unilateral sialadenitis (on either parotid or submandibular gland) or parotid gland pleomorphic adenoma were selected. Contralateral non-affected glands (normal) were also analyzed. DW images were achieved using a spin-echo pulse sequence with a 1.5-T MRI device. Mean ADC values were compared among the three groups analyzed (contralateral normal glands, sialadenitis and pleomorphic adenoma). The mean ADC values were significantly higher in cases of parotid sialadenitis (p = 0.001), but not in cases of submandibular sialadenitis (p = 0.466), as compared with the contralateral non-affected glands. Cases of pleomorphic adenoma presented the highest ADC values of the study. In addition, one-way ANOVA test revealed a significant difference among the three groups of parotid glands analyzed. Within the limitations of this study, the present results suggest that DWI allows for differentiation between parotid sialadenitis and pleomorphic adenoma.

Recurrent Pleomorphic Adenoma of the Parotid Gland.

Pleomorphic adenoma is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Because of its propensity for invasion, pleomorphic adenoma of the parotid requires superficial parotidectomy or total parotidectomy to minimize the risk of tumor recurrence. We report a case of pleomorphic adenoma of the parotid gland with repeated recurrences. A 23-year-old male patient presented with a protruding neck mass. Six years prior to this presentation, the patient had undergone superficial parotidectomy for the removal of pleomorphic adenoma of the right parotid gland at our institution. The patient experienced recurrence at 17 months after the initial resection, which required a total parotidectomy with partial resection of the facial nerve. Pathologic examination revealed histologic findings consistent with pleomorphic adenoma across the surgical specimen from all three of the operations. The patient suffered from facial nerve paralysis, with facial expressions partially recovered over a year.

The role of aryl hydrocarbon receptor (AhR) in the pathology of pleomorphic adenoma in parotid gland

ObjectivesPleomorphic adenoma (benign mixed tumor) is one of the most common salivary gland tumors. However, molecular mechanisms implicated in its development are not entirely defined. Therefore, the study aimed at definition of aryl hydrocarbon receptor (AhR) involvement in pleomorphic adenoma pathology, as the AhR controlled gene system was documented to play a role in development of various human tumors. DesignThe study was carried out in pleomorphic adenoma and control parotid gland tissues where gene expression of AHR, AhR nuclear translocator (ARNT), AhR repressor (AHRR), as well as AhR controlled genes: CYP1A1 and CYP1B1, at mRNA and protein (immunohistochemistry) levels were studied. Functional evaluation of AhR system was evaluated in HSY cells (human parotid gland adenocarcinoma cells) using 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) as AhR specific inducer. ResultsPleomorphic adenoma specimens showed cytoplasmic and nuclear AhR expression in epithelial cells as well as in mesenchymal cells. In parotid gland AhR was expressed in cytoplasm of duct cells. Quantitative expression at mRNA level showed significantly higher expression of AHR, ARNT and CYP1B1, and comparable levels of CYP1A1 in pleomorphic adenoma tissue in comparison to healthy parotid gland. The HSY cell study revealed significantly higher expression level of AHRR in HSY as compared with MCF-7 cells (human breast adenocarcinoma cell line used as reference). Upon TCDD stimulation a drop in AHRR level in HSY cells and an increase in MCF-7 cells were observed. The HSY and MCF-7 cell proliferation rate (measured by WST-1 test) was not affected by TCDD. ConclusionsSummarizing both in vitro and in vivo observations it can be stated that AhR system may play a role in the pathology of pleomorphic adenoma.

Incidentally Detected Carcinoma Ex Pleomorphic Adenoma of Parotid Gland by F-18 FDG PET/CT.

Incidentally Detected Carcinoma Ex Pleomorphic Adenoma of Parotid Gland by F-18 FDG PET/CT.

The role of Nrf2 in pathology of pleomorphic adenoma in parotid gland.

BackgroundPleomorphic adenoma (benign mixed tumor) is one of the most common salivary gland tumors. However, the processes involved in its carcinogenesis are not well defined. This study aimed to define the contribution of Nfr2 (nuclear factor (erythroid-derived 2)-like 2) to pleomorphic adenoma pathology. The Nrf2-controlled gene system is one of the most critical cytoprotective mechanisms, providing antioxidant responses.Material/MethodsThe study was carried out in pleomorphic adenoma and control parotid gland tissues, investigating gene expression of NFE2L2, as well as KEAP1 (Kelch-like ECH-associated protein 1) and NQO1 (quinone oxidoreductase), at mRNA and protein (immunohistochemistry) levels. Functional evaluation of Nrf2 system in the parotid gland was evaluated in HSY cells (human parotid gland adenocarcinoma cells).ResultsPleomorphic adenoma specimens showed cytoplasmic and nuclear Nfr2 expression in epithelial cells, as well as more variable lower Nrf2 level in mesenchymal cells. In the parotid gland, Nrf2 was expressed in cytoplasm of serous, mucous, and duct cells. Nuclear Nrf2 expression was predominantly seen in serous cells, whereas mucous and duct cells were mostly negative. Comparable mRNA levels of NFE2L2 and NQO1 genes and significantly higher expression of KEAP1 in pleomorphic adenoma were seen. HSY cell incubation with oltipraz demonstrated significant elevation of NFE2L2 after 24 and 48 hours of stimulation, whereas NQO1 was elevated, but significantly only after 24 hours, and KEAP1 expression remained unchanged.ConclusionsSummarizing both in vitro and in vivo observations, it can be stated that Nrf2 may play a role in the pathology of pleomorphic adenoma.

Surgical management of pleomorphic adenoma of parotid gland in elderly patients: Role of morphological features

The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly these tumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is an almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called “capsule” but there is disagreement about the form, extension and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical “enucleation like” method called nucleoresection.

Pleomorphic adenoma of parotid gland with extensive bone formation – A rare case report

Pleomorphic adenoma is the most common type of all salivary gland tumors, involving more frequently the parotid gland. In most series, it represents 45–75% of all salivary gland neoplasms. We report an unusual case of a huge tumor that measured 9×8cm & 400g by weight with extensive bone formation, occurring in the parotid gland of a 22year old man. Thorough clinical examination was done. FNAC was done which showed Myxochondroid matrix with glandular epithelial cells suggesting pleomorphic adenoma. CT scan head & neck revealed a large mass with nodular areas of calcification within soft tissue with marked narrowing of orophayngeal lumen. Total parotidectomy with preservation of facial nerve was done by the Transcervical Transparotid approach. The histopathological findings suggested the possibility of extensive endochondral ossification in pleomorphic adenoma. Preservation of facial nerve functions is a key to successful parotid surgery.

多臓器転移を来した耳下腺多形腺腫の1例

In January 2011, a 64-year-old woman who had undergone tumor resection for pleomorphic adenoma of the left parotid gland four times since her first operation in 1996 visited an orthopedist in our hospital complaining of pain in her right lower limb. Computed tomography (CT) of the whole body showed multiple tumors on the left parotid gland, right kidney, the sacrum, and both lungs. Biopsy of the sacral region and right nephrectomy were performed based on a clinical diagnosis of sacral and pulmonary metastases from renal cell carcinoma, and palliative radiation therapy was immediately begun on the sacral region. Given the definitive pathological diagnosis of metastasis of pleomorphic adenoma of the parotid gland, the recurrent tumor of the left parotid gland and the surrounding lymph nodes were first removed. Postoperative findings demonstrated that the pleomorphic adenoma had metastasized to the lymph nodes. The lung tumors were resected subsequently, and postoperative findings led to the diagnosis of pleomorphic adenoma. Metastasis of pleomorphic adenoma is known to be extremely rare, and to our knowledge this case of metastasis to a kidney is the first reported in Japan.