Histopathology of pleomorphic adenoma in the parotid gland. As a nuclear oncogene, plag1 encodes a developmentally regulated transcription factor and constitutes a subfamily of zinc finger proteins 2. Inmunohistochemical expression of pcna, p53 and bcl2 in pleomorphic adenomas. Pleomorphic adenoma benign mixed tumor is the most common benign neoplasm of the salivary glands and of the lacrimal gland. It is found mostly in the parotid gland in middleaged women. Pathophysiology of pleomorphic adenoma doctor answers. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. The diagnosis, pathological features, pathogenesis, treatment, and prognosis of multiple primary parotid benign tumors similar to this case are discussed with reference to the relevant literature. Panorama of pleomorphic adenoma in a series of patients. Pleomorphic adenoma is the most common amongst these, comprising 60 70% of all parotid tumours. An extensive research of the pertinent world literature has revealed only a handful of documented cases related to pleomorphic adenoma arising from the buccal mucosa minor salivary glands. Furthermore, the lesions are uncommon and often have a difficult diagnosis by clinicians and pathologists, because the residual small pa component and various. Semiology and oral pathology, dental school, university of campinas. In 1998 atula demonstrated ebv dna positivity, from a pleomorphic adenoma arising in the.
Although the pleomorphic adenoma is normally benign it does have the potential to become cancerous, also referred to as malignant. Pleomorphic adenoma benign mixed tumor represents 45% to 74% of all salivary gland tumors and 65% of them occur in the parotid gland. Pleomorphic adenoma is a benign salivary gland tumor that exhibits wide cytomorphologic and architectural diversity. If pleomorphic adenomas are untreated they can increase gradually up to numerous kilograms in weight.
Surgery is the most common form of treatment for pleomorphic adenoma. Pleomorphic adenoma symptoms, causes, treatment, surgery. The role of nrf2 in pathology of pleomorphic adenoma in. It progresses slowly and, left untreated, can produce signi. Benign tumour polymorphous low grade adenocarcinoma plga rare lesion 23% of benign s. Hiroshi katoh, keishi yamashita, takumo enomoto and. Histologically, pleomorphic adenomas are characterized by the presence of both epithelial and mesenchymal elements, with marked morphological diversity. One hundred benign and ten malignant pleomorphic adenomas of the parotid gland were analyzed. Pleomorphic adenoma, also referred to as benign mixed tumors bmts, is a benign or a noncancerous growth in the salivary gland, the most commonly occurring parotid tumor. Pleomorphic adenoma of the minor salivary glands most commonly occurs in the palate 16.
The patient presented excellent cosmetic and functional results, without signs of facial nerve palsy, damage or recurrence. Most cases reported in literature describe 2 pleomorphic adenoma nodules in one gland although one patient with 4 separate nodules has been described 4. Incomplete pseudocapsule, extracapsular extension, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule are also likely. There have been many cases reported in literature of unilateral synchronous tumours of the parotid gland.
Hybrid salivary gland tumors are rare, and their pathogenesis is controversial. Recurrent pleomorphic adenoma of the parotid gland. According to the world health organisation the characteristic of this tumor is benign in histologically but distant or local metastasis are possible 3. Pleomorphic adenoma gene 1, located on 8q12, plays a critical role in tumorigenesis of pleomorphic adenoma, whereas the t3. Pleomorphic adenomas are the commonest tumors of the salivary glands. Viral involvement has been discussed in the pathogenesis of pa regarding the role of epstein barr virus ebv, human herpes virus 8 hhv 8, human papiloma virus hpv and human cytomegalovirus cmv. Pleomorphic adenoma clinical features incidence of malignant transformation increases with duration of tumour 2% for tumours less than 5 years 10% for tumours more than 15 years duration usually adenocarcinoma or undifferentiated carcinoma tumours are very aggressive for a diagnosis of carcinoma ex pleomorphic adenoma, recognizable traces of. Malignant degeneration of an adenoma increases from 1. However, there are a few studies in this topic in the recent literature. Mar, 2019 pleomorphic adenoma pa is the most common type of salivary gland tumor with a high recurrence and malignant transformation. However, pleomorphic adenoma has been reported to involve the minor salivary glands as well.
Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. Metastasizing pleomorphic adenoma is the third type of malignant mixed tumor of salivary glands and is the rarest. Carcinoma ex pleomorphic adenoma is an uncommon malignant tumor with high aggressive behavior and poor prognosis. Histologic localization of plag1 pleomorphic adenoma gene 1 in pleomorphic adenoma of the salivary gland. Discussion pleomorphic adenoma appears as a painless slowly growing firm mass. A pleomorphic adenoma is the most common salivary gland neoplasm in both children and adults. Surgical treatment of pleomorphic adenoma of the parotid. The majority of these neoplasms originate from the mucosa of the bony or cartilaginous septum.
Immunohistochemical features of carcinoma ex pleomorphic. Catenin exerts multiple functions in several neoplasms, playing a major role in cell signaling and tumor progression. It is the commonest of all salivary gland tumors constituting up to twothirds of all salivary gland tumors. T rise within sg tissue, common parotid 78% composed of cellular elements oncocytes. The treatment of pleomorphic adenoma is surgical excision. The molecular pathogenesis of pleomorphic adenoma of the. Histopathological findings of pleomorphic adenomas of the salivary. Here we are presenting a case of giant pleomorphic adenoma of the parotid, being the largest in size to be excised in pakistan in.
Pleomorphic adenoma of the cervical heterotopic salivary. Pleomorphic adenoma is the most common salivary gland tumor and accounts for approximately 80% of parotid tumors. Previous studies of the pathogenesis of pleomorphic adenomas were mainly focused on chromosom al. Introduction pleomorphic adenoma pa, also known as benign mixed tumor, is the most common salivary tumor, constituting up to twothirds. Pleomorphic adenoma an overview sciencedirect topics. In the early stages a pleomorphic adenoma is usually painless but as they start to grow larger these tumors can start to cause complication in your ears or mouth. Pleomorphic adenoma benign mixed tumour of the salivary glands. There are three main patterns of malignant change that occur in pleomorphic adenoma. Warthins tumor, pleomorphic adenoma, parotid gland, multiple primary tumor introduction pleomorphic adenoma and warthins tumor are. Pdf primary pleomorphic adenoma in posterior cranial fossa. Most recurrent pleomorphic adenoma are multinodular.
The mammogram can reveal a mass with poorly outlined borders that suggest a malignant process. Pleomorphic adenoma is the most common benign salivary gland neoplasm. Pleomorphic adenoma may show various architectural and cytologic features that resemble other salivary tumors identifying areas typical of pleomorphic adenoma with triphasic ductal, myoepithelial and stromal components is helpful to establish the diagnosis squamous cell carcinoma. Inmunohistochemical expression of pcna, p53 and bcl2 in. Most commonly affected site is the parotid gland 84% of cases. Metastasizing pleomorphic adenoma of the salivary gland. Ioffe 2008 metastasizing pleomorphic adenoma of the salivary gland. If the pleomorphic adenoma is in your parotid gland it can be a delicate surgery due to the closeness to your facial nerves and the potential for the surgery to cause damage to these facial nerves. Malignant transformation, though rare, has been reported. The combination of mucoepidermoid carcinoma and basal cell adenoma has not been previously described.
About 30 cases have been reported in the literature. Etiology and management of recurrent parotid pleomorphic. Case report pleomorphic adenoma presenting with a mediastinal. Pleomorphic adenoma surgery, symptoms, causes, treatment. To investigate cmyc, ki67, pancytokeratin, and vimentin immunohistochemical features of carcinoma ex pleomorphic adenoma caexpa and pleomorphic adenoma pa in the lacrimal gland in order to find some clues in the differential diagnosis between them. Therefore, enucleation or local dissection of the pleomorphic adenoma is not a sufficient surgical treatment of this special tumor entity. Pleomorphic adenomas are derived from ductal and myoepithelial cells and are most commonly found in. Dec 14, 2019 the etiology of metastasizing pleomorphic adenoma is not clearly understood, but a number of theories have been put forward. Pdf histopathological findings of pleomorphic adenoma of the. Monoclonal origin of primary unilateral multifocal. Pleomorphic adenoma benign mixed tumor is the most common neoplasm of the salivary glands. Clinical manifestations of recurrent parotid pleomorphic adenoma article pdf available in clinical and experimental otorhinolaryngology 24. Recurrent pleomorphic adenoma of submandibular region.
While malignant transformation of adenoma to carcinoma seems plausible, gene sequencing was more suggestive of their independent derivation. Pleomorphic adenoma arising from heterotopic salivary gland tissue in the neck a b c fig. Carcinoma ex pleomorphic adenoma is the most common variety of mixed malignant tumor where carcinoma develops from the epithelial elements of a preexisting pleomorphic adenoma. Etiology and familial inheritance of pleomorphic adenomas background. Pleomorphic adenoma pleomorphic adenoma of the breast is a rare benign tumor, with patients ranging age from 23 to 78years. Friedlander on pathophysiology of pleomorphic adenoma.
For lesions located superficially in the parotid gland, superficial parotidectomy identifying and preserving the. Here we report the case of a 33yearold woman with acromegaly and also who presented with a swelling on the left neck and diagnosed as pleomorphic adenoma arising from parotid gland after. Outside of the central nervous system, a higher incidence of renal angiomyolipomas has been described in patients with tuberous sclerosis. Immunohistochemical pattern of pleomorphic adenoma. In that case report of a posterior fossa pleomorphic adenoma, typical myxochondroid stroma was not identified on histology, and its pathogenesis was not explored. Pleomorphic adenoma is the most common form of the salivary gland tumor. They originate from an uncommitted reserve cell of the intercalated duct which has the potential to differentiate into epithelial and myoepithelial cells 25. Department of surgery, kitasato university school of medicine, japan. Total parotidectomy, given the multicentricity of recurrent pleomorphic adenoma, is appropriate in many patients, but may be inadequate to control recurrent pleomorphic. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma.
Hence, the final diagnosis was of giant pleomorphic adenoma with negative surgical margins. Although pleomorphic adenomas most commonly occur in the parotid gland about 85%, this tumor may be encountered in the submandibular, lingual, and minor salivary glands as well. It is the most common type of salivary gland tumor. Etiology and familial inheritance of pleomorphic adenomas. Treatment of recurrent pleomorphic adenoma must be individualized. The aim of the study was to determine the immunohistochemical expression of the pcna, p53 and bcl2 proteins in pleomorphic adenomas. It is the most common salivary gland tumor, with a slight. Doctor answers on symptoms, diagnosis, treatment, and more. Pleomorphic adenoma is the most common salivary gland tumor on the head and neck region 1. Pleomorphic adenoma with extensive squamous metaplasia and cystic change may cause diagnostic confusion both in cytology and histopathology, which stresses the need for a guarded approach while. Carcinoma ex pleomorphic adenoma of the salivary glands. Pleomorphic adenoma of nasal septum is a rare, benign, minor salivary gland tumour arising from the nasal septum.
Metastasizing pleomorphic adenoma the term currently preferred by the world health organization who is also known as metastasizing benign pleomorphic adenoma. Etiology and management of recurrent parotid pleomorphic adenoma. The presence of these different elements accounts for the name pleomorphic tumor or mixed one characteristic of a pleomorphic adenoma is the presence of microscopic projections of tumor outside of the. Pleomorphic adenoma in the deep lobe of the parotid gland may present as an oral retrotonsillar mass or parapharyngeal space tumor.
The morphologic features of the dysplastic epithelium and the morphogenesis of adenomas in fpc have been well described. Little is known about the etiology and pathogenesis of multifocal pleomorphic adenoma, and clonal relationship has only been studied in one patient presenting with 2 unilateral pleomorphic adenomas 4. Pleomorphic adenoma arising from heterotopic sali vary g. Generally more than 80% of cases has a history of local recurence of pleomorphic adenoma before metastatic form. Pleomorphic adenoma, the most common salivary gland tumor, is also known as benign mixed tumors bmts, because of its dual origin from epithelial and myoepithelial elements. Metastasizing form of the pleomorphic adenoma is really rare but mortality is extremely high when detected as 22% 2. The source of the data was ovid medline from 1946 to 2014. The stroma may be chondroid, myxoid, osteoid, or fibroid. Metastasizing pleomorphic adenoma is a rarely detected form of clinic antity 2,3.
Pathogenesis and histogenesis of salivary gland tumours by. Little is known about the etiology and pathogenesis of multifocal pleomorphic adenoma, and clonal relationship has only been. May also occur in other major salivary glands submandibular and sublingual. Semiology and oral pathology, dental school, university of. In addition to carcinoma ex pleomorphic adenoma, true malignant mixed tumors of the salivary glands usually arise from preexisting pleomorphic adenomas 1,3. Most common presentation is recurrent epistaxis and nasal obstruction. Mixed tumor of the lacrimal gland pleomorphic adenoma definition. Classification and general considerations of thyroid. Contrastenhanced ct scan at level of the hyoid bone shows a well marginated, ovoid, poorlyenhancing mass with. The molecular pathogenesis of pleomorphic adenoma of the salivary glands with genetic aberrations involving chromosome 12q15. Histopathology, pleomorphic adenoma, salivary gland neoplasms.
Pleomorphic adenoma table of contents previous next. The aim of our study was to present our findings in a series of patients who were treated for recurrent parotid pleomorphic adenoma with their clinical, surgical, and followup. This study analyzed possible ctnnb1 mutations in salivary gland pleomorphic adenomas pas and adenoid cystic carcinomas accs, and determined possible differences in. A case report of 28 year old male patient diagnosed of pleomorphic adenoma of palate, is presented here. Clinical manifestations of recurrent parotid pleomorphic. Among salivary gland tumors, cxpa is unique and interesting because it is histologically diverse and contains both benign pleomorphic adenoma and carcinomatous components. Pleomorphic adenoma of the salivary glands radiology. Although missing the typical pattern of cartilaginous components, the neoplasm in plag1 transgenic mouse model shared the major features when compared to its counterparts of human pleomorphic adenomas. View the article pdf and any associated supplements and figures for a period of 48 hours. Metastasizing pleomorphic adenoma has neither age or sex predilection nor any association with race or geographic location.
The epidemiology of pleomorphic adenoma can cover all ages and both genders but is more prevalent among women from thirty to sixty years of age. Thyroid cancer is the most common malignancy in endocrine system, composed of. The diagnostic value of plag1 was challenged in separating pleomorphic adeno. Pdf clinical profile and management of pleomorphic adenoma of. Pleomorphic adenoma is a common benign salivary gland tumor which presents as a painless swelling that gradually increases in size, if left untreated. The tumor can occur at any age but it is most common in young and middle aged adults between the ages of 30 60. Pdf to describe the histopathological features of pleomorphic adenoma pa with. Case report multiple bilateral warthins tumors of the. The pathogenesis of adenomas in adenomatous polyposis of the gastrointestinal tract familial polyposis coli, fpc is not completely known. Usdj 2019 volume 3 issue 1 48 pleomorphic adenoma a diversified bizzare tumor bhardwaj n1, kaur s2 1pg student hids paonta sahib, 2 general dentist abstract pleomorphic adenoma is a lesion which accounts for the vast majority of all salivary tumors pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland.
Pleomorphic cells in a tumor may tell of the genetic instability thats central to cancer, but the benign pleomorphic adenoma of the salivary glands merely has many different tissue types. Pleomorphic adenomas are benign and tend to increase in size slowly. Dec 26, 2014 the epithelial cells make up a trabecular pattern that is contained within a stroma. Pdf recurrent pleomorphic adenoma of the parotid gland. Oct 09, 2015 the pleomorphic adenoma, shown in the images below, is by far the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. In such cases, it is critical to make a definite diagnosis as each of these tumors has an entirely different treatment protocol. Carcinoma ex pleomorphic adenoma cxpa is a rare and poorly understood malignancy that develops from either a longstanding primary or a recurrent pleomorphic adenoma pa. They are benign except for a rare carcinoma ex pleomorphic adenoma but are not always completely encapsulated and show a definite tendency to recur after excision, in which case recurrence represents local growth because of incomplete excision and not malignancy. Discussion pleomorphic adenoma pa is a benign salivary gland tumour.
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