Gruczolak wielopostaciowy (adenoma poly- morphum, tumor mixtus) albo guz mieszany śli- nianki należy do najczęstszych nowotworów tego narządu. Występuje zarówno w dużych gruczo- łach ślinianek, jak i w drobnych gruczołach ślino- wych błony śluzowej jamy ustnej, gardzieli, warg, zatok szczękowych, oskrzela, a także w obrębie żuchwy oraz w gruczołach łzowych. Stanowi 80% nowotworów tych struktur .
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.
The material of this study consisted of 53 formalin-fixed, paraffin-embedded specimens of malignant salivary gland neoplasms, all collected from the archives of the General Pathology Department, Faculty of Medicine, Ain Shams University and National Cancer Institute, Cairo University. Fifteen cases of mucoepidermoid carcinoma (MEC), 10 of which were diagnosed as high grade and the other 5 cases as low grade, 14 cases of adenoid cystic carcinoma (ADCC), 5 cases of salivary duct carcinoma (SDC), 3 cases of epi-myoepithelial carcinoma (EMC), 5 cases of malig- nant pleomorphicadenoma (MPA), 6 cases of polymor- phous low-grade adenocarcinoma (PLGA) and 5 cases of acinic cell carcinoma (ACC). Clinical information about lymph node metastasis was obtained from patients ’ medi- cal records (summary of cases is displayed in table 1). For all specimens five micrometer thick sections were pre- pared and stained with hematoxylin and eosin to confirm the diagnosis.
This study provides for the first time, a comparative DNA methylation profiling between Ca ex PSA and PSA. Due to the rarity of Ca ex PSA, the investigation was based on only 31 cases of Ca ex PSA even though the combined cases of two large British cities constituting a population of around 7 million over 14 years were used. Seven cases were included based on particular clinical history and histopathological evidence of malignancy rather than the histologically demonstrable presence of pre-existing / ghost of PSA. It is noted that these cases gave comparable results to those that did present with demonstrable PSA, which supports their inclusion in the material.
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-
The minor salivary glands are widely dispersed throughout the upper respiratory tract, including the palate, lip, pharynx, nasopharynx, larynx, parapharyngeal space and sinonasal cavities. The greatest densities of glands are found in the hard and soft palates, while they are not present in the gingival or the midline and anterior part of the hard palate . The most common tumor of the palate is the pleomorphic ade- noma, accounting for approximately 40% - 52% of all palatal minor salivary gland tumors -.
myoepitheliomas. Among them, benign and malignant tumours such as pleomorphicadenoma, adenocarcinoma, nerve sheath tumour, fibrous hystiocytoma, nodular fasciitis, synovial sarcoma, leiomyoma, leiomyosarcoma, hemangiopericytoma, solitary fibrous tumour and paraganglioma may be cited. In that way, it is very important to differentiate myoepitheliomas from malignant neoplasms [11,12]. Clinical appearance of the lesions mentioned above can share similarity with myoepitheliomas and the only safe way to differentiate them is by the means of histological evaluation. Myoepitheliomas present rare mitoses and absence of nuclear and cellular pleomorphism as well as a non-infiltrative growth typical of a benign tumour . The tumour cells are also generally positive for smooth muscle actin (SMA) .
Results: The most common neoplasms in our study were epithelial neoplasms, of which, pleomorphic adenomas (benign) had the highest frequency followed by adenoid cystic carcinoma(malignant). These were followed by lymphoid tumors which included reactive lymphoid hyperplasia and malignant lymphomas. Mesenchymal tumors included neurofibromas and lymphangioma. There was one case of metastatic breast carcinoma.
The aim of this study was to contribute to strengthen- ing the efficiency in the treatment of the salivary gland tumours in the Stomatology and Maxillo-facial surgery service at the University Hospital Centre/Yal- gado OUEDRAOGO of Ouagadougou. It has been a retrospective and descriptive study covering seven (7) years [January 2006-December 2012] on epidemiol- ogy and the treatment of 54 cases of the salivary glands tumours histologically confirmed. Benign tu- mours (non-malignant tumours were prevalent (61.11% of cases). The annual incidences were 4.71 cases for non malignant tumours and 3 cases for malignant tumours. The average age was 34 - 45 years for non malignant tumours and 44 - 33 years for malignant ones. In both groups, the tumour was discovered lately with an average 32 - 48 months before consult- ing in case of non malignant tumours and 18 - 29 mon- ths for malignant tumours. The location of non ma- lignant tumours was very often the parotid (42.42%), under mandible gland (27.28%). Malignant tumours very often concerned the parotid (76.18%) and the under mandible gland (14.29%). The histology has revealed that pleomorphicadenoma was the leading type of non-malignant tumours (93.94% of cases) whereas carcinoma was predominant in malignant tumours (80.95% of cases). Long term track keeping was difficult and it has been complicated by the loss of contact with some patients. The low living stand- ard, the time wasted before consulting, limited human resources and therapeutic means constitute handicaps to the treatment in our African context.
Salivary gland neoplasms [n = 39, 60.0%] were the commonest lesions in this study followed by sialolithiasis [21.5%]. Mucous retention/extravasation cysts accounted for 13.9% [n = 9] of the cases [Figure 1]. Pleomorphicadenoma was the predominant tumor in this series [87.2%] while Warthin’s tumor and low grade mucoepidermoid carcinoma accounted for 7.8% and 5.1% respectively. Parotid gland was the commonest site for pleomorphicadenoma [n = 20, 58.8%] followed by the palate [n = 8, 23.5%] [Figure 2]. The two cases of mucoepider- moid carcinoma encountered occurred, one each in the parotid and submandi- bular glands. Warthin’s tumor affected only the submandibular gland.
Dermoids were excised completely. A lateral orbitotomy, with temporary removal of the lateral orbit wall was done for lesions in the lacrimal fossa and lateral orbit, including the areas above and below the optic nerve. Ten lateral orbitotomies were done. Most of them were for cavernous hemangioma followed by pleomorphicadenoma of lacrimal gland. Seven anterior orbitotomies were done. They were performed for Cavernous hemangioma, meningioma, pleomorphicadenoma of lacrimal gland, diffuse large B cell lymphoma. An upper lid splitting technique was used for superior lesions.
account for less than 3% of head and neck tumors . Pleomorphicadenoma is the most common salivary gland 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 ls . A case of Pleomorphicadenoma of the minor salivary gland of the
Among different salivary gland tumors, carcinoma ex pleomorphicadenoma (Ca ex PA) accounts for approximately 3.6% (1). It constitutes 6.2% of all pleomorphicadenoma (PA) and 11.7% of all malignant salivary gland neoplasms (1, 2). Furthermore, the risk of malignant transformation in PAs in the first five years after evolution of the lesion is 1.6% (3). Car ex PA is defined as an epithelial malignant transformation within a primary or previous PA, and is often considered as a diagnostic challenge for the pathologists and clinicians, since it is difficult to
In this report, we described the first document- ed case of primary ductal adenocarcinoma of the lacrimal sac. Ductal adenocarcinoma is a relatively rare malignant tumor that mainly occurs in the salivary gland, especially in the parotid gland, which represents approximately 9% of salivary malignancies, and is referred to as salivary duct carcinoma (SDC) . This type of tumor is also reported in the lacrimal [8, 9] and minor salivary glands [7, 10]. SDC is char- acterized histopathologically by the presence of a cribriform growth pattern with comedone- crosis, which is composed of neoplastic cells containing rich eosinophilic granular cytoplasm and large pleomorphic nuclei with conspicuous nucleoli, and resembles ductal carcinoma of the breast . Positive immunoreactivity for GCDFP-15 and AR is characteristic, and more- over, most SDC show positive membranous staining for HER2/neu protein [7, 10, 11]. The histopathological features of the present case corresponded to SDC because typical cribri- form growth with comedonecrosis, which was composed of neoplastic cells containing rich granular eosinophilic cytoplasm and large round to oval nuclei. Poorly differentiated area comprising of small-sized glands, cords or sin- gle cells as seen in the present case can be Figure 1. Computed tomography shows an irregular-
Controversies are evident from this work and mostly relate to the type of operation and the use of post-operative radiotherapy. Often clinicians adopt a pragmatic view that takes into account the location of the recurrent tumour, whether it is a multinodular or uninodular recurrence, the size and the rate of growth as well as the patient’s co-morbidities. Selected cases can be observed. Conservative surgical management can include partial superficial parotidectomy or extracapsular dissection. In patients that are symptomatic but unfit for a surgical intervention, radiotherapy could be suggested as an alternative for surgery. Total parotidectomy, is appropriate in many patients, but may be inadequate to control recurrent pleomorphic adenomas. Adjuvant radiotherapy seem to significantly improved control in multinodular recurrences 56 . Sometimes the clinical scenario may include elderly patients with multifocal recurrences where the facial nerve is engulfed by scar and tumour. Limited data 55,60 suggested a role for radical parotidectomy with immediate nerve reconstruction.
Abstract: Pleomorphicadenoma of the breast (PAB) is an extremely rare tumor in the breast. Herein, we reported two Asian female patients diagnosed as PAB and reviewed the relevant literature briefly. The two cases were both diag- nosed as fibroadenoma in breast ultrasonography before surgery. Case one is a 28-year-old woman presented with a seven year history of a slowly-growing painless mass in left breast, which was about 1.46×0.93 cm in size. Case two is a 47-year-old female who had a complaint of left breast mass three months ago, which was 2.31×1.37 cm in size. The two tumors both located under areola. The two patients both underwent lumpectomy. Microscopically, they were both comprised of mixture of epithelial cells and myoepithelial cells embedded in myxochondroid matrix background. Immunohistochemically, the two cases displayed positive cytokeratin 7 (CK7) for epithelial cells, posi- tive smooth muscle actin (SMA) and S-100 for myoepithelial cells. PAS staining was positive in case two. According to the pathologic histology and immunohistochemical findings, the two cases were diagnosed as PAB. However, the pathogenesis of PAB has been unclear and further studies remain to be researched.
Salivary gland anlage tumor (SGAT), also referred to as congenital pleomorphicadenoma, is a benign congenital tumor of the nasopharynx, which may produce nasal obstruction and other associated, non- specific symptoms. We report a case of SGAT caus- ing nasal obstruction and feeding difficulties in the neonatal period. A common diagnostic approach to neonatal nasal obstruction was performed, resulting in an unexpected and potentially life-threatening, albeit curative, result. The differential diagnosis and clinical approach to managing neonates with symp- toms of nasal obstruction is discussed.
the age group of 41-50 years. Most common histopathology encountered in HPE was pleiomorphic adenoma. The most common complications encountered were different grades and types of facial nerve palsy. Parotidectomy of various types are surgical procedures done frequently by the both the department of ENT as well the department of General Surgery of various institutes. The extent of surgery depends on the pre- operative FNAC, clinical and radiological assessment and nothing can replace the expertise and anatomical knowledge of a skilful and experienced parotid surgeon. In fact, this paper is an institutional audit of parotid surgeries done in the Head neck unit of our ENT department during the mentioned time period. Indeed, it was an observation that more the number of cases were operated by the same group of skilled surgeons, less frequent were the complication, which is always expected. In conclusion, this was a demographic study of the various types of parotid surgeries encountered in our practice, their histopathology, their complications and the management of the complications involved. This is also a comprehensive guide to future parotid surgeons to avoid various complications during parotid surgery and how to manage them if complications occur.
Microscopically the tumor cells are arranged in different morphological growth patterns like cribriform, tubular, solid, and mixed pattern. The most common pattern is cribriform pattern which is composed of numerous pseudocystic spaces which are filled with hyalinized eosinophilic material. In tubular pattern bilayered epithelium is made up of, the inner ductal epithelial cells and the outer myoepithelial cells. Occasional cases show squamous, oncocytic and sebaceous metaplasia 64 .