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Revista Española de Cirugía Oral y Maxilofacial

versión On-line ISSN 2173-9161versión impresa ISSN 1130-0558

Rev Esp Cirug Oral y Maxilofac vol.28 no.1 Madrid ene./feb. 2006




¿Cuál es su diagnóstico?

What should the diagnosis be?



Female patient, 39 years old, with a medical history of congenital myotonia (Thomsen’s disease), subclinical primary hypothyroidism with diffuse goiter and allergy to penicillins. She attended the Oral and Maxillofacial Unit as over the previous month she had noted a tumorlike mass of soft tissue on the left side of her face by the anterior wall of the maxillary sinus.

On physical examination a tumorlike mass was observed that was located by the left genian area. It had a diameter of 1.5 cm – 2 cm, was well-defined, movable with an elastic consistency and it did not adhere to the skin nor to the deeper layers. No further pathological findings were made during the remainder of the examination.

Given these findings, a Fine Needle Aspiration Puncture (FNAP) was requested, but not enough material was obtained to give a diagnosis. A facial Computed Tomography (CT scan) was also requested (Fig. 1) that showed a thickening of the soft tissue in front of the anterior wall of the left maxillary sinus. It had a nodular morphology that showed moderate enhancement and that revealed a craniocaudal extension of approximately 1.8 cm. The underlying fat of the lesion was also hyperintense although there was no bone erosion or deformity.

Lastly a preoperative study was carried out and the surgical excision was programmed.


Adenoma pleomorfo intraoral

Intraoral Pleomorphic Adenoma



S. Gallana Alvarez1, F. Mayorga Jimenez2, J. Herce López3, M. Díaz Delgado4

1 Médico Interno Residente. Servicio de Cirugía Oral y Maxilofacial.
2 Médico Adjunto. Servicio de Cirugía Oral y Maxilofacial.
3 Médico Interno Residente. Servicio de Cirugía Oral y Maxilofacial.
4 Médico Interno Residente. Servicio de Anatomía Patológica.
Hospital Universitario Virgen Macarena. Sevilla, España

Dirección para correspondencia



Under local anesthesia, a firm, well-encapsulated mass was removed by means of an incision at the back of the patient’s left vestibule (Fig. 2).

The characteristics of the mucosa covering the lesion were normal. The surgical specimen that was obtained had a diameter of 1 x 1.8 cm. Its consistency was elastic and it did not have any calcifications (Fig. 3).

The definitive anatomopathologic study of the sample removed revealed a pleomorphic adenoma or mixed tumor of the minor salivary glands (Fig. 4).



Tumors of the salivary glands represent approximately 3% of the neoplasms of the head and neck in adults and around 8% in infants.1 Of these, the pleomorphic adenoma is the most common tumor of the salivary glands representing between 40 and 70% of all the tumors affecting the major and minor salivary glands.2,3

This tumor can appear at any age, although it is more prevalent between the 4th and 6th decades in life and it is slightly more frequent in women.4

The tumors that develop in the minor salivary glands represent 22% of all neoplasm of the salivary glands. Most of these are malignant and only 18% are benign. Within these the pleomorphic adenoma is the most common benign tumor.5 The most common place for it to appear when affecting the minor salivary glands is the palate (up to 50% of cases),5 followed by the upper lip, buccal mucosa, floor of the mouth, tongue, pharynx, retromolar area and nasal cavity.

Recently authors such as Jansisyamont and cols.,6 registered a series of 80 cases of minor salivary gland tumors, with a rate of 21.3% for pleomorphic adenomas with 39.5% affecting the palate.

Of the malignant tumors affecting the minor salivary glands, the most common was the cystic adenoid carcinoma.7

Clinically the pleomorphic adenoma appears as a painless, slow-growing nodule that is usually solitary. The skin or mucosa that surrounds it tends to have normal characteristics and the tumor does not adhere to deeper areas, except when it affects the hard palate. In these cases it can extend towards the periosteum and the underlying bone.4

On palpation it may have cystic cavities, these being soft, but if bone or cartilaginous formation is present it will be firmer.

With regard to its histological characteristics the pleomorphic adenoma has a mixture of epithelial and stromal elements. The stroma can be chondroid, myxoid or hyaline. The histogenesis of the tumor is related to a proliferation of cells with ductal and/or myoepithelial characteristics. Myoepithelial cell differentiation has an important role when determining the final appearance of mixed tumors. Most studies show a large variety of cells in mixed tumors, in some cases with epithelial characteristics and in others they are completely myoepithelial, and, between these two extremes, less differentiated cells may appear that have both ductal and myoepithelial elements.8

In order to diagnose these tumors, their clinical presentation is important, as this can help us determine their possible benign or malignant character. FNA is fundamental as is an incisional biopsy, and in this sense there are studies such as those carried out by Cerulli y cols.,7 that compare the efficiency of both techniques for establishing a preoperative diagnosis in palatal tumor cases. They reached the conclusion that FNA had a precision of 91.6% in the diagnosis of pleomorphic adenoma vs. cystic adenoid carcinoma when appearing in the minor salivary glands of the palate.

Lastly CAT scans are useful for establishing the exact location of the tumor and it enables adapting surgical treatment.

The potential for malignant transformation of the pleomorphic adenoma is estimated at around 6%, although this risk increases to 10% when the tumor has been evolving for more than 15 years.1

The differential diagnosis of intraoral pleomorphic adenoma, when the buccal mucosa is affected, has to be established fundamentally with neurofibromas and other benign mesenchymal tumors.

The treatment for these tumors is essentially surgical. For benign tumors that are apparently well-encapsulated, tumor resection with an adequate margin of surrounding healthy tissue is necessary for preventing possible local recurrence9, as these tumors have characteristic microscopic extensions towards surrounding healthy tissue due to dehiscence of the false capsule surrounding it.

Spiro and cols.10 registered a rate of recurrence of 7% in 1342 patients with benign parotid neoplasms and 6% in patients with benign tumors of minor salivary glands.

Another therapeutic option would be postoperative radiotherapy that would permit reducing the rate of recurrence especially in those cases where the tumor affects the parapharyngeal space and complete resection is not possible.11



Dirección para correspondencia
Silvia Gallana Alvarez
C/ Isbilia Nº 10
41907 Valencina de la Concepción (Sevilla), España




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