Estudo clinicopatológico de 106 adenomas pleomórficos de glândula salivar maior

Abstract

Introdução: O adenoma pleomórfico (AP) é o mais comum dos tumores das glândulas salivares. Transformação maligna pode ocorrer após recorrências ou em casos com longo tempo de evolução. Objetivo: Analisar os aspectos clinicoepidemiológicos e anatomopatológicos do AP de glândula salivar maior, principalmente os considerados indício de transformação maligna. Material e método: Foram avaliados 106 casos de AP pela pesquisa retrospectiva nos prontuários clínicos e revisão das preparações histológicas. Resultados: A média de idade dos pacientes foi de 39,51 anos, houve predomínio do sexo feminino (69,5%), a glândula parótida foi a mais acometida (86,8%) e o tempo de evolução foi superior a um ano em 76,74% dos casos, com tamanho tumoral de 3,48 cm em média. A avaliação histopatológica demonstrou cápsula tumoral incompleta e delgada em 49% dos casos. Protrusões para a cápsula ou extensão extracapsular foram infreqüentes, 11,32% e 8,49%, respectivamente. A matriz extracelular variou entre mixocondróide (41,5%), mixóide (36,8%), condróide (3,8%) e fibrótica (1,9%), tendo sido observadas associações entre os diversos tipos. O componente epitelial/mioepitelial constituiu 50% ou mais do tumor em 65,1% dos casos e estava disposto em arranjos cordonal (86,8%), ductal (81,1%), sólido (40,6%), cístico (20,7%) e em "paliçada" (8,49%). Metaplasia escamosa ocorreu em 16,04% dos casos. Alterações histopatológicas relacionadas com transformação maligna foram incomuns: hialinização extensa (4,7%) e necrose (0,9%

An unusual pleomorphic adenoma

“…The dental surgeon should be well aware of this and also the treatment since, in the majority of cases, early diagnosis results in more conservative treatment and a better prognosis for the patient 16 . The pleomorphic adenoma is the most frequently found tumor amongst benign tumors of the salivary glands, afflicting both minor and major salivary glands, the parotid being the gland most affected [2][3][4][5][10][11] . It can appear at any age, though rarely in children 2,5,7,8,12 .…”

“…Pleomorphic adenoma the tumor mass, signals that represent, retrospectively, benignity and potential malignancy of the lesion 11 . RibeiroRotta et al 10 suggested that where magnetic resonance exams are available to the patient, it should be the first option for differential diagnosis and treatment planning.…”

“…Even though it has an origin which is exclusive to epithelial tissue, the variety of components accords it a mesenchymal appearance as a result of the production of secretions from the tumor cells themselves, which may be ductal or myoepithelial 7 . PA makes up approximately 90% of all benign lesions of the salivary glands 5,[8][9][10][11] . It represents between 53% and 77% of parotid tumors, 44% to 68% of tumors of the submandibular gland and 33% to 43% of tumors of the minor salivary glands…”

“…On the other hand, calcifications inside the mass suggest a benign neoplasm or, less commonly, schwannoma or mucoepidermoid carcinoma 1,5,10,[13][14] . Even though it has well-known clinical and morphological characteristics, the malignancy of the pleomorphic adenoma is the holder of a pathogenesis which is still uncertain, as is the expression of oncogenes and the factors that influence its transformation 11 . In the long run, malignant degeneration may occur, which is most likely in adenomas that have been evolving for over ten years.…”

Pleomorphic Adenoma: Clinical Case Report

“…The likely risk of malignant transformation is small, but it may occur in approximately 3 % to 4 % of all cases. The risk increases with the time of evolution of the neoplasm (DAS NEVES et al, 2007;NEVILLE et al, 2016;SENGUL;SENGUL, 2011). The potential for malignant transformation of Pleomorphic Adenoma has been observed, mainly in cases of incomplete surgical excision.…”