The pleomorphic adenoma is a benign salivary tumor which can however become cancerous. It is treated surgically with the important objective of preventing recurrence.
What is a pleomorphic adenoma?
“The pleomorphic adenoma is a common benign salivary tumor which can be had at any age, but which more often affects adults from 30 to 60 years old” teaches Pr Sébastien Vergez, Head of the ENT and Cervico-facial Surgery Department at the University Hospital of Toulouse Rangueil-Larrey. He specifies that this salivary tumor has two particularities. It recurs frequently, which impacts the way in which it is taken care of. and it is a tumor that has a risk of degenerating into cancer.
What causes a pleomorphic adenoma?
“We do not know of a risk factor for pleomorphic adenoma” informs Pr Sébastien Vergez. This salivary tumor develops most of the time in the parotid gland, the largest salivary gland located in the cheek and below the earlobe and traversed by the facial nerve. It can also sometimes develop in other salivary glands such as thea submandibular gland (located at the level of the neck, under the jaw) or in accessory salivary glands located in the mouth, throat or even the nose.
Is it benign or is it cancer?
A pleomorphic adenoma is a benign salivary tumor. However, it is not uncommon for this benign tumor to develop into cancer. This is why any pleomorphic adenoma is the subject of a surgery to be removed. “An extemporaneous analysis (Editor’s note: an anatomopathological examination during the operation) of the tumor is carried out during the intervention in order to ensure that the nodule is not cancerous“explains Professor Vergez. If the nodule turns out to be cancerous, the intervention is completed.
What are the symptoms of a pleomorphic adenoma?
Symptoms of a pleomorphic adenoma depend on where it grows. In all cases the main symptom is the appearance of a nodule (lump). The pleomorphic adenoma is most often born in the parotid gland, the nodule if it is superficial or voluminous can be perceived by the person under the ear or even the cheek. When pleomorphic adenoma develops in the submandibular gland the lump can be felt under the jaw. If it is located in an accessory salivary gland, a ball can be perceived in the mouth at the level of the palate, for example. Deep pleomorphic adenoma cannot be felt by the affected person and may be discovered incidentally during an MRI performed for another reason. “This salivary tumor is exceptionally painful“ specifies Professor Vergez who also points out that these benign tumors are not accompanied by satellite lymph nodes. There is also no paralysis of the facial nerve.
Which examinations to make the diagnosis of a pleomorphic adenoma?
The diagnosis of pleomorphic adenoma is made with a clinical examination carried out by a specialist, most often an ENT and imaging examinations. “This one looks if there is no sign of aggressiveness (ganglia), if it can be a cancer of the parotid itself or another salivary tumor” indicates Pr Sébastien Vergez. The reference examination to confirm the diagnosis is a MRI done by a radiologist expert in the exploration of the parotid. an ultrasound can be done first when the parotid nature of the nodule is not certain, but MRI is the most relevant for the diagnosis of pleomorphic adenoma. If the MRI is not typical of a pleomorphic adenoma, a fine needle aspiration biopsy is done. A few cells from the nodule are removed and analyzed. “This makes it possible to confirm before the intervention that it is indeed a pleomorphic adenoma. This determines the deadline and the terms of the operation. explains Professor Sébastien Vergez.
A pleomorphic adenoma is always the subject of surgery
What treatment to treat a pleomorphic adenoma?
There is no treatment other than surgery to prevent progression of this tumour. “The treatment also aims to make the risk of recurrence as low as possible. We want to avoid recurrence at all costs because the second surgery is then very complex and very risky for the facial nerve.“says Professor Vergez.
When to have surgery?
A pleomorphic adenoma is always the subject of a surgery. The affected part of the gland, most often the parotid, is removed. Sometimes, it is all the parotid which must be withdrawn when the nodule invades all the latter. It is necessary to take some margins around the nodule to limit the risks of recurrence. “If the frozen section examination suggests cancer we remove the entire salivary gland and satellite nodes“ says Professor Sébastien Vergez. The second intervention in case of recurrence is more at risk of sequelae (most often temporary paralysis of the facial nerve). “It is often supplemented by a radiotherapy with lower doses than for cancer to limit or at least delay the emergence of a new recurrence” informs the Head of the ENT and Cervicofacial Surgery department at the Toulouse Rangueil-Larrey University Hospital.
Thanks to Pr Sébastien Vergez, Head of the ENT and Cervico-facial Surgery Department at the Toulouse Rangueil-Larrey University Hospital.