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Capsular Significance in Parotid Tumour Surgery: Reality and Myths of Lateral Lobectomy
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Toby Pitts-Tucker, Costa Repanos
The data collected is purely histological, and the authors' claims are thus made without any recourse to follow-up data. Pleomorphic adenomas have been known to recur up to 15 years following primary surgery,3 and this study's failure to address any follow-up seriously diminishes the strength of its conclusions. Also lacking in the results is any mention of preoperative assessment of the parotid tumours, although it does state that “case histories” were examined. This omission is important, as it is the process by which a tumour is deemed to be benign or malignant, a key step in surgical planning.
The salivary glands
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Pleomorphic adenomas, also known as benign mixed tumours, are the most common salivary gland tumour. The tumours have epithelioid and connective tissue components. In the parotid gland, 90% occur in the superficial lobe, with some of these forming ‘dumbbell tumours’ that originate in the superficial lobe and stretch through the stylomandibular ‘tunnel’ to form a narrow isthmus connecting with more tumours in the deep lobe. Ten per cent originate completely within the deep lobe. Pleomorphic adenomas can also originate in minor salivary glands, most commonly in the palate and then the upper lip. Multiple pleomorphic adenomas are rare [14].
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Around 80% of salivary gland tumours occur within the parotid gland. Around 80% of these are pleomorphic adenomas, of which 80% are in the superficial lobe. Pleomorphic adenomas usually present as a painless, mobile and slow-growing lump in middle-aged patients. These are benign lesions, but can undergo malignant transformation. They are removed by superficial parotidectomy.
A case of pleomorphic adenoma of the lacrimal gland invading the lower orbit
Published in Orbit, 2022
Ryosei Kado, Satoru Kase, Yuka Suimon, Susumu Ishida
On MRI, common pleomorphic adenoma is round or oval and localized in the lacrimal gland. On the other hand, pleomorphic adenoma in this case was unique, showing a large multinodular gourd-shaped configuration on coronal section MRI. The differential diagnoses included intraorbital hematoma, malignant lymphoma, and epithelial tumors including adenoid cystic carcinoma. In this case, it was difficult to diagnose pleomorphic adenoma preoperatively as the imaging findings were different from those of typical pleomorphic adenoma. Therefore, biopsy could be considered for making a correct diagnosis and determining eventual treatments. However, for pleomorphic adenoma, biopsy is often avoided, as it may damage the capsule, disseminate tumor cells, and lead to recurrence during long-term follow-up periods7 and subsequent malignant transformation.2 In this case, we successfully resected the total tumor and diagnosed it as pleomorphic adenoma. This report highlights the fact that ophthalmologists should keep variations of tumor configurations in mind, and consider total removal without incisional biopsy when pleomorphic adenoma is suspected.
Cutaneous pleomorphic adenoma of the periocular region – a case series
Published in Orbit, 2022
Micheal A. O’Rourke, Paul S. Cannon, Joseph F. Shaw, Luciane C. Irion, Penelope A. McKelvie, Alan A. McNab
Pleomorphic adenomas are benign mixed tumours with epithelial and mesenchymal components occurring most frequently in lacrimal and salivary glands. These tumours may rarely arise in accessory lacrimal glands of Krause and Wolfring and ectopic lacrimal gland tissue.4–6 Accessory or ectopic lacrimal gland tissue origin is unlikely if the pleomorphic adenoma is not in the usual location for accessory lacrimal gland tissue or if there is no normal lacrimal gland tissue external to the pseudo-capsule.7 When occurring in skin, they arise from sweat glands and have a reported frequency of 0.01% to 0.098%.1 We report a series of three cases arising in skin – two at the medial canthus and one in the sub-brow region. Such tumours have been described in the eyelid margins, sub-brow region, central lids, as well as elsewhere on the face including the nose and cheek.1,2,7–12 This diagnosis was not suspected on initial presentation and cases 1 and 2 required further excision to be more confident of complete clearance. A third case of recurrent pleomorphic adenoma at the medial canthus highlights the potential for recurrence of such lesions and the importance of establishing complete excision.
Lacrimal gland pleomorphic adenoma with extensive necrosis
Published in Orbit, 2022
Micheal A. O’Rourke, Penelope A. McKelvie, Christopher M. Angel, Alan A. McNab
Subsequently, PET CT imaging showed no abnormality in the area of interest. Following discussion at a multidisciplinary head and neck oncology meeting and review by a salivary gland pathologist, a diagnosis of atypical pleomorphic adenoma with necrosis was suggested as more likely. Further sections by the review pathologist showed areas of myxoid and sclerotic stroma in the necrotic tumour. Immunohistochemistry for PLAG1 showed prominent nuclear reactivity (Figure 2b). Wide local excision of the orbital and palpebral lobes of the lacrimal gland with a surrounding cuff of fat and periosteum was undertaken 1 month after initial incisional biopsy. Histology showed residual pleomorphic adenoma surrounded by fibrosis with no necrosis, atypia, or mitoses seen. There was prominent acinar atrophy with large lymphoid nodules and reactive lymphoid follicles (Figure 2c,d). Surgical margins were clear. The initial skin crease incision tract was also excised with no evidence of pleomorphic adenoma present.