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| {{DiseaseDisorder infobox | Name = Pleomorphic adenoma | ICD10 = {{ICD10|D|11||d|10}} | ICD9 = {{ICD9|210.2}} | ICDO = 8940/0 | Image = Pleomorphic adenoma (1) parotid gland.jpg | Caption = Pleomorphic adenoma consists of mixed epithelial (left) and mesenchymal cell components (right). The latter often exhibits myxofibrous appearance and in some instances shows chondromatous differentiation. | OMIM = 181030 | OMIM_mult = | MedlinePlus = | eMedicineSubj = radio | eMedicineTopic = 531 | DiseasesDB = | MeshID = D008949 | }} | | __NOTOC__ |
| {{SI}}
| | {{Pleomorphic adenoma}} |
| {{EH}}
| | '''For patient information, click [[Pleomorphic adenoma (patient information)|here]]''' |
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| ==Overview==
| | {{CMG}}; {{AE}} {{M.N}} |
| '''[[Pleomorphic]] [[adenoma]]''' is a benign neoplastic tumour of the [[salivary gland]]s. It is the most common type of salivary gland tumour and the most common tumour of the [[parotid gland]]. It derives its name from the architectural pleomorphism (variable appearance) seen by light microscopy. It is also known as "Mixed tumor, [[salivary gland]] type", which describes its pleomorphic appearance as opposed to its dual origin from epithelial and myoepithelial elements.
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| ==Clinical Presentation==
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| The tumour is usually solitary and presents as a slow growing, painless, firm single nodular mass. Isolated nodules are generally outgrowths of the main nodule rather than a multinodular presentation. It is usually mobile unless found in the palate and can cause atrophy of the mandibular ramus when located in the parotid gland. When found in the parotid tail, it may present as an eversion of the ear lobe. Though it is a benign tumour, pleomorphic adenomas have the capacity to grow to large proportions.
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| ==Diagnosis== | | ==[[Pleomorphic adenoma overview|Overview]]== |
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| The diagnosis of salivary gland tumors utilize both histopathological sampling and radiographic studies. Histopathological sampling procedures include [[fine needle aspiration]] (FNA) and core needle biopsy (bigger needle comparing to FNA). Both of these procedures can be done in an outpatient setting. Diagnostic imaging techniques for salivary gland tumors include [[ultrasound]], [[computer tomography]] (CT) and [[magnetic resonance imaging]] (MRI). Fine needle aspiration biopsy (FNA), operated in experienced hands, can determine whether the tumor is malignant in nature with [[sensitivity]] around 90%<ref>{{cite journal |author=Cohen EG, Patel SG, Lin O, ''et al'' |title=Fine-needle aspiration biopsy of salivary gland lesions in a selected patient population |journal=Arch Otolaryngol Head Neck Surg |volume=130 |issue=6 |pages=773–8 |year=2004 |month=Jun |pmid=15210562 |doi=10.1001/archotol.130.6.773 |url=}}</ref><ref>{{cite journal |author=Batsakis JG, Sneige N, el-Naggar AK |title=Fine-needle aspiration of salivary glands: its utility and tissue effects |journal=Ann Otol Rhinol Laryngol |volume=101 |issue=2 Pt 1 |pages=185–8 |year=1992 |month=Feb |pmid=1739267 |doi= |url=}}</ref>. FNA can also distinguish primary salivary tumor from metastatic disease. Core needle biopsy can also be done in outpatient setting. It is more invasive but is more accurate compared to FNA with diagnostic [[accuracy]] greater than 97%<ref>{{cite journal |author=Wan YL, Chan SC, Chen YL, ''et al'' |title=Ultrasonography-guided core-needle biopsy of parotid gland masses |journal=AJNR Am J Neuroradiol |volume=25 |issue=9 |pages=1608–12 |year=2004 |month=Oct |pmid=15502149 |doi= |url=http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=15502149}}</ref>. Furthermore, core needle biopsy allows more accurate histological typing of the tumor. In terms of imaging studies, ultrasound can determine and characterize superficial parotid tumors. Certain types of salivary gland tumors have certain sonographic characteristics on ultrasound<ref>{{cite journal |author=Białek EJ, Jakubowski W, Karpińska G |title=Role of ultrasonography in diagnosis and differentiation of pleomorphic adenomas: work in progress |journal=Arch Otolaryngol Head Neck Surg |volume=129 |issue=9 |pages=929–33 |year=2003 |month=Sep |pmid=12975263 |doi=10.1001/archotol.129.9.929 |url=}}</ref>. Ultrasound is also frequently used to guide FNA or core needle biopsy. CT allows direct, bilateral visualization of the salivary gland tumor and provides information about overall dimension and tissue invasion. CT is excellent for demonstrating bony invasion. MRI provides superior soft tissue delineation such as perineural invasion when compared to CT only<ref>{{cite journal |author=Koyuncu M, Seşen T, Akan H, ''et al'' |title=Comparison of computed tomography and magnetic resonance imaging in the diagnosis of parotid tumors |journal=Otolaryngol Head Neck Surg |volume=129 |issue=6 |pages=726–32 |year=2003 |month=Dec |pmid=14663442 |doi=10.1016/j.otohns.2003.07.009 |url=}}</ref>.
| | ==[[Pleomorphic adenoma historical perspective|Historical Perspective]]== |
| ==Diagnostic Findings==
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| *At US, pleomorphic adenomas are hypoechoic, well-defined, lobulated tumors with posterior acoustic enhancement and may contain calcifications.
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| *On CT, pleomorphic adenomas are typically smooth, well-marginated tumors. The attenuation values of the mass are usually homogeneous and higher than that of the surrounding gland. Tumor enhancement is variable and can result in a missed diagnosis if delayed images are not acquired (Pleomorphic adenomas are poorly enhancing in the early phase of contrast enhancement, though the amount of enhancement increases over time).
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| [http://www.radswiki.net Images courtesy of RadsWiki] | | ==[[Pleomorphic adenoma classification|Classification]]== |
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| <gallery perRow="3">
| | ==[[Pleomorphic adenoma pathophysiology|Pathophysiology]]== |
| Image:Pleomorphic adenoma MRI 101.jpg|MRI: A right parotid pleomorphic adenoma
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| Image:Pleomorphic adenoma MRI 102.jpg|MRI: A right parotid pleomorphic adenoma
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| Image:Pleomorphic adenoma MRI 103.jpg|MRI: A right parotid pleomorphic adenoma
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| Image:Pleomorphic adenoma MRI 104.jpg|MRI: A right parotid pleomorphic adenoma
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| Image:Pleomorphic adenoma MRI 105.jpg|MRI: A right parotid pleomorphic adenoma
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| Image:Pleomorphic adenoma PET 106.jpg|PET: A right parotid pleomorphic adenoma
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| </gallery>
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| ==Histology== | | ==[[Pleomorphic adenoma causes|Causes]]== |
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| Histologically, it is highly variable in appearance, even within individual tumours. It is characterized by an admixture of [[epithelial]] and [[myoepithelial]] elements in a variable background stroma that may be mucoid, myxoid, cartilaginous or hyaline. Epithelial elements may be arranged in duct-like structures, sheets, clumps and/or interlacing strands and consist of polygonal, spindle or stellate-shaped cells (hence pleomorphism). Areas of squamous metaplasia and epithelial pearls may be present. The tumour is usually enveloped by a fibrous capsule of varying thickness and often incomplete. The tumour often extends through these discontinuities but is not a sign of malignant transformation as it does not invade surrounding tissues.
| | ==[[Pleomorphic adenoma differential diagnosis|Differentiating Pleomorphic Adenoma from other Diseases]]== |
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| ==Treatment== | | ==[[Pleomorphic adenoma epidemiology and demographics|Epidemiology and Demographics]]== |
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| Overall, the mainstay of the treatment for salivary gland tumor is surgical resection. Needle biopsy is highly recommended prior to surgery to confirm the diagnosis. More detailed surgical technique and the support for additional [[adjuvant]] radiotherapy depends on whether the tumor is malignant or benign. Generally, benign tumors of the parotid gland are treated with superficial or total parotidectomy with the latter being the more commonly practiced due to high incidence of recurrence<ref>{{cite journal |author=Stennert E, Guntinas-Lichius O, Klussmann JP, Arnold G |title=Histopathology of pleomorphic adenoma in the parotid gland: a prospective unselected series of 100 cases |journal=Laryngoscope |volume=111 |issue=12 |pages=2195–200 |year=2001 |month=Dec |pmid=11802025 |doi= 10.1097/00005537-200112000-00024|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0023-852X&volume=111&issue=12&spage=2195}}</ref>. The [[facial nerve]] should be preserved whenever possible. The benign tumors of the [[submandibular gland]] is treated by simple excision with preservation of mandibular branch of the [[trigeminal nerve]], the [[hypoglossal nerve]], and the [[lingual nerve]]<ref>{{cite journal |author=Leonetti JP, Marzo SJ, Petruzzelli GJ, Herr B |title=Recurrent pleomorphic adenoma of the parotid gland |journal=Otolaryngol Head Neck Surg |volume=133 |issue=3 |pages=319–22 |year=2005 |month=Sep |pmid=16143173 |doi=10.1016/j.otohns.2005.04.008 |url=}}</ref>. Similarly, other benign tumors of minor salivary glands are treated similarly. Malignant salivary tumors usually require wide local resection of the primary tumor. However, if complete resection cannot be achieved, adjuvant radiotherapy should be added to improve local control<ref>{{cite journal |author=Ganly I, Patel SG, Coleman M, Ghossein R, Carlson D, Shah JP |title=Malignant minor salivary gland tumors of the larynx |journal=Arch Otolaryngol Head Neck Surg. |volume=132 |issue=7 |pages=767–70 |year=2006 |month=Jul |pmid=16847187 |doi=10.1001/archotol.132.7.767 |url=}}</ref><ref>{{cite journal |author=Terhaard CH, Lubsen H, Rasch CR, ''et al'' |title=The role of radiotherapy in the treatment of malignant salivary gland tumors |journal=Int J Radiat Oncol Biol Phys |volume=61 |issue=1 |pages=103–11 |year=2005 |month=Jan |pmid=15629600 |doi=10.1016/j.ijrobp.2004.03.018 |url=}}</ref>. This surgical treatment has many sequellae such as cranial nerve damage, [[Frey's syndrome]] , cosmetic problems, etc.
| | ==[[Xyz risk factors|Risk Factors]]== |
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| ==References== | | ==[[Pleomorphic adenoma screening|Screening]]== |
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| {{reflist|2}}
| | ==[[Pleomorphic adenoma natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==See also== | | ==Diagnosis== |
| * [[Warthin's tumor]] - monomorphic adenoma
| | [[Pleomorphic adenoma diagnostic study of choice|Diagnostic study of choice]] | [[Pleomorphic adenoma history and symptoms|History and Symptoms]] | [[Pleomorphic adenoma physical examination|Physical Examination]] | [[Pleomorphic adenoma laboratory findings|Laboratory Findings]] | [[Pleomorphic adenoma electrocardiogram|Electrocardiogram]] | [[Pleomorphic adenoma x ray|X-Ray Findings]] | [[Pleomorphic adenoma echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Pleomorphic adenoma CT scan|CT-Scan Findings]] | [[Pleomorphic adenoma MRI|MRI Findings]] | [[Pleomorphic adenoma other imaging findings|Other Imaging Findings]] | [[Pleomorphic adenoma other diagnostic studies|Other Diagnostic Studies]] |
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| ==External links==
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| * {{GPnotebook|-1804926964}}
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| * [http://brighamrad.harvard.edu/Cases/bwh/hcache/75/full.html Harvard]
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| {{SIB}}
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| {{Soft tissue tumors and sarcomas}}
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| [[Category:Oral pathology]] | |
| [[Category:Oncology]] | |
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| [[pl:Gruczolak wielopostaciowy]] | |
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| | ==Treatment== |
| | [[Pleomorphic adenoma medical therapy|Medical Therapy]] | [[Pleomorphic adenoma surgery|Surgery]] | [[Pleomorphic adenoma primary prevention|Primary Prevention]] | [[Pleomorphic adenoma secondary prevention|Secondary Prevention]] | [[Pleomorphic adenoma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pleomorphic adenoma future or investigational therapies|Future or Investigational Therapies]] |
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| {{WikiDoc Help Menu}}
| | ==Case Studies== |
| {{WikiDoc Sources}}
| | [[Pleomorphic adenoma case study one|Case #1]] |