ADENOMA PLEOMORFO PDFJuly 22, 2020
Often women in 30s but any age; 90% occur in parotid gland (represent 60% of parotid tumors; 50% occur in tail, 25% in superficial lobe, 25%. Request PDF on ResearchGate | On Mar 1, , I. Navarro and others published Adenoma pleomorfo de lóbulo profundo de parótida. Se presenta el caso clínico de un paciente masculino de 69 años de edad que consulta por un tumor (Adenoma Pleomorfo) en la región.
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Pleomorphic adenoma is the most pleomorco tumour of the salivary glands. However, it is extremely rare for these to originate in the nose and even when they do so, it is most commonly in the nasal septum.
It is important to be aware of the paucity of presenting symptoms nasal obstruction and epistaxisas the lesion may not be recognized immediately. Growth is generally restricted locally and the tumour is not known to spread to the neighbouring structures. Surgical resection is the treatment of choice.
Recurrences and evolution to malignancy are not frequent, but adenona follow-up is recommended. The case is presented of pleomorphic adenoma arising from the lateral wall of plwomorfo right nasal cavity, in a year-old male, which was resected completely, endoscopically. Histological and immunohistochemical evaluation revealed the presence of a pleomorphic adenoma. Presentiamo un caso di adenoma pleomorfo ad origine dalla parete laterale della fossa nasale di destra in un paziente di 34 anni, trattato chirurgicamente con resezione endoscopica completa.
La valutazione istologica ed immunoistochimica hanno dimostrato la presenza di un adenoma pleomorfo.
Rare cases have been reported in the lip 2the hard and soft palate 3the lacrimal gland 4and the external auditory canal 5. It is extremely rare to find these in the respiratory tract 6 — 8.
The incidence is even lower in the upper respiratory tract, such as the nasal cavity, maxillary sinus and nasopharynx 8 9. The largest reported case series of intra-nasal pleomorphic adenomas are those of Spiros et al. Intranasal pleomorphic adenomas generally arise in the nasal septal mucosa reported incidence varies between Various theories have been proposed to explain this observation.
According to Stevenson 15remnants of the vomero-nasal organ, an epithelium-lined duct in the cartilaginous nasal septum degenerated in early foetus, could be the reason for the appearance of these tumours in this particular region. According to Ersner and Saltzman, inthe precursors of the septal pleomorphic adenoma are ectopic embryonic epithelialised cells on the nasal septum mucosa, found during the migration of the nasal buds According to Evans and Cruikshank, it originates directly from the matured salivary glandular tissue 6 ; Dawe, in, proposed a viral aetiology from polyoma virus A year-old male, non-smoker, presented at our Department, in Januaryreporting an isolated episode of epistaxis from the right nasal cavity.
He also complained of worsening of a right nasal obstruction which had been present for 10 years, frontal cephalalgia and anosmia. External clinical examination showed a mass arising from the lateral wall of the right nasal cavity and filling the naso-facial furrow.
Anterior rhinoscopy revealed a smooth, pink-grey, translucent, painless mass, obstructing the nasal cavity, not bleeding on touch, and a deviated nasal septum to the left. The rest of the ear, nose, and throat examination was normal and there was no evidence of cervical lymphadenopathy.
Computed Tomography CT scan revealed a soft tissue mass in the right nasal cavity, not involving the paranasal sinuses, with thinning of the nasal process of the maxilla Fig.
Endoscopic surgery, under general anaesthesia, confirmed the mass 2 cm in diameter to be arising from the lateral wall of the right nasal cavity and extending from the anterior end of the inferior turbinate to the agger nasi.
We excised the tumour completely, including the sub-periostal layer and a healthy margin of mucosa. Axial CT scan showing soft density mass in anterior portion of right nasal fossa with thinness of nasal process of maxillary bone. Histopathological analysis of the tumour showed a mixed epithelial and myxoid stromal appearance.
Epithelial structures displayed different solid, trabecular and cystic growth patterns Fig. Immuno-histochemical stainings for smooth muscle actin Fig. The histo-morphological and immunophenotypical features observed were consistent with the diagnosis of pleomorphic adenoma. Nasal pleomorphic adenoma is seen predominantly in females 4 — 11 usually between the third and fifth decades of life There is no reported correlation with occupational exposure or inhaled toxic chemical compounds.
It is generally known to be a slow-growing tumour and, therefore, clinical symptoms appear after a long silent period.
Patients commonly present with gradual worsening of monolateral nasal obstruction and occasional epistaxis. Less commonly, when the tumoural mass reaches a relatively large size, to that of the nasal pleo,orfo, external swelling of the nasal pyramid as well as pain may be present.
Clinically, it appears as a polypoid, unilateral, sessile, translucent, pinkish-grey mass, with smooth surface and soft consistency. The clinical features, such as absence of superficial ulceration, no bleeding either on touch or spontaneously and lack of invasion of surrounding structures suggest a benign nature of the mass. Histologically, all pleomorphic adenomas have a collagenous thin capsule, with a clear-cut distinction of the tumour tissue from the surrounding normal connective tissue.
The tumours consist of three main structures: The tubuloductal structure presents ducts with double cell layers: Predominantly the solid areas consist of the spindle-shaped cells with high cellularity; the myxoid areas are characterised by their low cellularity The intra-nasal pleomorphic adenoma shows a predominance of epithelial rather than stromal elements, as compared with major salivary gland tumours.
Aadenoma epithelial cells are small, oval-shaped and often arranged in cordons; sometimes, they are organized in small acinous structures Differential diagnosis of intra-nasal pleomorphic adenoma includes both malignant and benign tumours such as squamous cell carcinoma the most common intra-nasal malignancyadenocarcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, melanoma, olfactory esthesioneuroblastoma 20polyps, papillomas including inverted papillomaangiofibromas and osteomas.
Diagnosis is possible on account of the lack of an extracellular neurofibrillar structure, neurotubules, neurosecretive granules and due to the presence of mucinous material and the rarity of malpighian lobules disseminated on the pleomorphic adenoma Regardless of where the lesion originates, the main treatment modality aadenoma be surgical.
While complete excision of the tumour with histologically clear margins is mandatory, the surgical approach will depend upon the lpeomorfo, location and extension. A radical and wide resection lowers the risk of recurrence, especially when the capsule is interrupted and a direct contact with aadenoma surrounding normal tissue is present. Approaches include lateral rhinotomy 22 — 24trans-nasal or mid-facial degloving 13 — 18 and intra-nasal excision.
The present patient underwent endoscopic resection since the tumour was small enough to observe under the endoscope. The advantages of plelmorfo resection include no external scar, less blood loss. In the presence of large masses, the mid-facial degloving approach is pleomorro, since it has the advantage of wide exposure of the mass pleomogfo direct approach to the nasal pleomorof. Recurrences are not frequent, Compagno and Wong reported 3 cases of local recurrences in 40 patients 7.
The risk is increased by delay in diagnosis. A histopathologically confirmed case adenlma adenoid cystic and squamous carcinomatous differentiation has been reported There has also been a report of metastasis to the submandibular lymph-node, in a recurrent septal pleomorphic adenoma, 17 years after the first diagnosis.
Even in this case, the microscopic features of both the primary and metastatic lesion were benign. In this regard, a iatrogenic theory has been proposed. This theory suggests that the metastasis occurs as a result of incomplete excision or inadvertent disruption of the tumour with consequent spread through haematogenous or lymphatic routes.
Pulmonary, hepatic and bone metastasis have also been reported Long term follow-up is therefore necessary for early diagnosis of loco-regional recurrences by endoscopic examination followed by imaging CT adsnoma MR in case of clinical evidence of disease.
In the presence of a slow-growing unilateral mass of the nasal cavity, it is important to consider, among the various diagnoses, the presence of pleomorphic adenoma, even if it is not frequently encountered. Early diagnosis offers the possibility of a more complete excision with adequate care being pleomotfo not to disrupt the tumour in order to prevent local and distant spread of avenoma cells.
Pleomorphic adenoma of the lateral nasal wall: case report
The endoscopic approach is preferred, as it allows complete control of the margins under direct vision and reduces the post-operative recovery period when compared to open surgery. Long-term follow-up, both endoscopic and radiologic, to exclude malignancy is mandatory, even if the tumour appears to be clinically benign and resected completely.
National Center for Biotechnology InformationU. Journal List Acta Otorhinolaryngol Ital v. Author information Article notes Copyright and License information Disclaimer. Received May 31; Accepted Aug This article has been cited by other articles in PMC. Summary Pleomorphic adenoma is the most common tumour of the salivary glands. Nose, Nasal tumour, Pleomorphic adenoma, Diagnosis, Histopathology.
Case report A year-old male, non-smoker, presented at our Department, in Januaryreporting an isolated episode of epistaxis from the right nasal cavity. Open in a separate window. Discussion Nasal pleomorphic adenoma is seen predominantly in females 4 — 11 usually between the third and fifth decades of life Conclusions In the presence of a slow-growing unilateral mass of the nasal cavity, it is important to consider, among the various diagnoses, the presence of pleomorphic adenoma, even if it is not frequently encountered.
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Carcinoma ductal sobre adenoma pleomorfo de parótida
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