Pleomorphic adenoma (patient information): Difference between revisions
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{{Pleomorphic adenoma (patient information)}} | |||
'''To go back to the main page, click [[Guide to Creating a Disease Page|here]]''' | '''To go back to the main page, click [[Guide to Creating a Disease Page|here]]''' | ||
{{CMG}}; {{ | {{CMG}}; {{M.N}} | ||
==Overview== | ==Overview== | ||
'''Pleomorphic adenoma''' also known as ("[[Benign mixed tumors of the salivary gland|Benign mixed tumor]] of the [[salivary glands]]") is a [[benign]] [[neoplastic tumor]] of the [[salivary glands]]. It is the most common type of [[salivary gland tumor]] and the most common [[tumor]] of the [[parotid gland]]. In 1874, pleomorphic adenoma was first described by Minssen in a monograph named Ahlbom's. Later Mark and Dahlenfors in 1986 and Bullerdiek et al. in 1987 found some clonal [[chromosome abnormalities]] related to pleomorphic adenoma, with a majority of aberrations involving 8q12. Pleomorphic adenoma can be classified on the basis of the [[histological]] appearance into 4 subgroups. Subgroup 1 is the classical pleomorphic adenoma with a [[stroma]] content of 30-50%, subgroup 2 has a [[stroma]] content of 80%, subgroup 3 has a poor [[stroma]] content of 20-30%, subgroup 4 has also a poor [[stroma]] content (6%). Pleomorphic adenoma shows [[chromosomal transposition]] mainly involving [[PLAG1]] and [[HMGA2]]. Pleomorphic adenoma's are usually firm, mobile, well demarcated and [[encapsulated]] on [[gross]] apperance. On [[microscopy]] it is characterized by both [[epithelial]] elements and [[stroma]]<nowiki/>l [[Matrix extracellular phosphoglycoprotein|matrix]] which can be either [[hyaline]], [[myxoid]] or [[cartilaginous]]. The [[Incidence (epidemiology)|incidence]] of pleomorphic adenoma is approximately 2-3.5 cases per 100,000 [[population]]. [[Females]] are predominantly affected by Pleomorphic adenoma than [[males]]. The various [[risk factors]] for the [[development]] of pleomorphic adenoma are prior [[irradiation]] to [[Head (anatomy)|head]] and [[neck]], [[Working area|working]] in rubber, [[asbestos]] industries. The most common presentation is a painless, [[slow]] growing and single [[palpable]] [[mass]]. Pleomorphic adenoma is usually [[asymptomatic]] but some people present with [[dysphagia]], [[hoarseness]], difficulty with [[chewing]]. [[MRI]] is the [[imaging]] modality of choice for pleomorphic adenoma. Total [[parotidectomy]] is the mainstay of treatment for pleomorphic adenoma. The [[complications]] of [[parotidectomy]] include [[haematoma]] or [[haemorrhage]], [[facial nerve palsy]], [[frey's syndrome]]. The [[prognosis]] of pleomorphic adenoma is excellent after complete surgical [[excision]]. | |||
==What are the symptoms of pleomorphic adenoma?== | ==What are the symptoms of pleomorphic adenoma?== | ||
* | *[[Patients]] usually present with a history of [[swelling]], which is gradual in onset and painless. | ||
*The majority of [[patients]] with pleomorphic adenoma are [[asymptomatic]]. | |||
*The [[symptoms]] mainly depend upon the size, location and the [[potential]] to undergo [[malignant]] [[transformation]]. | |||
*When pleomorphic adenoma arises from the [[Parotid glands|parotid gland]] patients present with: | |||
**[[Dry mouth]] | |||
**Difficulty in [[swallowing]] | |||
**[[Hoarseness]] | |||
**[[Dyspnea]] | |||
**Difficulty in [[chewing]] | |||
*When the [[tumor]] arises from the [[lacrimal glands]] [[patients]] presents with: | |||
**[[Diplopia]] | |||
**[[Proptosis]] | |||
**Slight fullness in the [[temporal]] [[upper eyelid]] | |||
**[[Visual impairment]] | |||
==What causes (disease name)?== | ==What causes (disease name)?== | ||
* | *There are no established [[causes]] for the [[development]] of pleomorphic adenoma. | ||
* | *However some clonal [[chromosomal abnormalities]] with aberrations involving 8q12 and 12q15 have been described. | ||
*[[Oncogenic]] [[Simian virus 40|simian virus]](SV40) may play a role in the onset or progression of pleomorphic adenoma. | |||
==Who is at highest risk?== | ==Who is at highest risk?== | ||
The [[risk factors]] for the [[development]] of Pleomorphic adenoma are as follows: | |||
* | *Prior [[head]] and [[neck]] [[irradiation]] is a [[risk factor]] for the [[development]] of Pleomorphic adenoma. | ||
*[[Environmental epidemiology|Environmental]] factors | |||
* | *Occupations associated with increased risk include: | ||
**Rubber products manufacturing | |||
* | **[[Asbestos]] mining | ||
**Plumbing | |||
**Some types of wood working | |||
**Hair dressing | |||
==Diagnosis== | ==Diagnosis== | ||
*Physical examination of the [[tumor]] is always done first. | |||
* | *[[CT]] is usually the first [[imaging]] modality of choice for pleomorphic adenoma. | ||
*It helps in identifying the [[lesion]] and also helps the [[physician]] in assessing the [[extension]] of the [[tumor]]. | |||
* | *[[MRI]] is the usually ordered investigation next after [[CT]], for an even more detailed study. | ||
*It is a [[Non-ionizing radiation|non-ionizing]] modality with excellent [[soft tissue]] distinction. | |||
* | *[[FNA]] and [[biopsy]] is the definitive method of [[diagnosis]] for pleomorphic adenoma. | ||
==When to seek urgent medical care?== | ==When to seek urgent medical care?== | ||
| Line 38: | Line 55: | ||
==Treatment options== | ==Treatment options== | ||
*Surgery is the mainstay of treatment for pleomorphic adenoma. | |||
*There are two procedures [[superficial]] [[parotidectomy]] and total [[parotidectomy]], the latter of which is the most commonly performed one due to its low [[incidence]] on recurrence of the [[tumor]] | |||
==Where to find medical care for pleomorphic adenoma?== | |||
Medical care for pleomorphic adenoma can be found [https://www.google.com/maps/search/hospitals/ here]. | |||
==Prevention== | ==Prevention== | ||
*At present there are no established measures for the [[primary prevention]] of pleomorphic adenoma. | |||
* | *Individuals those who are [[Working area|working]] in rubber and [[asbestos]] industries should be advised to seek an alternative job. | ||
*If possible advise the [[patients]] to minimize unnecessary [[radiation]] exposure to [[head]] and [[neck]] region. | |||
* | *Secondary preventive measures include timely [[screening]] at regular intervals with routine [[physical examination]], [[radiological]] [[imaging]], and [[blood tests]]. | ||
*Once diagnosed and successfully treated, [[patients]] with pleomorphic adenoma are followed-up every 6 or 12 months. | |||
==What to expect (Outlook/Prognosis)?== | ==What to expect (Outlook/Prognosis)?== | ||
*[[Prognosis]] is generally excellent for most of the patients after surgical [[resection]]. | |||
* | *Depending on the extent of the [[tumor]] at the time of [[diagnosis]], the [[prognosis]] may vary sometimes. | ||
*Recurrence can be a problem if the [[tumor]] arises from the [[Parotid gland|parotid]] gland. | |||
* | *2-7% of cases can go into [[malignant]] [[transformation]] if left untreated. | ||
* | |||
==Possible complications== | ==Possible complications== | ||
====Intra-operative complications include:==== | |||
*[[Rupture]] of the [[capsule]] of the [[Parotid gland|parotid]] [[tumor]]. | |||
*Incomplete [[resection]] of the [[tumor]]. | |||
*[[Facial nerve]] [[transection]] especially after [[Parotidectomy|superficial parotidectomy.]] | |||
====Post-operative complications include:==== | |||
*[[Haemorrhage]] or [[haematoma]] | |||
* | *[[Infection]] at the site | ||
*[[Trismus]] | |||
*[[Parotid]] [[fistula]] | |||
*[[Frey's syndrome]] | |||
*[[Hypoesthesia]] of the [[greater auricular nerve]]. | |||
Apart from the above mentioned other [[complications]] include [[facial]] [[disfigurement]] and multiple recurrences. | |||
==Sources== | ==Sources== | ||
Latest revision as of 14:23, 12 February 2019
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Pleomorphic adenoma |
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Pleomorphic adenoma On the Web |
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To go back to the main page, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Maneesha Nandimandalam, M.B.B.S.[2]
Overview
Pleomorphic adenoma also known as ("Benign mixed tumor of the salivary glands") is a benign neoplastic tumor of the salivary glands. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. In 1874, pleomorphic adenoma was first described by Minssen in a monograph named Ahlbom's. Later Mark and Dahlenfors in 1986 and Bullerdiek et al. in 1987 found some clonal chromosome abnormalities related to pleomorphic adenoma, with a majority of aberrations involving 8q12. Pleomorphic adenoma can be classified on the basis of the histological appearance into 4 subgroups. Subgroup 1 is the classical pleomorphic adenoma with a stroma content of 30-50%, subgroup 2 has a stroma content of 80%, subgroup 3 has a poor stroma content of 20-30%, subgroup 4 has also a poor stroma content (6%). Pleomorphic adenoma shows chromosomal transposition mainly involving PLAG1 and HMGA2. Pleomorphic adenoma's are usually firm, mobile, well demarcated and encapsulated on gross apperance. On microscopy it is characterized by both epithelial elements and stromal matrix which can be either hyaline, myxoid or cartilaginous. The incidence of pleomorphic adenoma is approximately 2-3.5 cases per 100,000 population. Females are predominantly affected by Pleomorphic adenoma than males. The various risk factors for the development of pleomorphic adenoma are prior irradiation to head and neck, working in rubber, asbestos industries. The most common presentation is a painless, slow growing and single palpable mass. Pleomorphic adenoma is usually asymptomatic but some people present with dysphagia, hoarseness, difficulty with chewing. MRI is the imaging modality of choice for pleomorphic adenoma. Total parotidectomy is the mainstay of treatment for pleomorphic adenoma. The complications of parotidectomy include haematoma or haemorrhage, facial nerve palsy, frey's syndrome. The prognosis of pleomorphic adenoma is excellent after complete surgical excision.
What are the symptoms of pleomorphic adenoma?
- Patients usually present with a history of swelling, which is gradual in onset and painless.
- The majority of patients with pleomorphic adenoma are asymptomatic.
- The symptoms mainly depend upon the size, location and the potential to undergo malignant transformation.
- When pleomorphic adenoma arises from the parotid gland patients present with:
- Dry mouth
- Difficulty in swallowing
- Hoarseness
- Dyspnea
- Difficulty in chewing
- When the tumor arises from the lacrimal glands patients presents with:
- Diplopia
- Proptosis
- Slight fullness in the temporal upper eyelid
- Visual impairment
What causes (disease name)?
- There are no established causes for the development of pleomorphic adenoma.
- However some clonal chromosomal abnormalities with aberrations involving 8q12 and 12q15 have been described.
- Oncogenic simian virus(SV40) may play a role in the onset or progression of pleomorphic adenoma.
Who is at highest risk?
The risk factors for the development of Pleomorphic adenoma are as follows:
- Prior head and neck irradiation is a risk factor for the development of Pleomorphic adenoma.
- Environmental factors
- Occupations associated with increased risk include:
- Rubber products manufacturing
- Asbestos mining
- Plumbing
- Some types of wood working
- Hair dressing
Diagnosis
- Physical examination of the tumor is always done first.
- CT is usually the first imaging modality of choice for pleomorphic adenoma.
- It helps in identifying the lesion and also helps the physician in assessing the extension of the tumor.
- MRI is the usually ordered investigation next after CT, for an even more detailed study.
- It is a non-ionizing modality with excellent soft tissue distinction.
- FNA and biopsy is the definitive method of diagnosis for pleomorphic adenoma.
When to seek urgent medical care?
- This section should focus on the symptoms that may indicate impending life threatening situations, or significant worsening.
- For an example of a section detailing this on a patient information page, click here
Treatment options
- Surgery is the mainstay of treatment for pleomorphic adenoma.
- There are two procedures superficial parotidectomy and total parotidectomy, the latter of which is the most commonly performed one due to its low incidence on recurrence of the tumor
Where to find medical care for pleomorphic adenoma?
Medical care for pleomorphic adenoma can be found here.
Prevention
- At present there are no established measures for the primary prevention of pleomorphic adenoma.
- Individuals those who are working in rubber and asbestos industries should be advised to seek an alternative job.
- If possible advise the patients to minimize unnecessary radiation exposure to head and neck region.
- Secondary preventive measures include timely screening at regular intervals with routine physical examination, radiological imaging, and blood tests.
- Once diagnosed and successfully treated, patients with pleomorphic adenoma are followed-up every 6 or 12 months.
What to expect (Outlook/Prognosis)?
- Prognosis is generally excellent for most of the patients after surgical resection.
- Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary sometimes.
- Recurrence can be a problem if the tumor arises from the parotid gland.
- 2-7% of cases can go into malignant transformation if left untreated.
Possible complications
Intra-operative complications include:
- Rupture of the capsule of the parotid tumor.
- Incomplete resection of the tumor.
- Facial nerve transection especially after superficial parotidectomy.
Post-operative complications include:
- Haemorrhage or haematoma
- Infection at the site
- Trismus
- Parotid fistula
- Frey's syndrome
- Hypoesthesia of the greater auricular nerve.
Apart from the above mentioned other complications include facial disfigurement and multiple recurrences.
Sources
- Put the sources for your information here.
- The National Library of Medicine is a good source to reference for patient information pages: http://www.nlm.nih.gov/medlineplus/.
Things to Remember
- Include a link back to the physician page at the top of the page.
- Always put {{CMG}} at the top of every page.
- Never take content directly from a source without checking copyright.
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- [[Category:Patient information]]
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