Salivary gland swellings can result from tumors, an inflammatory process
or cysts. It can sometimes be difficult to establish; whether pathology arises
from the salivary gland itself or adjacent structures. Neoplasms of the salivary
glands account for less than 1% of all tumors, 3–5% of all head and neck
tumors and benign pleomorphic adenoma (PA) of minor salivary glands arising
de novo is very rare. PA is the most common tumor of the salivary gland. While
the majority arises from the parotid gland, only a small percentage arises from
the buccal minor salivary gland. A case of PA of minor salivary glands in the
buccal mucosa in a 70‑year‑old female is discussed. It includes review of
literature, clinical features, histopathology, radiological findings and treatment
of the tumor; with emphasis on diagnosis.
Case presented in National ENT conference in serena hotel, Islamabad in Dec. 2015
Author
Dr. Ghulam Saqulain HOD
Dr. Jawad Ahmed Assoc. surgeon
Dr. Zaimal Shahan PGT
Case presented in National ENT conference in serena hotel, Islamabad in Dec. 2015
Author
Dr. Ghulam Saqulain HOD
Dr. Jawad Ahmed Assoc. surgeon
Dr. Zaimal Shahan PGT
Childhood mumps, certain bacterial infections (for example, of the tonsils or teeth), and other diseases that are typically more common among adults (such as AIDS, Sjögren syndrome, diabetes mellitus, sarcoidosis, and bulimia) often cause swelling of the major salivary glands.
Benign salivary gland tumor part 1 / dental crown & bridge coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Salivary gland tumours are a relatively rare and morphologically diverse group of lesions. So here are slides containing information about salivary gland tumours with images.
guideline for long case presentation,include history,examination,,investigation,treatment option,surgical procedure of superficial parotidectomy,short discussion about plemorphic adenoma
Childhood mumps, certain bacterial infections (for example, of the tonsils or teeth), and other diseases that are typically more common among adults (such as AIDS, Sjögren syndrome, diabetes mellitus, sarcoidosis, and bulimia) often cause swelling of the major salivary glands.
Benign salivary gland tumor part 1 / dental crown & bridge coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Salivary gland tumours are a relatively rare and morphologically diverse group of lesions. So here are slides containing information about salivary gland tumours with images.
guideline for long case presentation,include history,examination,,investigation,treatment option,surgical procedure of superficial parotidectomy,short discussion about plemorphic adenoma
Forensic science and pathology Journal - SciDocPublishersScidoc Publishers
International Journal of Forensic Science & Pathology (IJFP) ISSN 2332-287X is a comprehensive, peer reviewed journal devoted to Forensic Science & Pathology. IJFP, published by SciDocPublishers is an Open Access journal that includes high quality papers, which covers all major areas of Forensic Science & Pathology and its diagnosis. SciDocPublishers with its Open Access publication model spreads all the day-to-day developments and research to readers around the world.
IJFP is an Open Access journal which publishes original research articles, review articles, and clinical studies in all areas of Forensic Science & Pathology. IJFP will become an international interdisciplinary forum for the publication of basic science and clinical research papers offering critical analysis and scientific appraisal.
Tumors of the appendix are rare. They pose both a diagnostic and therapeutic dilemma to the surgeon. The paper discusses the various intricacies of these lesions.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
Porocarcinoma of the nose- reconstructed with seagull flap
Authors:Balasubramaniam, Ramanandham, Pradeep, Sivakumar, Kalpa Pandya
Int J Biol Med Res. 2024; 15(1): 7760-7763
https://www.biomedscidirect.com/2847/porocarcinoma-of-the-nose-reconstructed-with-seagull-flap
Abstract: Of all the cutaneous tumours, the reported incidence of porocarcinoma is as low as 0.005-0.01%. Very few cases of porocarcinoma of the nose have been described in English literature. Median forehead flap, also known as seagull flap is an excellent reconstruction modality for the nasal defect. We describe here an interesting case of porocarcinoma of the dorsum of the nose which was reconstructed in the first stage using a seagull flap providing the patient with a pleasing nasal profile.
Porocarcinoma of the nose- reconstructed with seagull flap
Authors:Balasubramaniam, Ramanandham, Pradeep, Sivakumar, Kalpa Pandya
Int J Biol Med Res. 2024; 15(1): 7760-7763
https://www.biomedscidirect.com/2847/porocarcinoma-of-the-nose-reconstructed-with-seagull-flap
Papillary Hidradenoma is a rare benign tumor of apocrine glands. Very limited number of case reports are available in the literature detailing the cytological features of papillary hidradenoma. Such a rare case specimen came in notice here at Pathology Department of SMS Medical College, Jaipur (Raj.) India. So, one such a rare case of papillary hidradenoma was explored with its cytological findings. A 30 year old female presented with a vulval cyst. Fluid from this cyst was sent for cytology with a clinical diagnosis of Bartholin cyst. The cytology suggested it to be a benign adnexal tumour by the presence of Biphasic pattern of cell arrangement which was further confirmed histologically. So whenever an middle aged female presents with a nodular lesion in the anogenital area, hidradenoma papilliferum should be kept in mind along with other conditions.
Abstract: We report a case of sinonasal paraganglioma presenting with episodes of epistaxis. A 55 year old male presented with a
nasal mass. It is an uncommon site of presentation and in an uncommon age group. A high grade of suspicion is required to diagnose
sino nasal paraganglioma. However, CT Scan and histopathology helps in early diagnosis and treatment. Surgical excision done with
cranialization of frontal sinus with fascia lata graft, followed up for 1 year without any evidence of disease recurrence.
Keywords: Sinonasal; Paraganglioma; Fascia Lata.
Metastatic papillary thyroid carcinoma typically appears in local lymph nodes, nasal and skull base metastases are rare. The authors describe the third case of Metastatic papillary thyroid carcinoma to nasal cavities and paranasal cavities in the literature.The objective of this study is to describe - from our clinical case and from literature review- the clinical radiological features of this rare entity, and to discuss its therapeutic management. Until now, there is not enough data on postoperative radioactive iodine ablation, external radiation,
or chemotherapy, but early diagnosis is essential for an ideal care. It seems that surgical approach is one of the best methods to manage and eradicate this type of tumor.
Pericytes are the perivascular or mural cells of micro vessels. They are of mesenchymal origin and capable of differentiating into a number of different cell lineages. They are intimately associated with endothelial cells and communicate with them via direct physical contact or through paracrine signaling pathways. These interactions are important for blood vessel maturation, remodelling, and maintenance. Pericytes are versatile and their varying morphological characteristics and distribution make them difficult to study. The lack of universal pericytes markers is a major problem. A number of different functions have been attributed to pericytes, and in some organs they have more specific roles. The role of pericytes in tumor vessels is debated, but pericytes may contribute to stability, and might protect the vessels from antiangiogenic therapy. Understanding the process of angiogenesis in angiogenesis dependent diseases role of pericytes may be of therapeutic benefit.This article gives an overview of pericytes their role in health and disease particularly in relation to oral cavity.
The objective of this review is to introduce Merkel cells (MCs), to provide a basic
overview on the theoretical background of function, development and clinical
importance of MCs. The origin of human MCs have been controversial. Some
investigators believe that it is a neural crest derivate, whereas others have
proposed that it is a differentiation product of the fetal epidermal keratinocytes.
MCs are cells primarily localized in the epidermal basal layer of vertebrates
and concentrated in touch‑sensitive areas in glabrous, hairy skin and in some
mucosa. In routine light microscopy, human MCs can hardly be identified.
Cytokeratin 20 (CK20) is a reliable marker with highest degree of specificity.
MCs can be also distinguished by electron microscopy. MC carcinoma (MCC)
is an uncommon and often aggressive malignancy and found mainly in elderly
patients. It occurs most frequently in the head and neck region. Diagnosis is
based on typical histological presentation on hematoxylin and eosin (H and E)
stained slides together with the results of immunohistochemistry. Histologically,
MCC has been classified into three distinct subtypes: Trabecular, intermediate
and small cell type.
With the discovery in 1956 that the correct chromosome number in humans is 46, the new era of clinical
cytogenetics began its rapid growth. During the next few years, several major chromosomal
syndromes with altered numbers of chromosomes were reported, i.e. Downsyndrome (trisomy21),
turner syndrome (45,x) and klinefelter syndrome (47,xxy). Since then it has been well established that
chromosome abnormalities contribute significantly to genetic disease resulting in reproductive loss,
infertility, stillbirths, congenital anomalies, abnormal sexual developmentmental retardation and
pathogenesis of malignancy.specific chromosome abnormalities have been associated with over 60
identifiable syndromes. They are present in at least 50% of spontaneous abortions, 6% of stillbirths,
about 5% of couples with two or more miscarriages and approximately 0.5% of newborns. In women
aged 35 or over, chromosome abnormalities are detected in about 2% of all pregnancies. Some of the
abnormalities and their clinical consequences will be Discussed in the following sections.
Orofacial pain in patients with cancer a review Prashant Munde
Orofacial pain is commonly associated with cancer and may motivate patients to seek care from an oral and maxillofacial surgeon. Pain may be a presenting symptom of primary tumors, metastatic disease, systemic cancer, or distant non-metastasized cancer. Patients with head and neck cancer undergoing therapy may suffer treatment-induced complications, which are often associated with acute pain. Following cancer therapy, permanent changes to tissues may cause late effects of treatment that may result in chronic orofacial pains. Oral and maxillofacial surgeons should be knowledgeable regarding these orofacial pain presentations.Orofacial pain is commonly associated with cancer and may motivate patients to seek care from an oral and maxillofacial surgeon. Pain may be a presenting symptom of primary tumors, metastatic disease, systemic cancer, or distant non-metastasized cancer. Patients with head and neck cancer undergoing therapy may suffer treatment-induced complications, which are often associated with acute pain. Following cancer therapy, permanent changes to tissues may cause late effects of treatment that may result in chronic orofacial pains. Oral and maxillofacial surgeons should be knowledgeable regarding these orofacial pain presentations.
Most deep fungal infections have their primary foci in the lungs, therefore those presenting with distant organs or skin involvement should be managed aggressively as untreated or severe disease can lead to severe scarring, disfigurement and even death.
Investigations in hemorrhegic disorders ppt Prashant MunePrashant Munde
Clinical assessment, pertinent history, and family history are good indicators for determining patient's bleeding tendencies.
The most appropriate laboratory tests performed are Routine screening tests include a complete blood cell count, platelet count, and evaluation of a peripheral blood sample, a prothrombin time, and an activated partial thromboplastin time.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Evaluation of antidepressant activity of clitoris ternatea in animals
Pleomorphic adenoma of the buccal salivary gland
1.
2. Journal of Oral and Maxillofacial Pathology Vol. 19 Issue 1 Jan - Apr 2015
INTRODUCTION
Pleomorphic adenoma (PA) is a benign, mixed tumor which
most commonly involves the parotid gland. Approximately,
8% of PA involves the minor salivary glands and the palate is
the most common site (60–65%).[1]
PAs are known to occur
in other minor salivary gland sites, including the lip, buccal
mucosa and tongue.[2]
PA of a buccal minor salivary gland,
which lies on the external aspect of buccinators, has not been
reported previously. We report a case of a PA apparently
arising from such a gland and relevant review of literature.
An extensive research has revealed only few well‑documented
cases of PA of a buccal minor salivary gland. This article is
presented to share our experience with a case of very rare PA
of a buccal minor salivary gland.
CASE REPORT
A70‑year‑oldfemalepatientpresentedwiththechiefcomplaint
of swelling over right side of face since 2 years. The swelling
was initially small in size; gradually increased to a present size
of 4 cm × 3 cm. Patient had no significant medical history. On
general and systemic examinations, the patient was apparently
healthy. There was no regional lymphadenopathy. On
extraoral examination, facial asymmetry due to swelling was
noted on the right side.A solitary dome‑shaped, oval swelling
with smooth surface was present on right cheek region. No
abnormality was detected with overlying skin. Swelling was
approximately in mid cheek region, 4 × 3 cm in size extending
superior‑inferiorly from ala‑tragus line to the lower border
of mandible. Antero‑posteriorly it was extending 2 cm from
right ala of nose to angle of mandible [Figure 1]. Opening
of the mouth was adequate. No significant findings were
observed on intraoral examination [Figure 2]. On palpation
all findings of inspection were confirmed, the swelling was
nontender, mobile, soft to firm in consistency and not fixed
to the underlying structures. Additional findings noted were
swelling was nonfluctuant, nonreducible, nonpulsatile and
mobile in all planes. Local temperature over the swelling
was not raised. There was no evidence of nasal obstruction
or ophthalmologic signs of extension of the lesions into
these anatomical regions. There were also no signs of
neurosensory deficit associated with the infraorbital nerve.
Computed tomography (CT) face [Figure 3] was suggestive
of heterogeneously enhancing lesion in close proximity to
superficial lobe of right parotid gland without invasion of
the adjacent structures. Ultrasonography (USG) from the
lesion was carried out, which revealed large, well‑defined,
soft tissue lesion in superficial aspect of right buccal region
with solid and cystic components. Fine‑needle aspiration
cytology (FNAC) from the lesion was carried out which
revealed chondromyxoid stroma and plenty of hemosiderin
laden cyst macrophages. Spindle cells were seen embedded
in stromal matrix and cells were also seen in cohesive
clusters showing mild anisonucleosis. All these features
Pleomorphic adenoma of the buccal salivary gland
Shubhangi Khandekar, Alka Dive, Prashant Munde, Neena Dongre Wankhede
Department of Oral and Maxillofacial Pathology, Vidya Shikshan Prasarak Mandal’s Dental College and Research Centre, Nagpur,
Maharashtra, India
CASE REPORT
Address for correspondence:
Dr. Prashant Munde,
Department of Oral and Maxillofacial Pathology,
Vidya Shikshan Prasarak Mandal’s Dental
College and Research Centre, Nagpur,
Maharashtra ‑ 440 019, India.
E‑mail: pinkclimate@gmail.com
Received: 20‑08‑2014
Accepted: 24‑03‑2015
ABSTRACT
Salivary gland swellings can result from tumors, an inflammatory process
or cysts. It can sometimes be difficult to establish; whether pathology arises
from the salivary gland itself or adjacent structures. Neoplasms of the salivary
glands account for less than 1% of all tumors, 3–5% of all head and neck
tumors and benign pleomorphic adenoma (PA) of minor salivary glands arising
de novo is very rare. PA is the most common tumor of the salivary gland. While
the majority arises from the parotid gland, only a small percentage arises from
the buccal minor salivary gland. A case of PA of minor salivary glands in the
buccal mucosa in a 70‑year‑old female is discussed. It includes review of
literature, clinical features, histopathology, radiological findings and treatment
of the tumor; with emphasis on diagnosis.
Key words: Buccal minor salivary gland, chondromyxoid stroma,
pleomorphic adenoma
Access this article online
Quick Response Code:
Website:
www.jomfp.in
DOI:
10.4103/0973-029X.157222
3. Journal of Oral and Maxillofacial Pathology: Vol. 19 Issue 1 Jan - Apr 2015
Pleomorphic adenoma of the buccal salivary gland Khandekar, et al.
were suggestive of PA. Based on the clinical, radiological
and cytological appearance; a provisional diagnosis of PA of
minor salivary gland was made. Surgical excision of tumor
was performed. Excisional biopsy specimen revealed a single
soft tissue specimen, approximately 4.5 cm × 3 cm in size,
reddish in color, irregular in shape and was soft to firm in
consistency with rough surface texture. Cut sections that were
2 × 1 cm and 1.5 cm × 1.5 cm in size revealed homogeneous
white glistening cut potato appearance. Scattered areas
of hemorrhages and necrosis were also noted [Figure 4].
Hematoxylin and eosin (H and E) stained sections showed
lesional tissue which was encapsulated [Figure 5]. The
lesional tissue was composed of neoplastic glandular
epithelial cells arranged in the form of sheets interspersed
with numerous small and large duct‑like structures filled with
eosinophilic coagulum [Figure 6]. These cells were spindle
shaped at places and round to oval at other places with
hyperchromatic to vesicular nuclei along with chondromyxoid
areas [Figure 7]. At places, pleomorphic and hyperchromatic
cells with few mitotic figures were evident [Figure 8]. Clear
cells and hyalinized areas were interspersed in between these
neoplastic glandular epithelial cells [Figure 9]. These cells
showed squamous metaplasia, along with osteoid‑like tissue
[Figure 10]. Higher‑power view showed spindle‑shaped cells
with duct‑like places and eosinophilic coagulum with few clear
cells [Figure 11]. Higher‑power view showed spindle‑shaped
cells with necrotic areas at places and clear cells [Figures 12
and 13]. Histologically, the features were consistent with
PA. Although the patient was treated surgically with wide
margins of resection and is doing well presently, but knowing
the notorious nature of minor salivary gland neoplasms the
patient has been kept under a close long‑term follow‑up.
DISCUSSION
Tumors of the salivary glands represent less than 5% of all
head and neck tumors and two‑thirds of these tumors are PAs.[1]
PA is the most common salivary gland tumor that affects both
major and minor salivary glands. The parotid gland is the most
common site of PA. In the parotid gland, this tumor most often
presents in the lower pole of the superficial lobe, about 10%
Figure 1: Extraoral photograph showing swelling and extension over
right buccal region
Figure 2: Intraoral photograph showing no significant finding
Figure 3: Computed tomography (CT) suggestive of heterogeneously
enhancing lesion in close proximity to superficial lobe of right parotid
gland without invasion of the adjacent structures
Figure 4: (a) Excisional biopsy of the resected tumor mass. (b) Cut
sections reveals homogeneous white glistening cut potato appearance.
(c) Cut sections show scattered areas of hemorrhages and necrosis
c
ba
4. Journal of Oral and Maxillofacial Pathology: Vol. 19 Issue 1 Jan - Apr 2015
Pleomorphic adenoma of the buccal salivary gland Khandekar, et al.
of the tumors arises in the deeper portions of the gland. PA is
seen in approximately 8% of the minor salivary glands.[2]
Most
salivary gland tumors spread by local infiltration, perineural
or hematogenous spread and less commonly, via lymphatic.
Rarely, metastases from other malignancies may involve the
parotid glands. The cause of salivary gland tumors remains
Figure 5: Scanner view showing lesional tissue which is encapsulated
(HE stain, x40) HE = Hematoxylin and eosin
Figure 6: Scanner view showing duct like spaces with eosinophilic
coagulum. (HE stain, x40)
Figure 7: Low-power view showing myxochondroid areas having clear
cells with eccentric nuclei (HE stain, x100)
Figure 8: Low-power view showing pleomorphic and hyperchromatic
cells with few mitotic figures (HE stain, x100)
Figure 9: Low -power view showing the clear cells and hyalinized
areas. (HE stain, x200)
Figure 10: Higher-power view showing the numerous malignant
pleomorphic and hyperchromatic cells with osteoid tissue and
squamous metaplasia (HE stain, x400)
5. Journal of Oral and Maxillofacial Pathology: Vol. 19 Issue 1 Jan - Apr 2015
Pleomorphic adenoma of the buccal salivary gland Khandekar, et al.
obscure, but ionizing radiation has been identified as a risk
factor.[1]
PAs are known to occur in other minor salivary gland
sites, including the lip, buccal mucosa and tongue.[3]
There
are 800–1,000 minor salivary glands located throughout
the oral cavity in the tissue of the buccal, labial and lingual
mucosa; the soft palate; the lateral parts of the hard palate;
and the floor of the mouth. Unlike the major glands, they
are not encapsulated by connective tissue, only surrounded
by it and usually have a number of acini connected in a tiny
lobule.[4]
The glandular lobules are 1–5 mm in diameter and
are separated by thin connective tissue.[5]
A minor salivary
gland may have a common excretory duct with another
gland, or may have its own excretory duct. Their secretion
is mainly mucous in nature (except for Von Ebner glands).[4]
The patient usually comes with the chief complain of a small,
painless, quiescent nodule which slowly begins to increase in
size, sometimes showing intermittent growth. The skin rarely
ulcerates even though these tumors may reach a very large
size. Pain is not a common symptom, but local discomfort
is frequently present. Facial nerve involvement manifested
by facial paralysis is rare.[2]
PAs of the minor salivary glands
usually present as painless, submucosal swellings with size
ranging from 2 to 6 cm in greatest diameter, but some tumors
are massive.[6]
Grossly, they are usually encapsulated, solitary,
well‑defined, ovoid or round masses. Larger neoplasms may
have a characteristic bosselated surface with necrotic or cystic
regions. Their consistency varies from hard to rubbery to soft
swelling that may be fluctuant. The cut surface of the tumor
is characteristically solid and the color varies from gray blue,
pale yellow to tan. There may be gritty areas and gelatinous
or glistening foci may be present when there is cartilaginous
or myxochondroid differentiation.[7]
Willis described PA as
the lesion with unusual histologic pattern consisting of cells
exhibiting the ability to differentiate to epithelial (ductal and
nonductal) cells and mesenchymal (chondroid, myxoid and
osseous) cells. It demonstrates combinations of glandular
epithelium and mesenchyme‑like tissue and the proportion
of each component varies widely among individual tumors.
Foote and Frazell (1954) categorized the tumor into the
following types: Principally myxoid, myxoid and cellular
components present in equal proportions, predominantly
cellular and extremely cellular. The epithelial components
form ducts and small cysts that may contain an eosinophilic
coagulum, the epithelium may also occur as small cellular
nests, sheets of cells anatomizing cords and foci of keratinizing
squamous or spindle cells. Myoepithelial cells have variable
morphology, sometimes appearing as angular or spindled,
rounded with eccentric nuclei and hyalinized eosinophilic
cytoplasm resembling plasma cells. Myoepithelial cells are
also responsible for the characteristic mesenchyme‑like
changes, giving a myxoid appearance. Vacuolar degeneration
of the myoepithelial cells result in a cartilaginous appearance.
Foci of hyalinization, bone and even fat can be noted in the
connective tissue stroma of many tumors.[2]
FNA biopsy,
operated in experienced hands, can determine whether the
Figure 11: Higher-power view showing spindle-shaped cells with
duct-like spaces and eosinophilic coagulum with few clear cells
(HE stain, x400)
Figure 12: Higher-power view showing spindle-shaped cells with
duct-like places filled with eosinophilic coagulum, with necrotic areas
and clear cells at places (HE stain, x400)
Figure 13: Higher-power view showing spindle-shaped cells with
duct-like places filled with eosinophilic coagulum (HE stain, x400)
6. Journal of Oral and Maxillofacial Pathology: Vol. 19 Issue 1 Jan - Apr 2015
Pleomorphic adenoma of the buccal salivary gland Khandekar, et al.
tumor is malignant in nature with sensitivity of around
90%.[4]
The differential diagnosis of PAcheek includes buccal
abscess, dermoid cyst, sebaceous cyst, neurofibromas, lipoma,
mucoepidermoid carcinoma and polymorphous low‑grade
adenocarcinoma.[8]
The buccal space abscess shows signs of
inflammation, which were absent in present case. The solid
nature of PA and lack of tissue showing the three germ layers
rule out the possibility of mature dermoid cyst. Sebaceous cyst
shows punctum and fixed mass, which differentiate it from PA.
As on histological picture, both epithelial and myoepithelial
cells were seen; which ruled out mucoepidermoid carcinoma.
The negative slip test clinically and absence of lipomatous
component histologically rules out lipoma. The absence of
perineural invasion and mitotic figures obscure the chances
of polymorphic low‑grade adenocarcinoma. PA is known to
produce recurrence either due to spillage, inadequate removal
or enucleation at the time of operation, but is not known to
produce distant metastasis. A recurrence rate of 2–44% has
been reported in the literature. The ideal treatment of choice
for PA is wide local excision with good safety margins and
follows‑up for at least 3–4 years.[9]
The accepted treatment is
surgical excision, but intraoral lesions can be treated somewhat
more conservatively by extracapsular excision. Since these
tumors are radioresistant, the use of radiation therapy is
contraindicated. Rarely, a malignant tumor may arise within
this tumor, a phenomena known as carcinoma ex PA.[2]
In
our patient since the surgery was simple and were able to
completely remove a well‑circumscribed lesion, the removal
of associated gland was not an issue. This is in agreement with
Leverstein et al., 1997 who stated that surgery of PA must be
highly customized on the basis of histologic type, extension
and patient’s age.[10]
CONCLUSION
The salivary glands may show a diverse range of lesions
presenting a challenge to even the most experienced clinician
and pathologist. PA of minor salivary gland is a tumor of rare
occurrence and a diagnosis should be made carefully lest a
major salivary gland be resected. A point to be noted here is
that the ear lobule was not raised, thus clinically indicating that
the swelling may not be of parotid gland origin. The swelling
was painless, slow growing, mobile with well‑defined borders.
Histopathologically, plenty of myoepithelial cells and strands
of epithelium in myxoid, stroma were evident throughout
tumor confirming diagnosis of PA. The complete surgical
excision with surrounding dispensable normal tissues is the
key to successful treatment of such tumors.
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How to cite this article: Khandekar S, Dive A, Munde P,
Wankhede ND. Pleomorphic adenoma of the buccal salivary gland. J Oral
Maxillofac Pathol 2015;19:111.
Source of Support: Nil. Conflict of Interest: None declared.