Intracapsular Carcinoma Ex-Pleomorphic Adenoma of the Parapharyngeal Space: Report of Two Cases and Review of the Literature

2017 ◽  
Vol 103 (1_suppl) ◽  
pp. S73-S77
Author(s):  
Remo Accorona ◽  
Diego Barbieri ◽  
Davide Farina ◽  
Davide Lombardi ◽  
Mario Bussi ◽  
...  
Keyword(s):  
Pleomorphic Adenoma ◽  
Adjuvant Radiotherapy ◽  
Parapharyngeal Space ◽  
Correct Diagnosis ◽  
Needle Aspiration ◽  
Malignant Degeneration ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Transcervical Approach ◽  
Needle Aspiration Cytology ◽  
Clinical Records

Background Carcinoma ex-pleomorphic adenoma of the parapharyngeal space is an exceedingly rare entity. Methods The clinical records of two patients with primary carcinoma ex-pleomorphic adenoma of the parapharyngeal space surgically treated at two different centers were retrospectively analyzed. Results Despite ultrasound-guided fine-needle aspiration cytology and magnetic resonance imaging, the correct diagnosis was preoperatively missed in both cases. Excision was obtained through a transcervical-transparotid approach in 1 case and a minimally-invasive endoscopic-assisted transcervical approach in the other. Definitive histology was consistent with intracapsular carcinoma ex-pleomorphic adenoma. Adjuvant radiotherapy was performed in the case with macroscopic malignant degeneration; both patients are alive and free from disease 36 months after surgery. Conclusions Carcinoma ex-pleomorphic adenoma of the parapharyngeal space is a rare disease, and definitive diagnosis may be challenging. Surgery is the mainstay of treatment, but adjuvant radiotherapy also may be required in the presence of specific risk factors.

A Clinical Approach to the Parapharyngeal Space

2017 ◽  
Vol 8 (1) ◽  
pp. 1-4
Author(s):  
AM Shivakumar ◽  
Praveen D Shivanandappa ◽  
Veena P Doddamane ◽  
KS Munish ◽  
BS Yogeesha
Keyword(s):  
Parapharyngeal Space ◽  
Malignant Tumors ◽  
Imaging Study ◽  
Needle Aspiration ◽  
Benign Tumors ◽  
Clinical Approach ◽  
Preoperative Diagnostic ◽  
Clinicopathological Profile ◽  
Needle Aspiration Cytology ◽  
Clinical Records

ABSTRACT Aim To present the clinicopathological profile, surgical management, and the outcome of parapharyngeal space (PPS) neoplasms in 14 patients. Materials and methods This is a retrospective review of the clinical records of 14 patients treated for PPS tumors. The age of patients ranged from 24 to 54 years, with female to male ratio of 1.3:1. The commonest clinical presentation was a slowgrowing, painless neck swelling. The preoperative protocol was based on: (1) imaging study to establish site, size, and anatomical relationships. (2) Fine-needle aspiration cytology (FNAC) was performed to determine the nature of the mass. Details of the management, morbidity, and outcome of these patients are presented. Results A total of 85.7% of the PPS neoplasms were benign and 14.2% were malignant. Majority of the benign tumors were of neurogenic origin. The histocytopathology confirmed 12 (85.7%) of these diagnoses (2 patients were with “nondiagnostic” result). The positive predictive value of the FNAC was 83.3% for benign tumors and 100% for malignant tumors. In 6 patients (60%), a transcervical surgery was performed. Three patients (30%) underwent transparotid–transcervical surgery for a pleomorphic adenoma of the deep lobe of the parotid gland in the prestyloid space and transcervical–transmandibular approach was taken in 1 case (10%). Postoperative complications occurred in 3 out of 10 patients (33.3%). Conclusion The results of our study are in agreement with other studies reported in the literature and confirm the need to follow a careful preoperative diagnostic protocol that must take advantage of imaging studies (computed tomography, magnetic resonance imaging) and of cytology FNAC, in order to plan surgical treatment with a safe approach and that reduces complications, esthetic and functional damage, and the risk of recurrence. How to cite this article Shivanandappa PD, Doddamane VP, Munish KS, Yogeesha BS, Shivakumar AM. A Clinical Approach to the Parapharyngeal Space. Int J Head Neck Surg 2017;8(1):1-4.

scholarly journals Carcinoma ex pleomorphic adenoma: a case report and review of literature

1970 ◽  
Vol 19 (4) ◽  
pp. 3253-3263
Author(s):  
Deepak Khanna ◽  
Tanay Chaubal ◽  
Ranjeet Bapat ◽  
Anshad Mohamed Abdulla ◽  
Sunil Thomas Philip ◽  
...  
Keyword(s):  
Pleomorphic Adenoma ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Clinical Symptoms ◽  
Needle Aspiration ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Needle Aspiration Cytology ◽  
High Degree

Background: Carcinoma ex pleomorphic adenoma (CA-ex-PA) is extremely unusual in minor salivary glands of oral cavity. CA-ex-PA is a carcinomatous change as a primary or as a recurrence of pleomorphic adenoma.Objective: Due to resemblance of clinical symptoms of Ca ex PA and benign pleomorphic adenoma, it is mandatory for surgeons to keep high degree of clinical alertness, considering the peculiarity of this tumor.Case Report: 54-year-old male presented with swelling on left side in the pre-auricular region from the middle of zygomatic arch to mastoid process and from tragus of the ear up to angle of mandible. Fine needle aspiration cytology revealed a mixture of benign and malignant components. Total left parotidectomy with left radical neck dissection followed by reconstruction with cervicodeltopectoral flap was performed. Combination of chemotherapy and radiotherapy were given to patient. Histologic examination and pre-operative fine needle aspiration cytology confirmed the diagnosis of Carcinoma ex pleomorphic adenoma (CA-ex-PA). Two-year follow-up of patient showed no recurrence of the lesion.Conclusion: Due to the similarity in the clinical symptoms of CA-ex-PA and benign pleomorphic adenoma, it is vital that clinicians maintain a high degree of clinical vigilance, considering the oddity of this malignancy.Keywords: Carcinoma ex pleomorphic adenoma, Fine needle aspiration cytology, parotidectomy.

scholarly journals Diagnosis and Management of Extracranial Head and Neck Schwannomas: A Review of 27 Cases

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Ryuji Yasumatsu ◽  
Torahiko Nakashima ◽  
Rina Miyazaki ◽  
Yuichi Segawa ◽  
Shizuo Komune
Keyword(s):  
Head And Neck ◽  
Postoperative Morbidity ◽  
Tumor Resection ◽  
Clinical History ◽  
Needle Aspiration ◽  
Vagus Nerves ◽  
Surgical Data ◽  
Needle Aspiration Cytology ◽  
Clinical Records ◽  
Complete Tumor

Objectives. Clinical records of 27 patients with extracranial head and neck schwannoma were retrospectively reviewed.Methods. Ultrasonography (US) was performed in all cases. Seven patients underwent CT. Twenty-five patients underwent MRI. Fine needle aspiration cytology (FNAC) was performed for 12 of the 27 patients. Clinical history, surgical data, and postoperative morbidity were analyzed.Results. The images of US showed a well-defined, hypoechoic, primarily homogeneous solid mass. At CT, only one of 7 cases (14%) was able to suggest the diagnosis of schwannoma. At MRI, twenty of 25 cases (80%) suggested the diagnosis of schwannoma. Only three of 12 cases (25%) displayed a specific diagnosis of schwannoma rendered on FNAC. The distribution of 27 nerves of origin was 10 (37%) vagus nerves, 6 (22%) sympathetic trunks, 5 (19%) cervical plexuses, 3 (11%) brachial plexuses, 2 (7%) hypoglossal nerves, and 1 (4%) accessory nerve. Complete tumor resection was performed in 11 patients, and intracapsular enucleation of the tumor was performed in 16 patients. The rate of nerve palsy was 100 (11/11) and 31% (5/16).Conclusions. MRI is sensitive and specific in the diagnosis of schwannoma. Intracapsular enucleation was an effective and feasible method for preserving the neurological functions.

scholarly journals Pleomorphic adenoma of the upper lip: a case report and review of literature

2016 ◽  
Vol 4 (1) ◽  
pp. 8
Author(s):  
Rashmi Metgud ◽  
Bhardwaj Tina Neelesh ◽  
Saurabh Goel ◽  
Smitha Nail ◽  
Shrikant Patel ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Pleomorphic Adenoma ◽  
Unusual Case ◽  
Needle Aspiration ◽  
Myoepithelial Cells ◽  
Upper Lip ◽  
Epithelial Tumor ◽  
Needle Aspiration Cytology ◽  
Benign Mixed Tumor ◽  
Morphological Patterns

<p>Pleomorphic Adenoma is a benign epithelial tumor arising from the salivary gland. It is a benign mixed tumor composed of epithelial and myoepithelial cells arranged with various morphological patterns, demarcated from surrounding tissues by fibrous capsule. In this article, we report an unusual case of 30 year, male with a single, nodular swelling evident in the upper lip which was discovered during a routine dental procedure. Fine Needle Aspiration Cytology (FNAC) was planned for the patient, where a of cytological diagnosis of Pleomorphic Adenoma was rendered, which was confirmed by biopsy. Hence, this highlights, FNAC makes up an important diagnosing tool as the first line of investigation to distinguish between benign and malignant salivary gland neoplasms.</p>

scholarly journals Study of spectrum and clinical profile of benign breast disease in the rural area: is there any change

2020 ◽  
Vol 7 (7) ◽  
pp. 2121
Author(s):  
Kailash K. Jawade ◽  
Vaishali Bande
Keyword(s):  
Rural Area ◽  
Benign Breast Disease ◽  
Breast Disease ◽  
Needle Aspiration ◽  
Clinical Profile ◽  
Breast Tuberculosis ◽  
Chronic Abscess ◽  
Needle Aspiration Cytology ◽  
Clinical Records ◽  
Tumor Like Lesions

Background: Recent understanding of pathophysiology and health awareness may have impact on spectrum of benign breast disease (BBD) in rural area. We have analyzed clinical data of 88 cases of BBD for spectrum and clinical profile to compare with present studies.Methods: Clinical records of 88 cases of BBD were reviewed for demographic details, clinical presentation, management and outcome. Recent literature related to BBD in rural area was searched using various search engines. Results of our study were compared with recent studies.Results: Fibroadenoma (FA) was most common condition followed by fibrocystic disease. BBD were common in third decade 46 (52.3%). Lump was present in 87 cases. Lump was painful in 45 (52.3%), and associated with fever in 15 (17.1%) cases. Fine needle aspiration cytology and ultrasound was done in 70 and 32 patients in which diagnostic accuracy with histopathology was seen in 69.7% and 56.2% respectively. Surgical treatment included lumpectomy, lump excision, mastectomy, drainage with debridement and axillary clearance. Three patients of breast tuberculosis were treated with 9 months AKT. When compared with recent studies, over all spectrum was same expect chronic abscess presenting as lump was more in our series.Conclusions: Our study revealed benign neoplasms, inflammatory condition and tumor like lesions in 43.1%, 14.6% and 13.8% cases respectively. FA was the most common lesion. BBD were common in third decade. Except the chronic mastitis, incidence of various types of benign lesions was comparable with those found in other studies. There is not much change in overall spectrum of benign breast disease.

scholarly journals Pleomorphic adenoma with squamous and appendageal metaplasia mimicking mucoepidermoid carcinoma on cytology

CytoJournal ◽  
2008 ◽  
Vol 6 ◽  
pp. 5 ◽  
Author(s):  
Meenakshi Batrani ◽  
Manju Kaushal ◽  
A. K. Sen ◽  
Rajbala Yadav ◽  
N. K. Chaturvedi
Keyword(s):  
Pleomorphic Adenoma ◽  
Mucoepidermoid Carcinoma ◽  
Squamous Metaplasia ◽  
Salivary Gland Tumor ◽  
Giant Cells ◽  
Needle Aspiration ◽  
Case Presentation ◽  
Squamous Cells ◽  
Foreign Body Giant Cells ◽  
Needle Aspiration Cytology

Background: Histological diversity is the hallmark of pleomorphic adenoma, the most common salivary gland tumor. It may cause difficulty in cytological interpretation, due to limited and selective sampling. Case presentation: A 16-year-old female patient presented with right cheek swelling. Fine needle aspiration cytology showed squamous cells, basaloid cells, and foamy cells, along with extracellular keratin and foreign body giant cells. Characteristic metachromatic fibrillary chondromyxoid stroma, which is usually seen in pleomorphic adenoma, was not seen in the aspirate. A diagnosis of mucoepidermoid carcinoma was given on cytology. Subsequent resection revealed an encapsulated pleomorphic adenoma, with extensive squamous metaplasia and appendageal differentiation on histology. Conclusion: This case illustrates that pleomorphic adenoma with squamous metaplasia presents a potential for misinterpretation as mucoepidermoid carcinoma on cytology. We discuss the various pitfalls and the features that are helpful in distinguishing these two lesions.

Surgical treatment results of parapharyngeal space tumors: a report of 22 cases.

2018 ◽  
Vol 72 (4) ◽  
pp. 6-12
Author(s):  
Ewa Osuch-Wójcikiewicz ◽  
Anna Rzepakowska ◽  
Zuzanna Krupa ◽  
Aneta Durmaj ◽  
Kazimierz Niemczyk
Keyword(s):  
Surgical Treatment ◽  
Head And Neck ◽  
Pleomorphic Adenoma ◽  
Parapharyngeal Space ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
External Carotid ◽  
Malignant Neoplasms ◽  
Transcervical Approach ◽  
Lower Group

Introduction: Parapharyngeal space (PPS) is the anatomical area lateral to the upper pharynx and clinically important due to PPS tumors. They account for less than 1% of head and neck neoplasms. Both benign and malignant neoplasms may arise there and typical for this localization is diversity of histological origin. Complete surgical excision is still the basis of treatment. Aim of the study: Evaluation of the results of surgical treatment of PPS tumors in the Department of Otolaryngology at the Medical University over the period 2015-2017. Material and methods: A retrospective analysis of medical records including complaints, physical examination, results of imaging studies, surgical approach, postoperative complication and histopathological results in 22 patients with a diagnosis of a PPS tumors. Results: The most frequent complaints reported by the patients were: discomfort in the throat, dysphagia, hearing disorders and a palpable tumor on the neck. Asymptomatic course of the disease was demonstrated in 4 cases. All patients were treated surgically: 2 with transoral approach, 9 with transparotid-transcervical approach, 11 with transcervical approach. In most cases the tumor was removed radically. In 2 patients intracapsular tumor resection was performed. Based on histopathological examination the benign lesions dominated (18/22). In 4 cases malignant neoplasms were diagnosed: carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma and two cases of squamous cell carcinoma. The most common origin of PPS tumors was deep lobe of parotid gland and for this group 11 patients had diagnosis of pleomorphic adenoma. Other diagnosis included: paraganglioma, neurofibroma, hemangioma, lymphangioma and rhabdomyoma. Postoperative complications occurred in 9 patients and presented as hoarseness and dysphagia due to paresis of the lower group of cranial nerves (IX, X, XII). Significant intraoperative bleeding during surgery occurred in 2 cases and ligation of the external carotid artery was necessary. Conclusion: Due to the anatomical topography of PPS and its content with the essential vessels and the lower group of cranial nerves, the surgical treatment of pathology of this area is still a challenge for head and neck surgeons. The decrease of voice quality and impaired speech and swallowing should always be considered as complications post the surgical resection in PPS.

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