• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.233-237
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• 2000

Pleomorphic adenoma is the most common of all salivary gland tumors, constituting over 50 per cent of all cases of tumors, and approximately 90 per cent of all benign salivary gland tumors. Since the term mixed tumor' was introduced by Broca for its dual origin of epithelial and mesenchymal elements, the term plemorphic adenoma suggested by Willis characterizes closely the unusual histologic pattern of the lesion. The parotid gland is the most common site but it may occur in any of the salivary glands. It is somewhat more frequent in women and in the fourth to sixth decades, but they are also relatively common in young adult and have been known to occur in children. Treatment of choice is surgical excision. Adequate surgery with safe margin reduce its recurrence rate. We represent a case of pleomorphic adenoma with literature review in 65-year old male occured in the palate. The lesion was successfully treated by surgical excision.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.520-524
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• 2011

A 27-year-old female presented to our hospital with a slow growing, hard and soft palate mass on the right that had been present for the several months. Physical examination showed a 2 cm, firm, well-circumscribed, painless mass on the right side of the palate. PNS computer tomographic imaging showed a $1.5{\times}1.3{\times}2$ cm well-defined cystic mass on the right side of both the hard and soft palate without any underlying bone change. The lesion was completely excised under general anesthesia. In order to preserve the palatal mucosa, trapdoor approach for removal of the pleomorphic adenoma was done. This technique provided more comfortable healing of the operative site. Three years after surgery, there was no evidence of recurrence. If pleomorphic adenoma without bony and mucosal destruction exists, we suggest consideration of the trapdoor approach to protect the palatal mucosa. In view of the potential for tumour recurrence, long-term follow-up and careful examination are necessary.

• The Korean Journal of Cytopathology
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• v.13 no.1
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• pp.42-46
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• 2002

Epithelial-myoepithelial carcinoma(EMC) is a rare, low grade malignant tumor of the salivary glands. The EMC has a distinctive histological appearance comprising ductal structures with an inner epithelial cell component and an outer layer of myoepithelial cells which show plump clear cytoplasm. The cytologic features of the EMC have been rarely described. A correct cytological diagnosis to this rare tumor is difficult with high false negative rate. We report a case of EMC in which fine needle aspiration cytologic findings were misinterpreted as a pleomorphic adenoma.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.2
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• pp.163-166
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• 1994

Pleomorphic adenoma(benign mixed tumor) is the most common tumor of the major salivary glands, constituting approximately 70 per cent of benign tumors of these glands. The term mixed tumor was introduced in the nineteenth century to stress the dual origin of this neoplasm from epithelial and mesenchymal elements, and the designation pleomorphic adenoma is preferred because it emphasizes both the epithelial origin and the variety of histological patterns found in this common salivary gland lesion. Rauch, in a review of 4245 pleomorphic adenomas, found 92.5 per cent in the major salivary glands and 6.5 per cent in the minor salivary glands, 8 per cent arose in the submandibular glands, and in another large series of over 6,000 cases, approximately 4 per cent arose in the hard and soft palates with equal frequency in each. The prognosis of pleomorphic adenoma depends more upon the choice and adequacy of treatment than upon histological appearances. The accepted treatment for this tumor is excision. With adequate surgery recurrence rates of less than 1 per cent can be obtained. In this hospital, I experienced two patients who were identified PMA which occurred in the hard palate and submandibular gland. The lesions were successfully treated by surgery.

• Korean Journal of Head & Neck Oncology
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• v.10 no.1
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• pp.25-30
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• 1994

Minor salivary gland tumors vary in their primary sites, histopathology and bilogical behavior. Therefore various factors are considered in selecting the treatment modality and predicting the prognosis. The prognosis of milignant tumors of minor salivary glands are worse than that of such lesions of major salivary glands. Authors experienced 26 cases of minor salivary gland tumors(10 benign tumors and 16 malignant tumors) during the past 7 years and analyzed their clinical characteristics. 1) The palate was the most common site of origin of minor salivary gland tumors (38.5%). 2) The most common benign tumor was pleomorphic adenoma and majority of them occur red in the palate(60.0%) and the remaining occured in the nasal cavity or the paranasal sinuses (30.0%), and the lip ( 10.0%). 3) In the case of malignant tumors the most frequent sites were the nasal cavity or the paranasal sinuses (31.3%) with the following histopathologic frequencies: adenoid cystic carcinoma(56.3%), malignant pleomorphic adenoma(12.5%), mucoepidermoid carcinoma(12.5%), polymorphic adenocarcinoma (12.5%), epthelial-myoepithelial carcinoma (6.25%). 4) Minor salivary gland tumors have high probability of malignancy and tumor extension is important to their treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.2
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• pp.93-98
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• 1993

Pleomorphic adenoma is the most common of all salivary gland tumors, constituting over 50% of all cases of tumors of both major and minor salivary gland origin and approximately 90% of all benign salivary gland tumors. Of the major salivary glands, the parotid gland is the most common site of the pleomorphic adenoma. It may occur, however, in any of the major gland or in the widely distributed intraoral accessory salivary glands. The palatal glands are frequently the site of origin of tumors, and other parts of origins are as follows: upper and lower lip, buccal mucosa, tongue and occasionally other sites. The majority of the lesions are found in patients in the fourth to sixth decades, but they are also relatively common in young adults and have been known to occur in children. It is somewhat more frequent in women than men. The term "mixed tumor" has masquaeraded under a great variety of names throughout the years (e.g., enclavoma, branchioma, endothelioma, enchondroma), but the term "pleomorphic adenoma" suggested by Willis characterizes closely the unusual histologic pattern of the lesion. The accepted treatment for this tumor is surgical excision. The intraoral lesions can be treated somewhat more conservatively by extracapsular excision. In general, Lesions of the hard palate should be excised with the overlying mucosa, while those in lining mucosa, such as the lips, soft palate and buccal mucosa often can be treated successfully by enucleation or extracapsular excision. In our hospital, we experienced two patients who were identified pleomorphic adenoma which occurred at buccal mucosa, submandibular gland. The lesions were successfully treated by surgical excision.

• The Korean Journal of Cytopathology
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• v.12 no.2
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• pp.97-103
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• 2001

Carcinoma ex pleomorphic adenoma(CXPA) is a rare malignant tumor of the salivary gland, fine needle aspiration cytology(FNAC) of which are rarely reported. We retrospectively reviewed FNAC of five cases of histologically proven CXPA of the salivary glands diagnosed in Seoul National University Hospital to evaluate their cytologic characteristics. Histologically, the carcinoma components were low-grade in three cases and high-grade in two cases. The cytologic diagnosis were malignancy in two cases(40%), suspicious for malignancy in one(20%), and benign(pleomorphic adenoma) in two(40%). All of the high-grade carcinomas were correctly diagnosed by FNAC, however, 2 cases of low-grade carcinomas were diagnosed as benign by FNAC. The low sensitivity in cytologic diagnosis is due to interpretative difficulties in low-grade tumors. The characteristic cytologic features of CXPA were high cellularity, necrotic, bloody, and inflammatory background, marked nuclear overlapping, coarsely granular chromatin, prominent macronucleoli, and atypical mitosis in epithelial component in addition to the typical biphasic pattern of pleomorphic adenoma consisting of epithelial cells admired with spindle-shaped cells and chondromyxoid stroma. Even though low-grade tumors show mild pleomorphism, the cytologic findings of necrotic background, moderate to high cellularity, and nuclear overlapping could lead to an accurate cytodiagnosis of CXPA.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.2
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• pp.116-122
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• 2003

Pleomorphic adenoma is the most common salivary neoplasm mainly occurring in the major salivary glands - especially in parotid gland, which is characterized by variable histopathologic appearances and high recurrence rate with malignant transformation according to surgical situations. And this benign mixed tumor occurring in minor salivary glands is believed to shows same clinicopathologic appearances and relatively low recurrent rate compared with the case in major salivary glands. But there are few comparative studies of large series of pleomorphic adenoma occurring in minor salivary glands which includes different histopathologic appearance, clinical characteristics, treatment methods, recurrence rate, and malignant transformation. We retrospectively studied the 54 patients who were pathologically confirmed with pleomorphic adenoma occurring in minor salivary glands, and analyzed the clinico-histopathological appearance, surgical methods, recurrent cases. The results obtained are as follows. 1. The incidence of the tumor was most frequent in 4th & 5th decade, and in female. 2. Palate(90%) including hard & soft palate was the most frequent site for pleomorphic adenoma in minor salivary glands. 3. The exact duration could not be known due to asymptomatic slow growth patterns of the tumor. 4. The mean tumor size was 2.3cm. 5. 28 (52%) pleomorphic adenomas were classified as Cellular type (cell-rich), 17 (31%) specimen as Intermediate type(equal cell to stroma ratio), and 9 (17%) as Myxoid type(stroma-rich). 6. Surgically 51 cases (94%) were showed well-encapsulated tumors, but histopathologically only 34 specimen (63%) were wellencapsulated. Therefore pleomorphic adenomas in minor salivary glands also have to be excised more widely, not enucleated. And in case of suspicious malignancy or large tumor, preoperative incisional biopsy can be applied in the center of the tumor for prevention of rupture of tumor cell, and total excision with use of frozen biopsy for detection of malignancy and confirming the excision margin, and closed follow-up according to final histopathologic results is recommended.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.4
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• pp.206-211
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• 2003

The pleomorphic adenoma is the most common neoplasm involving both the major and minor salivary glands. It is a benign, slowgrowing tumor, but local recurrences can occur. The pleomorphic adenoma gene 1 (PLAG1), which is a novel zinc finger gene, is frequently activated by reciprocal chromosomal translocations involving 8q12 in a subset of salivary gland pleomorphic adenomas. This experimental study was preformed to observe the translocation patterns between PLAG1 gene and the three translocation partner genes. We also have analyzed the presence of PLAG1 transcripts by RT-PCR. CTNNB1/PLAG1 gene fusion was observed in three of nine pleomorphic adnomas. However, LIFR/PLAG1 and SII/PLAG1 gene fusions were not detectable. All of three gene fusions was not detectable in one Warthin's tumor and three inflammatory salivary gland tissues. PLAG1 transcripts were expressed in all inflammatory salivary gland tissues and tumors except for three pleomorphic adenomas. Of particular one pleomorphic adenoma showing CTNNB1/PLAG1 gene fusion did not express PLAG1 transcipt. Our data indicate that gene fusion involving PLAG1 is a frequent event in pleomorphic adenoma, but correlation between gene fusion involving PLAG1 and PLAG1 transcription is not definite.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.3
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• pp.247-255
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• 2007

The bone morphogenic protein(BMP) can promote migration and growth of mesenchymal cells and initiate process for bone and cartilage formation. Cartilage-derived morphogenic protein(CDMP)-1 and -2 belong to the bone morphogenetic protein family in the transforming growth factor(TGF)-${\beta}$ superfamily. Although pleomorphic adenoma of the salivary glands is an epithelial tumor, it frequently shows ectopic cartilaginous formation with biomolecular studies. The mechanism of pathogenesis in cartilaginous formation is still controversy. We examined the expression and localization of CDMP-1 and -2, in comparison with the localization of cartilaginous matrix proteins, in human normal salivary glands and 20 cases of pleomorphic adenoma using immunohistochemical methods. The results were followed. 1. CMP-1 was immunolocalized in the striated ducts and the intercalated ducts, but not expressed in excretory duct, CDMP-2 was not expressed in the normal salivary glands. 2. CMP-1 was immunolocalized in the ductal cell and cuboidal neoplastic myoepithelial cells around the chondroid areas of the pleomorphic adenomas, whereas these molecules were not localized in the spindle-shaped neoplastic myoepithelial cells of the myxoid element in these tumors. CDMP-2 was expressed neither in normal salivary glands nor in any elements of the pleomorphic adenomas. 3. In transmission electron microscopic view, the tumor cells are composed of modifed myoepithelial cells between hyaline and myxoid stroma. 4. In Immuno-blot analysis, strong overexpression of CDMP-1 was frequently seen in pleomorphic adenomas, but the level of CDMP-2 was expressed minimally in pleomorphic adenoma. From the these results, it should be suggested that undifferentiated neoplastic myoepithelial cells around the chondroid areas expressed CDMP-1 and suggested that this molecule may play a role in the differentiation of neoplastic myoepithelial cells in pleomorphic adenoma, but not CDMP-2.