Abstract Since the argyrophilic nucleolar organizer region (AgNOR) technique has successfully distinguished various grades of malignancies and enabled prognostic assessment, this paper traces its prognostic validity in predicting the behavior of pleomorphicadenoma (PA). Ten cases of recurrent PAs were compared, on the one hand, where AgNOR score of area fraction was measured before and after recurrence. The same findings were contrasted to ten cases of normal glandular mucosa. Diagnosing both pleomorphic adenomas was based on clinical and histological records of the archival submitted cases. The data were statistically analyzed by t-test, ANOVA, Tukey and Pearson’s tests. The study concludes that AgNOR score lack the prognostic validity on testing PA, in terms of distinguishing and or predicting recurrence.
Multiple parotid gland tumors are unusual. Warthin’s tumor is the most represented neoplasm in this condition. We present a case of bilateral synchronous pleomorphicadenoma affecting the pa- rotid glands in a 28-year-old woman. Clinically, the lesions were similar to solitary pleomorphicadenoma. Both lesions were diagnosed by fine-needle aspiration cytology. A total parotidectomy for left tumor and surgical enucleation for the right tumor, respectively, were performed with no facial nerves injury. A review of the pertinent literature is included.
Pleomorphicadenoma (PA) is a benign tumor that usu- ally originates in a major salivary gland. It also arises from minor salivary glands and other structures in the head and neck region such as the lip and cheek . PA arising in the ear canal is very rare. Since the first report of PA in the ear canal by Mark and Rothberg in 1951 , there have been only a few similar case reports. PA in the ear canal is derived primarily from the ceruminous gland, the modified apocrine sweat gland of the ear canal . We report a case of PA arising in the ear canal and provide a brief review of the relevant literature.
Pleomorphicadenoma (PA) is an epithelial tumor of complex morphology, possessing epithelial and myoepi- thelial elements being intermingled with mucoid, myxoid, or chondroid tissue arranged in a variety of pat- terns and embedded in a mucopolysaccharide stroma . It is the commonest benign tumor of salivary glands [2,3], and accounts for 90% of all salivary gland tumors . The submandibular gland is the second most common site of pleomorphicadenoma after the parotid gland [2,4]. It is also the most frequent benign tumor arising in submandibular gland [5,6]. Pleomorphic adenomas in the parapharyngeal space (PPS) can arise either de novo or may arise in the deep lobe of the parotid gland and extend through the stylomandibular tunnel into the PPS . Tumors in the parapharyngeal space are rare and consti-
Pleomorphicadenoma (PA) or benign mixed tumor is the most common tumor type in the salivary gland . Its uncommon sites are larynx, paranasal sinuses, palate, and nasal septum . It also occurs in skin and is known as chondroid syringoma . PA is uncommon in the breast tissue. The first case report was in 1906 when Lec`ene was the first one that reported PA in the breast . From then only 73 cases of PA of breast have been reported in the world literature [4–7]. We are reporting the 74th case of PA of the breast reported to date.
in size over a 1-year period. Her past medical history is remarkable for left submandibular gland PA treated with enucleation more than 30 years ago. The details of the operative report from this first procedure were not available. On physical examination, head and neck revealed a 4 × 3 . 5 × 3 cm well-defined-enlarged-multilobulated submandibular gland. No pain or signs of facial nerve weakness or palsy were present. MRI of orbit, face, and neck without IV contrast showed ipsilateral cervical adenopathies and fluid signal intensity lymph nodes. The largest node measured 1.2 × 1.1 cm. Chest X-ray was unremarkable. Fine Needle Aspiration Biopsy of left submandibular gland yielded myoepithelial cells and myxoid stroma consistent with pleomorphicadenoma. Selective Left Neck Dissection of IA, IB, IIA, IIB, and III levels and total left parotidectomy were performed. Facial nerve and all its branches were identified and preserved during surgery with the aid of a nerve monitor. No tumor involvement of facial nerve was found. Despite nerve monitoring and appropriate nerve preservation, the patient shows a residual left facial nerve marginal branch weakness. Intraoperative pathology consul- tation revealed left submandibular gland with characteristic epithelial proliferation and focal myxoid changes of pleo- morphic adenoma. Permanent histopathology diagnosed MPA of the left submandibular with 58/59 nodules positive for the lesion as well as 3 out of 5 left parotid gland nodules positive for lesion. The margins of surgical specimen were free of tumor (see Figures 1, 2, and 3). Therefore, this patient presented with local recurrence and simultaneous metastatic disease. Immunohistochemistry staining done on this tumor tissue revealed positive immunoreactivity for p16 (similar positive immunoreactivity in both nuclear and cytoplasmic compartments) and Bcl-2, whereas negative for Ki-67 and p53. Postoperative stay was unremarkable. The patient was discharged home in stable condition. Currently, the patient has completed adjuvant radiotherapy. There is no evidence of recurrence so far in 10 months after surgery.
Methods : A clinical study of 12 cases of pleomorphicadenoma of hard palate operated between January 2014 to March 2018 were included in the study. FNAC was done preoperatively in all cases and coronal CT scan was obtained to rule out bony erosions. All patients had a palatal splint fabricated before surgery to help in retention of dressing and prevent food lodgement into the surgical wound during the healing phase. Wide local excision was done in all cases.
Salivary tissue is present in the major salivary glands (parotid, submandibular, and sublingual), minor salivary glands (scattered within oral cavity and upper airway) and accessory salivary glands (periparotid area). Sometimes, normal salivary tissue may occur at aberrant site termed as heterotopic salivary gland tissue (HSGT). They arise due to abnormal persistence of epithelial remnants in the branchial apparatus or faulty embryological migration. These heterotopias can be seen in tissues as diverse as the cerebellopontine angle, temporal bone, nasal cavity, lymph nodes, mandible, thyroid and parathyroid tissue, tonsils, tongue, along the anterior border of sternocleidomastoid in the upper neck and lower neck resulting in pleomorphicadenoma of ectopic salivary gland tissue. 6,7
Currently, a defined time period prior to the des- ignation as a metachronous lesion has not been established. Ethunandan  used an interval of 6 months in their study to define it. In this case, it took a long time (approximately 58 months) to discover the tumor in the posterior part of the parotid gland, after the tumor found in the anterior part. As a result, it was consid- ered a synchronous lesions on both parts (ante- rior and posterior of the left parotid gland), and also, metachronous lesions on both sides (left and right parotid glands). According to another Yu’s  statistics, multiple tumors makes up 3.4% of all the tumors of parotid gland with males outnumber females by 0.3-4.9 on aver- age, where metachronous ones could account for 30%. It could also be read in Ethunandan’s  statistics that metachronous tumors acco- unted for 20% of multiple tumors and were all bilateral in distribution. He concluded that 83% metachronous tumors were of the same histo- logical type and Warthin’s tumor is the most common metachronous tumor (50%). We can come to realize that bilateral Warthin’s tumors with a pleomorphicadenoma is extremely rare.
CONCLUSION: Although recurrent disease is usually clinically apparent, sometimes prior surgical history is lacking or recurrence may be detected on routine surveillance imaging after initial surgery. The presence of solitary or multiple subcutaneous T2 hyperintense lesions in the operative bed, subcutaneous fat, and/or spaces adjacent to the parotid in patients with prior parotidectomy for pleomorphicadenoma is consistent with the diagnosis of neoplastic recurrence. The radiologist should maintain a high index of suspicion for recurrent pleomorphicadenoma with this characteristic imaging appearance.
The differential diagnosis of the juvenile pleomorphicadenoma of the cheek (Table 1) includes buccal space abscess, dermoid cyst, foreign body reaction, fibroma, lipoma, neurofibroma, rhabdomyosarcoma, mucoepider- moid carcinoma, adenoid cystic carcinoma, polymor- phous low-grade adenocarcinoma and carcinoma ex pleomorphicadenoma [16,18]. The possibility of buccal space abscess was ruled out due to absence of sign of inflammation. The solid nature of the lesion coupled with the lack of tissue representing the three germ layers rule out the possibility of mature cystic teratoma (dermoid cyst). The lack of ulceration of the buccal mucosa, pain, paresthesia or invasion of the surrounding tissue rules out the possibility of malignant transformation. Carcinoma ex pleomorphicadenoma is characterized by the presence of malignant epithelium (salivary duct carcinoma, undif- ferentiated carcinoma, adenocarcinoma not otherwise specified, terminal duct carcinoma or myoepithelial carci- noma) with benign stroma. Carcinoma ex pleomorphicadenoma is extensively infiltrative malignancy with necrosis, perineurial invasion, frequent mitotic figures, marked nuclear atypia. Adenoid cystic carcinoma usually shows cribriform, solid or tubular pattern similar to cylin- dromas of skin. It is composed of small bland myoepithe- lial cells with scant cytoplasm and dark compact angular nuclei that surround pseudoglandular spaces with PAS+ excess basement membrane material and mucin. Periph- eral perineurial invasion and small true glandular lumina are sometimes seen but no squamous differentiation; or extensive necrosis are usually absent. Adenoid cystic carci- noma has high proliferative index, high p53 immunoreac- tivity, intense staining for BCL-2 but negative reactivity for glial fibrillary acidic protein. In contrast, pleomorphicadenoma is not invasive, show no perineurial invasion; has squamous metaplasia and mesenchyme-like areas. Charactaristically, pleomorphicadenoma has strong glial fibrillary acidic protein in the myxochondromatous areas . The basal cell carcinoma is a low grade malignancy similar to basal cell adenoma. It is an infiltrative tumor with perineurial invasion and vascular invasion; variable cytologic atypia and mitotic activity. It is composed of solid, trabecular, tubular or membranous patterns but there is no myxoid matrix or cartilegenous areas. The basal cell adenoma is composed of basaloid cells sharply delin- The histological features of the juvenile pleomorphic ade-
PURPOSE: To assess the usefulness of MR findings in establishing a specific diagnosis of parotid pleomorphicadenoma. METHODS: T1-weighted and T2-weighted MR images with and without contrast enhancement were obtained in 82 patients with parotid tumors. Imaging findings in the 38 patients in whom surgery subsequently revealed pleomorphic adenomas were compared with findings in the 44 patients who had other types of tumor. Specifically, the homogeneity, signal intensity, contrast enhancement, capsule thickness, lobulation, adenopathy, and infiltration of adjacent fat were compared among the different types of tumor. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: A low-signal capsule on T2-weighted images and a lobulated contour characterized most pleomorphic adenomas. The sensitivity of the first finding for pleomorphicadenoma was 82%; specificity, 85%; positive predic- tive value, 82%; and negative predictive value, 84%. For the second finding, the sensitivity was 53%; specificity, 84%; positive predictive value, 74%; and negative predictive value, 67%. CON- CLUSION: None of the signs evaluated had perfect sensitivity and specificity. The MR findings of a complete capsule, lobulated contour, or high T2 signal intensity have a high predictive value for the diagnosis of pleomorphicadenoma.
Pleomorphicadenoma can be defined as a benign mixed tumor composed of epithelial and myoepithelial cells arranged with various morphological patterns, demarcated from surrounding tissues by fibrous capsule. It is one of the salivary gland tumors affecting both major and minor salivary glands. Parotid gland is the most commonly affected of the major group, and palate is the most common site intraorally. We report a case of palatal pleomorphicadenoma in a 24 year-old adult female came to our College with the chief complaint of a swelling at the left side of the palate. Computed Tomography scans revealed areas of bony erosion. The patient was treated by wide local excision followed by placement of bactiguage over the defect and stabilised with palatal plate. The defect was left to granulate of itself uneventfully.
Carcinoma ex PleomorphicAdenoma (Ca ex PSA) is a rare and poorly understood malignancy of salivary glands. It accounts for 3-4% of salivary neoplasms and approximately 12% of all salivary malignancies (Gnepp 1991). It has been suggested that Ca ex PSA originates as a result of malignant transformation of ductal epithelial and / or abluminal myoepithelial cells within pre-existing Pleomorphic Salivary Adenomas (PSA), the majority of which are untreated or recurrent in nature (Eneroth and Zetterberg 1974). These cancers are typically high-grade in nature, with frequent metastasis, and have a poor prognosis (Lewis, Olsen and Sebo 2001, Olsen and Lewis 2001).
Salivary gland tumors account for less than 3% of head and neck tumors . Pleomorphicadenoma is the most common salivary gland tumor accounting for about 40 – 70% of all major and minor salivary gland tumors . The most common site of this tumor in the oral cavity is the palate (42.63%) followed by lip (10%), buccal mucosa (5.5%), and retromolar area (0.7%) and uncommonly affecting the floor of the mouth . It is also called a mixed salivary gland tumor because of its dual origin from the epithelium and myoepithelial cells . A case of Pleomorphicadenoma of the minor salivary gland of the palate is discussed.
Generally, parapharyngeal space (PPS) tumours are less than 1% of all head and neck tumours . Most PPS tumours are benign (70-80%). The malignant ones are fewer. The post - styloid compartment lesions tend to be of neurogenic origin whereas the prestyloid ones arise from the minor salivary glands in the lateral pharyngeal wall or extensions of tumours of the deep lobe of the parotid . Among the benign tumours of the PPS, the pleomorphicadenoma is the commonest . We present a case of a left parapharyngeal mass which caused a cerebrovascular accident (CVA) and was excised transorally with resolution of the CVA. We believe that the left parapharyngeal tumour in our case was compressing on the ipsilateral carotid sheath and therefore by inference on the walls of the internal carotid artery thus limiting the blood supply to the left half of the brain. This led to the left brainstem infarct with the resultant right hemiparesis. The occluded vessel recanalized after the tumour was excised with resolution of
Results: In this series, there were 7 males and 10 females. The tumors originated from the nasal septum in 4 cases, from the lateral wall of the nasal cavity in 2 cases, from the maxillary sinus in 1 case, and from the nasopharynx in 7 cases. The origin sites of 3 cases were not clear. The main symptoms were usually unilateral nasal congestion and epistaxis. All patients underwent endoscopic resection surgery. The postoperative period was uneventful. Ten patients were diagnosed with benign PA, and 7 patients were diagnosed with CXPA, including 5 cases of adenocarcinoma, 1 patient with mucoepidermoid carcinoma, and 1 patient with adenoid cystic carcinoma. After a mean follow-up period of 2.2 years (6 months – 5.3 years), the recurrence rate of benign PA was 10% (1/10); the rate of malignant recurrence was 42.8% (3/7). Conclusion: Sinonasal/nasopharyngeal PA and CXPA are rare neoplasms, and the most common primary site of PA and CXPA is the nasopharynx. As any salivary carcinoma type can arise in PA, these PA sites should be thoroughly sampled and closely examined to exclude the possibility of malignant transformation. Furthermore, PA and CXPA should be treated as soon as possible after de ﬁ nitive diagnosis, and endoscopic resection of tumor- negative margins may be helpful in preventing recurrence.
It commonly presents as a solitary well-defined, slow growing and painless swelling. Mean age of the patient is around 46 years and females are commonly affected than male. Pleomorphicadenoma is also known as mixed tumor as it contains both epithelial and also mesenchymal or stromal material. The tumor possibly develops from the pluripotent reserve cells of the intercalated duct.