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Transmandibular approach to polycentric recurrent pleomorphic adenoma of the parapharyngeal space  [PDF]
Grubor A.,Jovanovi? M.,Said M.,Vlastarakou V.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0503103g
Abstract: Surgery for tumors of the parapharyngeal space (PPS) requires adequate exposure to identify and protect vital structures. Thus transcervical and transcervical-transparotid approaches to the PPS may be enhanced by mandibulotomy for better visualization. We have chosen this approach with single mandibulotomy just in front of foramen mental and without lip incision. We present a 39 years old male who was undergone surgery for policentric recurrency of a pleomorphic adenoma of the parapharyngeal space.
Concurrent pleomorphic adenoma in parapharyngeal space and submandibular gland
A L Ladeinde, W L Adeyemo, B O Bamgbose, M O Ogunlewe, F O Ajayi
World Journal of Surgical Oncology , 2004, DOI: 10.1186/1477-7819-2-6
Abstract: A rare synchronous occurrence of pleomorphic adenoma in the parapharyngeal space and submandibular gland of a 48-year-old Nigerian male is reported.Pleomorphic adenoma concurrent in the parapharyngeal space and submandibular gland is very rare. A complete surgical excision of both tumors is the treatment of choice.Pleomorphic adenoma (PA) is an epithelial tumor of complex morphology, possessing epithelial and myoepithelial elements being intermingled with mucoid, myxoid, or chondroid tissue arranged in a variety of patterns and embedded in a mucopolysaccharide stroma [1]. It is the commonest benign tumor of salivary glands [2,3], and accounts for 90% of all salivary gland tumors [3].The submandibular gland is the second most common site of pleomorphic adenoma after the parotid gland [2,4]. It is also the most frequent benign tumor arising in submandibular gland [5,6]. Pleomorphic adenomas in the parapharyngeal space (PPS) can arise either de novo or may arise in the deep lobe of the parotid gland and extend through the stylomandibular tunnel into the PPS [7]. Tumors in the parapharyngeal space are rare and constitute less than 0.5% of head and neck neoplasm [8]. Of these, PA is the commonest benign tumor (40%) [9,10]. The origin of de novo PA is probably from displaced or aberrant salivary gland tissue within a lymph node [11]. A Medline literature search did not reveal any reported cases of concurrent PA in the PPS and submandibular gland.A 42-year-old Nigerian male was referred to the outpatient clinic of the Oral and Maxillofacial Surgery Department of the Lagos University Teaching Hospital in May 2002 with a painless, slow growing recurrent left neck mass of 20 years, duration without any associated constitutional symptoms. There was no history of difficulty in swallowing. He had undergone surgical resection for the similar neck mass earlier in 1972 and 1982, which was diagnosed as pleomorphic adenoma. The patient gave a history of tuberculosis in 1973 and regul
Primary pleomorphic adenoma of minor salivary gland in the parapharyngeal space
Arsheed H Hakeem, Biswajyoti Hazarika, Sultan A Pradhan, Rajan Kannan
World Journal of Surgical Oncology , 2009, DOI: 10.1186/1477-7819-7-85
Abstract: Two cases of primary pleomorphic adenomas arising de novo from minor salivary glands in the para pharyngeal space are reported. Review of literature, clinical features, pathology, radiological findings and treatment of these tumours are discussed.Pleomorphic adenoma arising de novo in the parapharyngeal space is of rare occurrence. High index of suspicion and an adequate clearance of the tumour with a cuff of surrounding dispensable normal tissues is the key to successful treatment of such tumours.Parapharyngeal space tumours are not very frequent, accounting for some 0.5% of neoplasms of head and neck. Most of these tumours (70%-80%) are benign and 40-50% of these originate in the salivary glands, particularly the pleomorphic adenoma [1]. Pleomorphic adenoma in the parapharyngeal space (PPS) can develop de novo or may arise from deep lobe of the parotid and extend through the stylomandibular tunnel into the PPS [2]. The origin of de novo pleomorphic adenoma is probably from displaced or aberrant salivary gland tissue within a lymph node [3]. However, pleomorphic adenoma arising de novo in the parapharyngeal space is extremely rare which made us to report these cases.A 20 -year- old male presented with gradually progressive painless swelling of the left upper neck and change in the quality of voice of 1 year duration. On intraoral examination there was a smooth firm bulge of the soft palate and left lateral pharyngeal wall (Figure 1). Neck examination revealed a firm swelling in the upper neck involving retromandibular region on the left side. There was no history of difficulty in swallowing. The swelling was bimanually palpable and ballotable. Posterior nasal examination showed the extension of the swelling into the nasopharynx. There was no significant lymph node enlargement in the neck. Clinical examination did not reveal involvement of any of the cranial nerves. With a clinical diagnosis of parapharyngeal space tumour a CT scan was taken which showed homogenousl
Giant De Novo Pleomorphic Adenoma Arising from the Parapharyngeal Space  [PDF]
Sang Hwang,Sim Choroomi,Ben McArdle,Ian Jacobson
Case Reports in Otolaryngology , 2013, DOI: 10.1155/2013/742910
Abstract: Introduction. De novo pleomorphic adenomas in the parapharyngeal space are rare and cause difficulties in its surgical management. We report the largest de novo pleomorphic adenoma arising from the parapharyngeal space and discuss its surgical management. Presentation of Case. A 34-year-old male presented with a giant de novo pleomorphic adenoma arising from the parapharyngeal space, which was initially misdiagnosed as an impacted wisdom tooth. Measuring ?cm in size and weighing 87.3?g, this is the largest primary salivary gland tumour arising de novo from the parapharyngeal space reported in the literature, presenting challenges in its surgical management. Discussion. Parapharyngeal space tumours cause nonspecific symptoms and may be difficult to diagnose, which can allow the tumours to become very large and cause obstructive and compressive symptoms in an anatomically difficult area. A combined trans-cervical and trans-oral approach can be used to safely perform an en bloc resection. Conclusion. We report the diagnosis and surgical management of the largest pleomorphic adenoma arising de novo from the parapharyngeal space reported in the literature. 1. Introduction The parapharyngeal space is found anterior to the cervical column, posterior to the infratemporal fossa, and laterally to the nasopharynx. It forms an inverted pyramid with the skull base superiorly and the apex at the joint between the posterior belly of the digastric muscle and the greater cornu of the hyoid bone [1]. Tumours arising de novo in the parapharyngeal space are very rare and present challenges in achieving en bloc excision without spilling the contents of the tumour [1]. We describe the largest primary salivary gland tumour arising de novo from the parapharyngeal space and discuss its management. 2. Case History A 34-year-old male presented to our multidisciplinary head and neck clinic with a 3-year history of recurrent discomfort in his right retromolar trigone. These episodes were initially diagnosed by a dentist as an impacted wisdom tooth with subclinical infection and were treated with oral antibiotics with minor improvement in symptoms. One year prior to presentation, the patient noticed a prominence on the right side of his oropharynx but this was not reviewed by a medical professional. Over the last 2 years, the patient had worsening obstructive symptoms, including snoring, episodes of sleep apnoea, nasal speech, and a sensation of decreased hearing in his right ear. The patient also reported 7?kg of weight loss and lethargy in the preceding 3 months before
The rapid growth of a pleomorphic adenoma of the parotid gland in the third trimester of pregnancy
Frederike Palluch, Martin Lehmann, Joachim Volz, Tahwinder Upile, Holger Sudhoff
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-141
Abstract: A 43-year-old Caucasian woman presented in her 32nd week of gestation with a tumor of the parotid gland. Ultrasonography of her neck showed a parotid lesion of 40 × 30 × 27.5 mm. A follow-up magnetic resonance imaging scan of the neck four weeks later revealed that the tumor had grown to 70 × 60 × 60 mm, reaching the parapharyngeal space with marked obstruction of the oropharynx of about 50%. After discussing the case with our multidisciplinary tumor board and the gynecologists it was decided to deliver the baby by caesarean section in the 38th week of gestation, and then to perform a surgical resection of the tumor.Indications for early surgical intervention of similar cases should be discussed on an individual patient basis in a multidisciplinary setting.With an incidence of 65%, pleomorphic adenoma is the most common tumor of the salivary glands [1], and 80% of the pleomorphic adenomas are located in the parotid gland. These tumors are characterized by slow growth over a period of years, and tend to remain asymptomatic. In 4% of cases, they turn into malignant tumors. In the following case report, we describe a pleomorphic adenoma of the parotid gland that showed rapid growth within the third trimester of pregnancy.A 43-year-old Caucasian woman presented in her 32nd week of gestation with a tumor of the parotid gland. She had noticed the swelling increasing over the past six months. She was otherwise asymptomatic, without any pain, mouth-opening difficulties or facial nerve dysfunction. Ultrasonography of her neck showed a parotid lesion 40 × 30 × 27.5 mm in size, with an heterogeneous appearance. Considering her advanced state of pregnancy, we advised conservative management in the form of watchful waiting and regular review until the birth.At our patient's next review, only five weeks later, we noticed rapid growth of the lesion with expansion into the parapharyngeal space. There was still no facial nerve involvement, although our patient's mouth opening was sl
Pleomorphic adenoma of minor salivary gland in the parapharyngeal space
Bipin T Varghese, Paul Sebastian, Elizabeth K Abraham, Anitha Mathews
World Journal of Surgical Oncology , 2003, DOI: 10.1186/1477-7819-1-2
Abstract: A rare case of a minor salivary gland pleomorphic adenoma of the parapharyngeal space is reported. Review of literature, clinical features, pathology, radiological findings and treatment of these tumours are discussed.Parapharangeal salivary tumours presents as a painless progressive swelling with majority of these being malignant. Pleomorphic adenoma in parapharangeal space is of rare occurrence. Complete surgical excision is the treatment of choice.The majority of minor salivary gland tumours are malignant [1]. Among benign tumours of the minor salivary glands pleomorphic adenoma is the commonest, found most often in the oral cavity. The parapharyngeal space is a very rare site for this tumour. A case of a large pleomorphic adenoma arising de novo in the parapharyngeal space is reported.A 40-year-old man presented with a gradually progressive painless swelling in the throat and change in quality of speech of one-year duration. On examination there was a smooth firm bulge of the soft palate and right lateral pharyngeal wall and a diffuse firm fullness of the right retromandibular fossa and the adjacent submandibular trigone. The swelling was bimanually palpable and ballottable. Postnasal examination showed extension of the swelling into the nasopharynx and indirect laryngoscopy revealed the lower limit of swelling at the level of vallecula. There was no significant lymph node enlargement in the neck. With the clinical diagnosis of parapharyngeal tumour a CT scan of the head and neck was taken which showed a poorly enhancing tumour measuring 5 × 4 cm in the right parapharyngeal space, extending from the base of skull to the level of vallecula (Figure 1).Through a mandibular swing approach, to gain entry into parapharyngeal space, the tumour was excised, after controlling right external carotid artery. On gross examination the lesion was 6 × 4 × 2.5 cm in size with a whitish faintly lobulated and focally glistening cut surface. Histopathological examination showed a
Myoepithelial cells are the main component in pleomorphic adenomas?
Ponce Bravo,Santa; Ledesma Montes,Constantino; López Becerril,Uriel; Morales Sánchez,Israel;
Medicina Oral, Patología Oral y Cirugía Bucal (Internet) , 2007,
Abstract: objective: the aim of this study was to quantify by immunohistochemistry the number of myoepithelial cells (myecs) in pleomorphic adenomas (pas). material and methods: we retrieved the paraffin cubes of 27 pas, new slides were done and they were stained with anti-s100 protein antibody. the amount of s-100 protein positive cells was quantified, their morphology was recorded and comparison among myec number with age, gender and involved gland were also done. results: with s-100 protein, myecs in normal salivary gland tissue were seen surrounding the ductual structures only. in the analysed pas a mean of 27.4% of the neoplastic cells were positive to the antibody. with the exception of one pa, in all the analysed cases the plasmacytoid cells were the most commonly identified cells (48,6%). conclusions: results of this study suggest that myecs do not constitute the main cellular component of the neoplastic compartment in pas and corroborate the previously reported evidence by different au-thors, who studying the pas suggested that myecs does not comprise the main cellular neoplastic component of these entities.
Myoepithelial Cell-Rich Pleormorphic Adenoma of Minor Salivary Gland of Parapharyngeal Space  [PDF]
Digvijay Singh Rawat,Divij Sonkhya,Nishi Sonkhya,Shubha Gupta
Case Reports in Otolaryngology , 2012, DOI: 10.1155/2012/537381
Abstract: Parapharyngeal space tumors are rare and constitute only 0.5–1.0% of head and neck tumors. Minor salivary gland tumor is still rare in parapharyngeal space. We are reporting a case of pleomorphic adenoma of minor salivary gland of parapharyngeal space. A 42-year-old female presented with a history of mass in the oropharynx for 3 years. She presented with “hot potato voice” and dysphagia. CECT and MRI were done, showing large parapharyngeal space tumor. FNAC was suspicious for tumor of nerve cell origin. Tumor was excised using “paramedian mandibulotomy with mandibular swing approach”. Histopathological examination was inconclusive, suggesting possibility of extraskeletal myxoid chondrosarcoma, solitary fibrous tumor, neurogenic tumor. On immunohistochemistry, tumor was positive for cytokeratin, EMA (dim), S-100, and P 63 and negative for SMA thus proving the case as myoepithelial cell-rich pleomorphic adenoma. 1. Introduction Parapharyngeal space tumors are rare [1, 2]. Pleomorphic adenomas are the most common parapharyngeal tumors and present as slowly increasing painless mass in neck and/or retrotonsillar area causing dysphagia, hoarseness, otalgia, and difficulty in breathing [1, 3]. Pleomorphic adenomas in the parapharyngeal space usually arise from deep lobe of the parotid, but rarely can develop de novo from displaced or aberrant salivary gland tissue within a lymph node [2]. We are reporting a case of large parapharyngeal space tumor, presented with dysphagia, “hot potato voice,” and difficulty in breathing. The tumor was initially suspected to be of neurogenic origin on FNAC. Histopathology and immunohistochemistry proved it to be a rare tumor of minor salivary gland origin, myoepithelial cell-rich pleomorphic adenoma. 2. Case Report A 42 years old female presented with painless slowly progressing mass in the oropharynx for 3 years. There was a history of difficulty in deglutition for 1 year and difficulty in breathing for 3 months. Patient was nonsmoker and nonalcoholic. On clinical examination a large mass occupying the whole of the oropharynx arising from the left lateral pharyngeal wall crossing the midline and almost touching the opposite side was observed. Neurological examination was normal. Patient consulted for swelling in oropharynx 2 years ago, she was investigated and advised for surgery but she was lost to followup. MRI with Gadolinium enhancement (dated February 2009-2010) showed well-defined heterogenous mass occupying left parapharyngeal space (Figure 1). Figure 1: T1-weighted post-Gd MRI large showing heterogenous mass in left
Inmunohistochemical Expression of PCNA, p53 and bcl-2 in Pleomorphic Adenomas
Gordón-Nú?ez,Manuel Antonio; Godoy,Gustavo Pina; Soares,Rosilene Calazans; Souza,Lélia Batista de; Freitas,Roseana de Almeida; Queiroz,Lélia María Guedes;
International Journal of Morphology , 2008, DOI: 10.4067/S0717-95022008000300010
Abstract: the aim of the study was to determine the immunohistochemical expression of the pcna, p53 and bcl-2 proteins in pleomorphic adenomas.onineteen specimens of pleomorphic adenomas were selected for analysis by the streptavidin-biotin-peroxidase method with antibodies againstp53, pcna and bcl-2 proteins. it was observedweak labeling for p53 in 12 cases (63.1%) andforpcna in 8 (42.1%). with respect to the bcl-2 labeling index,ono expression of this protein was detected in 12 cases, corresponding to 63.1% of the sample. based on these findings, it was concluded that p53 and pcna can favor the proliferative activity of pleomorphic adenomas, whereas bcl-2 probably doesonot effectively particípate in the pathogenesis of this tumor.
Inmunohistochemical Expression of PCNA, p53 and bcl-2 in Pleomorphic Adenomas Expresión Inmunohistoquímica de PCNA, p53 y bcl-2 en Adenomas Pleomórficos  [cached]
Manuel Antonio Gordón-Nú?ez,Gustavo Pina Godoy,Rosilene Calazans Soares,Lélia Batista de Souza
International Journal of Morphology , 2008,
Abstract: The aim of the study was to determine the immunohistochemical expression of the PCNA, p53 and bcl-2 proteins in pleomorphic adenomas.onineteen specimens of pleomorphic adenomas were selected for analysis by the streptavidin-biotin-peroxidase method with antibodies againstp53, PCNA and bcl-2 proteins. It was observedweak labeling for p53 in 12 cases (63.1%) andforPCNA in 8 (42.1%). With respect to the bcl-2 labeling index,ono expression of this protein was detected in 12 cases, corresponding to 63.1% of the sample. Based on these findings, it was concluded that p53 and PCNA can favor the proliferative activity of pleomorphic adenomas, whereas bcl-2 probably doesonot effectively particípate in the pathogenesis of this tumor. El objetivo del estudio fue determinar la expresión inmmunohistoquímica de las proteínas PCNA, p53 y bcl-2 en adenomas pleomórficos. Fueron seleccionados 19 especímenes de adenomas pleomórficos para análisis a través del método de la estreptavidina-biotina-peroxidasa con anticuerpos contra las proteínas p53, PCNA y bcl-2. Fue observada leve marcación para p53 en 12 casos (63,1%) y para PCNA en 8 (42,1%). Con relación al índice de marcación para bcl-2,ono fue detectada en 12 casos (63,1%) expresión de esta proteína. En base a los resultados, se concluyó que las proteínas p53 y PCNA pueden favorecer la actividad proliferativa de adenomas pleomórficos, y por otro lado, la bcl-2 probablementeono participaría efectivamente de la patogenia de este tumor.
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