pleomorphic adenoma

1. Pleomorphic Adenoma

2. CASE
⚫A 45 yrold female
⚫C/0 – slow growing, painless
swelling below the left sideof ear for
the past 5 months
⚫O/e – 5x3 cm,oval, lifting theear
lobule
No localised warmth, not tender
Surface-smooth, Margins- well
defined. Retromand grooveoblit.
Variableconsistency. Mobile
Notadherent toskin, masseter muscle
No signs suggestive of facial N inv
Examinationof oral cavity is normal

3. ⚫FNAC : showsductal cells, chondromyxoid
matrixand myoepithelial cells
⚫DIAGNOSIS : PLEOMORPHIC
ADENOMA

4. PLEOMORPHIC ADENOMA
⚫MIXED TUMOUR
⚫SITE : MC: PAROTID GLAND ( 90%)- MC –Tail of gland
Submandibulargland (7%)
Minorsalivaryglands-MC : Palate
Occurs morecommonly in females (3:1)
AGE : anyage . MC : 40-50yrs
Usuallyunilateral

5. PATHOLOGY
⚫BENIGN TUMOR
⚫Tumorcapsule-well formed, but incomplete
Tinyexcrescences (pseudopods) projectoutside.
Giverise torecurrences.
GROSS :
circumscribed,pseudoencapsulated,rounded,fir
m mass with bosselated surface.
CUT SECTION: G.W. variegated,semitranslucent
usually solid but may show small cystic spaces.

7. MICROSCOPIC APPEARANCE
s
⚫2 groupsof cells :
⚫Well differentiated epithelial
cells-acini/cords/sheets
⚫Spindle/stellatecells
⚫Abundant intercellular
mucoid material-
resemblescartilage
⚫Pleomorphicstroma
⚫No necrosis
⚫Rarityof mitotic figures

9. 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

10. COMPLICATIONS
⚫RECURRENCE ( 1 – 5 %)
⚫MALIGNANCY
⚫3-5 % IN EARLY TUMORS
⚫10% IN LONG DURATION( >15 YRS)