Salivary Gland Tumors
Dongyou Liu in Tumors and Cancers, 2017
Pleomorphic adenoma (also called benign mixed tumor) is a painless, slow growing tumor mostly found in the parotid gland (90%) and submandibular gland (10%). Macroscopically, the tumor is well-demarcated, partially encapsulated, gray-white, myxoid, rubbery mass of <6 cm with solid cut surface and subtle extensions into adjacent tissue. Histologically, the tumor contains biphasic population of epithelial and mesenchymal cells; glandular or squamous, spindled or oval epithelial cells with large hyperchromatic nuclei; myoepithelial basal layer or overlying pseudoepitheliomatous hyperplasia; myxoid, hyaline stroma; presence of mucin; absence of mitotic figures and necrosis. The ductal component stains positive for CK19, CK14, EMA, CEA, alpha-1-antitrypsin, alpha-1-antichymotrypsin, GCDFP-15, PSA (50%), PAP (50%); the myoepithelial component stains positive for keratin, actin, myosin, other smooth muscle proteins, S100 (particularly in cartilaginous areas), and GFAP. The tumor is negative for amylase and p53. and may contain rearrangements at 8q12 or 12q14–15.
Ophthalmology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
See also Chapter 8 Neurology, page 203. Dacryoadenitis, usually caused by a viral infection of the lacrimal gland but may be associated with orbital pseudotumour. It is not usually associated with proptosis per se but causes the upper lid to develop an ‘S’ shape and is very tender to touch. Treatment is with pain relief and antibiotics if from an infectious cause, but if pseudotumuour related, steroids are indicated. CT scan is usually needed to make the distinction together with serology.Dacryops is due to a dilatation of the major lacrimal ducts secondary to obstruction and again does not usually cause proptosis.Pleomorphic adenoma. Very rarely this essentially ‘adult’ tumour presents in children with a painless, slowly progressive non-axial proptosis. Biopsy may be needed to make the diagnosis. It is very rare.
Benign Salivary Gland Tumours
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Most patients with a pleomorphic adenoma should be offered and advised to have surgery on the basis of: definitive histologycontinued growth if left untreatedsmall chance of malignant transformation (see below). Most parotid pleomorphic adenomas are within the superficial lobe but a small but significant proportion arise either within the deep lobe or involve it by direct growth. Pleomorphic adenomas, left untreated for many years, can attain a large size (Figure 9.6). Pleomorphic adenoma can also arise from accessory parotid tissue along the line of the duct (Figure 9.7). If far enough anteriorly in this area, they then may only be visible when the mouth is opened and the tumour is pushed outward by the forward movement of the coronoid process of the mandible. Pleomorphic adenomas can also arise in the submandibular gland, or minor salivary glands (e.g. soft palate, see Figure 9.4).
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
Although mostly benign, pleomorphic adenomas may also have atypical and malignant variants and complete excision with an intact pseudo-capsule is required to prevent recurrences, which can be multifocal, and possible malignant transformation.11,13 Both de novo cases (cases 1 and 2) in this series had possible initial incomplete excision. Clinical information is not available on case 3 to indicate if initial removal had been reported as complete. Recurrence of pleomorphic adenoma of the lacrimal gland has also been described to occur in a multinodular pattern and may be widespread with removal leading to significant morbidity if complete histological clearance is to be achieved.14 Similarly, recurrence of pleomorphic adenoma in salivary glands is thought to be due to tumour spillage intra-operatively with careful and complete surgical excision reducing recurrence to 0–2.5%.15
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.
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.
Related Knowledge Centers
- Atrophy
- Benign Tumor
- Carcinoma Ex Pleomorphic Adenoma
- Mandible
- Parotid Gland
- Aneuploidy
- Salivary Gland Tumour
- Pleomorphism
- Salivary Gland
- Adenoma