|Year : 2014 | Volume
| Issue : 4 | Page : 277-280
Pleomorphic adenoma of palate
Manisha Chauhan Solanki, Sumir Gandhi, George Koshy, Inderjot Singh
Department of Oral and Maxillofacial Surgery, Christian Dental College and Hospital, Ludhiana, Punjab, India
|Date of Web Publication||16-Oct-2014|
Dr. Manisha Chauhan Solanki
Department of Oral and Maxillofacial Surgery, Christian Dental College and Hospital, Brown Road, Ludhiana - 141 008, Punjab
Source of Support: None, Conflict of Interest: None
A case of 55-year-old female has been presented, who reported to our centre with an unnoticed painless swelling in the posterior part of hard palate, which was interfering in posterior palatal seal formation during denture fabrication. This swelling was diagnosed as pleomorphic adenoma and complete surgical excision was done along with capsule.
Keywords: Minor salivary glands, pleomorphic adenoma palate, posterior palatal seal
|How to cite this article:|
Solanki MC, Gandhi S, Koshy G, Singh I. Pleomorphic adenoma of palate. CHRISMED J Health Res 2014;1:277-80
| Introduction|| |
Pleomorphic adenoma is benign tumor of salivary gland. It arises from myoepithelial cells of salivary gland and contains both epithelial and connective tissue elements. ,,, Following is the case report of 55-year-old female patient who was diagnosed with pleomorphic adenoma of the palate from minor salivary gland during fabrication of denture, as the adenoma was interfering in posterior palatal seal (PPS) formation.
| Case Report|| |
A 55-year-old female patient referred to department of oral and maxillofacial surgery with difficulty in PPS formation during denture construction because of swelling in posterior part of hard palate.
On examination, upper ridge was edentulous and orthopantomogram did not show any remaining teeth. The patient had never been aware of the swelling. The swelling was of approximately 2 cm × 2 cm in size in the posterior part of the hard palate near the junction of soft and hard palate [Figure 1]. The swelling was approaching the midline; it was firm in consistency and was neither tender nor fluctuant. The mass was freely mobile over the deeper tissues and mucosa was not ulcerated. Overlying mucosa was normal in color. However, the patient denied any difficulty in deglutition and phonation.
We made differential diagnosis of lipoma,  salivary gland tumor, and malignant lesion arising from the salivary gland.
Pleomorphic adenoma arising from the deep lobe of parotid gland usually presents in the posterolateral part of the palate.  However, in our case, the swelling was approaching the midline of the palate. Therefore, the tumor seemed to be arising from the minor salivary gland rather than the parotid gland. Since the lesion was not ulcerated, mobile, and not interfering with speech and deglutition, we ruled out the malignant lesion. As lipoma is very common in the posterior part of palate, we stuck to the working diagnosis of lipoma and tumor of minor salivary gland.
To assess the extent of growth concerning palatal bone and surrounding soft tissue further, magnetic resonance imaging (MRI) was done. MRI showed it to be a well-defined benign growth arising from palate and it involved neither any major salivary gland nor the palatal bone [Figure 2]. Fine needle aspiration cytology (FNAC) of the swelling was done. Aspiration cytology smears suggested the lesion to be pleomorphic adenoma.
As the treatment of choice for pleomorphic adenoma is complete surgical removal by extra capsular excision, we planned the excisional biopsy under local anesthesia [Figure 3], [Figure 4]. Histopathology of the specimen confirmed the lesion to be pleomorphic adenoma of the salivary gland origin [Figure 5].
|Figure 5: Photomicrograph showing capsule and myoepitheial cells (hematoxylin– eosin stain, original magnifi cation; ×10)|
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| Discussion|| |
Pleomorphic adenoma is the most common salivary gland tumor. It is a benign epithelial tumor of adenoid structure. Research proves epithelial origin of the mixed tumor as well as clonal chromosome abnormalities with aberrations involving 8q12 and 12q15. The tumor often displays characteristic chromosomal translocations between chromosomes #3 and #8. This causes the PLAG gene to be juxtaposed to the gene for β-catenin, thus activating the catenin pathway and leads to inappropriate cell division. 
It is preferentially arising from parotid gland (75-90%), followed by the submandibular and minor salivary glands (8%). ,,, When occurring in minor salivary glands, the palate is most common site (60-65%). ,,, The smaller the salivary gland that is affected, the more likely it is to trigger a malignant tumor.  Majority of neoplasms developing in the intraoral minor salivary glands are malignant, with adenoid cystic carcinoma being the most common type. ,, The most common age group is between 3 rd to 6 th decades with a predilection for females. ,,, Adenoid cystic carcinoma usually develops as a small, painless, quiescent nodule, which slowly begins to increase in size, sometimes with intermittent growth. ,,, In our case, the patient was unaware of the swelling that was accidentally diagnosed during denture fabrication.
Intraoral lesions that appear as asymptomatic in the posterolateral part of the palate, if not related to a dental infection, are probably developing in minor salivary glands.  In such cases, the differential diagnosis should include palatal abscess, odontogenic and non-odontogenic cysts, soft-tissue tumors (e.g. fibroma, neurofibroma, neurilemmoma, and lymphoma)  and tumors of minor salivary gland of palate (e.g. pleomorphic adenoma, myoepithelioma, oncocytoma, basal cell adenoma, and mucoepidermoid carcinoma), tumors arising from deep lobe parotid gland tumor  and lipoma. 
As the patient was edentulous, palatal abscess was ruled out. FNAC ruled out any type of cystic lesion.
Myoepithelioma, basal cell adenoma and oncocytoma are benign tumors of salivary gland but occur less commonly than pleomorphic adenoma and clinically present as pleomorphic adenoma. Mucoepidermoid carcinoma is a malignant epithelial tumor of salivary gland. These can be differentiated histologically from pleomorphic adenoma. ,,,
Lipomas are relatively rare intraorally and present more commonly in subcutaneous tissues of neck. They represent only 1-5% of the tumors of oral cavity  and are common in adults with no specific gender predilection. The most common site is the buccal mucosa followed by the tongue, palate, and floor of mouth. These are well encapsulated and freely movable beneath the mucosa and soft on palpation.  In our case, the swelling was encapsulated and firm in consistency. However, considering the relatively common nature of the lipomas on the palate, we considered lipoma as one of the differential diagnosis.
Magnetic resonance imaging (MRI) was advised to discern the extent of tumor in relation to the palatal bone and surrounding structures. MRI showed it to be a capsulated benign growth approximately 2 cm × 2 cm in size, not involving bone and surrounding tissue. FNAC is a gold standard for diagnosis of salivary gland pathologies. It is also useful to differentiate non-neoplastic lesions from neoplasms and benign from malignant.  FNAC proved its usefulness in our case also.
Complete surgical removal by extracapsular excision is treatment of choice for intraoral pleomorphic adenoma, and there is low recurrence rate of 2-8% when incomplete removal is done. ,,, Under local anesthesia, the tumor was carefully dissected and removed in toto along with capsule. If the capsule ruptures during excision, there are chances of recurrence due to spillage of tumor cells into surrounding structures. The defect left after the removal of tumor was closed primarily with interrupted sutures. Histopathological report confirmed our provisional diagnosis of pleomorphic adenoma. Postoperative recovery was uneventful, and the patient is maintaining regular follow ups.
| Summary|| |
This case report is interesting because it represents a case of unnoticed swelling in the posterior part of palate that was interfering in PPS during denture construction, and hence was treated at early stages. Moreover, a delay in treatment will lead to larger tumors, which can lead to problems in functions and recurrences due to incomplete excision.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]