Etiology and management of recurrent parotid pleomorphic adenoma

Abstract

The objective of this review study was to encompass the relevant literature and current best practice options for this challenging, sometimes incurable problem. The source of the data was Ovid MEDLINE from 1946 to 2014. Review methods consisted of articles with clinical correlates. The most important cause of recurrence is enucleation with rupture and incomplete tumor excision at operation. Incomplete pseudocapsule, extracapsular extension, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule are also likely linked to recurrent pleomorphic adenoma. Most recurrent pleomorphic adenoma are multinodular. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Treatment of recurrent pleomorphic adenoma must be individualized. Total parotidectomy, given the multicentricity of recurrent pleomorphic adenoma, is appropriate in many patients, but may be inadequate to control recurrent pleomorphic. There is accumulating evidence from retrospective series that postoperative radiation therapy results in significantly better local control.

Recurrent Parotid Pleomorphic Adenomas: Our Clinical Experience

“…The tumor often has low intensity in the T1-weighted series and high intensity in the T2-weighted series. It can demonstrate moderate contrast enhancement in a contrast-enhanced series (9). However, MRI may not be able to detect all the foci.…”

“…It also helps to identify any residual parotid tissue (9). The tumor often has low intensity in the T1-weighted series and high intensity in the T2-weighted series.…”

“…Another reason is tumor seeding, which is common in the surgical field, after opening the pseudocapsule structure of the tumor during surgery. In the majority of patients with recurrent pleomorphic adenomas, increased recurrence rates of up to 5% have been detected in the follow-up of patients who have multifocal tumors around the incision scar and when it is known that the tumor has been opened during surgery (8,9). It was reported that 20 to 45% of the recurrence rates were encountered in patients who underwent simple enucleation (2, 7).…”

A unique case of benign pleomorphic adenoma metastasizing to the thyroid gland and liver

“…PSAs are contained within a pseudocapsule but have finger-like projections [17] . Therefore, total conservative parotidectomy with adequate margins and preservation of the facial nerve is the treatment of choice, and the use of intra-operative facial nerve monitoring is advisable [18] . Revision surgery of the parotid can be extremely difficult due to the presence of fibrosis and should be reserved for experienced surgical teams dealing regularly with this cohort of patients.…”

“…There is evidence to suggest that post-operative radiotherapy helps local control and should be employed in multi-centric recurrences or if there is doubt of complete excision [18] . Treating teams may also take into account age, treatment morbidity, facial nerve involvement, and contraindications to further surgery when considering radiotherapy [20] .…”