CARCINOMA EX PLEOMORPHIC ADENOMA IN PAROTID GLAND – CASE REPORT INTRODUCTION Pleomorphic adenoma, also know as benign mixed tumor because of the presence of both epithelial and mesenchymal tissue, are the most common tumors of the major salivary glands. (1,2). These tumors occurs most frequently in the parotid gland. Most pleomorphic adenomas of parotid gland develop in the superficial parotid lobe. Generally they presents as a well-deliniated, solitary, painless mass with slow growth. (3). Although 205 Journal of Experimental Medical & Surgical Research Cercetãri Experimentale & Medico-Chirurgicale Year XVII • Nr.3/2010 • Pag. 205 - 209 Experimental Medical Surgical RE SEARCH JOURNAL of Correspondence to: Dr. Anamaria Mag, Clinica ORL Timiºoara, Bd. Revoluþiei No. 6, Telefon: 0740 43 47 40, Email: [email protected]SUMMARY: Carcinoma ex pleomorphic adenoma is defined as a pleomorphic adenoma from which derived an epithelial malignancy. This tumor develops in primary or recurrent pleomorphic adenoma. Carcinoma ex pleomorphic adenoma is rare and comprises approximately 3.6% of all salivary tumors. The authors present a case of carcinoma ex pleomorphic adenoma, which is one of the 6 cases of carcinomas ex pleomorphic adenoma that have been operated in ENT Department Timiºoara over the last 10 years, emphasizing diagnostic steps taken and therapeutic methods. We present the case of a 63 year old female from urban area who was admitted to hospital for a mass in the parotid region, witch appeared so, after seven months, gradually increasing in size. At MRI examination appeared an expansive polilobulated tumor mass with axial diameters of 4/5 cm, in the left parotid gland projection. We performed total left parotidectomy with facial nerve preservation and lateral neck dissection Level II – IV. Histopathological exam revealed mucoepidermoid carcinoma ex pleomorphic adenoma. The evolution of this tumor presents a high aggressiveness, the patient undergone postoperative radiotherapy, respectively. Key Words: carcinoma ex pleomorphic adenoma, malignant parotid tumor, parotidectomy CARCINOM EX ADENOM PLEOMORF PAROTIDIAN – PREZENTARE DE CAZ Rezumat: Carcinomul ex adenom pleomorf este definit ca adenom pleomorf în care apar elemente maligne strict epiteliale. Acesta se dezvoltã în adenom pleomorf primar sau recurent. Carcinomul ex adenom pleomorf este rar ºi reprezintã aproximativ 3,6% din toate tumorile glandelor salivare. Autorii prezintã un caz de carcinom ex adenom pleomorf, dintre cele 6 cazuri diagnosticate ºi operate în Clinica ORL Timiºoara în ultimii 10 ani, subliniind etapele diagnostice parcurse, precum ºi modalitatea terapeuticã utilizatã. Prezentãm cazul unei paciente în vârstã de 63 de ani din mediu urban, ce a fost internatã în Clinica ORL Timiºoara pentru o formaþiune tumoralã în regiunea parotidianã stângã, apãrutã, afirmativ, în urmã cu aproximativ ºapte luni înaintea internãrii, crescând treptat în dimensiuni. Examinarea RMN a evidenþiat o masã tumoralã expansivã cu contur polilobulat cu diametrele axiale maxime de 4/5 cm., în proiecþia glandei parotide stângi. S-a efectuat parotidectomie totalã stângã cu conservarea nervului facial ºi evidare ganglionarã funcþionalã selectivã parþialã stângã (ariile II-IV). Examenul histopatologic a relevat: carcinom mucoepidermoid ex adenom pleomorf. Evoluþia acestei tumori prezintã o agresivitate crescutã, motiv pentru care s-a indicat efectuarea de radioterapie postoperator. Cuvinte-cheie: carcinom ex adenom pleomorf, neoplasm parotidian, parotidectomie totalã. A. Mag 1 S. Cotulbea 1 A. H. Marin 1 C. Doros 1 D. Neamtu 1 N. Balica 1 A. Ruja 2 M. Preda 3 Received for publication: 01.05.2010 Revised: 21.07.2010 1. - ENT Department, University of Medicine and Pharmacy Timiºoara 2. - Clinic of Odontotherapiy, Faculty of Dentistry, University of Medicine and Pharmacy Timiºoara 3. - Clinic of General and Oncologic Surgery, University of Medicine and Pharmacy Timiºoara
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CARCINOMA EX PLEOMORPHIC ADENOMA INPAROTID GLAND – CASE REPORT
INTRODUCTION
Pleomorphic adenoma, also know as benign mixed
tumor because of the presence of both epithelial and
mesenchymal tissue, are the most common tumors of
the major salivary glands. (1,2). These tumors occurs
most frequently in the parotid gland. Most pleomorphic
adenomas of parotid gland develop in the superficial
parotid lobe. Generally they presents as a well-deliniated,
solitary, painless mass with slow growth. (3). Although
205
Journal of Experimental Medical & Surgical Research
Cercetãri Experimentale & Medico-Chirurgicale
Year XVII · Nr.3/2010 · Pag. 205 - 209E x p e r i m e n t a l
M e d i c a l S u r g i c a l
R E S E A R C H
J O U R N A L o f
Correspondence to: Dr. Anamaria Mag, Clinica ORL Timiºoara, Bd. Revoluþiei No. 6, Telefon: 0740 43 47 40, Email: [email protected]
SUMMARY:Carcinoma ex pleomorphic adenoma is defined as a pleomorphic adenoma from whichderived an epithelial malignancy. This tumor develops in primary or recurrent pleomorphicadenoma. Carcinoma ex pleomorphic adenoma is rare and comprises approximately 3.6%of all salivary tumors. The authors present a case of carcinoma ex pleomorphic adenoma,which is one of the 6 cases of carcinomas ex pleomorphic adenoma that have beenoperated in ENT Department Timiºoara over the last 10 years, emphasizing diagnostic steps taken and therapeutic methods. We present the case of a 63 year old female from urbanarea who was admitted to hospital for a mass in the parotid region, witch appeared so, afterseven months, gradually increasing in size. At MRI examination appeared an expansivepolilobulated tumor mass with axial diameters of 4/5 cm, in the left parotid gland projection.We performed total left parotidectomy with facial nerve preservation and lateral neckdissection Level II – IV. Histopathological exam revealed mucoepidermoid carcinoma expleomorphic adenoma. The evolution of this tumor presents a high aggressiveness, thepatient undergone postoperative radiotherapy, respectively.
Key Words: carcinoma ex pleomorphic adenoma, malignant parotid tumor, parotidectomy
CARCINOM EX ADENOM PLEOMORF PAROTIDIAN – PREZENTARE DE CAZ
Rezumat:Carcinomul ex adenom pleomorf este definit ca adenom pleomorf în care apar elementemaligne strict epiteliale. Acesta se dezvoltã în adenom pleomorf primar sau recurent.Carcinomul ex adenom pleomorf este rar ºi reprezintã aproximativ 3,6% din toate tumorileglandelor salivare. Autorii prezintã un caz de carcinom ex adenom pleomorf, dintre cele 6cazuri diagnosticate ºi operate în Clinica ORL Timiºoara în ultimii 10 ani, subliniind etapelediagnostice parcurse, precum ºi modalitatea terapeuticã utilizatã. Prezentãm cazul uneipaciente în vârstã de 63 de ani din mediu urban, ce a fost internatã în Clinica ORL Timiºoarapentru o formaþiune tumoralã în regiunea parotidianã stângã, apãrutã, afirmativ, în urmã cuaproximativ ºapte luni înaintea internãrii, crescând treptat în dimensiuni. Examinarea RMN a evidenþiat o masã tumoralã expansivã cu contur polilobulat cu diametrele axiale maximede 4/5 cm., în proiecþia glandei parotide stângi. S-a efectuat parotidectomie totalã stângã cu conservarea nervului facial ºi evidare ganglionarã funcþionalã selectivã parþialã stângã(ariile II-IV). Examenul histopatologic a relevat: carcinom mucoepidermoid ex adenompleomorf. Evoluþia acestei tumori prezintã o agresivitate crescutã, motiv pentru care s-aindicat efectuarea de radioterapie postoperator.Cuvinte-cheie: carcinom ex adenom pleomorf, neoplasm parotidian, parotidectomie totalã.
A. Mag1
S. Cotulbea1
A. H. Marin1
C. Doros1
D. Neamtu1
N. Balica1
A. Ruja2
M. Preda3
Received for publication: 01.05.2010
Revised: 21.07.2010
1. - ENT Department, University of Medicine and Pharmacy Timiºoara2. - Clinic of Odontotherapiy, Faculty of Dentistry, University of Medicine and Pharmacy Timiºoara3. - Clinic of General and Oncologic Surgery, University of Medicine and Pharmacy Timiºoara