Salivary Gland Tumors

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INTRODUCTION

Minor salivary gland tumors constitute a heterogeneous group of neoplasms with great histomorphologic variation1 accounting for 11% of all the salivary gland tumours.2 The ratio of benign and malignant tumours in case of minor salivary gland tumours is closer to 1:1 revealing their aggressive biological behaviour.3 Highly cellular variants accounting for 12-15% of the pleomorphic adenomas4 are more likely to undergo malignant change, with 50% of carcinomas developing in cell-rich variants of pleomorphic adenomas.2 We present here a case report of a longstanding palatal cellular pleomorphic adenoma in a 53 year old male patient which gave misleading results following FNAC.

CASE REPORT

A 53 year old male patient reported with the complaint of swelling on his palate since 14 years. Onset of swelling was insidious and it slowly and painlessly progressed to the present size. Swelling was not associated with tenderness, discharge, ulceration or any tingling sensation. However, patient had difficulty in speech since past 2 to 3 years. General health of the patient, symmetry of the face, adequacy of mouth opening was preserved. No lymphadenopathy was detected. On examination, there was a well defined swelling with bosselated smooth surface measuring approximately 6 x 5 cm in diameter on right side of the palate, extending from upper right canine to distal of upper right third molar antero-posteriorly and from palatal gingival margin to 0.5 cm beyond midline medio-laterally. Swelling was attached to the overlying mucosa which appeared stretched and adjacent surrounding mucosa was normal (Figure 1). Palpation revealed varying consistency of the swelling which was soft towards the center, firm on the periphery except on pa...

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...t show local recurrence 1 year after surgery. This rare case of cellular pleomorphic adenoma alerts the clinician to keep in mind that though cellular pleomorphic adenoma accounts for only about 12-15% of the pleomorphic adenomas3, its diagnosis can be mystifying based on FNAC alone due to its histological features similar to many other salivary gland tumours. Hence FNAC, which is well accepted as the initial approach in the morphologic diagnosis of salivary gland lesions, is not of much help in case of cellular variant of pleomorphic adenomas.4 Also malignant degeneration is more in case of cellular pleomorphic adenoma especially those arising on palate as they are rarely mucoid in nature.2 Regular attentive follow up is mandatory especially in cases with tumours of long duration, larger size in male patients as they have more chances of malignant degeneration.11

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