PRESENTATION: It is slow growing, painless, and firm and is often solitary. Smaller nodules originate from the main tumor. Mobile unless attached to the palatine plate (tumor usually in parotid gland). At this location atrophy to the ramus of the mandible usually occurs. The earlobe may appear everted if tumor located in parotid tail. The tumor may grow and progress to malignant over time--carcinoma ex-pleomorphic adenoma. The tumor may return after resection.
HISTOLOGY: Tissue appears biphasic due to the mixture of the epithelial and myoepithelial cells. Contained within a pseudocapsule, extends within the parenchyma in the form of pseudpodia--finger-like. Exhibits characteristic chromosomal translocations between #3 and #8. Results in PLAG gene being juxtaposed to gene necessary for beta catenin causing inappropriated cell division.
DIAGNOSIS:
1. FNA--fine needle aspiration--determine malignancy--90% accurate
2. Core needle biopsy--determine malignancy-->97% accurate
3. Ultrasound
4. CT
5. MRI
TREATMENT:
1. Superficial or Parotidectomy: Surgical excision of the tumor is the standard treatment with biopsy prior to to confirm diagnosis.
2. Tricky surgey due to relationship of facial nerve to the parotid gland. Early detection is key to recurrent tumors.
3. Submandibular Gland: Excised, careful not to disturb the trigeminal, hypoglossal, or lingual nerves.
4. Malignant tumors: Wide, local resection of the tumor in conjunction with radiation therapy if necessary. Sequellae include but not limited to: cranial nerve damage, cosmetic issues, Frey's syndrome--neurological condition where the ears and/or cheeks become sweaty or flushed, especially when eating spicy, hot, bitter foods or chocolate, as a result of parotid gland surgery.
SURVIVAL RATE:
The rate is at the most 44% with total histiological resection of the tumor.
The mortality rate for the 44% is high at 87%.
The locoregional control rate for malignant tumors is only 66% over a 5 year recovery period making the recurrenc of the cancer undoubtedly fatal.
REFERENCES:
1. Frey's syndrome. (2011, January 26). Retrieved from http://www.wrongdiagnosis.com/f/freys_syndrome/intro.htm.
2. Hajiioannou, J., Vlastos, Y., Lachanas, V., & Kyrmizakis, D. (2006). Giant pleomorphic adenoma of parotis. Internet Journal of Otorhinolaryngology, 4(2), http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijorl/vol4n2/adenoma.xml.
3. Pleomorphic adenoma. (2011 , March 6). Retrieved from http://en.wikipedia.org/wiki/Adenoma%2C_pleomorphic.
5. Templer, J., & Meyers, A. (2009, July 6). Parotitis. Retrieved from http://emedicine.medscape.com/article/882461-overview
4. Yabuuchi, H., Matsuo, Y., Kamitani, T., Setoguchi, T., & Okafugi, T. (2008). Parotid gland tumors: can addition of diffusion weighted mr imaging to dynamic contrast-enhanced mr imaging improve diagnostic accuracy in characterization?. Radiology, 249(3909-916), http://radiology.rsna.org/content/249/3/909/F6.expansion.
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| Location of parotids and accessoy glands. |
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| Pleomorphic tumor-benign, diagnosis confirmed by FNA biopsy. Tumor has been growing for over 20 years. Patient denied treatment. |
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| Pleomorphic tumor of right parotid Axial MR T1--Post-contrast |
Thanks for sharing this.The Doctors i am referring to are quite vague-to the point it gets very frustrating.I have been diagnosed with the Pleomorphic adenoma but yet still have not heard from them.Is surgery the only alternative? Surgery i have been told can affect the facial features/expressions?
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