A longstanding tumour was removed from the parotid gland. The pathologist reported that the tumour was composed of sheets, strands and islands of ductal cells separated by myxochondroid tumour. Plasmacytoid myoepithelial cells were present in some areas and islands of squamous cells were also present. The tumour was enclosed by an intact pseudo- capsule formed by compressed fibrous tissue into which tumour pseudopodia extended.

Hey, peeps! Let’s decode a cool case from the world of dentistry! 🦷🔍 So, there was this long-standing tumor hanging out in the parotid gland. 🤨 The pathologist spilled the tea – the tumor had ductal cells in groups, mixed with myxochondroid stuff! 😲 Plus, there were some plasmacytoid myoepithelial cells hanging around, and even squamous cell islands crashed the party! 🕺🏻💃 The tumor had a slick move too – it had a pseudo-capsule made of tight fibrous tissue!

💪 But guess what? This is known as pleomorphic adenoma, aka a “mixed tumor”! 🎉 ‘Cause it’s a mix of ductal cells and myxochondroid stromal elements! 🧪 And those hyaline plasmacytoid myoepithelial cells? They’re like the signature VIPs of this party! 🤘 Stay tuned for more dental mysteries, y’all! 🌟🦷 #PleomorphicAdenoma #MixedTumorMagic [Link]

RECENT ADVANCES IN PLEOMORPHIC ADENOMA

Pleomorphic adenoma is a common tumor of the salivary glands, particularly the major salivary glands (AlAmari et al., 2021). It typically presents in the third to sixth decades of life (AlAmari et al., 2021). Surgical excision is the mainstay of treatment for pleomorphic adenoma, as these tumors can grow to giant sizes if left untreated (AlAmari et al., 2021). However, recurrent pleomorphic adenoma can be a challenge to treat and has variable outcomes (Kanatas et al., 2018). The recommended treatment for recurrent pleomorphic adenoma includes surgical excision, radiation therapy, or a combination of both (Hemavathy et al., 2022). External beam and neutron radiotherapy may be alternative treatments offered to select patients (Hemavathy et al., 2022).

Recent advances in the diagnosis and treatment of pleomorphic adenoma have focused on improving diagnostic accuracy and refining treatment strategies. Modern imaging techniques, such as MRI, allow for the evaluation of the anatomical extent of the tumor and its relationship to surrounding structures, particularly the facial nerve (Poorten et al., 2011). The World Health Organization (WHO) Histological Classification facilitates accurate and consistent diagnosis of pleomorphic adenoma (Poorten et al., 2011).

In terms of grading and prognostication, there has been a shift in understanding that carcinoma ex pleomorphic adenoma is not automatically a high-grade tumor, as traditionally suggested (Seethala, 2009). Grading schemes for salivary gland carcinomas, including adenoid cystic carcinoma and mucoepidermoid carcinoma, have been developed based on various histological features (Seethala, 2009). These grading schemes help predict the prognosis and guide treatment decisions (Seethala, 2009). Adenoid cystic carcinomas are graded based on the pattern of solid components, with solid components portending a worse prognosis (Seethala, 2009). Mucoepidermoid carcinomas are graded in a three-tier fashion based on various features, including cystic component, border, mitoses, anaplasia, and perineural invasion (Seethala, 2009).

Recent research has also focused on the molecular biology of pleomorphic adenoma. Alterations in the PLAG1 gene have been identified in both benign and malignant pleomorphic adenomas (Martins et al., 2005). These gene alterations play a role in the tumorigenesis of pleomorphic adenoma and may provide insights into the morphogenesis of these tumors (Martins et al., 2005).

In terms of treatment outcomes, postoperative radiotherapy has been shown to improve locoregional control in all stages and grades of parotid carcinoma (Poorten et al., 2011). However, systemic treatment for distant failure remains disappointing, although recent progress in molecular biology has suggested the potential for targeted therapy (Poorten et al., 2011). The prognosis of individual patients can be increasingly accurately predicted through multivariate analysis (Poorten et al., 2011).

In conclusion, recent advances in the diagnosis and treatment of pleomorphic adenoma have focused on improving diagnostic accuracy, refining treatment strategies, and understanding the molecular biology of these tumors. Surgical excision remains the mainstay of treatment, but recurrent pleomorphic adenoma can be challenging to manage. Grading schemes have been developed to predict prognosis and guide treatment decisions for salivary gland carcinomas. Further research is needed to explore targeted therapies and improve outcomes for patients with pleomorphic adenoma.

Cutting-edge tech like MRI and WHO Histological Classification are our allies for precise diagnosis and treatment planning! 📊📸 And guess what? The rulebook for grading and predicting outcomes is getting a makeover! 😲 Carcinoma ex pleomorphic adenoma might not be an automatic baddie – it’s all about those histological features! 📝

We’re delving into the molecular secrets of pleomorphic adenoma with the PLAG1 gene stealing the spotlight! 🧬🔬 Targeted therapy might be the game-changer on the horizon! 🌅 So, while surgery remains the star, the future is filled with potential to conquer these challenges and boost patient outcomes! 🚀

References

AlAmari, K., Zahlan, A., Albawardi, E., Dababo, M., Alotaibi, N. (2021). A Case Report Of a Rare Nasopharyngeal Myoepithelial Dominant Pleomorphic Adenoma. International Journal of Surgery Case Reports, (82), 105859. https://doi.org/10.1016/j.ijscr.2021.105859 Hemavathy, K., V, G., Subramani, V., Susruthan, M. (2022). Recurrent Palatal Pleomorphic Adenoma: a Case Report With A Long-term Follow-up. Cureus. https://doi.org/10.7759/cureus.26363 Kanatas, A., Ho, M., Mücke, T. (2018). Current Thinking About the Management Of Recurrent Pleomorphic Adenoma Of The Parotid: A Structured Review. British Journal of Oral and Maxillofacial Surgery, 4(56), 243-248. https://doi.org/10.1016/j.bjoms.2018.01.021 Martins, C., Fonseca, I., Roque, L., Pereira, T., Ribeiro, C., Bullerdiek, J., … & Soares, J. (2005). Plag1 Gene Alterations In Salivary Gland Pleomorphic Adenoma and Carcinoma Ex-pleomorphic Adenoma: A Combined Study Using Chromosome Banding, In Situ Hybridization And Immunocytochemistry. Modern Pathology, 8(18), 1048-1055. https://doi.org/10.1038/modpathol.3800386 Poorten, V., Bradley, P., Takes, R., Rinaldo, A., Woolgar, J., Ferlito, A. (2011). Diagnosis and Management Of Parotid Carcinoma With A Special Focus On Recent Advances In Molecular Biology. Head & Neck, 3(34), 429-440. https://doi.org/10.1002/hed.21706 Seethala, R. (2009). An Update On Grading Of Salivary Gland Carcinomas. Head and Neck Pathology, 1(3), 69-77. https://doi.org/10.1007/s12105-009-0102-9