Diagnosis requires that elements from the benign pleomorphic adenoma and the malignant component need to be seen. Of all the benign tumours pleomorphic adenoma is the commonest. Pleomorphic adenoma and mucoepidermoid carcinoma are common in occurrence and create problems in diagnosis. Nov 01, 2015 pleomorphic adenoma forms the majority of salivary gland neoplasms.
Pleomorphic adenoma polymorphic, fibrillary matrix basal cell adenocarcinoma nuclear atypia, mitosis, necrosis adenoid cystic carcinoma hyperchromatic irregular nucleus, coarse chromatin. Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. Pleomorphic adenoma, also referred to as benign mixed tumors bmts, is a benign or a noncancerous growth in the salivary gland, the most commonly occurring parotid tumor. To assess the value of fine needle aspiration cytology fnac in the diagnosis of pleomorphic adenoma and to determine the cytologic variations responsible for diagnostic errors. It progresses slowly and, left untreated, can produce signi. A case report of 28 year old male patient diagnosed of pleomorphic adenoma of palate, is presented here. Carcinoma ex pleomorphic adenoma ca ex pa is a malignant neoplasm arising from primary or recurrent benign pleomorphic adenoma. Pleomorphic adenoma pleomorphic adenoma of the breast is a rare benign tumor, with patients ranging age from 23 to 78years. Pleomorphic adenoma definition of pleomorphic adenoma by. Fine needle aspiration cytology of benign salivary gland tumors. Cellular specimens with sparse or absent matrix material lesions with focal hyalineglobulesadenoid cysticlike areas lesions with cytologicatypia lesions with metaplasticchanges, especially squamous. On these bases, a diagnosis of atypical pleomorphic adenoma was performed.
Pleomorphic adenoma is the most common salivary gland tumor and accounts for approximately 80% of parotid tumors. Fine needle aspiration cytology of cellular pleomorphic adenoma. May also occur in other major salivary glands submandibular and sublingual. Primary pleomorphic adenoma of the external auditory canal. Invasive salivary duct carcinoma ex pleomorphic adenoma of.
Fine needle aspiration cytology of salivary gland lesions. It is isointense to muscle on t1 and strikingly hyperintense on t2. Atypical pleomorphic adenoma with chronic sialoadenitis of. Carcinoma ex pleomorphic adenoma is an epithelial malignant neoplasm arising from a primary or recurrent pleomorphic adenoma and is a diagnostic challenge for cytopathologists. Pleomorphic adenoma of the minor salivary glands most commonly occurs in the palate 16. Ashok kumar tanwani department of pathology, pakistan institute of medical sciences introduction. Among all salivary gland neoplasms, carcinoma ex pleomorphic adenoma ca ex pa accounts for approximately 3. Plasmacytoid cell rich pleomorphic adenoma a diagnostic. The most common site of pleomorphic adenoma of the minor salivary glands is the palate followed by lip, buccal mucosa, floor of mouth, tongue, tonsil, pharynx, retro molar area and nasal cavity 47. Mri through the left parotid gland demonstrates a sharply circumscribed solid mass in the superficial aspect of the gland. Mixed tumor of the lacrimal gland pleomorphic adenoma definition. Pdf fine needle aspiration cytology of pleomorphic.
Pleomorphic adenoma or benign mixed tumor is the most common salivary gland neoplasm. The diagnosis of pleomorphic adenoma is established on the basis of history, physical examination, cytology and histopathology. Carcinoma ex pleomorphic adenoma diagnostic histopathology. An introduction to cytopathology is in the cytopathology article. The patient presented excellent cosmetic and functional results, without signs of facial nerve palsy, damage or recurrence. Occasionally, some scattered foci of capsular pseudoinfiltration were detected. Pleomorphic adenoma, abbreviated pa, is a very common benign salivary gland tumour.
Dec 26, 2014 the epithelial cells make up a trabecular pattern that is contained within a stroma. Fine needle aspiration cytology fnac of salivary gland lesion is being increasingly used. Despite of that, ca ex pa is uncommon and has a prevalence rate of 5. The malignant component can be of any histologic type, but salivary duct carcinoma is the most common histologic type seen.
The present study was performed to evaluate the variations in the cytological features of pleomorphic adenoma and to assess the efficacy of fnac in its diagnosis. Primary pleomorphic adenoma of minor salivary gland in the. Pleomorphic adenoma is the most common benign salivary gland neoplasm. The diverse morphological features encountered in pleomorphic adenoma pa may cause diagnostic errors in. Mucin in the background atypia in pleomorphic adenoma cellularity with scanty matrix pitfalls in diagnosing pleomorphic adenomas.
A pleomorphic adenoma is a tumour of a gland that produces saliva in the mouth. It is a benign tumor composed of epithelial and myoepithelial cells arranged in various morphological patterns. Primary pulmonary pleomorphic adenoma is a very rare benign tumor that tends to arise in the large airways tumors tend to show small, branching, double layered ductules rather than ducts and less cartilaginous stroma as compared to pleomorphic adenomas arising in the salivary gland. The epidemiology of pleomorphic adenoma can cover all ages and both genders but is more prevalent among women from thirty to sixty years of age. Pleomorphic adenoma is the most common epithelial tumour of. A case of adenoid cystic carcinoma was underdiagnosed as basal cell adenoma in fnac. Surgery is the most common form of treatment for pleomorphic adenoma. Mar 15, 20 the diagnosis of pleomorphic adenoma is established on the basis of history, physical examination, cytology and histopathology. Pleomorphic adenoma is the most common neoplasm of the parotid gland. There are three main patterns of malignant change that occur in pleomorphic adenoma. Most commonly affected site is the parotid gland 84% of cases.
Fine needle aspiration cytology of pleomorphic adenoma. Discussion pleomorphic adenoma pa is a benign salivary gland tumour. To assess the value of fine needle aspiration cytology fnac in the diagnosis. The most common missed diagnosis was mucoepidermoid carcinoma. Pleomorphic adenoma is the most common tumor of the salivary glands. Features are characteristic of a pleomorphic adenoma which was subsequently excised and confirmed histologically.
Pleomorphic adenoma, the most common salivary gland tumor, is also known as benign mixed tumors bmts, because of its dual origin from epithelial and myoepithelial elements. The present study was performed to evaluate the variations in the cytological features of pleomorphic adenoma and to assess the ef. Fineneedle aspiration biopsy of salivary gland lesions. We used antisera to vimentin v, desmin d, epithelial membrane antigen ema, prostate specific antigen psa, pancytokeratin, carcinoembryonic antigen cea, glial. Therefore, we finally made a diagnosis of invasive salivary duct carcinoma ex pleomorphic adenoma. Pleomorphic adenoma of the lacrimal gland in a teenager, a. The objective of this study was to clarify the clinical presentation and treatment of pa of the eac. Fine needle aspiration cytology fnac showed ductal cells, chondromyxoid matrix and myoepithelial cells, most likely pleomorphic adenoma. The accuracy of salivary cytology is high for the diagnosis of the most common salivary gland tumors such as pleomorphic adenoma and warthin tumor, but the specificity for subtyping a particular neoplasm shows a wide range 48 to 94 percent depending on tumor type. Primary pulmonary pleomorphic adenoma is a very rare benign tumor that tends to arise in the large airways tumors tend to show small, branching, double layered ductules rather than ducts and less cartilaginous stroma as compared to. It has a female predilection and occ excision bears a risk of injury to the facial nerve as it enters the substance of the parotid gland and divides into its key adenoma constitutes up to two third pleomorphic adenoma is the most common. Pleomorphic adenoma pa is a benign tumour that mainly arises from salivary glands, and pa of the external auditory canal eac is very rare.
Pleomorphic adenoma is a painless swelling which gradually increases in size if left untreated. Salivary gland tumor fineneedle aspiration cytology ncbi. Hereby we report this interesting and rare case of cystic pleomorphic adenoma in a 32yearold male. Hereby we report this interesting and rare case of cystic pleomorphic adenoma in a 32yearold. The diverse morphological features encountered in pleomorphic adenoma pa may cause diagnostic errors in fine needle aspiration cytology fnac. The pleomorphic adenoma most commonly occurred in parotid gland 72. Pdf to assess the value of fine needle aspiration cytology fnac in the diagnosis of pleomorphic adenoma and to determine the cytologic variations. The presence of these different elements accounts for the name pleomorphic tumor or mixed one characteristic of a pleomorphic adenoma is the presence of microscopic projections of tumor outside of the. Within the background of pleomorphic adenoma, the carcinoma cells sometimes replaced ductal luminal cells while retaining an intactlike myoepithelial layer.
The difference in the clinical features between carcinoma. The epithelial cells make up a trabecular pattern that is contained within a stroma. Pleomorphic adenoma surgery, symptoms, causes, treatment. Pdf fineneedle aspiration fna and pleural fluid cytology. Immunomorphological characteristics of pleomorphic adenoma of salivary glands the immunohistochemical profile of 23 pleomorphic adenomas and 7 normal salivary glands was studied. Pdf fine needle aspiration cytology of pleomorphic adenoma. Pleomorphic adenoma forms the majority of salivary gland neoplasms. One was a basal cell adenoma and the other was a myoepithelioma.
Metastasizing pleomorphic adenoma the term currently preferred by the world health organization who is also known as metastasizing. During the surgery the part of the organ that is affected by the pleomorphic. Pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. A further limitation of this study is that no adc comparisons could be performed among the different histological types of the pleomorphic adenoma cases of this study. Fineneedle aspiration fna and pleural fluid cytology diagnosis of benign metastasizing pleomorphic adenoma of the parotid gland in the lung. An incisional biopsy must be performed to determine the proper management regimen and treatment 15, 16. Pm roplekar, sn ramraje, sg surase abstract pleomorphic adenoma p. Hence, the final diagnosis was of giant pleomorphic adenoma with negative surgical margins. It is found mostly in the parotid gland in middleaged women. Pleomorphic adenoma of the parapharyngeal space is rare. An introduction to cytopathology is in the cytopathology article salivary gland cytopathology and salivary gland cytology redirect to here. Management and prognostic factors of recurrent pleomorphic. It derives its name from the architectural pleomorphism variable. Carcinoma ex pleomorphic adenoma is a malignant salivary gland tumor that arises in association with pleomorphic adenoma.
Pleomorphic adenoma pa is the most common salivary gland tumor in both children and. Pleomorphic adenoma symptoms, causes, treatment, surgery. It is the commonest of all salivary gland tumors constituting up to twothirds of all salivary gland tumors. Dec 14, 2019 the etiology of metastasizing pleomorphic adenoma is not clearly understood, but a number of theories have been put forward. Both may contain squamous epithelium with keratinization and may be difficult to differentiate in small biopsy or cytology material.
Mar, 2019 pleomorphic adenoma pa is the most common type of salivary gland tumor with a high recurrence and malignant transformation. Cystic change in pleomorphic adenomas is a diagnostic dilemma and can mimic mucoepidermoid carcinoma, mucocele or carcinoma ex pleomorphic adenoma and squamous cell carcinoma. Future studies would be recommended to address the diagnostic performance of subjective evaluations of images from mri and dwi for screening sialadenitis and pleomorphic adenoma. Thyroid cytopathology is dealt with in the thyroid cytopathology article. However, it is extremely rare for these to originate in the nose and even when they do so, it. Pleomorphic adenoma pa is the most common type of salivary gland tumor with a high recurrence and malignant transformation. A fineneedle aspiration cytology using a 23 gauge 0. However, it is extremely rare for these to originate in the nose and even when they do so, it is most commonly in the nasal. Pleomorphic adenoma is the most common salivary gland neoplasm, constituting up to 60% of all benign salivary gland tumors, regardless of major or minor tumors. Pleomorphic adenomas are benign and tend to increase in size slowly. Pleomorphic adenoma is the most common tumour of the salivary glands. If the pleomorphic adenoma is in your parotid gland it can be a delicate surgery due to the closeness to your facial nerves and the potential for the surgery to cause damage to these facial nerves. Pleomorphic adenoma is a benign salivary gland tumor that exhibits wide cytomorphologic and architectural diversity. The stroma may be chondroid, myxoid, osteoid, or fibroid.
An epithelial cell component a myoepithelial cell component a stromal mesenchymal component identification of these 3 components, which may vary quantitatively from one tumor to anot. If yes, where can i get it done and what is the expected cost of the surgery. Thinning or absence of the pseudocapsule and the presence of wngerlike projections of the tumor have been observed in all histologic subtypes of pleomorphic ade. The mammogram can reveal a mass with poorly outlined borders that suggest a malignant process. Identifying areas typical of pleomorphic adenoma with triphasic ductal, myoepithelial and stromal components is helpful to establish the diagnosis squamous cell carcinoma. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. We retrospectively studied 212 cases cytologically diagnosed as pleomorphic adenoma.
Immunomorphological characteristics of pleomorphic adenoma. Pitfalls in salivary gland fineneedle aspiration cytology. Plasmacytoid cell rich pleomorphic adenoma a diagnostic dilemma. Eighty per cent of pleomorphic adenomas of this particular gland are benign, and 20 per cent are cancerous. Pleomorphic adenoma an overview sciencedirect topics. Histopathology remains the gold standard for the diagnosis of ca ex pa, with only a handful of cases reported on cytology. They originate from an uncommitted reserve cell of the intercalated duct which has the potential to differentiate into epithelial and myoepithelial cells 25. Mounting evidence suggest that pleomorphic adenoma gene 1 plag1 is correlated with the tumorigenesis of pleomorphic adenoma. Pleomorphic adenoma of the cervical heterotopic salivary.
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