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Atypical features in pleomorphic adenoma--a clinicopathologic study and implications for management
M Ethunandan1, R Witton, G Hoffman
1Maxillofacial unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom.
International Journal of Oral and Maxillofacial Surgery
|March 17, 2006
Summary
Atypical pleomorphic adenomas, including those with dysplasia or vascular invasion, often lack distinct clinical signs. Complete surgical excision of these salivary gland tumors ensures no recurrence.
Area of Science:
- Oncology
- Pathology
- Otolaryngology
Background:
- Pleomorphic adenoma is the most common salivary gland neoplasm.
- Malignant transformation into carcinoma ex pleomorphic adenoma is infrequent but characterized by infiltrative growth and aggressive features.
- Recent descriptions include variants with vascular invasion and malignant features without extra-capsular extension, yet their clinical impact is unclear.
Purpose of the Study:
- To investigate the clinical presentation and outcomes of pleomorphic adenomas with atypical histological features.
- To correlate histological variants with clinical presentation and treatment results.
- To evaluate the significance of vascular invasion and dysplasia in pleomorphic adenomas.
Main Methods:
- Retrospective review of 100 consecutive pleomorphic adenomas from major salivary glands.
- Histopathological analysis to identify atypical features, including vascular invasion and dysplasia/carcinoma without extra-capsular extension.
- Correlation of histological findings with clinical presentation, diagnostic imaging (CT scan), fine needle aspiration cytology (FNAC), and treatment outcomes.
Main Results:
- Four cases (4%) exhibited atypical histological features: 3 with dysplasia/carcinoma and 1 with benign vascular invasion, none showing extra-capsular invasion.
- No distinct clinical features indicated the atypical nature of these neoplasms.
- Diagnostic modalities showed limited suspicion: FNAC was suspicious in 2 cases, and CT scan in 1 case.
- All patients underwent complete surgical excision (superficial parotidectomy or submandibular gland excision) with no recurrences observed during the follow-up period.
Conclusions:
- Atypical histological features in pleomorphic adenomas, such as vascular invasion or dysplasia, may not present with specific clinical signs.
- Complete surgical excision appears to be an effective treatment, leading to favorable outcomes and no recurrences in this series.
- Further research is needed to fully understand the long-term implications of these histological variants and optimize diagnostic strategies.
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