BACKGROUND Salivary gland tumors are relatively rare.Most minor salivary gland tumors are malignant with benign tumors accounting for 18%of the tumors.Pleomorphic adenoma(PA)is the most common salivary gland tumor.Lip...BACKGROUND Salivary gland tumors are relatively rare.Most minor salivary gland tumors are malignant with benign tumors accounting for 18%of the tumors.Pleomorphic adenoma(PA)is the most common salivary gland tumor.Lip PA is uncommon with 9.8%occurring in the upper lip.We are adding on the knowledge of the rare upper lip PA(benign mixed tumor).CASE SUMMARY We report an upper lip PA(benign mixed tumor)in a 28-year-old man.His complaint was a painless swelling on the upper lip.A painless,non-tender,well-circumscribed,slightly mobile,sessile,nodular,and rubbery(in consistency)tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip.The overlying skin was not fixed and of normal color.There was no ulceration,and palpation did not elicit pain or bleeding.There was no history of trauma.Blunt dissection was used to completely excise the nodular,whitish,and encapsulated tumor.Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion,with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells,well-formed tubules containing eosinic secretion,and nests of myoepithelial cells.A diagnosis of PA(benign mixed tumor)was confirmed.CONCLUSION Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.展开更多
Pleomorphic adenoma is the most common tumor of the salivary glands, accounting for approximately 50% of salivary gland lesions. It develops mainly in the salivary glands: parotid (80%), submaxillary (10%), sublingual...Pleomorphic adenoma is the most common tumor of the salivary glands, accounting for approximately 50% of salivary gland lesions. It develops mainly in the salivary glands: parotid (80%), submaxillary (10%), sublingual (1%) and in the accessory oral-pharyngeal glands (9%). The aim of this work was to report 2 cases of pleomorphic adenoma of atypical location and then to discuss the difficulties linked to its diagnostic and therapeutic management in the Malian context. They were a 40-year-old man and a 72-year-old woman. They were admitted to the ENT department of the “Luxembourg Mere-infant” hospital for oropharyngeal swelling for the first and swelling of the palate for the second. The clinical expression was a swelling in both cases, of a hard, mobile consistency with healthy mucosa on their surface. The remainder of the physical examination was unremarkable. The diagnosis of a tumor of the oropharynx and palate was made following clinical radiological examinations. The histopathological examination of the surgical specimen made it possible to make the diagnosis of pleomorphic adenoma of the palate and the left palatine tonsil. The follow-up surgery was straightforward, with a favorable outcome. Pleomorphic adenomas are relatively rare benign tumors of the accessory salivary glands;their clinical expression remains swelling. Therapeutic management is surgery and the diagnosis is confirmed by histopathological examination.展开更多
·AIM: To detect proteomic differences in tears between adenoid cystic carcinoma(ACC) and pleomorphic adenoma(PA).·METHODS: Tear samples were collected from 4 patients with ACC, 5 with PA, and 4 control cases...·AIM: To detect proteomic differences in tears between adenoid cystic carcinoma(ACC) and pleomorphic adenoma(PA).·METHODS: Tear samples were collected from 4 patients with ACC, 5 with PA, and 4 control cases. Label-free analysis and parallel reaction monitoring(PRM) were used to screen and validate the tear proteome. Gene Ontology(GO) annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG) were conducted for bioinformatics analysis.·RESULTS: In total, 1059 proteins in tear samples were identified by label-free analysis. Between ACC and PA, 415 differentially expressed proteins were detected. Based on the GO annotation, enzyme regulator activity and serinetype endopeptidase inhibitor activity in the molecular function category, blood microparticle and extracellular matrix in the cellular component category, and response to nutrient levels in the biological process category were most predominant. By KEGG pathway annotation, the different proteins between ACC and PA mainly par ticipated in complement and coagulation cascades, amoebiasis, African trypanosomiasis and cholesterol metabolism. Eight proteins with mostly significant differences were verified by PRM, and five proteins with more than 10-fold increases in ACC compared with PA, including integrin β, α-2-macroglobulin, epididymal secretory sperm binding protein Li 78p, RAB5C, and complement C5, were identified.·CONCLUSION: The combined tools of label-free analysis and PRM are very effective and efficient, especially for samples such as tears. Some proteomic dif ferences in tears between ACC and PA are identified and these protein candidates may be specific biomarkers for future exploration.展开更多
Pleomorphic adenoma is the most common benign parotid gland tumor. Although its local recurrence rate is known to be high, the recurrence extending to the cervical region is rare. Here we report a case of a young fema...Pleomorphic adenoma is the most common benign parotid gland tumor. Although its local recurrence rate is known to be high, the recurrence extending to the cervical region is rare. Here we report a case of a young female (25 years old) with pleomorphic adenoma of the parotid gland which showed multiple recurrences through facial to cervical regions over a span of eight years. We also discuss how this benign tumor with a high recurrence rate has been treated in other cases, and how it should be treated.展开更多
Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological diagnosi...Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological diagnosis. Methods: We present a case of a 71-year-old male with an enlarging left neck mass over several months. CT showed both a parapharyngeal space mass and a separate level II neck mass. Results: The patient underwent resection of the left parapharyngeal mass and ipsilateral selective level II-IV lymphadenectomy. The final pathologic diagnosis was metastatic high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma. Conclusions: We describe a novel presentation of high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma as a metastatic parapharyngeal mass.展开更多
Introduction: Pleomorphic adenoma or mixed salivary gland tumor is a heterogeneous benign tumor of the salivary glands. The most common site is the parotid gland. Its extra-parotid locations, particularly in the acces...Introduction: Pleomorphic adenoma or mixed salivary gland tumor is a heterogeneous benign tumor of the salivary glands. The most common site is the parotid gland. Its extra-parotid locations, particularly in the accessory salivary glands, are rarer. We report a case of a pleomorphic adenoma of the posterior palate which posed management problems. Observation: This is an 85-year-old patient who consulted for a tumor of the posterior palate that had been evolving for 3 years. The examination revealed a globular tumor of the posterior palate extending beyond the midline by approximately 7 cm in long axis, shooting towards the oropharynx and hindering breathing, speech and eating, indicating a life-saving tracheotomy. A CT scan of the facial area revealed a well-circumscribed tumor at the expense of the soft palate, with multiple sites of bone lysis. The biopsy performed was in favor of a pleomorphic adenoma. The patient underwent total surgical excision of a huge tumor on the palate. The aftermath of the operation was marked by a loosening of the sutures with an oronasal fistula requiring the creation of an obturator plate due to the patient’s refusal to have another operation. Conclusion: Large pleomorphic adenoma of the posterior palate is a rare entity that can cause respiratory problems and surgical difficulties. His prognosis is generally good.展开更多
The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowled...The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy.We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland(i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms.We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies.To date the development of facial spasm has not been reported with parotid malignancies.The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle(termed primary or idiopathic)(62%), hereditary(2%), secondary to Bell's palsy or facial nerve injury(17%), and hemifacial spasm mimickers(psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm)(17%).Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.展开更多
The nuclear DNA content in 42 cases of primary parotid pleomorphic adenoma (PPA) and 15 cases of recurrent PPA were analysed with flowcytometer (FCM) to study the correlation of the DNA index (DI), S% and cellular pro...The nuclear DNA content in 42 cases of primary parotid pleomorphic adenoma (PPA) and 15 cases of recurrent PPA were analysed with flowcytometer (FCM) to study the correlation of the DNA index (DI), S% and cellular proliferous index (PI) with the biologic behaivor of the tumor. The results indicated that in a portion of pleomorphic adenoma, the nuclear DNA content had altered and possessed malignant potential before any evidence of malignancy could be found under lightmicroscope. The increase of S% and PI, which followed the course of tumor development, has a close relation with the capsular invasion and the recurrence. There was a significant difference on the DI, S%, PI as well as the incidence of heteroploid between the recurrent and the incipient tumor. A great portion of recurrent tumors, which still diagnosed as benign pathologically, was acually heteroploid.展开更多
The incidence of pleomorphic adenoma (PA) of the minor salivary glands is reported to be 10%, and while the histological findings in PA can be diverse, keratin-filled cysts lined by squamous epithelium are rarely repo...The incidence of pleomorphic adenoma (PA) of the minor salivary glands is reported to be 10%, and while the histological findings in PA can be diverse, keratin-filled cysts lined by squamous epithelium are rarely reported. The condition can, however, present with cyst formation in some cases. We review a rare case of pleomorphic adenoma in the buccal mucosa that involved the formation of multiple squamous epithelium-lined cysts in a 69-year-old woman. Magnetic resonance imaging (MRI), fine needle aspiration cytology, and histopathological examination were performed. Physical examination revealed a painless, mobile, elastic hard mass in the right buccal mucosa, measuring 2.5 × 1.0 cm. The MRI revealed a well-defined lesion with different signal intensities in the medial and distal regions of the right cheek. The medial side of the lesion showed a low signal intensity on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI), while the distal side showed a low signal intensity on T1WI, and a high signal intensity on T2WI and short tau inversion recovery (STIR) imaging. Fine needle aspiration of the lesion was performed under local anesthesia and a cytological diagnosis of an epidermoid or dermoid cyst was made. The tumor was completely resected under local anesthesia combined with intravenous sedation. The histopathological examination demonstrated the proliferation of atypical tumor cells with poor atypia and the formation of glandular, alveolar, large, and small cysts. The cysts were lined by keratinized squamous epithelial cells, their cavities were filled with keratinous material, and foreign body reaction was observed after rupture. Histopathological evaluation led to the diagnosis of pleomorphic adenoma. The patient had no evidence of recurrence, 2 years and 3 months after the surgery. In conclusion, the presence of multiple cysts lined by squamous epithelium can pose a significant diagnostic challenge in patients with PA. It is important to make the correct diagnosis in order to avoid unnecessarily aggressive therapy.展开更多
Background: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgery has been described in 1%-5% of cases, and malignant evolution in 2%-9% of cases. Metastasizing ple...Background: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgery has been described in 1%-5% of cases, and malignant evolution in 2%-9% of cases. Metastasizing pleomorphic adenomas has rarely been reported. No histologic or molecular parameters exist at the present time that could predict the development of metastasis in these neoplasms. Methods and Results: A 54-year-old woman had a superficial left parotidectomy with facial nerve preservation for pleomorphic adenoma. She developed two recurrences in 2000 and 2001, but 25 years later the first operation she presented a metastasis in her right gluteal region with evidence of local recurrence. Conclusion: Metastatizing pleomorphic adenoma is a rare pathologic situation but, in case of swelling or lump appearance in patients with pleomorphic adenoma history, it should be taken in mind.展开更多
Multiple parotid gland tumors are unusual. Warthin’s tumor is the most represented neoplasm in this condition. We present a case of bilateral synchronous pleomorphic adenoma affecting the parotid glands in a 28-year-...Multiple parotid gland tumors are unusual. Warthin’s tumor is the most represented neoplasm in this condition. We present a case of bilateral synchronous pleomorphic adenoma affecting the parotid glands in a 28-year-old woman. Clinically, the lesions were similar to solitary pleomorphic adenoma. Both lesions were diagnosed by fine-needle aspiration cytology. A total parotidectomy for left tumor and surgical enucleation for the right tumor, respectively, were performed with no facial nerves injury. A review of the pertinent literature is included.展开更多
Introduction: Minor salivary gland tumors are relatively rare, but have a higher chance of malignancy than major salivary gland tumors. The palate appears to be the most commonly involved site. The most frequent benig...Introduction: Minor salivary gland tumors are relatively rare, but have a higher chance of malignancy than major salivary gland tumors. The palate appears to be the most commonly involved site. The most frequent benign tumor is the pleomorphic adenoma. Case report: We report a case of a pleomorphic adenoma, which occurred in the hard and soft palate of a 34-year-old female and presented as an asymptomatic slow growing, painless mass. The patient was successfully treated with surgical excision. Discussion: Minor salivary gland tumors should be considered in the differential diagnosis of oral cavity and especially palate tumors. A histological examination is necessary due to the high percentage of malignancy.展开更多
AIM: To investigate C-myc, Ki-67, pan-cytokeratin, and vimentin immunohistochemical features of carcinoma ex pleomorphic adenoma(Ca-ex-PA) and pleomorphic adenoma(PA) in the lacrimal gland in order to find some clues ...AIM: To investigate C-myc, Ki-67, pan-cytokeratin, and vimentin immunohistochemical features of carcinoma ex pleomorphic adenoma(Ca-ex-PA) and pleomorphic adenoma(PA) in the lacrimal gland in order to find some clues in the differential diagnosis between them.METHODS: We reviewed microscopic slides and clinical records of 64 cases of PA and 15 cases of Ca-ex-PA in the lacrimal gland. Immunohistochemical antibodies for C-myc, Ki-67, pan-cytokeratin, and vimentin were employed.RESULTS: Median age of PA was 43.2 y(from 21 to 75). The 35 patients(54.7%) were male and 29 patients(45.3%) were female. For the PAs, the average positivity of C-myc was 4.6%;the average proliferation index of Ki-67 was 3.2%;pan-cytokeratin was positive in ductal cells, and vimentin was positive in myoepithelial cells. Median age of Ca-ex-PA was 54.3 y(from 26 to 76). There were 7 male patients(46.7%) and 8 female patients(53.3%). Among 15 Ca-ex-PAs, there were 6 myoepithelial carcinomas, 4 adenocarcinomas, 3 epithelial-myoepithelial carcinomas, and 2 squamous cell carcinomas. For the Ca-ex-PAs, the average positivity of C-myc was 36.4%;the average proliferation index of Ki-67 was 29.2%;pan-cytokeratin was positive in all cases, and vimentin was positive in myoepithelial carcinomas.CONCLUSION: PA has a lower positivity of C-myc and Ki-67, while Ca-ex-PA had a higher positivity of these two biomarkers. These four biomarkers as a set could provide valuable clues in the differential diagnosis between Ca-exPA and PA. Our results indicate that the activation of C-myc could play an important role in the pathogenesis of Ca-exPA and PA.展开更多
BACKGROUND Carcinoma ex pleomorphic adenoma (CXPA) is defined as a malignant salivary gland tumor arising from a primary or recurrent pleomorphic adenoma.Only three cases of CXPA of the trachea have been reported in t...BACKGROUND Carcinoma ex pleomorphic adenoma (CXPA) is defined as a malignant salivary gland tumor arising from a primary or recurrent pleomorphic adenoma.Only three cases of CXPA of the trachea have been reported in the literature.CASE SUMMARY We report a case of tracheal CXPA in a 55-year-old woman,who presented with a more than 3-mo history of progressive dyspnea.Computed tomography of the neck and thorax revealed an inhomogeneous,broad-based lesion arising from the tracheal wall on the right side.Endoscopy revealed a subglottic neoplasm causing up to 90% luminal stenosis.The tumor was resected using a highfrequency electrosurgical snare combined with argon plasma coagulation.Histopathology and immunohistochemistry revealed that the tumor was a CXPA of the trachea.CONCLUSION We report the fourth case of tracheal CXPA,and present the first instance of resection of CXPA using high-frequency electrosurgical snare and laser ablation.We also discuss the pathogenesis,diagnosis,histopathology,and systemic therapy of this rare disease.展开更多
We report a case of carcinoma ex pleomorphic adenoma of a sublingual gland in a 70-year-old man.Under a clinical diagnosis of benign salivary gland tumor,excision of the mass with the sublingual salivary gland in an e...We report a case of carcinoma ex pleomorphic adenoma of a sublingual gland in a 70-year-old man.Under a clinical diagnosis of benign salivary gland tumor,excision of the mass with the sublingual salivary gland in an en bloc fashion via an intraoral approach was performed.Histopathologically,there was a rupture of the fibrous capsule and diffuse cell-rich sheets composed of myoepithelial cells with round nuclei were also seen.Immunohistochemically,the cells that composed of cell rich sheets were positive to smooth muscle actin.Final diagnosis of myoepithelial carcinoma ex pleomorphic adenoma was made.展开更多
AIM:To monitor the prognosis of patients with lacrimal gland pleomorphic adenoma(LGPA)following surgical resection within the past 10y.The factors affecting patient prognosis are analyzed and the experience of surgica...AIM:To monitor the prognosis of patients with lacrimal gland pleomorphic adenoma(LGPA)following surgical resection within the past 10y.The factors affecting patient prognosis are analyzed and the experience of surgical treatment is summarized.METHODS:In this retrospective,comparative case series,clinical records from 109 cases of LGPA treated chiefly at the same institution between November 2009 and May 2019 were reviewed.All 109 patients underwent surgery,histopathological examination,and imaging examination.For patients who underwent surgery for the first time,LGPA could be resected completely,including tumor and capsule tissues,using a surgical approach via the eyebrow arch or double eyelid crease.RESULTS:The ratio of males to females was 1:1.60,the ages ranged from 19 to 74 years old with a mean age of 43.64±13.07 years old,and the ratio of left to right eyes was 1:1.37.A total of 109 patients underwent surgical excision and five of these收稿日期radiotherapy after malignant transformation.Of these patients,15 were lost to follow up within the April 1,2020 deadline and 1 was diagnosed as a recurring pathology.The 5-year recurrence rate for 86 patients who underwent initial surgery was 7.27%.Single factor analysis revealed that the course of disease,bone destruction,invasion of surrounding tissues,tumor size,capsule integrity,and expression of Ki-67 were statistically significant(P<0.05).Binomial Logistic regression analysis showed that capsule integrity was a risk factor influencing recurrence(P=0.008).CONCLUSION:LGPA has a risk of recurrence and potential for malignant transformation.Complete removal of the tumor and capsule in the initial surgery is a key factor in preventing recurrence.展开更多
BACKGROUND Myoepithelial carcinoma(MC)is a clinically rare malignancy,there is controversy regarding its etiology and its biological behavior is not fully elucidated.Extensive surgical resection is the main treatment ...BACKGROUND Myoepithelial carcinoma(MC)is a clinically rare malignancy,there is controversy regarding its etiology and its biological behavior is not fully elucidated.Extensive surgical resection is the main treatment method.We describe a case of pleomorphic adenoma(PA)with multiple postoperative recurrences after malignant transformation,and the history of the disease in this patient was more than 20 years.Complete resection during the first surgery of PA and long-term postoperative follow-up is necessary.CASE SUMMARY A 34-year-old male with PA and a history of 5 postoperative recurrences over 21 years,each surgically removed,presented 15 d ago with headache,nasal congestion,protrusion of the right eyeball and loss of vision in the right eye,with progressively worsening symptoms.The patient underwent surgery,and MC was confirmed by pathology examination.A small PA component was locally visible under light microscope.The patient had a recurrence of the tumor 2 mo after surgery and underwent surgical resection.CONCLUSION During the first operation for PA,care should be taken not to rupture the envelope to prevent tumor cell implantation,and when complete resection is not possible due to the anatomical site,postoperative radiotherapy is necessary to control the lesion and prevent infiltration and malignant transformation of the tumor to MC.Computed tomography and magnetic resonance imaging is important for establishing diagnosis and developing a treatment plan.展开更多
Salivary gland tumors, the second most common neoplasm of the mouth after squamous cell carcinoma, account for a significant proportion of tumors of the oral and perioral regions. An unusual case of adenoma presented ...Salivary gland tumors, the second most common neoplasm of the mouth after squamous cell carcinoma, account for a significant proportion of tumors of the oral and perioral regions. An unusual case of adenoma presented as a solitary intraoral palatine mass in a 32-year-old woman is reported here. The tumor was interpreted as an unusual pleomorphic adenoma because of the presence of exuberant squamous metaplasia, clinically mimicking squamous cell carcinoma. Moreover, the presence of cystic structures filled with keratinized material was also salient feature. Pleomorphic adenomas may occasionally display focal squamous metaplastic changes;when extensive, it presents the potential for misinterpretation of the histology as indicative of well-differentiated squamous cell carcinoma.展开更多
BACKGROUND Only a few cases of carcinoma ex pleomorphic adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic ...BACKGROUND Only a few cases of carcinoma ex pleomorphic adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic adenoma is surgical resection combined with postoperative radiotherapy,but the necessity of chemotherapy as well as the most appropriate treatment regimen for patients with distant metastasis after radiotherapy remains controversial.CASE SUMMARY This report presents the case of a 73-year-old woman who suffered submandibular gland carcinoma ex pleomorphic adenoma. She accepted surgery to remove the mass; she was found to have lung metastasis after radiotherapy.Her condition was controlled by chemotherapy with liposomal doxorubicin plus cisplatin.CONCLUSION The positive clinical outcome in the patient reveals that this chemotherapy regimen may be an alternative treatment for such a condition.展开更多
BACKGROUND Pleomorphic adenoma(PA)is the most common benign tumor that occurs in the salivary glands;however,tracheobronchial PA is rarely observed.To the best of our knowledge,fewer than 50 cases have been reported i...BACKGROUND Pleomorphic adenoma(PA)is the most common benign tumor that occurs in the salivary glands;however,tracheobronchial PA is rarely observed.To the best of our knowledge,fewer than 50 cases have been reported in the literature.We report a 49-year-old woman who had been treated for asthma for 2 years before being diagnosed with PA of the trachea.CASE SUMMARY A 49-year-old woman was referred to our hospital due to dyspnea upon exertion and chronic cough with wheezing for 2 years.Laboratory tests showed an elevated white blood cell count,absolute neutrophil count,and percentage of neutrophils.A chest computerized tomography scan showed a well-defined,softtissue density lesion measuring 2.4 cm×2.1 cm in the lower trachea.Flexible bronchoscopy revealed that nearly 90%of the tracheal lumen was obstructed.The histopathological and immunohistochemistry features suggested PA of the trachea.Furthermore,we review the characteristics of 29 patients with tracheobronchial PA over the last 30 years.CONCLUSION Tracheobronchial PA occurs without gender predominance,mostly in the lower or upper trachea,and has a low recurrence rate.The median age at diagnosis is 48 years.The most common symptoms are cough,stridor,dyspnea,and wheezing.展开更多
文摘BACKGROUND Salivary gland tumors are relatively rare.Most minor salivary gland tumors are malignant with benign tumors accounting for 18%of the tumors.Pleomorphic adenoma(PA)is the most common salivary gland tumor.Lip PA is uncommon with 9.8%occurring in the upper lip.We are adding on the knowledge of the rare upper lip PA(benign mixed tumor).CASE SUMMARY We report an upper lip PA(benign mixed tumor)in a 28-year-old man.His complaint was a painless swelling on the upper lip.A painless,non-tender,well-circumscribed,slightly mobile,sessile,nodular,and rubbery(in consistency)tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip.The overlying skin was not fixed and of normal color.There was no ulceration,and palpation did not elicit pain or bleeding.There was no history of trauma.Blunt dissection was used to completely excise the nodular,whitish,and encapsulated tumor.Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion,with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells,well-formed tubules containing eosinic secretion,and nests of myoepithelial cells.A diagnosis of PA(benign mixed tumor)was confirmed.CONCLUSION Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.
文摘Pleomorphic adenoma is the most common tumor of the salivary glands, accounting for approximately 50% of salivary gland lesions. It develops mainly in the salivary glands: parotid (80%), submaxillary (10%), sublingual (1%) and in the accessory oral-pharyngeal glands (9%). The aim of this work was to report 2 cases of pleomorphic adenoma of atypical location and then to discuss the difficulties linked to its diagnostic and therapeutic management in the Malian context. They were a 40-year-old man and a 72-year-old woman. They were admitted to the ENT department of the “Luxembourg Mere-infant” hospital for oropharyngeal swelling for the first and swelling of the palate for the second. The clinical expression was a swelling in both cases, of a hard, mobile consistency with healthy mucosa on their surface. The remainder of the physical examination was unremarkable. The diagnosis of a tumor of the oropharynx and palate was made following clinical radiological examinations. The histopathological examination of the surgical specimen made it possible to make the diagnosis of pleomorphic adenoma of the palate and the left palatine tonsil. The follow-up surgery was straightforward, with a favorable outcome. Pleomorphic adenomas are relatively rare benign tumors of the accessory salivary glands;their clinical expression remains swelling. Therapeutic management is surgery and the diagnosis is confirmed by histopathological examination.
文摘·AIM: To detect proteomic differences in tears between adenoid cystic carcinoma(ACC) and pleomorphic adenoma(PA).·METHODS: Tear samples were collected from 4 patients with ACC, 5 with PA, and 4 control cases. Label-free analysis and parallel reaction monitoring(PRM) were used to screen and validate the tear proteome. Gene Ontology(GO) annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG) were conducted for bioinformatics analysis.·RESULTS: In total, 1059 proteins in tear samples were identified by label-free analysis. Between ACC and PA, 415 differentially expressed proteins were detected. Based on the GO annotation, enzyme regulator activity and serinetype endopeptidase inhibitor activity in the molecular function category, blood microparticle and extracellular matrix in the cellular component category, and response to nutrient levels in the biological process category were most predominant. By KEGG pathway annotation, the different proteins between ACC and PA mainly par ticipated in complement and coagulation cascades, amoebiasis, African trypanosomiasis and cholesterol metabolism. Eight proteins with mostly significant differences were verified by PRM, and five proteins with more than 10-fold increases in ACC compared with PA, including integrin β, α-2-macroglobulin, epididymal secretory sperm binding protein Li 78p, RAB5C, and complement C5, were identified.·CONCLUSION: The combined tools of label-free analysis and PRM are very effective and efficient, especially for samples such as tears. Some proteomic dif ferences in tears between ACC and PA are identified and these protein candidates may be specific biomarkers for future exploration.
文摘Pleomorphic adenoma is the most common benign parotid gland tumor. Although its local recurrence rate is known to be high, the recurrence extending to the cervical region is rare. Here we report a case of a young female (25 years old) with pleomorphic adenoma of the parotid gland which showed multiple recurrences through facial to cervical regions over a span of eight years. We also discuss how this benign tumor with a high recurrence rate has been treated in other cases, and how it should be treated.
文摘Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological diagnosis. Methods: We present a case of a 71-year-old male with an enlarging left neck mass over several months. CT showed both a parapharyngeal space mass and a separate level II neck mass. Results: The patient underwent resection of the left parapharyngeal mass and ipsilateral selective level II-IV lymphadenectomy. The final pathologic diagnosis was metastatic high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma. Conclusions: We describe a novel presentation of high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma as a metastatic parapharyngeal mass.
文摘Introduction: Pleomorphic adenoma or mixed salivary gland tumor is a heterogeneous benign tumor of the salivary glands. The most common site is the parotid gland. Its extra-parotid locations, particularly in the accessory salivary glands, are rarer. We report a case of a pleomorphic adenoma of the posterior palate which posed management problems. Observation: This is an 85-year-old patient who consulted for a tumor of the posterior palate that had been evolving for 3 years. The examination revealed a globular tumor of the posterior palate extending beyond the midline by approximately 7 cm in long axis, shooting towards the oropharynx and hindering breathing, speech and eating, indicating a life-saving tracheotomy. A CT scan of the facial area revealed a well-circumscribed tumor at the expense of the soft palate, with multiple sites of bone lysis. The biopsy performed was in favor of a pleomorphic adenoma. The patient underwent total surgical excision of a huge tumor on the palate. The aftermath of the operation was marked by a loosening of the sutures with an oronasal fistula requiring the creation of an obturator plate due to the patient’s refusal to have another operation. Conclusion: Large pleomorphic adenoma of the posterior palate is a rare entity that can cause respiratory problems and surgical difficulties. His prognosis is generally good.
基金support of this research by the Mount Sinai Health System and the THANC Foundation
文摘The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy.We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland(i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms.We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies.To date the development of facial spasm has not been reported with parotid malignancies.The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle(termed primary or idiopathic)(62%), hereditary(2%), secondary to Bell's palsy or facial nerve injury(17%), and hemifacial spasm mimickers(psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm)(17%).Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.
文摘The nuclear DNA content in 42 cases of primary parotid pleomorphic adenoma (PPA) and 15 cases of recurrent PPA were analysed with flowcytometer (FCM) to study the correlation of the DNA index (DI), S% and cellular proliferous index (PI) with the biologic behaivor of the tumor. The results indicated that in a portion of pleomorphic adenoma, the nuclear DNA content had altered and possessed malignant potential before any evidence of malignancy could be found under lightmicroscope. The increase of S% and PI, which followed the course of tumor development, has a close relation with the capsular invasion and the recurrence. There was a significant difference on the DI, S%, PI as well as the incidence of heteroploid between the recurrent and the incipient tumor. A great portion of recurrent tumors, which still diagnosed as benign pathologically, was acually heteroploid.
文摘The incidence of pleomorphic adenoma (PA) of the minor salivary glands is reported to be 10%, and while the histological findings in PA can be diverse, keratin-filled cysts lined by squamous epithelium are rarely reported. The condition can, however, present with cyst formation in some cases. We review a rare case of pleomorphic adenoma in the buccal mucosa that involved the formation of multiple squamous epithelium-lined cysts in a 69-year-old woman. Magnetic resonance imaging (MRI), fine needle aspiration cytology, and histopathological examination were performed. Physical examination revealed a painless, mobile, elastic hard mass in the right buccal mucosa, measuring 2.5 × 1.0 cm. The MRI revealed a well-defined lesion with different signal intensities in the medial and distal regions of the right cheek. The medial side of the lesion showed a low signal intensity on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI), while the distal side showed a low signal intensity on T1WI, and a high signal intensity on T2WI and short tau inversion recovery (STIR) imaging. Fine needle aspiration of the lesion was performed under local anesthesia and a cytological diagnosis of an epidermoid or dermoid cyst was made. The tumor was completely resected under local anesthesia combined with intravenous sedation. The histopathological examination demonstrated the proliferation of atypical tumor cells with poor atypia and the formation of glandular, alveolar, large, and small cysts. The cysts were lined by keratinized squamous epithelial cells, their cavities were filled with keratinous material, and foreign body reaction was observed after rupture. Histopathological evaluation led to the diagnosis of pleomorphic adenoma. The patient had no evidence of recurrence, 2 years and 3 months after the surgery. In conclusion, the presence of multiple cysts lined by squamous epithelium can pose a significant diagnostic challenge in patients with PA. It is important to make the correct diagnosis in order to avoid unnecessarily aggressive therapy.
文摘Background: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgery has been described in 1%-5% of cases, and malignant evolution in 2%-9% of cases. Metastasizing pleomorphic adenomas has rarely been reported. No histologic or molecular parameters exist at the present time that could predict the development of metastasis in these neoplasms. Methods and Results: A 54-year-old woman had a superficial left parotidectomy with facial nerve preservation for pleomorphic adenoma. She developed two recurrences in 2000 and 2001, but 25 years later the first operation she presented a metastasis in her right gluteal region with evidence of local recurrence. Conclusion: Metastatizing pleomorphic adenoma is a rare pathologic situation but, in case of swelling or lump appearance in patients with pleomorphic adenoma history, it should be taken in mind.
文摘Multiple parotid gland tumors are unusual. Warthin’s tumor is the most represented neoplasm in this condition. We present a case of bilateral synchronous pleomorphic adenoma affecting the parotid glands in a 28-year-old woman. Clinically, the lesions were similar to solitary pleomorphic adenoma. Both lesions were diagnosed by fine-needle aspiration cytology. A total parotidectomy for left tumor and surgical enucleation for the right tumor, respectively, were performed with no facial nerves injury. A review of the pertinent literature is included.
文摘Introduction: Minor salivary gland tumors are relatively rare, but have a higher chance of malignancy than major salivary gland tumors. The palate appears to be the most commonly involved site. The most frequent benign tumor is the pleomorphic adenoma. Case report: We report a case of a pleomorphic adenoma, which occurred in the hard and soft palate of a 34-year-old female and presented as an asymptomatic slow growing, painless mass. The patient was successfully treated with surgical excision. Discussion: Minor salivary gland tumors should be considered in the differential diagnosis of oral cavity and especially palate tumors. A histological examination is necessary due to the high percentage of malignancy.
基金Supported by the National Natural Science Foundation of China (No.30371515)
文摘AIM: To investigate C-myc, Ki-67, pan-cytokeratin, and vimentin immunohistochemical features of carcinoma ex pleomorphic adenoma(Ca-ex-PA) and pleomorphic adenoma(PA) in the lacrimal gland in order to find some clues in the differential diagnosis between them.METHODS: We reviewed microscopic slides and clinical records of 64 cases of PA and 15 cases of Ca-ex-PA in the lacrimal gland. Immunohistochemical antibodies for C-myc, Ki-67, pan-cytokeratin, and vimentin were employed.RESULTS: Median age of PA was 43.2 y(from 21 to 75). The 35 patients(54.7%) were male and 29 patients(45.3%) were female. For the PAs, the average positivity of C-myc was 4.6%;the average proliferation index of Ki-67 was 3.2%;pan-cytokeratin was positive in ductal cells, and vimentin was positive in myoepithelial cells. Median age of Ca-ex-PA was 54.3 y(from 26 to 76). There were 7 male patients(46.7%) and 8 female patients(53.3%). Among 15 Ca-ex-PAs, there were 6 myoepithelial carcinomas, 4 adenocarcinomas, 3 epithelial-myoepithelial carcinomas, and 2 squamous cell carcinomas. For the Ca-ex-PAs, the average positivity of C-myc was 36.4%;the average proliferation index of Ki-67 was 29.2%;pan-cytokeratin was positive in all cases, and vimentin was positive in myoepithelial carcinomas.CONCLUSION: PA has a lower positivity of C-myc and Ki-67, while Ca-ex-PA had a higher positivity of these two biomarkers. These four biomarkers as a set could provide valuable clues in the differential diagnosis between Ca-exPA and PA. Our results indicate that the activation of C-myc could play an important role in the pathogenesis of Ca-exPA and PA.
文摘BACKGROUND Carcinoma ex pleomorphic adenoma (CXPA) is defined as a malignant salivary gland tumor arising from a primary or recurrent pleomorphic adenoma.Only three cases of CXPA of the trachea have been reported in the literature.CASE SUMMARY We report a case of tracheal CXPA in a 55-year-old woman,who presented with a more than 3-mo history of progressive dyspnea.Computed tomography of the neck and thorax revealed an inhomogeneous,broad-based lesion arising from the tracheal wall on the right side.Endoscopy revealed a subglottic neoplasm causing up to 90% luminal stenosis.The tumor was resected using a highfrequency electrosurgical snare combined with argon plasma coagulation.Histopathology and immunohistochemistry revealed that the tumor was a CXPA of the trachea.CONCLUSION We report the fourth case of tracheal CXPA,and present the first instance of resection of CXPA using high-frequency electrosurgical snare and laser ablation.We also discuss the pathogenesis,diagnosis,histopathology,and systemic therapy of this rare disease.
文摘We report a case of carcinoma ex pleomorphic adenoma of a sublingual gland in a 70-year-old man.Under a clinical diagnosis of benign salivary gland tumor,excision of the mass with the sublingual salivary gland in an en bloc fashion via an intraoral approach was performed.Histopathologically,there was a rupture of the fibrous capsule and diffuse cell-rich sheets composed of myoepithelial cells with round nuclei were also seen.Immunohistochemically,the cells that composed of cell rich sheets were positive to smooth muscle actin.Final diagnosis of myoepithelial carcinoma ex pleomorphic adenoma was made.
基金Beijing Hospitals Authority’Ascent Plan (No.DFL20190201).
文摘AIM:To monitor the prognosis of patients with lacrimal gland pleomorphic adenoma(LGPA)following surgical resection within the past 10y.The factors affecting patient prognosis are analyzed and the experience of surgical treatment is summarized.METHODS:In this retrospective,comparative case series,clinical records from 109 cases of LGPA treated chiefly at the same institution between November 2009 and May 2019 were reviewed.All 109 patients underwent surgery,histopathological examination,and imaging examination.For patients who underwent surgery for the first time,LGPA could be resected completely,including tumor and capsule tissues,using a surgical approach via the eyebrow arch or double eyelid crease.RESULTS:The ratio of males to females was 1:1.60,the ages ranged from 19 to 74 years old with a mean age of 43.64±13.07 years old,and the ratio of left to right eyes was 1:1.37.A total of 109 patients underwent surgical excision and five of these收稿日期radiotherapy after malignant transformation.Of these patients,15 were lost to follow up within the April 1,2020 deadline and 1 was diagnosed as a recurring pathology.The 5-year recurrence rate for 86 patients who underwent initial surgery was 7.27%.Single factor analysis revealed that the course of disease,bone destruction,invasion of surrounding tissues,tumor size,capsule integrity,and expression of Ki-67 were statistically significant(P<0.05).Binomial Logistic regression analysis showed that capsule integrity was a risk factor influencing recurrence(P=0.008).CONCLUSION:LGPA has a risk of recurrence and potential for malignant transformation.Complete removal of the tumor and capsule in the initial surgery is a key factor in preventing recurrence.
文摘BACKGROUND Myoepithelial carcinoma(MC)is a clinically rare malignancy,there is controversy regarding its etiology and its biological behavior is not fully elucidated.Extensive surgical resection is the main treatment method.We describe a case of pleomorphic adenoma(PA)with multiple postoperative recurrences after malignant transformation,and the history of the disease in this patient was more than 20 years.Complete resection during the first surgery of PA and long-term postoperative follow-up is necessary.CASE SUMMARY A 34-year-old male with PA and a history of 5 postoperative recurrences over 21 years,each surgically removed,presented 15 d ago with headache,nasal congestion,protrusion of the right eyeball and loss of vision in the right eye,with progressively worsening symptoms.The patient underwent surgery,and MC was confirmed by pathology examination.A small PA component was locally visible under light microscope.The patient had a recurrence of the tumor 2 mo after surgery and underwent surgical resection.CONCLUSION During the first operation for PA,care should be taken not to rupture the envelope to prevent tumor cell implantation,and when complete resection is not possible due to the anatomical site,postoperative radiotherapy is necessary to control the lesion and prevent infiltration and malignant transformation of the tumor to MC.Computed tomography and magnetic resonance imaging is important for establishing diagnosis and developing a treatment plan.
文摘Salivary gland tumors, the second most common neoplasm of the mouth after squamous cell carcinoma, account for a significant proportion of tumors of the oral and perioral regions. An unusual case of adenoma presented as a solitary intraoral palatine mass in a 32-year-old woman is reported here. The tumor was interpreted as an unusual pleomorphic adenoma because of the presence of exuberant squamous metaplasia, clinically mimicking squamous cell carcinoma. Moreover, the presence of cystic structures filled with keratinized material was also salient feature. Pleomorphic adenomas may occasionally display focal squamous metaplastic changes;when extensive, it presents the potential for misinterpretation of the histology as indicative of well-differentiated squamous cell carcinoma.
文摘BACKGROUND Only a few cases of carcinoma ex pleomorphic adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic adenoma is surgical resection combined with postoperative radiotherapy,but the necessity of chemotherapy as well as the most appropriate treatment regimen for patients with distant metastasis after radiotherapy remains controversial.CASE SUMMARY This report presents the case of a 73-year-old woman who suffered submandibular gland carcinoma ex pleomorphic adenoma. She accepted surgery to remove the mass; she was found to have lung metastasis after radiotherapy.Her condition was controlled by chemotherapy with liposomal doxorubicin plus cisplatin.CONCLUSION The positive clinical outcome in the patient reveals that this chemotherapy regimen may be an alternative treatment for such a condition.
基金Supported by the Natural Science Foundation of Guangdong Province,China,No.2020A1515010119.
文摘BACKGROUND Pleomorphic adenoma(PA)is the most common benign tumor that occurs in the salivary glands;however,tracheobronchial PA is rarely observed.To the best of our knowledge,fewer than 50 cases have been reported in the literature.We report a 49-year-old woman who had been treated for asthma for 2 years before being diagnosed with PA of the trachea.CASE SUMMARY A 49-year-old woman was referred to our hospital due to dyspnea upon exertion and chronic cough with wheezing for 2 years.Laboratory tests showed an elevated white blood cell count,absolute neutrophil count,and percentage of neutrophils.A chest computerized tomography scan showed a well-defined,softtissue density lesion measuring 2.4 cm×2.1 cm in the lower trachea.Flexible bronchoscopy revealed that nearly 90%of the tracheal lumen was obstructed.The histopathological and immunohistochemistry features suggested PA of the trachea.Furthermore,we review the characteristics of 29 patients with tracheobronchial PA over the last 30 years.CONCLUSION Tracheobronchial PA occurs without gender predominance,mostly in the lower or upper trachea,and has a low recurrence rate.The median age at diagnosis is 48 years.The most common symptoms are cough,stridor,dyspnea,and wheezing.
