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.

Analysis of Various Histopathological Patterns in Pleomorphic Adenoma - An Institutional Case Study

Introduction: Pleomorphic adenoma, the most common benign mixed salivary gland tumor which accounts for 70-80%, is a biphasic tumor with dual origin from epithelial and myoepithelial elements. It shows a malignant transformation rate of 6%. Microscopically, pleomorphic adenoma characteristically displays vast morphologic diversity. This present study is done to analyze prevalence rates and histomorphological variations to better elucidate the pattern of occurrence, diagnosis and treat- ment plan of pleomorphic adenoma. Materials and Methods: This are a retrospective study which was conducted in a private institution, Chennai. Based on the proportion of parenchymal and stromal tumor components, the cases were classified into four subtypes as proposed by Foote and Frazell. Morphological patterns, cellular patterns, capsular alterations and Stromal components were analyzed and statisti- cally evaluated. Results: Our analysis showed an overall 0.87% of pleomorphic adenoma cases being reported were associated with minor salivary glands followed buccal mucosa and palate. All the reported cases showed Type II pattern with histological cellular pat- tern of spindle cells and ductal morphological pattern. Conclusion: We observed the great diversity of morphological aspects of the stroma in pleomorphic adenoma, in which many cases showed variation in morphology and cellularity associated with tumor location.

Effect of tumor-stromal fibroblasts on the biological behavior of salivary gland pleomorphic adenoma cells in vitro / 华西口腔医学杂志

OBJECTIVES@#This study aims to investigate the effects of tumor-stromal fibroblasts (TSFs) on the proliferation, invasion, and migration of salivary gland pleomorphic adenoma (SPA) cells in vitro.@*METHODS@#Salivary gland pleomorphic adenoma cells (SPACs), TSFs, and peri-tumorous normal fibroblasts (NFs) were obtained by tissue primary culture and identified by immunocytochemical staining. The conditioned medium was obtained from TSF and NF in logarithmic phase. SPACs were cultured by conditioned medium and treated by TSF (group TSF-SPAC) and NF (group NF-SPAC). SPACs were used as the control group. The proliferation, invasion, and migration of the three groups of cells were detected by MTT, transwell, and scratch assays, respectively. The expression of vascular endothelial growth factor (VEGF) in the three groups was tested by enzyme linked immunosorbent assay (ELISA).@*RESULTS@#Immunocytochemical staining showed positive vimentin expression in NF and TSF. Results also indicated the weak positive expression of α-smooth muscle actin (SMA) and fibroblast activation protein (FAP) in TSFs and the negative expression of α-SMA and FAP in NFs. MTT assay showed that cell proliferation in the TSF-SPAC group was significantly different from that in the NF-SPAC and SPAC groups (P<0.05). Cell proliferation was not different between the NF-SPAC and SPAC groups (P>0.05). Transwell and scratch assays showed no difference in cell invasion and migration among the groups (P>0.05). ELISA showed that no significant difference in VEGF expression among the three groups (P>0.05).@*CONCLUSIONS@#TSFs may be involved in SPA biological behavior by promoting the proliferation of SPACs but has no effect on the invasion and migration of SPACs in vitro. Hence, TSF may be a new therapeutic target in SPA treatment.

MANAGEMENT OF A HUGE PARAPHARYNGEAL MASS : A SURGICAL NOVELTY

Parapharyngeal space(PPS) tumors are very uncommon. Though majority of these tumors are of benign origin, the most common among them is a pleomorphic adenoma. Surgical removal is mainstay for the treatment of these tumors for which a strategic preoperative evaluation of each patient and knowledge of different surgical approaches to PPS are essential. Here we report a rare but typical case of a 35 years old female presented to OPD with a mass in right the parapharyngeal space. The mass was excised successfully using mandibular swing approach and the post operative histopathology report suggested it to be “pleomorphic adenoma”

Histopathological study of salivary gland tumors: a tertiary care hospital-based study

Introduction: Salivary gland tumors (SGTs) are relatively uncommon and show a wide variety of morphological heterogeneities. The incidence of SGTs is said to be affected by geographical and racial factors. Histopathological diagnosis plays a major role in the diagnosis of these neoplasms. Objectives: This study investigated the incidence of SGTs and histopathological features of various SGTs, aimed at knowing the epidemiological pattern of these tumors and comparing the results of our study with other studies of SGTs in the literature. Materials and Methods: A retrospective study was conducted on SGTs at the Pathology Department of the Government Medical College and Hospital for a period of 5 years. Clinical and demographic data were documented and analyzed concerning histopathologic type. Results: A total of 86 SGTs were identified, 65.12% of which were classified as benign and 34.88% as malignant. Most tumors occurred in the parotid gland (59.14%). Pleomorphic adenoma (PA) was the most common tumor (56.98%), followed by mucoepidermoid carcinoma (MEC) (17.44%). The tumors occurred more often in men (51.16%) than in women (48.84%). Conclusion: SGTs exhibit broad morphological heterogeneity and these tumors are rare. The parotid gland is the most common location, and PA is the most frequent benign tumor. MEC followed by adenoid cystic carcinoma is the most common malignancy of the salivary gland.

Pleomorpic Adenoma of Infratemporal Fossa Co- Existing with Actinomycosis: A Rare Case Report with Review of Literature

Introduction: Salivary gland tumors account for about 3% of head and neck tumors and the majority are benign in nature. Among these, the most common pathological type is pleomorphic adenoma also called the mixed tumor. It is a kind of tumor containing glandular tissue, myxoid and cartilage-like tissue. As the structure of the tissue is diverse, it is called a “mixed tumor.” Actinomycosis is a chronic suppurative bacterial infection caused by Actinomyces israelii. In this case report, we are presenting a rare co-existence of pleomorphic adenoma and Actinomycosis in the infratemporal fossa. Case description: A 40-year-old female patient complains of pain over the upper left back tooth region for the past 6months. The patient had a past history of a small lesion in 28 region which resulted in constant irritation. The patient had consulted the dentist for the same and underwent extraction of 28 and 38 three years back, which was thought to be the cause of the swell- ing. Conclusion: The case highlights the importance of proper history taking, clinical examination, and histopathological examina- tion in arriving at a precise diagnosis of a lesion irrespective of size and clinical presentation.

Presentación inusual del adenoma pleomorfo congénito de fosa nasal en neonato

RESUMEN Introducción: El adenoma pleomorfo es la neoplasia benigna más frecuente en las glándulas salivales, su localización en vías aéreas superiores es poco frecuente. Objetivo: Describir la inusual presentación de un adenoma pleomorfo congénito nasal, no descrito con anterioridad en Cuba. Presentación del caso: se presenta un caso raro de recién nacido con datos clínicos de obstrucción nasal horas después de su nacimiento. Previos estudios y resultado de biopsia del tumor intranasal determinaron adenoma pleomorfo congénito. Se realizó exéresis de tumor por cirugía endoscópica nasal. Conclusiones: El adenoma pleomorfo debe ser considerado un diagnóstico diferencial en todas las edades; sospechar ante un paciente con síntomas de obstrucción unilateral o epistaxis. Un diagnóstico temprano permite un tratamiento oportuno con abordaje quirúrgico endoscópico menos invasivo y una menor tasa de recidiva. Este tumor se destaca por su potencial recurrencia o transformación maligna por lo que es importante mantener vigilancia endoscópica e imagenológica.

ABSTRACT Introduction: Pleomorphic adenoma is the most frequent benign neoplasm in the salivary glands; its location in the upper airways is rare. Objective: Describe the unusual presentation of a nasal congenital pleomorphic adenoma, not previously described in Cuba. Case Presentation: A rare case of a newborn with clinical data of nasal obstruction hours after birth is presented. Previous studies and biopsy result of the intranasal tumor determined congenital pleomorphic adenoma. Tumor excision was performed by endoscopic nasal surgery. Conclusions: Pleomorphic adenoma should be considered a differential diagnosis at all ages. Suspecting should be normal when a patient has symptoms of unilateral obstruction or epistaxis. Early diagnosis allows timely treatment with a less invasive endoscopic surgical approach and a lower rate of recurrence. This tumor stands out for its potential recurrence or malignant transformation, so it is important to maintain endoscopic and imaging surveillance.

Adenoma pleomorfo con lipometaplasia: inesperada causa de obstrucción traqueal / Unexpected cause of tracheal obstruction: pleomorphic adenoma with lipometaplasia

Resumen El adenoma pleomorfo de tráquea es un tumor benigno, infrecuente, que genera cuadros obstructivos, pudiendo confundirse con asma, lo que retrasa su diagnóstico. Presentamos el caso de una mujer de 40 años con antecedentes de asma y episodios de obstrucción respiratoria de 8 meses de evolución. La fibrobroncoscopía mostró una lesión polipoide, pediculada, en el primer anillo traqueal, con oclusión de 80% de la luz, que se resecó. El diagnóstico histopatológico fue adenoma pleomorfo con lipometaplasia. El tratamiento de estos tumores consiste en la resección completa de la lesión y seguimiento a largo plazo por la baja proba bilidad de recurrencia, malignización y metástasis.

Abstract Pleomorphic adenoma of the trachea is a benign tumor, extremely rare, that generates obstructive symp toms and sometimes is confused with asthma, which delays its diagnosis. We present the case of a 40-year-old woman with history of asthma and airway obstruction, of 8-months duration. Fibrobronchoscopy showed polypoid, pedunculated lesion in first tracheal ring which occluded 80% of the lumen, that was resected. The histopatho logical diagnosis was pleomorphic adenoma with lipometaplasia. Treatment of these tumors consists in complete resection of the lesion and long-term follow-up due to low probability of recurrence, malignancy and metastasis.

Specific antitumor activity and mechanism of protonic bis-phenanthroline / 药学学报

Hepatocellular carcinoma (HCC) is a common malignant tumor worldwise. The incidence rate of HCC is high and is easy to metastasis and recurrence, which seriously affects human health. Traditional chemical drugs have some challenges such as toxicity, side effects, and multidrug resistance, thus it is urgent to find new drugs and effective targets. Here we synthesized a novel chemical, protonic bis-phenanthroline (H-BP), and the antitumor effect was investigated in the study. The results showed that H-BP could selectively inhibit the proliferation of tumor cells and cause HCC apoptosis. And also, in HCC tumor-bearing mice, H-BP could effectively prevent the growth of tumor mass, even completely eliminate the tumor at medium dose (5 mg·kg-1) and high dose (10 mg·kg-1), and meanwhile H-BP has no significant effect on the body weight of mice. The experimental protocol was approved by the Animal Ethics Committee of Southwest University, and the experimental operation was strictly carried out in accordance with the ethical principles of animal use and care. Mechanism studies showed that H-BP induced HCC apoptosis was related to down-regulation the expression of pleomorphic adenoma gene like-2 (PLAGL2), a oncogene transcription factor, resulting in the down-regulation of PLAGL2 downstream proteins hypoxia inducible factor and β-catenin. This study not only introduces the dimerization method to form novel compounds that will provide a new approach for drug design, but also suggests that PLAGL2 may be an effective target in tumor therapy.

Clinical analysis of 19 cases of maxillary local tissue defects repaired by buccal fat pad flaps / 口腔疾病防治

Objective@# To investigate the clinical effect of buccal fat pad flaps on the restoration of maxillary defects.@*Methods@# Nineteen cases with oral-nasal communications and maxillary soft and hard tissue defects ranging from 3.0 cm×2.0 cm-5.0 cm×4.0 cm after resection of the primary tumor foci were repaired with a pedicled buccal fat pad flap, and the maxillary sinus cavity and oral-nasal communication were closed. The survival, healing and complications of the flap were observed during the 3-month follow-up. @*Results @#The buccal fat pad flaps of 19 patients all survived. Five days after the operation, the buccal fat pad flap was dark red with slight edema, and the maxillary defect area collapsed. Ten days after the operation, most of the buccal fat pad flap turned pink, and the collapse was alleviated. One month after the operation, the buccal fat pad flap had no obvious collapse, and its surface was epithelialized, with a shape and color close to those of the normal mucosa. The opening was slightly limited. Three months after the operation, the buccal fat pad flap was completely epithelialized, with no difference from the surrounding tissue, and the opening was approximately 3 transverse fingers. No complications, such as swelling and necrosis of the buccal fat pad flap, limitation of mouth opening, maxillary sinus fistulas, oral-nasal communications and facial changes occurred in 19 patients within 3 months after the operation.@*Conclusion @#The application of a buccal fat pad flap has a good effect to repair maxillary tissue defects and close oral maxillary sinus communication with diameters less than 5 cm, so it can be widely used in the clinic.

Avaliação da expressão da proteína EZH2 em carcinoma adenoide cístico e adenoma pleomórfico / EZH2 immunoexpression in adenoid cystic carcinoma and pleomorphic adenoma

As neoplasias de glândulas salivares apresentam comportamentos diferenciados, que não seguem os padrões clássicos das neoplasias benignas e malignas. A raridade de algumas destas lesões dificulta ainda mais o entendimento dos mecanismos envolvidos na etiopatogenia. Marcadores moleculares como a proteína EZH2 têm sido utilizados na investigação de alterações epigenéticas em diferentes neoplasias, auxiliando na definição do diagnóstico e prognóstico das lesões. O objetivo do presente trabalho é avaliar a expressão da proteína EZH2 e descrever as características clínicas e microscópicas de amostras de carcinoma adenoide cístico (CAC) e adenoma pleomórfico (AP) com ênfase na importância da definição da malignidade da lesão. A análise dos cortes microscópicos corados em Hematoxilina e Eosina dos casos de Adenoma pleomórfico mostraram células epiteliais e mioepiteliais glandulares dispostas em lençóis e estruturas ductiformes em meio a estroma variável. Os casos de Carcinoma adenoide cístico mostraram três padrões distintos de crescimento incluindo formações tubulares, cribriformes e sólidas. Todos os casos de AP e CAC foram positivos para reação imuno-histoquímica para EZH2. As amostras de CAC apresentaram expressão de EZH2 significativamente maior comparado ao AP. As covariáveis metástase em linfonodos, recorrência, padrão histológico, presença de áreas sólidas e invasão perineural foram descritas em relação à marcação de EZH2 em amostras de CAC. Dessa forma, os resultados do estudo melhoram o entendimento das características clínicas e histológicas do CAC, assim como sobre o comportamento das lesões. Além disso, a análise mostra que o EZH2 é um potencial marcador de malignidade e ressalta a importância da validação de marcadores moleculares de alterações epigenéticas.

Salivary gland neoplasms present different behaviors, which do not follow the classic patterns of benign and malignant neoplasms. The rarity of some of these lesions makes it even more difficult to understand the mechanisms involved in the etiopathogenesis. Molecular markers such as the EZH2 protein have been used to investigate epigenetic changes in different neoplasms, helping to define the diagnosis and prognosis of the lesions. The aim of the study was to evaluate the expression of the EZH2 protein and to describe the clinical and microscopic characteristics of adenoid cystic carcinoma (ACC) and pleomorphic adenoma (PA) which emphasizes the importance of defining the malignancy of the neoplasm. Histopathological analysis of PA cases showed myoepithelial and glandular epithelial cells arranged as duct-like structures and sheets intermingled in the variable stroma and ACC cases showed the three growth patterns, tubular, cribriform and solid forms. All ACC and PA cases were positive for EZH2, with diffuse nuclear staining in neoplastic cells. The ACC samples showed significantly higher EZH2 expression compared to the PA. The covariables nodal metastasis, recurrence, growth pattern, presence of solid areas and perineural invasion have been described in relation to EZH2 staining in ACC samples. The results of the study improve the understanding of the clinical and histological characteristics of ACC, as well as on the behavior of lesions. In addition, the analysis showed that EZH2 is a potential marker of malignancy and highlights the importance of validating molecular markers of epigenetic alterations.

Adenoma pleomórfico em palato duro: relato de caso / Pleomorphic adenoma in hard palate: case report / Adenoma pleomórfico en paladar duro: reporte de caso

Introdução: O adenoma pleomórfico (AP) é a neoplasia de glândula salivar mais comum e se apresenta como um aumento de superfície firme, indolor e com crescimento lento. O palato, a cavidade nasal e a nasofaringe são áreas em que se localizam muitas glândulas salivares menores, sendo o adenoma pleomórfico, o tumor benigno mais comum nessas glândulas. O AP pode acometer indivíduos em qualquer faixa etária, principalmente na terceira e quarta década de vida, com predominância pelo gênero feminino. O artigo objetiva relatar um caso clínico de adenoma pleomórfico em palato duro, comparando com dados presentes na literatura especializada em relação, especialmente, aos sítios acometidos e as formas de tratamentos existentes. Relato de caso: Paciente do sexo feminino, 34 anos, compareceu ao ambulatório do HU-Univasf com queixa de aumento de volume indolor em boca há 02 anos. Foi realizada uma biópsia incisional onde no exame histopatológico foi diagnosticado como Adenoma Pleomórfico. O tratamento eleito foi a excisão cirúrgica e uso de placa de polimetilmetacrilato no pós-operatório. Atualmente o paciente apresenta follow up de 02 anos e 05 meses, sem sinais de recidiva da lesão e sem queixas locais... (AU)

Introduction: Pleomorphic adenoma (PA) is a more common salivary gland neoplasia and presents as an increase in firm, painless and slow-growing surface. The palate, a nasal cavity and a nasopharynx, are areas that locate many minor salivary glands, being pleomorphic adenoma, the most com mon benign tumor in these glands. The PA can affect individuals in any age group, mainly in the third and fourth decade of life, with a predominance in a females. The article aims relates a clinical case of pleomorphic adeno ma on the hard palate, comparing it with the data present in the specialized literature in relation, especially, to the affected locations and the ways to ex isting treatments. Case Report: A 34 years old, female patient, showed up to the HU-Univasf outpatient clinic with a complaint of an increase in vol ume painless in the mouth for 2 years. An incisional biopsy was performed in which the histopathological examination was diagnosed as Pleomorphic Adenoma. The treatment chosen was surgical excision and use of polymeth ylmethacrylate plate. Currently, the patient has a follow-up of 02 years and 05 months, with no signs of recurrence of the lesion and no local complaints... (AU)

Introducción: El adenoma pleomórfico (AP) es la neoplasia de glándulas salivales más común y se presenta como un agrandamiento firme, indoloro y de crecimiento lento. El paladar, la cavidad nasal y la nasofaringe son áreas en las que se localizan muchas glándulas salivales menores, siendo el adenoma pleomórfico el tumor benigno más común en estas glándulas. La AF puede afectar a individuos de cualquier grupo de edad, especialmente en la tercera y cuarta década de la vida, con predominio del sexo femenino. El artículo tiene como objetivo reportar un caso clínico de adenoma pleomórfico en paladar duro, comparándolo con datos de la literatura especializada en relación, especialmente, con los sitios afectados y las formas de tratamiento existentes. Caso clínico: Paciente de sexo femenino de 34 años que acudió a la consulta externa de HU-Univasf quejándose de hinchazón bucal indolora durante 02 años. Se realizó biopsia incisional y el examen histopatológico se diagnosticó como adenoma pleomórfico. El tratamiento elegido fue la exéresis quirúrgica y el uso postoperatorio de placa de polimetilmetacrilato. Actualmente, el paciente tiene un período de seguimiento de 02 años y 05 meses, sin signos de recurrencia de la lesión y sin quejas locales... (AU)

Contradicción anestesiológica en una gestante con adenoma pleomórfico y alergia a los anestésicos locales / Anesthesiological contradiction in a pregnant woman with pleomorphic adenoma and allergy to local anesthetics

Introducción: El adenoma del paladar blando es frecuente en mujeres, aunado a los cambios fisiológicos que suceden durante el embarazo, es de presumir que la gestante puede presentar una vía aérea difícil. Objetivo: Describir el abordaje de la vía aérea en una gestante con adenoma del paladar blando. Presentación del caso: Se trata de una gestante de 20 años de edad con antecedentes patológicos personales de asma bronquial, alergia a los anestésicos locales, que presenta un adenoma en el paladar blando que impide ver la estructura de la orofaringe, Mallampatti IV, anunciada para procedimiento quirúrgico de urgencia para realizarle cesárea segmentaria anterior. Conclusiones: La embarazada presenta mayor incidencia de vía aérea difícil comparado con la población general, debido a los cambios fisiológicos que presenta en este periodo, si a ello se le adiciona la presencia de un tumor oro faríngeo que imposibilita la manipulación de la vía aérea, la evaluación preoperatoria y trazar una estrategia multidisciplinaria, constituyen los pilares para evitar complicaciones potencialmente fatales(AU)

Introduction: Adenoma of soft palate is frequent in women, together with the physiological changes that occur during pregnancy. The pregnant woman is to be presumed to have a difficult airway. Objective: To describe the airway managment in a pregnant woman with adenoma of soft palate. Case presentation: This is a 20-year-old pregnant woman (Mallampati IV) with a personal pathological history of bronchial asthma and allergy to local anesthetics, who presents an adenoma of soft palate that avoids seeing the oropharynx structure, announced for emergency surgical procedure for an anterior segmental cesarean section. Conclusions: The pregnant woman has a higher incidence of difficult airway compared to the general population, due to the physiological changes that she presents in this period. If, apart from this situation, the presence is considered of an oropharyngeal tumor that makes it impossible to manipulate the airway, preoperative assessment and tracing a multidisciplinary strategy are the pillars to avoid potentially fatal complications(AU)

Adenoma pleomorfo mimetizando lipoma oral / Adenoma pleomórfico que mimetiza el lipoma oral / Pleomorphic adenoma mimicking oral lipoma

Introdução: O adenoma pleomorfo é a neoplasia benigna de glândula salivar mais comum, podendo acometer glândulas salivares maiores e menores. Essa neoplasia ocorre em uma ampla faixa etária, e se caracteriza por uma ampla variabilidade clinico-patológica e por altas taxas de recorrência. Objetivo: Relatar um caso de um adenoma pleomorfo, com enfoque nos aspectos clinico-patológicos, diagnóstico diferencial e manejo clínico. Relato de caso: Paciente do sexo masculino, 72 anos, exibiu lesão nodular, bem delimitada, localizada em fundo de sulco maxilar esquerdo, com tempo de evolução de quatro anos. A biópsia excisional foi realizada, e as hipóteses diagnósticas de hiperplasia linfoide, adenoma pleomorfo e lipoma foram consideradas, sendo esta última reforçada pelo fato de ter flutuado em formol. Sob análise microscópica, observou-se uma proliferação de células epiteliais e mioepiteliais em meio a um estroma variável. Com isso, o diagnóstico histopatológico de adenoma pleomorfo foi emitido. Conclusão: O presente estudo enaltece a importância da realização de análise histopatológica criteriosa para exclusão de outras hipóteses diagnósticas e neoplasias malignas. Dessa forma, a partir da associação dos achados clínicos e microscópicos, é possível obter um diagnóstico correto, guiando, consequentemente, na adoção de uma conduta terapêutica adequada(AU)

Introducción: El adenoma pleomórfico es la neoplasia benigna de glándulas salivales más común, que puede afectar a las glándulas salivales mayores y menores. Esta neoplasia se presenta en un amplio grupo de edad y se caracteriza por una amplia variabilidad clínica y patológica y altas tasas de recurrencia. Objetivo: Describir un caso de adenoma pleomórfico, con énfasis en aspectos clínicos y patológicos, diagnóstico diferencial y manejo clínico. Caso clínico: Paciente masculino, de 72 años, que presentó una lesión nodular bien definida ubicada en la parte inferior del surco maxilar izquierdo, con un tiempo de evolución de cuatro años. Se realizó una biopsia escisional. Se consideraron las hipótesis diagnósticas de hiperplasia linfoide, adenoma pleomórfico y lipoma, con mayor atención este último por el hecho de que flotaba en formaldehído. Bajo análisis microscópico, se observó una proliferación de células epiteliales y mioepiteliales en medio de un estroma variable. Por lo tanto, se emitió el diagnóstico histopatológico de adenoma pleomorfo. Conclusión: El presente estudio destaca la importancia de llevar a cabo un cuidadoso análisis histopatológico para excluir otras hipótesis diagnósticas y neoplasias malignas. Luego, con base en la asociación de hallazgos clínicos y microscópicos, es posible obtener un diagnóstico correcto, imprescindible en la adopción de un enfoque terapéutico apropiado(AU)

Introduction: Pleomorphic adenoma is the most common benign salivary gland neoplasm. It may affect major and minor salivary glands. It presents at a broad age range and is characterized by great clinical and pathological variability and high recurrence rates. Objective: Describe a case of pleomorphic adenoma, with emphasis on clinical and pathological aspects, differential diagnosis and clinical management. Case report: A male 72-year-old patient presents with a well-defined nodular lesion in the lower section of the left maxillary groove with a time of evolution of four years. Excisional biopsy was performed. The diagnostic hypotheses considered were lymphoid hyperplasia, pleomorphic adenoma and lipoma, with greater attention to the latter, due to the fact that it floated in formaldehyde. Microscopic examination revealed proliferation of epithelial and myoepithelial cells amidst a variable stroma. Thus, a histopathological diagnosis of pleomorphic adenoma was issued. Conclusion: The present study highlights the importance of careful histopathological examination to rule out other diagnostic hypotheses and malignant neoplasms. Next, clinical and microscopic findings will lead to an accurate diagnosis indispensable to adopt an appropriate therapeutic approach(AU)

Simultaneous bilateral distinct parotid tumors: a case report / 华西口腔医学杂志

Parotid gland tumors are usually solitary tumors, and multiple tumors of the parotid gland are extremely rare. We present a highly unusual case of bilateral and simultaneous pleomorphic adenoma and basal cell adenoma of the parotid gland. We review the literature and discuss the clinical manifestations, diagnosis, and treatment of these two rare tumors.

Expression and Significance of Mitochondrial Autophagy-associated Protein PINK1 and Parkin in Parotid Pleomorphic Adenoma and Carcinoma ex Pleomorphic Adenoma / 肿瘤防治研究

Objective To investigate the expression of mitochondrial autophagy-associated protein PINK1 and Parkin in parotid pleomorphic adenoma (PA) and carcinoma ex pleomorphic adenoma(CA-EX-PA). Methods The expression of PINK1 and Parkin were detected by immunohistochemistry in 24 cases of normal parotid gland tissues, 32 cases of PA tissues and 42 cases of CA-EX-PA tissues. The correlations of PINK1 and Parkin expression with the clinicopathologic characteristics of CA-EX-PA patients were analyzed. Results The positive rates of PINK1 in normal parotid gland, PA and CA-EX-PA tissues were 100%, 91% and 67% respectively; and those of Parkin were 100%, 88% and 52% respectively. The expression rates of PINK1 and Parkin in PA and CA-EX-PA tissues were significantly lower than those in normal tissues (P < 0.05). The expression of PINK1 and Parkin protein were positively correlated in CA-EX-PA tissues (r=0.877, P < 0.01). In CA-EX-PA tissues, the expression of PINK1 and Parkin were associated with tumor invasion, lymph node metastasis and TNM stage (P < 0.05). Conclusion The expression of PINK1 and Parkin are decreased in PA and CA-EX-PA tissues. The decrease of mitochondrial autophagy activity might play important roles in the development, invasion and metastasis of parotid gland tumors.

Relato de caso: adenoma pleomórfico nasal / Nasal pleomorphic adenoma: a case report

INTRODUÇÃO: O adenoma pleomórfico é o tumor misto glandular benigno mais comum das glândulas salivares, raramente encontrado na cavidade nasal. A apresentação clínica típica é de obstrução nasal unilateral associada à epistaxe e à presença de uma massa polipoide, lisa, lobulada e firme na fossa nasal. O diagnóstico é feito por exame anatomopatológico, e o tratamento de escolha é cirúrgico, com ressecção do tumor com margem de segurança. RELATO DE CASO: O caso relatado é de uma paciente de 49 anos, com adenoma pleomórfico nasal, diagnosticado e tratado cirurgicamente. CONCLUSÃO: A importância do caso relatado reside na raridade do tumor nessa localização, sendo um diagnóstico diferencial que deve ser lembrado para os tumores nasais

INTRODUCTION: The pleomorphic adenoma is the most common benign mixed tumor of salivary glands, rarely found in the nasal cavity. Its typical clinical presentation is a unilat-eral nasal obstruction associated with an epistaxis and a presence of a polypoid, smooth, lobulated, and firm mass in the nasal fossa. It is diagnosed by anatomopathological ex-amination, and the treatment of choice is surgical with tumor resection, keeping a safety margin. CASE REPORT: The case reported is a female 49-year-old patient, diagnosed with a nasal pleomorphic adenoma that was surgically treated. CONCLUSION: The importance of the case reported lies in the rarity of the pleomorphic adenoma located in this area. Therefore, this is a differential diagnosis that must be remembered for nasal tumors.

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.

Adenoma pleomórfico del espacio parafaríngeo: una entidad escondida / Pleomorphic adenoma of the parapharyngeal space: a hidden entity

Resumen Los tumores del espacio parafaríngeo son poco frecuentes. Dentro de ellos, las neoplasias benignas son las más frecuentes, destacando principalmente los adenomas pleomorfos. Estos tumores suelen permanecer asintomáticos hasta alcanzar el tamaño suficiente para producir alteraciones debido al efecto de masa. A pesar de su naturaleza benigna, es necesario realizar resección completa dada su alta tasa de recurrencia y potencial de transformación maligna. Presentamos el caso de un paciente de 52 años que en estudio de vértigo se detecta incidentalmente una masa tumoral del espacio parafaríngeo de 45 mm × 32 mm de diámetro, de etiología incierta. Se realizó una biopsia incisional endoscópica que evidenció un adenoma pleomórfico, que actualmente se encuentra en etapa de evaluación y planificación de escisión completa. En conclusión, dado que los hallazgos clínicos y radiológicos no siempre son suficientes para determinar la naturaleza de las lesiones del espacio parafaríngeo, es importante contar con un diagnóstico histológico. Los avances en las técnicas de cirugía endoscópica sinusal han permitido acceder a esta zona con una mínima morbilidad y estadía hospitalaria. Debido a la posibilidad de transformación maligna los adenomas pleomórficos requieren un manejo activo.

Abstract Tumors of the parapharyngeal space are rare. Benign neoplasms are the most frequent and, among them, pleomorphic adenomas stand out. These tumors are usually asymptomatic until they reach a size large enough to produce symptoms due to mass effect. Despite its benign nature, it is necessary to perform a complete resection given its high recurrence rate and its potential for malignant transformation. We present the case of a 52-year-old man in whom a study of vertigo incidentally detected a mass in the parapharyngeal space measuring 45 mm × 32 mm in diameter, of unknown etiology. An endoscopic incisional biopsy was performed, showing a pleomorphic adenoma, which is currently under assessment to plan complete removal. In conclusion, as clinical and radiological findings are not always sufficient to determine the nature of parapharyngeal space lesions, it is important to obtain a histological diagnosis. Advances in endoscopic sinus surgery techniques have allowed access to this area with minimal morbidity and hospital stay. Due to the possibility of malignant transformation pleomorphic adenomas require active management.