Pleomorphic Adenoma of the Hard Palate: A Multidisciplinary Approach

Pleomorphic adenoma is the most common salivary gland tumor accounting for 80% of all major salivary gland tumors. It is a benign salivary gland neoplasm that constitutes 3% to 10% of the neoplasms in the head and neck region.1 Salivary gland neoplasms represents less than 1% of all tumors. This article is being showcased as a special case due to the fact it was done at a Taluk Hospital and also because ENT and oromaxillofacial surgeons were involved during the surgery.

Case report on adenoid cystic carcinoma of palate with review of literature

Adenoid cystic carcinoma (ACC) is a malignant tumor of minor salivary glands of the oral cavity, particularly the palate which accounts for about 5–10%. These tumors are slow growing with a high incidence of local recurrence, perineural invasion, and distant metastasis. Here, we report the case of a 69-year-old female who presented with swelling over the hard palate. Computerized tomography shows enhancing lesion along the undersurface of the left side of the hard palate, abutting the maxillary alveolus in the region of the second premolar and first two molars. There was no erosion of the inner cortex of the maxillary alveolus and no extension into the nasal cavity. Following the biopsy, she underwent a left hard palatectomy with upper alveolar resection. The final histopathological report confirmed ACC with no perineural invasion. Following she received adjuvant radiotherapy using an intensity-modulated radiotherapy technique. Now at 6 months of follow-up, there was no evidence of recurrence. Thus, our patient requires long-term follow-up to assess the benefit and survival outcome.

Clear cell-rich salivary duct carcinoma involving the palate / Carcinoma do ducto salivar rico em células claras envolvendo o palato

ABSTRACT Salivary duct carcinoma (SDC) is a rare and aggressive neoplasm arising from salivary glands. SDC occurs most frequently in major salivary glands, with isolated cases arising from the minor salivary glands. The occurrence of clear cells in salivary gland tumors is uncommon and is rarer in SDC cases. We report the case of a 51-year-old male diagnosed with a clear cell variant of SDC in the minor salivary gland, involving the left hard palate. Immunohistochemical analysis revealed positivity for HER2/neu and GATA-3. The patient was submitted to radical surgical excision, neck dissection, and radiotherapy. Unfortunately, he died 14 months after the cancer diagnosis.

RESUMEN El carcinoma ductal de las glándulas salivales (CDS) es un tumor raro y agresivo que surge de las glándulas salivales. El CDS ocurre con mayor frecuencia en las glándulas salivales mayores, sin embargo, existen casos aislados de afectación en las glándulas salivales menores. La aparición de células claras en los tumores de las glándulas salivales es infrecuente y más rara en los casos de CDS. Presentamos el caso de un varón de 51 años al que se le diagnosticó la variante de células claras del CDS en la glándula salival menor, que afecta al paladar duro izquierdo. El análisis inmunohistoquímica reveló positividad para HER2/neu y GATA-3. El paciente fue sometido a escisión local quirúrgica radical, disección del cuello y la radioterapia. Desafortunadamente, murió 14 meses después del diagnóstico de cáncer.

RESUMO O carcinoma do ducto salivar (CDS) é um tumor raro e agressivo que se origina nas glândulas salivares. O CDS ocorre mais frequentemente nas glândulas salivares maiores, porém, há casos isolados de acometimento nas glândulas salivares menores. A ocorrência de células claras em tumores de glândulas salivares é incomum, sendo ainda mais rara nos casos de CDS. Relatamos o caso de um homem de 51 anos de idade que foi diagnosticado com a variante de células claras de CDS em glândula salivar menor, envolvendo o palato duro do lado esquerdo. A análise imuno-histoquímica revelou positividade para HER2/neu, GATA-3. O paciente foi submetido a excisão cirúrgica radical, esvaziamento cervical e radioterapia. Entretanto, ele faleceu 14 meses após o diagnóstico do câncer.

Interpretación de la biopsia de glándula salival menor en el síndrome de Sjögren. Correlación clínico-patológica / Interpretation of minor salivary gland biopsy in Sjögren's syndrome. Clinical-pathological correlation

RESUMEN La biopsia de glándula salival menor (BGSM) es uno de los principales criterios (no el único) para el diagnóstico del síndrome de Sjögren, y esto tiene que ir en conjunto con la clínica y los niveles de anticuerpos. Diferentes clasificaciones se han desarrollado para evaluar la interpretación de los hallazgos observados en la BGSM y poder categorizar / diagnosticar el síndrome de Sjögren. Esto ha causado que los patólogos y los clínicos tengan una inadecuada interpretación de la BGSM debido a que existe confusión por las diferentes escalas de puntuación que se han implementado a lo largo del tiempo. El presente artículo de revisión tiene como objetivo ilustrar a la comunidad científica, especialmente reumatólogos, cirujanos orales, internistas y patólogos, entre otros, sobre los hallazgos a considerar en la BGSM al momento del reporte por parte del patólogo.

ABSTRACT The minor salivary gland biopsy (MSBG) is one of the main criteria (not the only one) for the diagnosis of Sjögren's syndrome, and has to be taken in conjunction with the clinic parameters and the antibodies levels. Different classifications have been developed to evaluate the interpretation of the findings observed in the MSBG and to be able to categorise / diagnose Sjögren's syndrome. This has meant pathologists and clinicians have had an unsuitable interpretation of the MSBG due to the existence of confusion due to the different scoring scales that have been implemented over time. This review article aims to illustrate to the scientific community, especially rheumatologists, oral surgeons, internists, and pathologists, among others, on the findings to be considered in the MSBG when reported by the pathologist.

Unusual treatment of pleomorphic adenoma of soft palate in adult / Tratamiento inusual del adenoma pleomórfico del paladar blando en adulto

Pleomorphic adenoma is the most common benign neoplasia of the salivary glands and affects mostly the parotid gland, less frequently the minor salivary glands. Minor salivary gland tumors have a higher risk of malignancy compared to tumors of the major salivary glands, so appropriate diagnostic evaluation should be prompt. In this case report, we present a case of an extensive pleomorphic adenoma of soft palate in an adult patient. After preoperative investigation using Fine Needle Aspiration (FNA) and imaging tests, the patient was successfully treated by surgical resection under general anesthesia. There was no recurrence seen after a follow-up period of 1 year.

El adenoma pleomórfico es la neoplasia benigna más común de las glándulas salivales y afecta principalmente la glándula parótida, con menos frecuencia en las glándulas salivales menores. Los tumores de las glándulas salivales menores tienen un mayor riesgo de malignidad en comparación con los tumores de las glándulas salivales mayores, por lo que la evaluación diagnóstica apropiada debe ser rápida. En este reporte de caso, presentamos un caso de un extenso adenoma pleomórfico de paladar blando en un paciente adulto. Después de la investigación preoperatoria utilizando aspiración con aguja fina y pruebas de imagen, el paciente fue tratado con éxito con la resección quirúrgica bajo anestesia general. No se observó recurrencia después de un período de seguimiento de 1 año.

Pleomorphic Adenoma of the Cheek. Case Report with Review / Adenoma Pleomórfico de Mejilla. Reporte de Caso con Revisión

ABSTRACT: Pleomorphic adenoma (PA), also called benign mixed tumor, is the most common tumor of the salivary glands. About 70 % of these tumors occur in the parotid gland and an uncommon site are the minor salivary glands. The most common sites of PA of the minor salivary glands are the palate followed by lips and cheek. Other rare reported sites include the fauces, floor of the mouth, tongue, tonsil, pharynx, retromolar area and nasal cavity. Here we report a case of pleomorphic adenoma of minor salivary glands of the cheek in a 22-year-old male. The mass was removed by wide local excision with adequate margins, and the patient was followed for 1-year post operatively with no recurrence.

RESUMEN: El adenoma pleomórfico (AP), conocido también como tumor mixto benigno, es el tumor más común de las glándulas salivales. Alrededor del 70 % de estos tumores ocurren en la glándula parótida y con menor frecuencia en las otras glándulas salivales. Los lugares más comunes de AP en las glándulas salivales son el paladar, seguido de labios y mejillas. Otros sitios poco frecuentes reportados, incluyen las fauces, el piso de la boca, la lengua, las tonsilas palatinas, la faringe, el área retromolar y la cavidad nasal. En este estudio se presenta un caso de adenoma pleomórfico de las glándulas salivales menores de la mejilla en un hombre de 22 años. Se extirpó la masa mediante escisión local amplia con márgenes adecuados, con un seguimiento del paciente durante un año después de la operación sin recurrencia.

Uncommon plasmacytoid myoepithelioma originating from ectopic minor salivary gland in neck: a rare case with rare site presentation

The aim of this case report is to present as case of plasmacytoid at ectopic minor salivary gland in the neck which is a rare neoplasm with uncommon presentation of site. Usually it is a tumor of major salivary gland and more common in parotid gland and less common in the minor salivary gland of the oral cavity predominantly in palate. Here authors are discussing a case of 10-year-old female who presented in our institute with complain of swelling over right mid cervical region which was clinically suspected as reactive cervical lymph node. Patient was evaluated further and cytologically diagnosed as a case of plasmacytoid myoepithelioma. It was also confirmed as a case of plasmacytoid myoepithelioma after histopathology and immunohistochemistry studies. Plasmacytoid myoepithelioma at ectopic minor salivary gland site in the neck is uncommon presentation and only a limited number of cases have been reported in literature.

Acinic cell carcinoma of the posterior buccal mucosa: A rare case report

Acinic cell carcinoma (ACC) is a low-grade malignant salivary gland neoplasm that comprises approximately 17% of primary salivary gland malignancies or about 6% of all salivary gland neoplasms. The most common intraoral sites are the buccal mucosa, lips, and palate. The diagnosis of ACC frequently presents difficulties, owing to its great radiological and cytological similarity with benign tumors and with normal acinar component of the salivary gland, respectively. The management of ACC consists of complete surgical excision. Here, we report a case of ACC on the left retromolar trigone, a rare location in a 44-year-old female

Extensive Basal Cell Adenocarcinoma Involving Minor Salivary Gland of the Hard Palate: A Rare Entity

@#Basal cell adenocarcinoma (BCAC) is a very rare slow-growing malignant basaloid tumour of the minor salivary gland. We reported a case of BCAC of the minor salivary gland of the hard palate occurring in a 56-year-old man. BCAC shares overlapping histopathological features with the other oral basaloid cell neoplasms which carries different prognosis and treatment modality. We emphasised on the histomorphologic features and the role of immunohistochemistry panel in the differential diagnosis of BCAC in incisional biopsies.

Pleomorphic Adenoma of a Minor Salivary Gland of the Hard Palate Report of a Case

The pleomorphic adenoma is the most common benign tumor of the minor salivary glands and is comprised of epithelial and mesenchymal tissues. The majority of the salivary gland tumors occur in the second decadeof life with a slight predilection for females. Clinically it presents as a firm or rubbery submucosal mass without ulceration or surrounding inflammation. Diagnosis is established on the clinical examination and histopathology, supplemented with plane radiographs, computerized tomography, and magnetic resonance imaging when necessary. Here, we report a case of pleomorphic adenoma of the hard palate in a 21-year-old female patient with a painless swelling in the left palatal region of nine months duration.

Fine needle aspiration cytology of minor salivary gland tumors: A retrospective 5-year study of 42 cases in a tertiary care hospital

Background: Minor salivary gland tumors (MSGTs) are less common than major salivary glands and involve only 15–20% of all salivary gland tumors. Most of the cases originate at intra- and peri-oral region. Minor salivary gland lesion cytology has been studied rarely in India. Aims: This present study was performed to evaluate the role of fine needle aspiration cytology (FNAC) in diagnosis of MSGTs and to explore the cases of cytohistological discrepancies in the study. Materials and Methods: This retrospective study was conducted over a 5-year period on 42 cases of MSGTs. In all the cases, cytology was correlated with histology and cytohistological discrepancies were searched. Sensitivity, specificity, and diagnostic efficacy were calculated using histopathology as gold standard. Results: We diagnosed 27 malignant (64.28%) and 15 benign (35.71%) MSGTs in cytological evaluation. We found two false negative and one false positive case in cytology. Sensitivity, specificity, and diagnostic accuracy of the study were 92.59%, 93.33%, and 92.85%, respectively. Conclusion: FNAC is a minimally invasive and cost-effective procedure with high accuracy (92.85%) in the assessment of MSGTs and helps in the management of benign and malignant tumors.

Tratamento cirúrgico de mucocele de tamanho atípico em lábio inferior: relato de caso / Surgical treatment of atypical size mucocele in the lower lip: case presentation

Mucocele é uma lesão oral, que ocorre a partir do acúmulo de mucina nos tecidos moles, por retenção ou extravasamento. Este último, o mais comum, ocorre, principalmente, após trauma mecânico, cujo ato resulta em rompimento do ducto da glândula salivar. O presente trabalho tem como objetivo relatar um caso de mucocele de tamanho atípico, em uma paciente de 28 anos. A abordagem clínica do caso, bem como o tratamento serão discutidos... (AU)

Mucocele is an oral injury that occurs from the mucin accumulation in soft tissue for retention or extravasation. The last, the most common, mainly occurs after mechanical trauma act which results in disruption of the salivary gland duct. This study has the purpose to report a case of atypical size of mucocele in a 28-year-old patient. The clinical approach of the case, and the treatment will be discussed... (AU)

Pleomorphic Adenoma of Hard Palate: A Case Report and Review of Literature.

Pleomorphic adenoma is a benign mixed tumor, which is composed of myoepithelial and epithelial cells. A fibrous capsule separates these cells from the surrounding tissues. Pleomorphic adenoma has unusual histopathologic features. It is the most common benign tumor affecting both major and minor salivary glands. Parotid salivary gland is affected mostly in the major group, and palate is the most common site affected in minor salivary glands. The upper lip is the second most common site followed by buccal mucosa. Less than 3% of the salivary gland tumors account for head and neck tumors. In few cases, benign pleomorphic adenoma may turn malignant also. In this case report, a female patient aged 32 years who reported with a complaint of painless swelling in the palate is presented.

Pleomorphic Adenoma with Predominant Myoepithelial Cells of the Hard Palate: Reconstruction with Pedicled Buccal Pad of Fat – A Case Report.

Pleomorphic adenoma is a mixed tumor of salivary gland origin presenting frequently in major salivary glands and sporadically in minor salivary glands. It is a benign tumor with both epithelial and mesenchymal tissues. Salivary glands in general may present with a diverse range of lesions posing a challenge to even the most experienced clinician. Resection with surrounding dispensable normal tissues is the key to successful management of such tumors. This case report illustrates an enormous pleomorphic adenoma of minor salivary gland in the hard palate of 10 years duration.

Adenoid cystic carcinoma arising from minor salivary glands of palate involving maxillary sinus.

Adenoid cystic carcinoma (ACC) was first described by Billroth in 1856 and was called ‘cylindroma’ due to its characteristic histological appearance. ACC is the most common malignant neoplasm of the lacrimal gland, and the second most common type of carcinoma arising in the salivary glands, following mucoepidermoid carcinoma. Palate is the most commonly affected site followed by parotid gland, submandibular gland, antrum & tongue. Characteristic features include aggressive, slow growth, with insidious destruction of surrounding tissues, perineural invasion, prolonged clinical course and the tendency for delayed onset of the distant metastases which worsens the prognosis. Long term survival can be achieved particularly with combined surgery and radiotherapy. The most common pattern is the cribriform architecture. Histopathology is the gold standard for the diagnosis of ACC. CT & MRI are considered to be of almost similar significance in detection of perineural spread with preference to MRI because of its high soft tissue contrast. Here we have mentioned a case of Adenoid Cystic carcinoma arising from minor salivary glands of palate.

Myoepithelial carcinoma of palate: Case report.

Myoepithelial carcinoma is an uncommon malignant salivary gland neoplasm with a predilection for parotid gland. However, its occurrence in minor salivary glands is considerably less with only 28 cases being reported in the literature. We report a case of myoepithelial carcinoma of palate in a 50-year-old woman. Computed tomography and magnetic resonance imaging revealed an extensive lesion in the palate. Microscopically, the tumor exhibited a wide spectrum of cytomorphologic features that overlap with other salivary gland tumors. Immunohistochemistry served as an adjunct in the diagnosis of the lesion. Clinical, radiographic, and histopathologic correlation along with immunohistochemical profi le enabled to arrive at a diagnosis of myoepithelial carcinoma.

Pleomorphic adenoma of cheek: A rare case report and review of literature.

Pleomorphic adenoma (PA) is the most common tumor of the salivary glands. About 90% of these tumors occur in the parotid gland and 10% in the minor salivary glands. The most common sites of PA of the minor salivary glands are the palate, followed by lips and cheeks. Throat, floor of the mouth, tongue, tonsil, pharynx, retromolar area and nasal cavity are rarely involved. Here, we report a case of PA of the cheek in a 42-year-old female. The mass was excised and the patient was followed for 3 years post operatively with no recurrence.

A Meta-analysis of the Diagnostic Value of Minor Salivary Gland Biopsy for Primary Sjogren's Syndrome

OBJECTIVE: The purpose of this study is to evaluate the diagnostic performance of minor salivary gland biopsy (MSGB) for patients with primary Sjogren's syndrome (pSS). METHODS: We have conducted a search from Medline, Embase, and Cochrane Library databases, and performed a meta-analysis on the diagnostic accuracy of MSGB in pSS patients. RESULTS: A total of eight studies, including 583 pSS and 627 non-pSS patients, were available for the meta-analysis. The pooled sensitivity and specificity of MSGB were 75.7% (95% confidence interval [CI], 72.0~79.1) and 90.7% (88.1~92.9), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 9.475 (4.051~22.16), 0.266 (0.208~0.340), and 38.92 (19.12~72.21), respectively. The area under the curve was 0.901 and the Q*; index was 0.902, indicating a high diagnostic accuracy. Some between-study heterogeneity was found in the meta-analyses; however, there was no evidence of a threshold effect (Spearman correlation coefficient= 0.419; p=0.301). Meta-regression showed that the study quality, sample size, study design, and diagnostic criteria were not sources of heterogeneity, and subgroup meta-analyses did not change the overall diagnostic accuracy. CONCLUSION: Our meta-analysis of published studies demonstrates that MSGB has a high diagnostic accuracy and may play an important role in the diagnosis of pSS.

A Case of Epithelial-Myoepithelial Carcinoma Originating from Minor Salivary Gland of Tongue Base / 대한이비인후과학회지

Epithelial-myoepithelial carcinoma (EMC) is a rare, often low grade malignant neoplasm that occurs most commonly in the parotid gland. However, EMC originating from a minor salivary gland is extremely rare. A 38-year-old female patient was referred to our department for dysarthria and a huge mass at the base of tongue. Transoral resection of the mass was performed using a midline glossotomy approach. The pathological examination revealed epithelial-myoepithelial carcinoma of a minor salivary gland. Sequential adjuvant chemoradiotherapy was performed. After clinical follow-up of 26 months, she has remained free of disease. We report on this rare condition in order to share our experience.

Salivary duct cyst in the upper lip: Case report and review of the literature.

Salivary duct cyst (SDC) in an uncommon lesion of the minor salivary glands, with etiology related to obstruction of the salivary duct. It presents with a color similar to that of the mucosa, is mobile, measures between 3 and 10 mm and affects preferentially the bottom lip, fl oor of the mouth and the jugal mucosa. SDC have a predilection for the male and individual in elderly groups. The pathogenesis of SDC is associated with the formation of a mucous plug that causes partial or total obstruction of the salivary gland system duct, resulting in the dilation of the duct and increase in intraluminal pressure. They present clinical-pathological characteristics similar to those of salivary gland tumors, making diagnosis diffi cult and subject to errors in treatment. It is important for the dentist to include SDC in the differential diagnosis of lesions that affect the upper lip, although it is relatively rarely found in this anatomic site.