Recurrent pleomorphic adenoma of the parotid gland

BACKGROUND: Surgery of recurrent pleomorphic adenoma presents an increased risk of facial nerve injury and a considerable re-recurrence rate. METHODS: A series of 33 patients with first recurrence of pleomorphic adenoma of the parotid gland was analyzed. The data were derived from medical records as well as from interviews and clinical examinations of all living patients. Histologic material of the initial and recurrent tumor were reviewed. RESULTS: Multifocal recurrence and carcinoma in pleomorphic adenoma were observed in 73% and 9% of patients, respectively. The incidence of permanent partial facial nerve injury after surgery was 23% in patients with initial enucleation and 14% in those with initial superficial parotidectomy (including 1 patient with facial nerve resection and 1 patient with a partial facial paresis before recurrence surgery). A subsequent recurrence occurred in 6 patients, all with initial enucleation after a mean time interval of 9 years. CONCLUSIONS: The preservation of the facial nerve was possible in all but 1 patient treated for the first recurrence with a relatively low rate of permanent partial facial paresis because of the use of the operating microscope and facial nerve monitor. To evaluate the re-recurrence rate, a follow-up of at least 10 years is necessary.     

Recurrent pleomorphic adenoma of the parotid gland.

OBJECTIVES: To assess the long-term results in the management of 42 patients with recurrent pleomorphic adenoma of the parotid gland. STUDY DESIGN: A retrospective analysis of 42 patients who underwent parotidectomy for recurrent pleomorphic adenoma was performed to study presenting clinicoradiographic features, surgical technique, facial nerve management, and the long-term risk of recurrence. RESULTS: All 42 patients had multi-focal, nontender recurrent nodules following one to four prior surgical procedures and 6 patients underwent prior radiotherapy. Surgical procedures included subtotal parotidectomy in 12 patients, total parotidectomy in 18 patients, parotidectomy with facial nerve resection in 7 cases, and subtotal petrosectomy with facial nerve resection in 5 individuals. The 2 patients with malignant transformation died of disseminated lung and bone metastasis. Twenty-nine of the remaining 40 patients had no recurrent disease. Seven patients developed local parotid bed or cutaneous recurrent disease, 2 patients died of unrelated causes, and 2 patients were lost to follow-up. CONCLUSIONS: All 7 patients with recurrent disease underwent subtotal parotidectomy with "negative" surgical margins. Total parotidectomy or subtotal petrosectomy with facial nerve resection in selected cases may reduce the risk of multiple episodes of pleomorphic adenoma recurrence. Two of 42 patients were found to have carcinoma ex-pleomorphic adenoma, both of these patients underwent prior radiotherapy, and both died of metastatic disease.     

Recurrent pleomorphic adenoma of the parotid

Nineteen patients with recurrent pleomorphic adenoma of the parotid are reported. The aetiology of recurrence is discussed and capsule rupture is emphasized as a major cause, especially of multinodular recurrence. Further surgical attempts to remove recurrences are justified by the possibility of misdiagnosis of the original tumour and the late development of malignancy in recurrent nodules. Tumour clearance was achieved in all but two of 19 patients with recurrence or incomplete primary excision in those in whom it was attempted. Radiotherapy does not seem to be an appropriate alternative to repeated surgical excision.     

Recurrent pleomorphic adenoma of the parotid gland: analysis of 108 consecutive patients

BACKGROUND: Surgery for recurrent parotid pleomorphic adenoma is a challenging problem. METHODS: One hundred eight patients who underwent 134 reoperations for recurrent parotid pleomorphic adenoma (follow-up, 22 years) were evaluated for histopathologic features and risk factors for recurrence. RESULTS: The number of reoperations for tumor recurrence ranged from 1 to 10. Twenty-seven patients (25%) developed permanent facial nerve weakness. The risks for clinically evident rerecurrence after 1, 5, and 15 years were 16%, 42%, and 75%, respectively. Female sex, young age at initial treatment, and enucleation instead of parotidectomy for treatment of the first recurrence were significant risk factors for rerecurrence. The mean number of recurrent tumor nodules was 26. CONCLUSIONS: Surgery for recurrent parotid pleomorphic adenoma has a high rate of facial nerve morbidity. The chance of rerecurrence is high. Extended parotidectomy seems to be the best approach for the reoperation to reduce the risk of rerecurrence.     

Recurrent pleomorphic adenomas of the parotid gland

Twenty-seven patients with recurrent pleomorphic adenomas of the parotid gland were seen. This study confirms that superficial parotidectomy with identification and dissection of the facial nerve greatly decreases the incidence of recurrent benign pleomorphic adenoma, and, in the small number that recur, are easier to cure. All lumps in the parotid area should be approached in the same manner, with the surgeon prepared to isolate the facial nerve and perform superficial parotidectomy. This technique is successful because it avoids dissection near the tumor capsule, which is the major cause of recurrence. The procedure recommended for treatment of patients to remove the first recurrent tumor is total parotidectomy and excision of the previous scar. This vigorous approach is dictated by the increasing difficulty of removing further recurrent tumors. Only 67% of patients with recurrent tumors ultimately achieve a tumor-free status. Experienced surgeons can preserve the facial nerve even after multiple operations.     

Giant recurrent pleomorphic adenoma of the parotid gland

European Journal of Plastic Surgery -     

Case-report: metastasizing pleomorphic adenoma of the parotid gland

CASE-REPORT: Metastasizing pleomorphic adenoma of the parotid gland. We present a case of metastasizing pleomorphic adenoma (MPA). The patient died in 2002 at the age of 64 years, following on an initial diagnosis of a pleomorphic adenoma of the right parotid gland at the age of nineteen, multiple local recurrences and finally rib metastases. Histological examination of the excised tissue from the parotid gland and the metastases showed it to be a pleomorphic adenoma without any signs of malignancy, although the metastatic deposits consisted mostly of a myoepithelial component. Both in our case as in most of the literature, MPA follows a probable incomplete removal of the first tumour. We conclude that the first operation is of great importance for the prevention of late recurrences and metastatic spread.     

Metachronous bilateral pleomorphic adenoma of the parotid gland.

Bilateral salivary gland tumors are very rare, accounting for 3% of all parotid gland tumors. Although the most common tumor with bilateral development is the Warthin tumor, pleomorphic adenomas (PA) have been diagnosed simultaneously as well, but in a smaller incidence. Because of this, the prevalence, etiology, pathogenesis, and behavior of the PA in this context are poorly understood. We present a case of bilateral metachronous PA affecting the parotid gland in a 63-year-old woman. Clinically, the lesions presented with similar aspects as seen in cases of solitary PA with slow-growing asymptomatic nodule. Both lesions were diagnosed by fine-needle aspiration biopsy at an interval of 2 years between them. A total and superficial parotidectomy for left and right tumors, respectively, was performed. Only on the left side some facial nerve branches were removed that induced partial paralysis in the patient. A review of the pertinent literature is included.     

Giant pleomorphic adenoma of the parotid gland with malignant transformation

A 72-year-old female is described who was admitted to the hospital with a giant mixed tumor of the left parotid gland that had grown to a weight of 6051 g within 20 years and ultimately underwent resection of the mass. Histopathological examination revealed adenocarcinoma cells with hyperchromatic nuclei and mitotic figures proliferated in pleomorphic adenoma. Many authors have reported giant tumors weighing more than a few kilograms of the parotid glands, and most were benign. The present tumor was the sixth largest among all the parotid tumors, including both benign and malignant, which were reported. Furthermore, our case was the largest one confirmed as malignant recorded in the world literature. The tumor was successfully resected with no marked facial nerve paralysis.     

Some particular aspects in cases of pleomorphic adenoma of the parotid gland

Twenty three cases of parotid gland pleomorphic adenoma from Surgical Oro-Maxillo Facial Clinic of "Sf. Spiridon" Hospital, Ia?i, have been evaluated. In order to reveal the particular microscopic aspects, several histological techniques have been used: HE, Van Gieson, PAS, Alcian Blue and Gordon Sweet. The microscopic evidences points out the variety of microscopic forms even within the same case, and also the prevalence of some particular forms such as myo-epithelial cell predominance, squamous metaplasia and cystic degeneration. Our observations, corroborated with the one from other research, support the hypothesis of an unique ectodermal cell origin for the lesion histogenesis.     

'Benign' pleomorphic adenoma of the parotid

A personal series of 141 surgically treated parotid tumours is reviewed. Of 112 parotid tumours in which a diagnosis of 'benign' pleomorphic adenoma or other benign tumour was made, 8% proved to be malignant on histological examination. Three patients were thought to demonstrate malignant change in long standing 'benign' parotid tumours. It is concluded that in otherwise healthy patients, discrete, mobile parotid tumours should be removed without undue delay because of the risk of misdiagnosis and the chance of late development of malignancy in pleomorphic adenomata. Malignant tumours simulate benign tumours often enough to warrant treating all as potentially malignant.     

Benign metastasizing pleomorphic adenoma of the parotid gland: a clinicopathologic puzzle

BACKGROUND: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgical treatment (lateral or total parotidectomy) has been described in 1% to 5% of cases. Malignant degeneration has been reported in 2% to 9% of cases of pleomorphic adenoma of salivary gland origin. Metastasizing pleomorphic adenomas without histologic evidence of malignancy have rarely been reported. Metastatic lesions have been discovered in bone, lymph nodes, the lung, oral cavity, pharynx, skin, liver, retroperitoneum, kidney, calvarium, and central nervous system. To the best of our knowledge, we hereby report the first case of pleomorphic adenoma of the parotid gland metastasizing to the ipsilateral maxilla. METHODS: We simultaneously examined apoptosis-related protein expression and markers of cell-proliferation activity in our case of benign pleomorphic adenoma metastasis and compared outcome with a control group of primary parotid pleomorphic adenomas. RESULTS: Analysis of p53, Bcl-2, MIB1, CD 105, p27, and p21 expression did not reveal significant differences between metastasizing pleomorphic adenoma of the salivary gland and the control group of primary parotid pleomorphic adenomas. CONCLUSIONS: Clinical rather than pathologic evidence seems to justify inclusion of metastasizing salivary pleomorphic adenoma in the group of low-grade malignant salivary tumors.     

Capsular penetration and perforation in pleomorphic adenoma of the parotid salivary gland

Both penetration and perforation of the capsule were seen on the superficial aspect of pleomorphic adenomas. Only penetration was noted on the deep aspect, where the tumour was adjacent to the facial nerve. In terms of local recurrence this may explain why it appears to be safe to separate the deep aspect of the tumour from the facial nerve without a wide margin of normal parotid tissue.     

Surgery for pleomorphic adenoma of the parotid gland evaluated by long term follow-up

Fifty six cases with pleomorphic adenoma of the parotid gland were evaluated on local recurrences following surgical treatments which were performed from 1970 to 1983. The surgical treatments for the tumors were 11 extirpations and 45 parotidectomies. The recurrence in each treatment was observed in one (9%) and in none (0%), respectively. The average follow-up period is 11 years (from 5 to 19). The treatment of choice for pleomorphic adenoma is the parotidectomy, of the superficial, deep and/or posterior, lobes.     

Management of pleomorphic adenoma of the parotid

A series of 336 parotidectomies, carried out for benign disease has been followed for up to 20 years. One hundred and thirty primary pleomorphic adenomas were treated by wide excision of the tumour after identification of the facial nerve. Recurrence occurred in only one patient and, although 20 patients (15 per cent) experienced some degree of facial nerve weakness postoperatively, there was only one case of permanent weakness.     

Giant pleomorphic adenoma of the parotid gland: a case report and review of the literature

We report the case history of a 72-year-old patient who had a giant parotid adenoma that developed over 12 years. Worrisome clinical signs started to develop when the tumor had reached the size of 50 cm and a weight of 2.6 kg. Histology reported a benign tumor of the parotid gland. We discuss this case in relation to the to similar cases in the literature, highlighting clinical and histological difficulties encountered in patients with giant tumors of the parotid.     

Simple enucleation and radiotherapy in the treatment of the pleomorphic salivary adenoma of the parotid gland.

A series of 76 patients with a primary pleomorphic salivary adenoma treated by simple extracapsular enucleation and high energy radiation between 1963 and 1976 is presented. Analysis of the results has shown a very low incidence of complications with only minimal cosmetic deformity. Of the 76 patients, only 5 have been lost to follow-up, 3 patients have died of causes unrelated to the tumour and only 1 patient has developed a recurrence. Further local excision in this patient showed the histological appearances of adenocarcinoma.     

Surgical treatment of recurrent pleomorphic adenoma of the parotid gland: a clinical analysis of 52 patients

BACKGROUND: Surgical management of recurrent pleomorphic adenoma of the parotid gland has a considerable risk of facial nerve injury and a high re-recurrence rate. To obtain more insight into this issue we evaluated our experiences. METHODS: Medical records and histologic material of all these patients (31 women and 21 men), who had been treated from 1976-1995 were reviewed. Median interval between initial treatment and commencement of recurrences was 3 (0.8-18) years. Last surgery consisted of parotidectomy in 48 patients (92%), including 19 (40%) total procedures and wide local excision with involved skin in four patients. RESULTS: At a median follow-up of 9 years, eight patients (8/52; 15%) had re-recurrences develop, including 4 of 21 patients (19%) after a previous parotidectomy (group I) and 4 of 31 patients (13%) without prior parotidectomy (group II). The chance of re-recurrence in a group of patients with a minimal follow-up of 10 years after salvage surgery was 17% (4 of 24). The risk of a new relapse was, respectively, 4% and 8% at 1 and 5 years after treatment of recurrent disease. Acceptable N.VII function was preserved in 45 of the 49 (92%) nerves at risk. The risk of N.VII injuy was higher and more serious in group I (29% vs 10% in group II). The function of four of the five (80%) reconstructed zygomaticotemporal branches of the N.VII was adequate. CONCLUSION: Surgical treatment of recurrent pleomorphic adenoma of the parotid gland, usually consisting of a parotidectomy with wide extent and eventually facial nerve reconstruction, demonstrates favorable results with acceptable morbidity. The risk of new relapse and N.VII injury was higher after previous parotidectomy.