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Peter Zbaren - One of the best experts on this subject based on the ideXlab platform.
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etiology and management of recurrent parotid Pleomorphic Adenoma
Laryngoscope, 2015Co-Authors: Robert L Witt, Vincent Vander Poorten, David W Eisele, Randall P Morton, Piero Nicolai, Peter ZbarenAbstract:The objective of this review study was to encompass the relevant literature and current best practice options for this challenging, sometimes incurable problem. The source of the data was Ovid MEDLINE from 1946 to 2014. Review methods consisted of articles with clinical correlates. The most important cause of recurrence is enucleation with rupture and incomplete tumor excision at operation. Incomplete pseudocapsule, extracapsular extension, pseudopods of Pleomorphic Adenoma tissue, and satellite Pleomorphic beyond the pseudocapsule are also likely linked to recurrent Pleomorphic Adenoma. Most recurrent Pleomorphic Adenoma are multinodular. Magnetic resonance imaging is the imaging study of choice for recurrent Pleomorphic Adenoma. Nerve integrity monitoring may reduce morbidity for recurrent Pleomorphic Adenoma. Treatment of recurrent Pleomorphic Adenoma must be individualized. Total parotidectomy, given the multicentricity of recurrent Pleomorphic Adenoma, is appropriate in many patients, but may be inadequate to control recurrent Pleomorphic. There is accumulating evidence from retrospective series that postoperative radiation therapy results in significantly better local control.
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Pleomorphic Adenoma of the parotid formal parotidectomy or limited surgery
American Journal of Surgery, 2013Co-Authors: Peter Zbaren, Robert L Witt, Alessandra Rinaldo, Vincent Vander Poorten, Julia A Woolgar, Ashok R Shaha, Asterios Triantafyllou, Robert P Takes, Alfio FerlitoAbstract:Abstract Background Optimal surgery for Pleomorphic Adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid Pleomorphic Adenoma capsule and its influence on surgery. Data Sources PubMed literature searches were performed to identify original studies. Conclusions Almost all Pleomorphic Adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.
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recurrent Pleomorphic Adenoma of the parotid gland
American Journal of Surgery, 2005Co-Authors: Peter Zbaren, Isabelle Tschumi, Michel Nuyens, Edouard StaufferAbstract:Abstract Background Surgery of recurrent Pleomorphic Adenoma presents an increased risk of facial nerve injury and a considerable re-recurrence rate. Methods A series of 33 patients with first recurrence of Pleomorphic Adenoma of the parotid gland was analyzed. The data were derived from medical records as well as from interviews and clinical examinations of all living patients. Histologic material of the initial and recurrent tumor were reviewed. Results Multifocal recurrence and carcinoma in Pleomorphic Adenoma were observed in 73% and 9% of patients, respectively. The incidence of permanent partial facial nerve injury after surgery was 23% in patients with initial enucleation and 14% in those with initial superficial parotidectomy (including 1 patient with facial nerve resection and 1 patient with a partial facial paresis before recurrence surgery). A subsequent recurrence occurred in 6 patients, all with initial enucleation after a mean time interval of 9 years. Conclusions The preservation of the facial nerve was possible in all but 1 patient treated for the first recurrence with a relatively low rate of permanent partial facial paresis because of the use of the operating microscope and facial nerve monitor. To evaluate the re-recurrence rate, a follow-up of at least 10 years is necessary.
R Schafer - One of the best experts on this subject based on the ideXlab platform.
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lipomatous Pleomorphic Adenoma of the parotid gland classification of lipomatous tissue in salivary glands
Pathology Research and Practice, 1999Co-Authors: G Seifert, Karl Donath, R SchaferAbstract:Lipomatous Pleomorphic Adenoma is an unusual subtype with a lipomatous stromal component of more than 90% of the tumour tissue. This special type of Pleomorphic Adenoma must be distinguished from other types of lipomatous tumours or non-tumourous lipomatosis of the salivary glands. Until now only two cases of lipomatous Pleomorphic Adenoma have been reported in the literature. We report of a 36-year old woman who developed a well circumscribed nodule measuring 3.5 x 2.5 x 2 cm in the right parotid gland. The cut surface was grey-yellowish. Histologically, more than 90% of the tumour tissue was fatty tissue with univacuolar adipocytes. The Pleomorphic epithelial elements were duct-like cells forming small lumina and spindle-shaped myoepithelial cell with surrounding mucoid stroma. Components of Pleomorphic Adenoma were intermingled with mature adipose tissue which was more concentrated in the central portion of the Adenoma. Some compressed epithelial cords in the adipose tissue formed a septa-like pattern. The differential diagnosis to other lipomatous tumours (lipoAdenoma, lipoma) and to non-tumourous interstitial lipomatosis as well as the possible pathogenesis as metaplastic change or epithelial-mesenchymal transdifferentiation are discussed.
Tomayoshi Hayashi - One of the best experts on this subject based on the ideXlab platform.
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metastasizing Pleomorphic Adenoma of the submandibular gland with metastasis to the lung and sternum ct and mr imaging findings
European Journal of Radiology Extra, 2009Co-Authors: Tetsuji Yamaguchi, Kazuto Ashizawa, Kenji Nagaoki, Hajime Abiru, Masataka Uetani, Tsutomu Tagawa, Takeshi Nagayasu, Tomayoshi HayashiAbstract:Abstract Distant metastasis of benign Pleomorphic Adenoma of salivary glands rarely occurs, and these neoplasms have been termed metastasizing Pleomorphic Adenoma. We present a rare case of metastasizing Pleomorphic Adenoma of the submandibular gland with lung and bone metastases obtained MR images and pathological findings. On MRI, the lesions were depicted as an area of high signal intensity on T2-weighted images (WI), reflecting myxoid or/and chondroid matrices. Metastasizing Pleomorphic Adenoma should be considered as a differential diagnosis when a pulmonary lesion shows high signal intensity on T2-WI and the patient has a medical history of salivary Pleomorphic Adenoma.
Motomu Tsuji - One of the best experts on this subject based on the ideXlab platform.
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carcinoma ex Pleomorphic Adenoma of the sublingual gland a case report
International Journal of Oral Science, 2012Co-Authors: Yasunori Ariyoshi, Masashi Shimahara, Toshiyuki Konda, Motomu TsujiAbstract:We report a case of carcinoma ex Pleomorphic Adenoma of a sublingual gland in a 70-year-old man. Under a clinical diagnosis of benign salivary gland tumor, excision of the mass with the sublingual salivary gland in an en bloc fashion via an intraoral approach was performed. Histopathologically, there was a rupture of the fibrous capsule and diffuse cell-rich sheets composed of myoepithelial cells with round nuclei were also seen. Immunohistochemically, the cells that composed of cell rich sheets were positive to smooth muscle actin. Final diagnosis of myoepithelial carcinoma ex Pleomorphic Adenoma was made.
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lipomatous Pleomorphic Adenoma of the ceruminous gland
Pathology International, 2006Co-Authors: Hiroko Kuwabara, Motomu Tsuji, Shinichi Haginomori, Atsuko Takamaki, Kanako Ito, Hiroshi Takenaka, Yoshitaka Kurisu, Hiroshi MoriAbstract:A case of lipomatous Pleomorphic Adenoma in the ceruminous gland is reported. A 69-year-old Japanese woman presented with a mass in the posterior wall of the cartilaginous external auditory canal. Light microscopic examination revealed a well-circumscribed tumor composed of tubular structures with apocrine secretion and ceroid deposition, extensive mature adipocytes, and spindle-shaped myoepithelial cells in the myxoid and fibrous stroma. This case demonstrates the peculiar location of a lipomatous Pleomorphic Adenoma in the external auditory canal.
Robert L Witt - One of the best experts on this subject based on the ideXlab platform.
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etiology and management of recurrent parotid Pleomorphic Adenoma
Laryngoscope, 2015Co-Authors: Robert L Witt, Vincent Vander Poorten, David W Eisele, Randall P Morton, Piero Nicolai, Peter ZbarenAbstract:The objective of this review study was to encompass the relevant literature and current best practice options for this challenging, sometimes incurable problem. The source of the data was Ovid MEDLINE from 1946 to 2014. Review methods consisted of articles with clinical correlates. The most important cause of recurrence is enucleation with rupture and incomplete tumor excision at operation. Incomplete pseudocapsule, extracapsular extension, pseudopods of Pleomorphic Adenoma tissue, and satellite Pleomorphic beyond the pseudocapsule are also likely linked to recurrent Pleomorphic Adenoma. Most recurrent Pleomorphic Adenoma are multinodular. Magnetic resonance imaging is the imaging study of choice for recurrent Pleomorphic Adenoma. Nerve integrity monitoring may reduce morbidity for recurrent Pleomorphic Adenoma. Treatment of recurrent Pleomorphic Adenoma must be individualized. Total parotidectomy, given the multicentricity of recurrent Pleomorphic Adenoma, is appropriate in many patients, but may be inadequate to control recurrent Pleomorphic. There is accumulating evidence from retrospective series that postoperative radiation therapy results in significantly better local control.
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Pleomorphic Adenoma of the parotid formal parotidectomy or limited surgery
American Journal of Surgery, 2013Co-Authors: Peter Zbaren, Robert L Witt, Alessandra Rinaldo, Vincent Vander Poorten, Julia A Woolgar, Ashok R Shaha, Asterios Triantafyllou, Robert P Takes, Alfio FerlitoAbstract:Abstract Background Optimal surgery for Pleomorphic Adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid Pleomorphic Adenoma capsule and its influence on surgery. Data Sources PubMed literature searches were performed to identify original studies. Conclusions Almost all Pleomorphic Adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.
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comparing capsule exposure using extracapsular dissection with partial superficial parotidectomy for Pleomorphic Adenoma
American Journal of Otolaryngology, 2012Co-Authors: Robert L Witt, Mary IacoccaAbstract:Abstract The aim of this study was to compare capsule exposure using extracapsular dissection (ECD) with partial superficial parotidectomy (PSP) for Pleomorphic Adenoma. Purpose Long-term favorable results for recurrence and facial nerve function have been reported for ECD and PSP for parotid Pleomorphic Adenoma. Extracapsular dissection is distinguished from PSP in that the facial nerve is dissected in PSP but not in ECD. This article attempts to answer the following hypothesis: the margin of normal parotid tissue surrounding a parotid Pleomorphic Adenoma is less for ECD compared with PSP. Material and Methods This is a retrospective individual case-control study. Twelve consecutive parotidectomy procedures with a final pathology report of Pleomorphic Adenoma were retrospectively measured for margin (the percent of capsule exposure around the tumor). In 8 highly selected patients, ECD was performed. Four parotid surgical procedures not meeting strict criteria underwent PSP and served as controls. Results The eight patients with ECD had a mean of 80% (71%–99%) of the capsule exposed. The 4 PSP procedures had 21% (4%-50%) of the capsule exposed (P Conclusions Extracapsular dissection results in higher capsule exposure.
