Surgical management of palatal pleomorphic adenoma (PPA) recurrence after 10 years, treated at a Brazilian center - A case report

Abstract

Pleomorphic adenoma, considered the most frequent benign mixed neoplasm of the minor salivary glands, occurs mainly in the region of the hard palate, with slight predilection in females and peak of incidence between the third and fifth decades of life. An increase in recurrence rates has been associated with the histopathological variants of the tumor, cellular characteristics, stroma, and capsule rupture during surgical removal of the lesion. The present case report aims to describe the surgical approach performed on the patient, a 45-year-old woman with a recurrent Pleomorphic Adenoma (PA) in the region of the hard palate on the right side, 10 years after initial enucleation of the lesion; her main complaint was an increase in volume in the palatal region. After extensive local surgical excision of the tumor and 2 years of follow-up, there were no signs of recurrence. Computed tomography and a correct histopathological diagnosis are essential to enable the establishment of an appropriate surgical treatment, with the purpose of achieving complete removal of the lesion, with wide surgical margins, including the lining mucosa and the underlying periosteum, as described in the present case.

Pleomorphic Adenoma of the Palate With an Atypical Malignant Presentation: A Case Report

“…The pseudocapsule is continuous in pleomorphic adenoma when it presents in the major salivary gland. However, when the tumor is present in the minor salivary gland, the pseudocapsule may be incomplete in some places [ 13 , 14 ].…”

Clinical behavior of recurrent pleomorphic adenoma in the palate: a systematic review

“…The results of the risk of bias of cases reports of RPA included are available as supplementary data (see Data Availability Statement section). Six studies demonstrated low risk of bias 25,26,28,[30][31][32] , six studies demonstrated unclear risk of bias 21,23,24,27,29,33 , and one study demonstrated high risk of bias 22 .…”

“…Thirteen articles met the eligibility criteria and were selected for full-text analysis. All 13 articles fulfilled the inclusion criteria and were included in this review: two retrospective studies 21,22 , 10 case reports [23][24][25][26][27][28][29][30][31][32] , and one letter to the editor 33 . All 13 studies were published in English, between 1957 and 2022, and were conducted in United Kingdom 24,25,33 , India 29,32 , United States 22,23 , Japan 21 , Greece 26 , Iran 27 , Italy 28 , South Africa 31 , and Brazil 30 .…”

“…RPA in the palate was clinically characterized as a painless, solitary well-defined and firm nodule, usually measuring up to 3 cm in diameter 21,22,[28][29][30][31][32][33] . The tumor was often covered by normal-colored oral mucosa with occasional superficial ulceration 25 .…”

“…The tumor recurrence time ranged from two to 41 years (mean 16.3 years) after treatment of the primary pleomorphic adenoma in the palate. The surgical removal was the treatment of choice in all cases 21,22,[24][25][26][27][28][29][30][31][32][33] . Two cases, that were managed with radiotherapy following the surgery of the primary tumor, underwent malignant transformation 24 .…”