PLEOMORPHIC ADENOMA presentaion sss.pptx

Medicine

1. PLEOMORPHIC ADENOMA RAJALEKSHMI P A ROLL NO: 74

2. PLEOMORPHIC ADENOMA Commonest salivary gland tumour in adults 80% of all salivary gland tumors 80% in parotids, 10% in submandibular , 0.5% in sublingual salivary gland

3. Benign tumors that consists of a mixture of ductal (epithelial), myoepithelial and mesenchymal cells. Grossly it contains cartilages, cystic spaces, solid tissues. Microscopically it is biphasic in nature with epithelial and stromal components- mixed tumors

4. GROSS MORPHOLOGY Round, well demarcated masses Rarely exceeds 6 cm in greatest dimension Even though it is capsulated, tumour may come out as pseudopods and may extend beyond the main limit of the tumour tissue. Cut surface- grey white with myxoid and blue translucent areas of chondroid stroma .

5. HISTOLOGY Dominant histologic feature- heterogeneity Epithelial elements – ductal cells or myoepithelial cells- arranged as ducts, acini, irregular tubules, strands or sheets of cells. These elements are typically dispersed within a background of loose myxoid and hyaline tissue containing islands of cartilage of foci of bone. Most cases, there is no mitotic activity or epithelial dysplasia.

6. EPIDEMIOLOGY 80% common. Common in females (3:1). Occurs in any age group. But common in 4th and 5th decade. Usually unilateral

7. CLINICAL FEATURES Present as a single painless, smooth, firm lobulated , mobile swelling in front of the parotid with positive curtain sign . Obliteration of retromandibular groove The ear lobule is lifted But sometimes only deep lobe is involved and then it presents as swelling in the lateral wall of the pharynx, soft palate and posterior pillar of the fauces.There may not be any visible swelling in the preauricular region. It is called as ‘ dumbbell tumour ’. This tumour is in relation to styloid process, mandible, stylohyoid , styloglossus , stylopharyngeus muscles. It may also present as dysphagia Facial nerve is uninvolved

8. Pleomorphic adenoma showing typical rise in earlobe Pleomorphic adenoma showing Curtain sign

9. COMPLICATIONS Recurrence—5–50%. Malignancy. 3–5% in early tumours . 10% in long duration (15 or more years) tumours .

10. CARCINOMA IN EX PLEOMORPHIC ADENOMA Long-standing pleomorphic adenoma may turn into carcinoma. Its features are: ™Pain and nodularity ™Involvement of skin, ulceration ™Involvement of masseter ™Involvement of facial nerve—lower facial nerve palsy—(Difficulty in closing eyelid, difficulty in blowing and clenching teeth) ™Involvement of neck lymph node ™Restriction of jaw movements

11. INVESTIGATIONS FNAC is very important and diagnostic. CT scan to know the status of deep lobe, local extension and spread. MRI is better method Open biopsy is contraindicated in parotid tumours due to: ™. Chance of injury to facial nerve ™. Seedling and high chance of recurrence ™. Chance of parotid fistula formation

12. TREATMENT Surgery—first line treatment. If only superficial lobe is involved, then superficial parotidectomy is done wherein parotid superficial to facial nerve is removed. If both lobes are involved, then total conservative parotidectomy is done by retaining facial nerve. Enucleation is avoided as it causes high recurrence due to extension of tumour outside as pseudopods across the capsule.

13. REFERENCES Bailey and Love- Short Practice Of Surgery 28 th edition SRB Manual Of Surgery 7 th edition Robbins Pathologic Basis Of Disease