Giant Pleomorphic Adenomas of Parotid Gland: a Case Series

Pareek, Yogendra Kumar; Gupta, Deendayal; Aseri, Yogesh; Rawat, Digvijay Singh; Singh, Baldeep; Verma, Prerna

doi:10.1007/s12070-020-01968-w

Cited by 5 publications

(11 citation statements)

References 24 publications

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“…Reviewing their abstracts, articles published in English only were selected based on them reporting a case or series of cases of giant parotid PA, including clinical, radiographic, histological, and surgical outcomes. Twenty-six articles published in English language were identified [ 4 , 8 – 32 ] since 1995, and they reported 43 cases of PA in total. While most of the articles selected for review were single case reports, three articles were case series reporting about two cases [ 16 ], three cases [ 17 ], and 15 cases [ 32 ], respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-six articles published in English language were identified [ 4 , 8 – 32 ] since 1995, and they reported 43 cases of PA in total. While most of the articles selected for review were single case reports, three articles were case series reporting about two cases [ 16 ], three cases [ 17 ], and 15 cases [ 32 ], respectively. The largest case series in the present review, comprising 15 PA patients, was reported by Pareek et al [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Predominant clinical presentation of the tumors was that of a large, lobulated, and pedunculated mass with apparently normal overlying skin. Ulceration of the skin was reported in eight patients, out of which five were reportedly associated with malignant change [ 15 , 23 , 24 , 30 , 32 ], and the remaining three were due to injury [ 18 , 29 , 32 ]. Anatomically, the tumor more commonly involved the superficial lobe of the parotid gland ( n = 29, 70.7%) giving rise to the clinical presentation of a large preauricular mass.…”

Section: Discussionmentioning

confidence: 99%

“…Based on our literature review, giant PA involving the superficial lobe of parotid was managed either by SP or ECD [ 4 , 10 , 24 , 26 – 29 , 31 , 32 ]. On the contrary, TP was reportedly done for tumors exhibiting malignant characteristics [ 8 , 12 , 15 , 17 , 19 , 20 , 23 , 30 ] and those involving both the deep and superficial lobes [ 9 , 13 , 14 , 16 – 18 , 21 , 32 ] ( Table 1 ). Since the present case was that of a PA involving superficial parotid only (Figures 1 and 2 ), the patient was surgically managed through ECD ( Figure 3 ), avoiding any iatrogenic damage to the facial nerve ( Figure 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although uncommon, giant pleomorphic adenomas of the parotid gland have been reported. An electronic search of the English-language articles through the Medline, Scopus, and Google Scholar databases revealed 43 reports of giant parotid PA since 1995 [ 4 , 8 – 32 ], with sizes ranging up to 28-33 cm [ 15 , 18 , 27 ] and tumor mass ranging up to 6.85–7.3 kg [ 10 , 27 ]. Major reasons for patients reporting with large PA are lack of resources, inaccessibility to medical facilities, fear of surgical procedure, and poor awareness, compounded by an asymptomatic and slow-growing lesion [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature

Alkindi

Ramalingam

Hakeem

et al. 2020

Case Reports in Dentistry

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Salivary gland tumors (SGT) comprise 3% of all head and neck tumors, are mostly benign, and arise frequently in the parotid gland. Pleomorphic adenoma (PA) is the commonest SGT, representing 60-70% of all benign parotid tumors. Clinically, parotid PA presents as irregular, lobulated, asymptomatic, slow-growing preauricular mass, involving both superficial and deep lobes, and could grow to gigantic proportions. Histologically, PA has epithelial and mesenchymal elements in chondromyxoid matrix and is managed surgically. Based on a review of 43 cases reported in English literature since 1995, giant parotid PA is reported as large as 35 cm (diameter) and 7.3 kg (resected weight). Although rare, 10 cases of malignant transformation were reported in the review. Surgical management included extracapsular dissection (ECD), superficial parotidectomy, and total parotidectomy for benign tumors, and adjuvant radiation or chemotherapy for malignant tumors. We further present the case of a 36-year-old healthy male with slow-growing and asymptomatic giant parotid PA, of 4-year duration. The patient presented with firm, lobulated preauricular swelling, provisionally diagnosed as PA based on radiographic and cytological findings. The tumor was resected through ECD, and the patient had uneventful postoperative recovery and a 7-year recurrence-free follow-up period. Histological examination revealed epimyoepithelial proliferation punctuated by chondromyxoid areas, with extensive squamous metaplasia and keratin cysts. To the best of knowledge from indexed literature, giant parotid PA is rarely reported in Saudi Arabia. In addition to its rarity, this case is reported for its benign nature despite atypical histological presentation, successful surgical management without complications, and long-term recurrence-free follow-up. Based on this report, clinicians must be aware of atypical histological presentations associated with PA and plan suitable surgical management and follow-up to avoid morbidity. Nevertheless, attempts must be made to diagnose and manage these lesions at an early stage and before they reach gigantic proportions.

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