pleomorphic adenoma major salivary .pptx

pleomorphic adenoma

1. Pleomorphic Adenoma

2. CASE A 4 5 y r old f emale 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

3. FNAC : shows ductal cells, chondromyxoid matrix and myoepithelial cells DIAGNOSIS : PLEOMORPHIC ADENOMA

4. PLEOMORPHIC ADENOMA MIXED TUMOUR SITE : MC: PAROTID GLAND ( 90%)- MC – Tail of gland S u bmand i b ular g land (7%) Minor salivary glands-MC : Palate O c cur s mo r e c ommo n l y i n f emales (3:1) AGE : any age . MC : 40-50yrs U sual l y unil a t e r al

5. PATHOLOGY BENIGN TUMOR T umo r ca p su l e - w ell f ormed, bu t i n c om p le t e Tiny excrescences (pseudopods) project outside. Give rise to recurrences. GROSS : circumscribed,pseudoencapsulated,rounded,firm mass with bosselated surface. CUT SECTION : G.W. variegated,semitranslucent usually solid but may show small cystic spaces.

6. MICROSCOPIC APPEARANCE s 2 groups of cells : W ell di f f e r entia t ed ep i thelial cells-acini/cords/sheets Spi n dle/ s t ella t e c ells Abundant intercellular mucoid material- resemble s cartilage P l eomorphic st r oma No necrosis Rarit y of m i t otic f igu r es

7. 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

8. COMPLICATIONS RECURRENCE ( 1 – 5 %) MALIGNANCY 3 -5 % IN EAR L Y T U MORS 10% IN LONG DURATION( >15 YRS)