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Metastasizing pleomorphic salivary adenoma
S A R Nouraei1, M S Ferguson, P M Clarke
1Department of Otolaryngology-Head and Neck Surgery, Charing Cross Hospital, London, England. RN@cantab.net
Archives of Otolaryngology--Head & Neck Surgery
|July 19, 2006
Summary
Metastasizing pleomorphic adenoma (MPA) is rare but aggressive. Complete surgical removal of the primary tumor is key to preventing metastasis. Surgical treatment of metastatic lesions offers survival benefits.
Area of Science:
- Oncology
- Pathology
- Surgical Oncology
Background:
- Metastasizing pleomorphic adenoma (MPA) is a rare malignant transformation of pleomorphic salivary adenoma.
- Understanding the etiology, behavior, treatment, and prognosis of MPA is crucial for patient management.
- Previous literature on MPA is limited, necessitating a comprehensive review and case series analysis.
Purpose of the Study:
- To investigate the characteristics of metastasizing pleomorphic adenoma (MPA).
- To analyze the etiology, behavior, optimal treatment, and prognosis of MPA.
- To construct a virtual case series of MPA from literature and institutional data.
Main Methods:
- Comprehensive literature review of English-language articles from 1953-2005 (MEDLINE and secondary references).
- Inclusion of an additional case from institutional records.
- Quantitative analysis of a virtual case series of 42 identified MPA patients.
Main Results:
- The average age of patients was 33 years, with a near-equal gender distribution.
- Incomplete primary surgery for pleomorphic adenoma was a common history; locoregional recurrences preceded metastasis in most cases, with a mean latency of 16 years.
- Bone (45%), head and neck (43%), and lung (36%) were common sites for metastases. 5-year disease-specific survival was 58%. Developing distant lesions within 10 years and multiple metastatic sites predicted poor survival. Metastasectomy improved survival (P<.02), while chemotherapy and radiotherapy showed limited efficacy.
Conclusions:
- Meticulous and complete surgical resection of the primary pleomorphic adenoma is essential for preventing MPA.
- Metastatic disease from MPA is associated with significant morbidity and mortality.
- Surgical intervention for metastatic lesions (metastasectomy) should be pursued when feasible to improve patient survival.
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