A case of pleomorphic adenoma of the nasal septum

We report a rare case of pleomorphic adenoma arising from the nasal septum. A 32-year-old woman presented with a 3-week-history of left-sided nasal obstruction. Computed tomographic scans revealed an oval mass, measuring about 30 mm in its greatest dimension, in the left anterior nasal cavity. The tumor arose from the anterior part of the nasal septum, and was removed endoscopically with endonasal approach. The microscopic finding showed a lobular and duct-like structures consisting of a loose chondromyxoid stroma. This lesion had histological characteristics of a pleomorphic adenoma, and this was confirmed by immunohistochemical expression of cytokeratin and S-100 protein. Her post-operative course was uneventful, and she is currently free from the disease 8 months after surgery. Diagnosis, clinical behavior and treatment of pleomorphic adenoma of the nasal septum are reviewed from perusal of the literature.     

鼻腔混合瘤的临床分析

目的探讨鼻腔混合瘤的临床表现、病理特点及治疗方法,以提高对此病的诊疗水平。方法回顾性分析6例鼻腔混合瘤患者的临床资料,根据术前鼻内镜和鼻窦CT等术前评估选择手术径路;其中2例行鼻侧切开术,4例行鼻内镜下肿瘤切除术。结果鼻腔混合瘤原发于鼻中隔者5例、鼻咽顶后壁1例;术后随访3年,5例痊愈,1例复发。结论鼻腔混合瘤虽属良性肿瘤,但术后易复发,首次彻底切除是预防复发的关键,术后需定期随访。     

MRI of intranasal pleomorphic adenoma

A pleomorphic adenoma in the nasal cavity constitutes a rarity. A 48-year-old woman presented with intranasal pleomorphic adenoma revealed by unilateral continuous obstruction and occasional epistaxis. Nasal endoscopy showed a mucosa-covered and opalescent polypoidal mass arising from the left nasal septum. Unlike cases affecting the major salivary gland, magnetic resonance image (MRI) revealed that the mass showed a low signal intensity on T1-weighted image and a heterogeneous, intermediate signal intensity on T2-weighted image. MRI findings can aid in diagnosis and help exclude the possibility of other neoplasms that occur at this site.     

鼻中隔后端巨大囊肿1例

患者,男,17岁,双鼻塞半年伴张口呼吸,持续性进行性加重,偶有头部胀痛,无耳部症状。体检：鼻中隔左偏,双鼻腔下鼻甲肥大,双鼻腔通畅。纤维鼻咽镜：巨大球形光滑淡红色新生物位于鼻咽顶后壁及鼻腔后端,大小约3．5cm×2．5cm,堵塞整个后鼻孔,新生物与双侧圆枕相贴（图1）。     

Myoepithelial carcinoma ex-pleomorphic adenoma of the parotid gland

INTRODUCTION: Myoepithelial carcinoma accounts for less than 1% of salivary gland malignant tumors. It may develop de novo or, in approximately 50% of the cases, from a pleomorphic adenoma. OBSERVATION: A 57-year-old man with a history of a pleomorphic adenoma of the parotid treated surgically 6 years earlier, presented with a 2 cm tumor mass, palpable in the scar region. The histological examination and immunohistochemical study revealed a low-grade myoepithelial carcinoma. The patient had no complementary treatment. He presented 5 years later with a 2 cm parapharyngeal recurrence which was resected. There was no evidence of recurrent tumor or of distant metastasis at 4 year follow-up. DISCUSSION: Although myoepithelial cells are often predominant in pleomorphic adenomas, carcinomas developing in pleomorphic adenomas show in most cases a glandular differentiation and myoepithelial carcinomas are rare. Currently the diagnostic criteria, the prognosis, and the management of myoepithelial carcinomas are not well documented. Invasive carcinomas developing in pleomorphic adenoma are known to be highly aggressive neoplasms and myoepithelial carcinomas ex-pleomorphic adenoma seem to have a better prognosis. Our reported case was characterized by the weak aggressiveness of the lesion.     

Pleomorphic adenoma of the nasal septum

Despite the common occurrence of pleomorphic adenoma of major salivary glands, intranasal pleomorphic adenoma are rare. We present a ease of pleomorphic adenoma of the nasal septum along with a brief review of literature. The histological nature of this lesion in comparison to other salivary gland tumours and the importance of an accurate diagnosis has been stressed.     

Pleomorphic adenoma originated from the inferior nasal turbinate

Although pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred.     

A case of pleomorphic adenoma of the parotid gland metastasizing to a mediastinal lymph node

OBJECTIVE: Pleomorphic adenomas are the most common salivary gland tumors and are typically cured with complete surgical excision. There are rare reports, however, in which these histologically benign tumors have inexplicably metastasized to distant sites. We present a case of a patient who presented, 27 years after excision of a parotid pleomorphic adenoma, with a recurrence in the parotid bed and a mediastinal metastasis. STUDY DESIGN: Case report. METHODS: A 43-year-old woman presented with a mass in the right parotid bed 27 years after excision of a pleomorphic adenoma of the parotid. The patient's presentation, workup, and final diagnosis of benign metastasizing pleomorphic adenoma will be discussed, along with a pertinent review of the literature. RESULTS: A diagnosis of recurrent pleomorphic adenoma was made from a fine needle aspiration biopsy of the right parotid mass. On subsequent computed tomographic scan, chest images revealed an incidental left mediastinal mass, which also proved to be a pleomorphic adenoma on computed tomography-guided fine needle aspiration biopsy. The patient underwent a completion parotidectomy and sternotomy with excision of the mediastinal mass. Examination of the pathology specimens confirmed a diagnosis of pleomorphic adenoma in both the parotid bed and the mediastinum. No histologic characteristics of malignancy were seen in either specimen; therefore, a diagnosis of benign metastasizing mixed tumor was rendered. CONCLUSION: Benign metastasizing pleomorphic adenoma is a rare and controversial but distinct clinical entity. Although the definition of the term benign precludes metastatic disease, these tumors do not demonstrate any malignant features yet metastasize to distant sites. It remains to be determined whether these benign metastasizing pleomorphic adenomas are really low-grade salivary malignancies.     

Pleomorphic adenoma of the external auditory canal in Japan, with a case report.

A rare case of a 51-year-old female with a pleomorphic adenoma, measuring 0.9 x 0.7 x 0.6 (cm3), originating from the right external auditory canal (EAC), was reported. The authors discussed the 7 reported cases of EAC pleomorphic adenoma in Japan, comparing them with pleomorphic adenomas occurring in the nasal cavity and the parotid gland. It is currently too early to conclude that pleomorphic adenoma in the EAC does not tend to recur or shows a marked tendency toward canceration. The best possible treatment for EAC pleomorphic adenoma at present seems to be, as in cases of tumors in other sites, surgical resection together with removal of a sufficient range of surrounding normal tissue, followed by careful long-term postoperative observation of the clinical course.     

Familial occurrence of pleomorphic adenoma

Pleomorphic adenoma is the most common neoplasm found in the parotid gland. The familial occurrence of any salivary gland neoplasm is rare. There are 8 previous reports in the literature of familial occurrence of salivary gland tumors. Two of these report the occurrence of pleomorphic adenoma of the parotid gland in siblings; all 4 patients were adults. We report here an 11-year-old male who presented with a left parotid mass and underwent parotidectomy. The mass proved to be a pleomorphic adenoma. His sister presented 9 years later at the age of 15 years with a similar mass also in the left parotid area. She underwent superficial parotidectomy which revealed the mass to be a pleomorphic adenoma. We believe these are the youngest siblings reported to date in which familial pleomorphic adenoma has occurred.     

Pleomorphic adenoma of the nasal septum: a case report

Pleomorphic adenomas arise most commonly in the major salivary glands; the minor salivary glands are affected in only 8% of the cases. Intranasal pleomorphic adenoma being extremely rare originates most commonly from the nasal septum. We present a case of a 55-year-old man who presented with complaints of right-sided nasal obstruction and occasional nasal bleed for the last 6 months. Examination showed a mucosa-covered, fleshy 2 x 2 x 1.5 cm mass in the right nasal cavity. Computed tomogram showed right-sided polypoidal mass with attachment to the cartilaginous nasal septum without any erosion of the surrounding structures. The clinical presentation, gross and microscopic appearance, and treatment of intranasal pleomorphic adenoma is briefly discussed.     

Adénome pléomorphe géant de la parotide

Introduction

Slow evolution pleomorphic parotid adenoma may be diagnosed late. These giant tumors have a functional, esthetic, and social impact. They raise prognostic issues because of the risk of degeneration. We present a case of a giant pleomorphic adenoma involving the parotid glands and try to explain the reasons for the diagnostic delay and describe therapeutic specificities.

Case report

A 54 year-old male patient consulted for swelling of the parotid region slowly evolving over the last 10 years. This lesion had been unsuccessfully treated by conventional methods. A painless 20 cm long plurinodular mass was located in the right lateral cervical region. Its consistence was heterogeneous. The CT scan revealed a heterogeneous tumor with hyperdense and hypodense areas without any associate lesions. A total conservative parotidectomy was performed; the anatomopathological examination confirmed the diagnosis of a pleomorphic adenoma, weighing 1.2 kg for a diameter of 19 cm, without malignant degeneration. The postoperative evolution was uneventful.

Discussion

The recommended treatment for giant parotid adenoma is total conservative parotidectomy. Besides its functional and esthetic impact, the giant parotid adenoma is at high risk of malignant degeneration. Documentation on the nature of the lesion, its evolutive potential, and an early surgical management could limit its incidence.     

Tuberculosis in the parotid gland in HIV infection

A 35-year-old man with HIV-infection presented with a progressive swelling of the left parotid gland lasting for 3 months. Physical examination revealed a firm mass on the tail of the parotid gland. Ultrasound examination of the left parotid showed a well-circumscribed round lesion. MR imaging demonstrated a 2 cm lesion in the ventral subcutaneous part of the parotid gland. Lateral parotidectomy was performed with suspected pleomorphic adenoma. Histologic analysis revealed a granulomatous necrotising inflammatory lesion of an intra- and extraparotideal lymph node. The patient had no family history of tuberculosis. Hematologic investigations were within normal limits. Chest X-ray was normal. Primary tuberculosis of the parotid gland in a patient with HIV-infection was diagnosed and anti-mycobacterial therapy was started. In HIV-patients with unilateral swelling of the parotid gland, tuberculosis should be considered in the differential diagnosis of pleomorphic adenoma and fine needle aspiration cytology should be performed to avoid unnecessary surgery.     

Tumoral mass presenting in the nasomalar region arising from the lateral nasal wall: pleomorphic adenoma

Pleomorphic adenoma is the most common benign salivary gland tumor. Although the major salivary glands are the most common sites of its origin, it can also occur in the minor salivary glands of the oral cavity and rarely in the neck, ear, nasal cavity and larynx. We report a rare case of intranasal pleomorphic adenoma arising from lateral nasal wall and discuss the clinical presentation, diagnosis and treatment approaches with the review of the literature.     

Giant pleomorphic adenoma in accessory salivary gland

Giant pleomorphic adenoma is the most common neoplasm of salivary glands, specially of parotitis. Less frequently derives from minor salivary glands and, in the case, its size is small. We report one case of pleomorphic adenoma of great mass seated in a palatine salivary gland and avail the opportunity to review these sort of tumors.     

Implantation of parotid pleomorphic adenoma in the upper neck.

This paper presents a case of pleomorphic adenoma from an abnormal site in the right upper neck in a patient surgically treated 4 years previously for pleomorphic adenoma of the right parotid gland. The lack of normal salivary tissue in the neck growth oriented us towards a diagnosis of implantation tumor, resulting from surgery of the parotid mass, rather than towards one of heterotopic tumor. The literature concerning salivary heterotopias and salivary tumors arising from heterotopic foci is also reviewed.     

Giant pleomorphic adenomas of the parotid gland

The authors describe four cases of giant pleomorphic adenomas of the parotid gland with the diameter greater then 15 cm in patients treated in the ENT Department, Medical University of Gdańsk in years 1989-2002. Three of the patients were treated surgically--parotidectomy was performed, in first case removing tumor of 28 cm in diameter and 3.2 kg, in second case 15 cm and 0.7 kg and in third case 18 cm and 1.3 kg. The forth patient was disqualified from the surgical treatment because of the metastases to the lungs from the giant malignant pleomorphic adenoma involving half of the head. The authors presented opinions on the diagnostic and therapeutic methods in that disease and also present case reports from Poland and other countries.     

A transpalatal approach (Palate Split) to the Parapharyngeal space

This is a case of a 20 years young boy with a large parapharyngeal pleomorphic adenoma excised via transpalatal approach. The incision was taken about 0.5cm away from the edges of the tumor it provided good, surgical access to the whole length of upper parapharyngeal space and allowed complete tumor excision.     

Adenocarcinoma ex pleomorphic adenoma of the head and neck: Report of five cases

OBJECTIVE: Adenocarcinoma ex pleomorphic adenoma is a rare tumor, and thus the management of the tumor has not been established. METHODS: The retrospective review of the clinical records at Okayama University was performed. RESULTS: We present five cases of adenocarcinoma ex pleomorphic adenoma of the head and neck, including a rare case with nasopharyngeal adenocarcinoma ex pleomorphic adenoma. There was no response to chemotherapy with nedaplatin and 5-FU, but the nasopharyngeal adenocarcinoma ex pleomorphic adenoma showed a remarkable regression after the administration of docetaxel. CONCLUSION: The combination therapy that includes docetaxel may be a promising treatment for adenocarcinoma ex pleomorphic adenoma of the head and neck.     

A rare case of pleomorphic adenoma of lateral wall of nasal cavity--with special reference of statistical observation of pleomorphic adenoma of nasal cavity in Japan

Pleomorphic adenoma, which is also called mixed tumor is considered to occur favorably in major salivary glands such as parotid and submandibular glands, and rarely in the nasal cavity, pharynx, larynx, trachea, and lacrimal gland. We reported here a rare case of pleomorphic adenoma (2.9 X 2.2 X 1.7 cm3) developed from the lateral wall of right nasal cavity in a 43-year-old woman. Statistical observation of pleomorphic adenoma of the nasal cavity in Japan was made and comparative study was also made between such adenoma and that in the parotid gland. In Japan, 41 cases of pleomorphic adenoma originated in the nasal cavity have been reported so far including ours. These cases had age of onset of 16-74 years, averaging 44.6 years. Sex ratio showed female predominance. No significant difference was noted in affected sides sites. Chief complaints were represented mostly by nasal obstruction (29 cases; 71%) and nasal bleeding (23 cases; 56%). Tumors were surgically extirpated in all cases. One recurrent case (2.4%) was reported and another malignant case (2.4%) was also reported. 4 cases (9.8%) were originated in the lateral wall of nasal cavity and all of the other cases were in the nasal septum. In comparison with pleomorphic adenoma developed in parotid gland in Japan, sex ratio was 1:1.8 compared with 1:2.1 for parotid gland with almost similar tendency. Age of onset averaged 44.6 compare with 32.8 years for parotid gland, with a little advance in age.(ABSTRACT TRUNCATED AT 250 WORDS)