Massive transcranial parotid pleomorphic adenoma: recurrence after 30 years

Bone alterations in head and neck pleomorphic adenoma: Scoping review

OBJECTIVES

Bone destruction adjacent to salivary gland tumors has been regarded as an indirect sign of malignancy. This scoping review explores possible bone changes due to head and neck pleomorphic adenoma and identifies risk factors for bone destruction.

METHODS

Articles on bone alterations in head and neck pleomorphic adenoma were searched online using PubMed, Scopus and Scholar, according to PRISMA-ScR guidelines. Only histopathologically confirmed pleomorphic adenomas were included. Extracted data were age, gender, location and size of tumor, duration of symptoms, type of bone erosion and recurrency status.

RESULTS

The search resulted in 145 pleomorphic adenomas with adjacent bone alterations. The majority caused expansile bone changes, such as cortex erosion (61.4%) and scalloping (31.0%). Extensive bone destruction was reported in 11 cases (full thickness erosion in 3.4% and bone marrow invasion in 4.1%). Significant risk factors for aggressive bone destruction were tumor size and duration of symptoms (OR = 1.08; 95% CI 1.02-1.14 and OR = 1.03; 95% CI 1.00-1.05).

CONCLUSIONS

Although mostly bone erosion or scalloping is observed, larger or longstanding pleomorphic adenomas have the capacity of developing more extensive bone destruction, without malignant transformation. However, bone destruction is very rare in pleomorphic adenoma and more likely indicates the presence of malignancy.

Melon-sized Parotid Pleomorphic Adenoma-A Case Report

This case report describes a 55 year-old gentleman who had been living with an extremely large (1.2 kg) pleomorphic adenoma for 24 years-despite its significant size, weight and appearance. A modified surgical incision and approach were required to remove the tumour, to avoid damaging the facial nerve and its branches.

Current thinking about the management of recurrent pleomorphic adenoma of the parotid: a structured review

Pleomorphic adenoma is the most common tumour of the parotid gland, and can recur after excision. Recurrent pleomorphic adenoma can be a challenge to treat, and has variable outcomes. The aim of this review was to summarise current thinking in its management, which may be helpful to clinical teams and could improve patients' health-related quality of life. We searched several online databases using the key terms pleomorphic adenoma, recurrent pleomorphic adenoma, parotid gland tumours, parotid surgery, radiotherapy and parotid pleomorphic adenoma, and parotid surgery outcomes. Information collected included sample size, recurrence rate, condition of the facial nerve, type of operation, adjuvant treatments associated with recurrence, and clinical outcome. We screened 2301 papers, of which 49 were eligible. There was no consensus among authors about management. There are few if any randomised studies, and so conclusions in most papers were based on coherent arguments. Pleomorphic adenomas of the parotid tend to recur after long intervals, with a propensity towards multifocal disease, and the risk of recurrence (which depends on the initial surgical technique) is higher when the initial operation was done at a young age, after enucleation, and if the initial margins were invaded. Published conclusions suggest that the accepted management varies from observation in selected cases to total parotidectomy with or without postoperative radiotherapy.