Pleomorphic adenoma is the most common benign tumor of the parotid gland. It consists of both epithelial cells and spindle-shaped mesenchymal cells within an abundant mucoid matrix. On pathology, it displays well-differentiated epithelial cells and spindle/stellate cells in a pleomorphic stroma with mucoid material. The tumor presents as a slow-growing, painless swelling of the parotid gland and is diagnosed by FNAC. The treatment is complete surgical excision via superficial parotidectomy while preserving the facial nerve. Recurrence is possible if there are pseudopods left behind or inadequate margins. Malignant transformation may occur in long-standing tumors.

1. PLEOMORPHIC ADENOMA

2. ANATOMY
 Para- around otis-ear
 Largest salivary gland
 Parts – superficial
(80%) , deep (20%)
 Duct – Stensen’s

3. HISTOLOGY

4. FACIAL NERVE

5. FACIOVENOUS PLANE OF PATEY

6.  BLOOD SUPPLY:
External carotid artery
 VENOUS DRAINAGE :
External jugular vein
 LYMPHATIC
DRAINAGE : Deep
cervical nodes

8. CLASSIFICATION OF PAROTID
GLAND TUMOURS
 EPITHELIAL( 90%)
 NONEPITHELIAL
 Hemangioma
 Lymphangioma
 Neurofibroma
• MALIGNANT LYMPHOMA – NHL TYPE

9. EPITHELIAL (90%)
 BENIGN (ADENOMAS)
 Pleomorphic adenoma
 Monomorphic adenoma
 Warthin’s tumour (adenolymhoma)
 Oncocytoma ( oxyphil adenoma )
 Basal cell adenoma

10. 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

11. 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
lobule
No localised warmth, not tender
Surface-smooth, Margins- well
defined. Retromand groove oblit.
Variable consistency. Mobile
Not adherent to skin, masseter muscle
No signs suggestive of facial N inv
Examination of oral cavity is normal

12.  FNAC : shows ductal cells, chondromyxoid
matrix and myoepithelial cells
 DIAGNOSIS : PLEOMORPHIC
ADENOMA

13. PLEOMORPHIC ADENOMA
 MIXED TUMOUR
 SITE : MC: PAROTID GLAND ( 90%)- MC –Tail of gland
Submandibular gland (7%)
Minor salivary glands-MC : Palate
Occurs more commonly in females (3:1)
AGE : any age . MC : 40-50yrs
Usually unilateral

14. PATHOLOGY
 BENIGN TUMOR
 Tumor capsule-well formed, but incomplete
 Tiny excrescences (pseudopods) project outside.
 Give rise to recurrences.
 GROSS :
 CUT SECTION:

15. 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

16. 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

19. 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

21. 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)

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

23. 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

24. CARCINOMA IN EX PLEOMORPHIC
ADENOMA
 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

25. 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.

26. -AISHWARYA. G