|LETTER TO THE EDITOR
|Year : 2018 | Volume
| Issue : 2 | Page : 476-477
Pleomorphic adenoma of palate with predominant chondroid tissue: A rarity
Treville Pereira, Subraj Shetty
Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
|Date of Web Publication||8-Mar-2018|
Dr. Treville Pereira
Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil University School of Dentistry, Sector 7, Nerul, Navi Mumbai - 400 706, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pereira T, Shetty S. Pleomorphic adenoma of palate with predominant chondroid tissue: A rarity. J Can Res Ther 2018;14:476-7
The pleomorphic adenoma (PA) accounts for 73% of all salivary gland tumors, the palate being the most preferred intraoral site followed by the lip. Patients are usually in the fifth or sixth decade of life and about 60% of them are women. They are usually slow growing, painless, and firm on palpation. Possible complications to treatment include the risk of recurrence and malignant transformation.
A 64-year-old female reported to our clinic with a complaint of pain in the upper anterior teeth. Intraoral examination revealed the presence of a fixed prosthesis anteriorly. Further examination revealed an oval-shaped, hard, circumscribed lesion adherent to the underlying structures, covered with slightly erythematous mucosa on the right side of the palate. History revealed that this swelling was initially pea sized and had been slowly growing for the past 20 years to its present size of 3 cm × 3 cm. The slow painless growth and the poor socioeconomic status of the patient had prevented her from seeking any treatment. There was neither sensory nor motor deficiency nor any alteration in the general physical examination. After treating the initial complaint, the patient was advised a computed tomography (CT) scan. The CT scan showed a well-defined, lobulated hypodense lesion in the right posterior hard palate without any bone involvement [Figure 1]. An incisional biopsy was performed under local anesthesia. The histopathological diagnosis was of a PA. Under general anesthesia, excision of the mass was carried out with 1 cm margin. The surgical site was protected with a removable prosthesis with retainers. On histopathological examination, a biphasic population of epithelial and mesenchymal cells was observed. The former was composed of glandular structures lined by round, oval cells with large hyperchromatic nuclei, pink cytoplasm, and myoepithelial basal cell layer. The stroma was predominantly chondroid. The features confirmed the diagnosis of a PA [Figure 2]. Postoperative course was uneventful with no evidence of recurrence 1 year after surgery.
|Figure 1: (a) Intraoral photograph of the patient showing an oval-shaped, hard, circumscribed lesion on the right side of the palate. (b) Computed tomography scan showing a well-defined, lobulated hypodense lesion in the right posterior hard palate|
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|Figure 2: Photomicrograph showing tumor islands arranged in sheets with a predominant chondroid tissue. (a) H and E, ×10. (b) Orcein stain, ×10|
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Minor salivary gland tumors present with a variety of symptoms, depending on its site. Symptoms may include dysphagia, epistaxis, and difficulty in chewing. The consistency of adenomas ranges from soft in cases of mucinous lesions to hard in tumors with extensive chondroid or collagenous components. In the present case, the patient did not have any complaint with the swelling in spite of its long-standing nature and the tumor was hard in consistency due to the excessive cartilage formation. CT scan is an important diagnostic tool for these tumors. Histopathologically, PA shows a great diversity in morphology. The mesenchymal components may be mucoid/myxoid, cartilaginous, osseous, or hyalinized. In a predominant chondroid stroma, it has been suggested that the myxoid stroma may undergo chondroid metaplasia. Immunohistochemically, Type II collagen can be localized in the intercellular matrix of the chondroid areas and in a few chondroid differentiating cells in myxoid areas, confirming its cartilage specificity. Long-standing tumors show increased hyalinization and in such fibrous areas using orcein staining, elastic fibers can be detected which are characteristic for PA.
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[Figure 1], [Figure 2]