Pleomorphic adenoma

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Pleomorphic adenoma

  1. 1. PLEOMORPHIC ADENOMA
  2. 2. ANATOMY Para- around otis-ear Largest salivary gland Parts – superficial (80%) , deep (20%) Duct – Stensen’s
  3. 3. HISTOLOGY
  4. 4. FACIAL NERVE
  5. 5. FACIOVENOUS PLANE OF PATEY
  6. 6.  BLOOD SUPPLY: External carotid artery VENOUS DRAINAGE : External jugular vein LYMPHATIC DRAINAGE : Deep cervical nodes
  7. 7. CLASSIFICATION OF PAROTIDGLAND TUMOURS EPITHELIAL( 90%) NONEPITHELIAL  Hemangioma  Lymphangioma  Neurofibroma• MALIGNANT LYMPHOMA – NHL TYPE
  8. 8. EPITHELIAL (90%) BENIGN (ADENOMAS)  Pleomorphic adenoma  Monomorphic adenoma  Warthin’s tumour (adenolymhoma)  Oncocytoma ( oxyphil adenoma )  Basal cell adenoma
  9. 9. EPITHELIAL ( 90% ) MALIGNANT  LOW GRADE • HIGH GRADE  Acinic cell • Adenocarcinoma carcinoma  Adenoid cystic •Squamous cell carcinoma carcinoma  Low grade mucoepidermoid •High grade carcinoma mucoepidermoid carcinoma
  10. 10. CASE A 45 yr old female 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 lobuleNo localised warmth, not tenderSurface-smooth, Margins- well defined. Retromand groove oblit.Variable consistency. MobileNot adherent to skin, masseter muscleNo signs suggestive of facial N invExamination of oral cavity is normal
  11. 11.  FNAC : shows ductal cells, chondromyxoid matrix and myoepithelial cells DIAGNOSIS : PLEOMORPHIC ADENOMA
  12. 12. PLEOMORPHIC ADENOMA MIXED TUMOUR SITE : MC: PAROTID GLAND ( 90%)- MC –Tail of gland Submandibular gland (7%) Minor salivary glands-MC : PalateOccurs more commonly in females (3:1)AGE : any age . MC : 40-50yrsUsually unilateral
  13. 13. PATHOLOGY BENIGN TUMOR Tumor capsule-well formed, but incomplete Tiny excrescences (pseudopods) project outside. Give rise to recurrences. GROSS : CUT SECTION:
  14. 14. MICROSCOPIC APPEARANCE 2 groups of cells : Well differentiated epithelial cells-acini/cords/sheets Spindle/stellate cells Abundant intercellular mucoid material-resembles cartilage Pleomorphic stroma No necrosis Rarity of mitotic figures
  15. 15. CLINICAL FEATURES Painless slow growing swelling In the parotid both lobes involved. If only deep lobe involved – DUMB BELL TUMOUR Dysphagia if deep lobe is involved Deviation of uvula&pharyngeal wall towards midline-deep Deep lobe swelling passes through PATEY’S STYLOMANDIBULAR TUNNEL Raised ear lobule Cannot be moved abv zygomatic bone-CURTAIN SIGN FACIAL NERVE NOT INVOLVED
  16. 16. 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
  17. 17. MANAGEMENT Tumor is RADIO RESISTANT SURGERY : ENUCLEATION –avoided. High recurrence. TOC : SUPERFICIAL PAROTIDECTOMY – PATEY’S OPERATION( if supf lobe alone involved) TOTAL CONSERVATIVE PAROTIDECTOMY (If both lobes involved)
  18. 18. COMPLICATIONS RECURRENCE ( 1 – 5 %) MALIGNANCY  3-5 % IN EARLY TUMORS  10% IN LONG DURATION( >15 YRS)
  19. 19. RECURRENCE AFTER SURGERY DUE TO : Spillage Inadequate margin Retained pseudopods Multicentricity Improper technique Recurrent tumor is multinodular without capsule Marker to predict recurrence : MUC1/DF3
  20. 20. CARCINOMA IN EX PLEOMORPHICADENOMA Long standing Pl.adenoma-malignant transformation Recent increase in size Pain , nodularity Involvement of skin, ulceration Involvement of masseter Involvement of facial nerve Neck lymph node Restriction of jaw movements
  21. 21. TAKE HOME MESSAGE MOST COMMON TUMOUR OF PAROTID FACIAL NERVE IS NOT INVOLVED TOC : SUPERFICIAL PAROTIDECTOMY FACIAL NERVE IS PRESERVED. CARCINOMA IN EX PLEOMORPHIC ADENOMA.
  22. 22. -AISHWARYA. G

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