Pleomorphic adenoma is the most common benign tumor of the parotid gland. It consists of both epithelial cells and spindle-shaped mesenchymal cells within an abundant mucoid matrix. On pathology, it displays well-differentiated epithelial cells and spindle/stellate cells in a pleomorphic stroma with mucoid material. The tumor presents as a slow-growing, painless swelling of the parotid gland and is diagnosed by FNAC. The treatment is complete surgical excision via superficial parotidectomy while preserving the facial nerve. Recurrence is possible if there are pseudopods left behind or inadequate margins. Malignant transformation may occur in long-standing tumors.
11. CASE
A 45 yr old female
C/0 – slow growing, painless
swelling below the left side of ear for
the past 5 months
O/e – 5x3 cm,oval, lifting the ear
lobule
No localised warmth, not tender
Surface-smooth, Margins- well
defined. Retromand groove oblit.
Variable consistency. Mobile
Not adherent to skin, masseter muscle
No signs suggestive of facial N inv
Examination of oral cavity is normal
13. PLEOMORPHIC ADENOMA
MIXED TUMOUR
SITE : MC: PAROTID GLAND ( 90%)- MC –Tail of gland
Submandibular gland (7%)
Minor salivary glands-MC : Palate
Occurs more commonly in females (3:1)
AGE : any age . MC : 40-50yrs
Usually unilateral
14. PATHOLOGY
BENIGN TUMOR
Tumor capsule-well formed, but incomplete
Tiny excrescences (pseudopods) project outside.
Give rise to recurrences.
GROSS :
CUT SECTION:
15. MICROSCOPIC APPEARANCE
2 groups of cells :
Well differentiated epithelial
cells-acini/cords/sheets
Spindle/stellate cells
Abundant intercellular
mucoid material-resembles
cartilage
Pleomorphic stroma
No necrosis
Rarity of mitotic figures
16. CLINICAL FEATURES
Painless slow growing swelling
In the parotid both lobes involved. If only deep lobe
involved – DUMB BELL TUMOUR
Dysphagia if deep lobe is involved
Deviation of uvula&pharyngeal wall towards midline-deep
Deep lobe swelling passes through
PATEY’S STYLOMANDIBULAR TUNNEL
Raised ear lobule
Cannot be moved abv zygomatic bone-CURTAIN SIGN
FACIAL NERVE NOT INVOLVED
17.
18.
19. INVESTIGATION
FNAC – IMPORTANT AND DIAGNOSTIC
OPEN BIOPSY – CONTRAINDICATED
DUE TO : chance of injury to facial nerve,
seedling & high chance of recurrence,
Parotid fistula formation
CT SCAN
MRI
20.
21. MANAGEMENT
Tumor is RADIO RESISTANT
SURGERY :
ENUCLEATION –avoided. High recurrence.
TOC : SUPERFICIAL PAROTIDECTOMY –
PATEY’S OPERATION( if supf lobe alone involved)
TOTAL CONSERVATIVE PAROTIDECTOMY (If both
lobes involved)
23. RECURRENCE AFTER SURGERY
DUE TO : Spillage
Inadequate margin
Retained pseudopods
Multicentricity
Improper technique
Recurrent tumor is multinodular without capsule
Marker to predict recurrence : MUC1/DF3
24. CARCINOMA IN EX PLEOMORPHIC
ADENOMA
Long standing Pl.adenoma-malignant
transformation
Recent increase in size
Pain , nodularity
Involvement of skin, ulceration
Involvement of masseter
Involvement of facial nerve
Neck lymph node
Restriction of jaw movements
25. TAKE HOME MESSAGE
MOST COMMON TUMOUR OF PAROTID
FACIAL NERVE IS NOT INVOLVED
TOC : SUPERFICIAL PAROTIDECTOMY
FACIAL NERVE IS PRESERVED.
CARCINOMA IN EX PLEOMORPHIC ADENOMA.