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National Journal of Maxillofacial Surgery
 
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Table of Contents
CASE REPORT
Year : 2011  |  Volume : 2  |  Issue : 2  |  Page : 219-221  

Pleomorphic adenoma of the upper lip


Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences and Hospital, Lucknow, India

Date of Web Publication31-Mar-2012

Correspondence Address:
Iqbal Ali
B-1/30 Sector J, Aliganj, Lucknow - 226024
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.94487

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   Abstract 

This case report describes a rare and unusual lesion found in a 33-year-old male, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 3 cm in diameter, almost obstructing the nares and characterized by slow growth. Complete excision was performed and the histopathologic analysis showed pleomorphic adenoma. The tumor did not recur. A brief review of the relevant literature is also presented.

Keywords: Minor salivary gland tumors, pleomorphic adenoma, upper lip


How to cite this article:
Ali I, Gupta AK, Singh S. Pleomorphic adenoma of the upper lip. Natl J Maxillofac Surg 2011;2:219-21

How to cite this URL:
Ali I, Gupta AK, Singh S. Pleomorphic adenoma of the upper lip. Natl J Maxillofac Surg [serial online] 2011 [cited 2019 Nov 20];2:219-21. Available from: http://www.njms.in/text.asp?2011/2/2/219/94487


   Introduction Top


The most common salivary gland tumor is pleomorphic adenoma (PA), which accounts for 60-65% of such diseases. [1] It mainly affects women in their fourth to sixth decade of life, and has a natural history of asymptomatic slow growth over a long period. It usually involves major salivary glands, most commonly involving the tail of parotid. It also involves minor salivary glands. The lips are commonly affected sites, second only to the palate, and account for about 20-40% of all intraoral PAs. [2],[3] The most common site of a PA of the minor salivary glands is the palate, followed by lip, buccal mucosa, floor of mouth, tongue, tonsil, pharynx, retromolar area and nasal cavity. [4],[5],[6],[7]

The etiology of PA is unknown. It is epithelial in origin, and clonal chromosome abnormalities with aberrations involving 8q12 and 12q15 have been described. [8] This paper describes the diagnosis and management of an asymptomatic, slowly growing PA in the upper lip of a male in the fourth decade of life. [8]


   Case Report Top


A 33-year-old male presented in Maxillofacial Surgery OPD of Career Post Graduate Institute of Dental Sciences and Hospital, with a complaint of painless lump in the upper lip. The overlying skin and labial mucosa was free. The mass slowly increased in size during the past 1 year and 6-7 months approximately. At the time of examination, nasal vestibule was almost obstructed. On examination, the mass was well circumscribed, slightly mobile, sessile, rubbery in consistency and 3 cm in diameter. The overlying mucosa was smooth with pinkish purple color, showing evidence of superficial vascularity. Skin over the tumor was not fixed. There was no pain or bleeding on palpation. Head and neck abnormalities were not noted on clinical examination. The medical history was unremarkable, and no other abnormalities were found on clinical examination. Computed tomography (CT) was done to see the extent of lesion tumor as shown in [Figure 1]. Two small radiopaque shadows were evident in the lesion [Figure 2]. A differential diagnosis of foreign body granuloma was made. Mixed salivary gland tumor was also considered. Due to well-circumscribed nature of the lesion, an excisional biopsy was planned.
Figure 1: Axial CT scan showing pathology

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Figure 2: Axial CT scan showing radiopacity in pathology

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The tumor was completely removed with lip splitting incision as shown in [Figure 3]. During the surgical procedure, the lesion was excised without difficulty with clinically normal margin because the mass was fully encapsulated [Figure 4]. Subsequent follow-up after 1 year showed no signs of recurrence. Histopathologic analysis of the surgical specimen revealed PA and there was no evidence of malignancy.
Figure 3: Lip split incision

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Figure 4: Pathology removed

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   Discussion Top


Differential diagnoses of intraoral, solid, asymptomatic nodules include minor salivary gland tumors, and benign and malignant mesenchymal lesions such as neurofibroma and rhabdomyosarcoma. For lesions affecting the buccal mucosa, lip and tongue, lipoma, neurofibroma and other benign mesenchymal tumors should be considered. The encapsulation and mobility of the nodule are signs of probable benignity, although a biopsy must always be performed. [9]

PAs are usually painless, slow-growing tumors; however, some cases exhibiting rapid growth have been reported, especially in the palate. PA appears to be encapsulated, but this capsule is often infiltrated by lateral extension of the tumor. Even though PA is benign, it has a high rate of implantability. Any rupture of the capsule or incomplete excision will leave residual tumor cells behind, resulting in recurrence. [10]

A lesion referred to as Salivary Gland Anlage Tumor (SGAT) histologically resembles a PA. [11],[12] The microscopic and ultrastructural pattern of this benign tumor shows epithelial and mesenchymal components, with tubular and cord-like structures composed of cells immunophenotypically compatible with myoepithelium, which express a broad spectrum of keratins and epithelial membrane antigens, while the stromal component expresses vimentin and smooth muscle actin. [13],[14]

Kroll and Hick [15] reviewed 4042 cases of PAs of the salivary glands. Only 445 originated in the minor salivary glands, and only 16.9% were located in the upper lip and 2.9% in the lower lip. Bernier found that the peak incidence of PA of the lips was in the third and fourth decades, with an average age of 33.2 years. [16] Owens and Calcaterra found 90% of the upper lip tumors to be benign. [17] Eveson and Cawson found 75% of the upper lip tumors as benign. [3]

Minor salivary gland tumor presents as soft or firm masses, with most of them having a nodular, exophytic component. Ulceration of the nodular mass may occur, but the presence of ulcer provides no clue to the invasiveness of the tumor. Those that are soft on palpation usually have large cystic cavities and an abundance of mucin.

The case reported here did not show any recurrence, 12 months after surgery.

We plan to follow the case for the next 4 years at least taking into consideration the characteristics of salivary gland tumor which may reoccur years after surgery.

The aim of presenting this case report is to alert the clinicians regarding the diagnosis of unusual cases of orofacial swellings. As these lesions are asymptomatic, the patient may not be aware of their existence or are discovered accidentally by a dentist during examination.

 
   References Top

1.Forty MJ, Wake MJ. Pleomorphic salivary adenomain an adolescent. Br Dent J 2000;188:545-6.  Back to cited text no. 1
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2.Chaudhry AP, Vickers RA, Gorlin RJ. Intraoral minor salivary gland tumors: An analysis of 1414 cases. Oral Surg 1961;14:1194 3.  Back to cited text no. 2
    
3.Eveson JW, Cawson RA. Tumors of the minor (oropharyngeal) salivary glands: A demographic study of 336 cases. J Oral Pathol 1985;14:500.  Back to cited text no. 3
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4.Spiro RH. Salivary neoplasms: Overview of a 35-yearexperience with 2,807 patients. Head Neck Surg 1986;8:177-84.  Back to cited text no. 4
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5.Waldron CA, el-Mofty SK, Gnepp DR. Tumours of theintraoral minor salivary glands: A demographic and histologic study of 426 cases. Oral Surg Oral Med Oral Pathol 1988;66:323-33.  Back to cited text no. 5
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6.Eveson JW, Cawson RA. Tumours of the minor (oropharyngeal) salivary glands: A demographic study of 336 cases. J Oral Pathol 1985;14:500-9.  Back to cited text no. 6
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7.Cohen MA. Pleomorphic adenoma of the cheek. Int J Oral Maxillofac Surg 1986;15:777-9.  Back to cited text no. 7
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8.Farina A, Pelucchi S, Grandi E, Carinci F. Histological subtypes of Pleomorphic adenoma and age frequency distribution. Br J Oral Maxillofac Surg 1999;37:154-5.  Back to cited text no. 8
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9.Jorge J, Pires FR, Alves FA, Perez DE, Kowalski LP, Lopes MA, et al. Juvenile intraoral leomorphic adenoma: Report of five cases and review of the literature. Int J Oral Maxillofacial Surg 2002;31:273-5.  Back to cited text no. 9
    
10.Daniels JS, Ali I, Al Bakri IM, Sumangala B. Pleomorphic adenoma of the palate in children and adolescents: A report of 2 cases and review of the literature. J Oral Maxillofac Surg 2007;65:541-9.  Back to cited text no. 10
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11.Har-El G, Zirkin HY, Tovi F, Sidi J. Congenital pleomorphic adenoma of the nasopharynx (report of a case). J Laryngol Otol 1985;99:1281-7.  Back to cited text no. 11
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12.Dehner LP, Valbuena L, Perez-Atayde A, Reddick RL, Askin FB, Rosai J. Salivary gland anlage tumor "congenital pleomorphic adenoma": A clinicopathologic, immunohistochemical and ultrastructural study of nine cases. Am J Surg Pathol 1994;18:25-36.  Back to cited text no. 12
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13.Herrmann BW, Dehner LP, Lieu JE. Congenital salivary gland anlage tumor: A case series and review of the literature. Int J Pediatr Otorhinolaryngol 2005;69:149-56.  Back to cited text no. 13
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14.Cohen EG, Yoder M, Thomas RM, Salerno D, Isaacson G. Congenital salivary gland anlage tumor of the nasopharynx. Pediatrics 2003;112:e66-9.  Back to cited text no. 14
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15.Krolls SO, Hicks JL. Mixed tumors of the lower lip. Oral Surg 1973;35:212.  Back to cited text no. 15
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16.Bernier JL. Mixed tumors of lips. J Oral Surg 1946;4:193.  Back to cited text no. 16
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17.Owens OT, Calcaterra TC. Salivary gland tumors of the lip. Arch Otolaryngol 1982;108:45.  Back to cited text no. 17
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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