Clin Exp Otorhinolaryngol.  2009 Dec;2(4):193-197. 10.3342/ceo.2009.2.4.193.

Clinical Manifestations of Recurrent Parotid Pleomorphic Adenoma

• Suh MW
• Hah JH
• Kwon SK
• Jung YH
• Kwon TK
• Kim KH
• Sung MW

• KMID: 1466497
• DOI: http://doi.org/10.3342/ceo.2009.2.4.193

Abstract

OBJECTIVES
This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA. METHODS: The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity. RESULTS: Mean age of initial operation in RPA without MT (RPA(-MT)) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA(+MT)) group was significantly greater than that of RPA(-MT) group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA(-MT) group tumor recurrence occurred in 21.4% of patients despite a clear resection margin. CONCLUSION: The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.

Keyword

Pleomorphic adenoma; Parotid glancl; Recurrence; Risk factor

MeSH Terms

Adenoma, Pleomorphic
Humans
Medical Records
Recurrence
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Progressive changes in clinical manifestations after multiple recurrences.Duration between revision operations and subsequent recurrences tended to shorten as the number of previous revisions increased (P=0.06). The percentage of patients with a malignant tumor at revision surgery was higher than at initial operation (P=0.04). The general trend toward an increased risk of further recurrence after repeated surgery was significant (P<0.01), despite our finding of a lower risk at the third than at the second operation.

Reference

1. Hanna EY, Lee S, Fan CY, Suen JY. Cummings CW, Flint PW, editors. Benign neoplasms of the salivery glands. Cummings Otolaryngology: Head & Neck Surgery. 2005. 4th ed. Philadelphia: Mosby;p. 1348–1377.

2. Suh MW, Hah JH, Lee KB, Kwon SK, Jung YH, Sung MW, et al. Immunohistochemical characteristics of primary and recurrent pleomorphic adenoma. Korean J Head Neck Oncol. 2005; 11. 21(2):146–150.

3. Junquera L, Alonso D, Sampedro A, Fresno F, Albertos JM, Lopez-Arranz JS. Pleomorphic adenoma of the salivary glands: prospective clinicopathologic and flow cytometric study. Head Neck. 1999; 10. 21(7):652–656. PMID: 10487953.

4. Bankamp DG, Bierhoff E. Proliferative activity in recurrent and non-recurrent pleomorphic adenoma of the salivary glands. Laryngorhinootologie. 1999; 2. 78(2):77–80. PMID: 10226990.

5. Leverstein H, Tiwari RM, Snow GB, van der Wal JE, van der Waal I. The surgical management of recurrent or residual pleomorphic adenomas of the parotid gland: analysis and results in 40 patients. Eur Arch Otorhinolaryngol. 1997; 254(7):313–317. PMID: 9298665.

6. Jackson SR, Roland NJ, Clarke RW, Jones AS. Recurrent pleomorphic adenoma. J Laryngol Otol. 1993; 6. 107(6):546–549. PMID: 8393908.

7. Hancock BD. Clinically benign parotid tumours: local dissection as an alternative to superficial parotidectomy in selected cases. Ann R Coll Surg Engl. 1999; 9. 81(5):299–301. PMID: 10645170.

8. Bradley PJ. Recurrent salivary gland pleomorphic adenoma: etiology, management, and results. Curr Opin Otolaryngol Head Neck Surg. 2001; 4. 9(2):100–108.

9. Seifert G, Langrock I, Donath K. A pathological classification of pleomorphic adenoma of the salivary glands (author's transl). HNO. 1976; 12. 24(12):415–426. PMID: 1002574.

10. Frazell EL. Clinical aspects of tumors of the major salivary glands. Cancer. 1954; 7. 7(4):637–659. PMID: 13172680.

11. Ghosh S, Panarese A, Bull PD, Lee JA. Marginally excised parotid pleomorphic salivary adenomas: risk factors for recurrence and management: a 12.5-year mean follow-up study of histologically marginal excisions. Clin Otolaryngol Allied Sci. 2003; 6. 28(3):262–266. PMID: 12755769.

12. Buchman C, Stringer SP, Mendenhall WM, Parsons JT, Jordan JR, Cassisi NJ. Pleomorphic adenoma: effect of tumor spill and inadequate resection on tumor recurrence. Laryngoscope. 1994; 10. 104(10):1231–1234. PMID: 7934593.

13. Henriksson G, Westrin KM, Carlsoo B, Silfversward C. Recurrent primary pleomorphic adenomas of salivary gland origin: intrasurgical rupture, histopathologic features, and pseudopodia. Cancer. 1998; 2. 15. 82(4):617–620. PMID: 9477091.

14. Natvig K, Soberg R. Relationship of intraoperative rupture of pleomorphic adenomas to recurrence: an 11-25 year follow-up study. Head Neck. 1994; May–Jun. 16(3):213–217. PMID: 8026950.

15. Carew JF, Spiro RH, Singh B, Shah JP. Treatment of recurrent pleomorphic adenomas of the parotid gland. Otolaryngol Head Neck Surg. 1999; 11. 121(5):539–542. PMID: 10547466.

16. Glas AS, Vermey A, Hollema H, Robinson PH, Roodenburg JL, Nap RE, et al. Surgical treatment of recurrent pleomorphic adenoma of the parotid gland: a clinical analysis of 52 patients. Head Neck. 2001; 4. 23(4):311–316. PMID: 11400233.

17. Hoorweg JJ, Hilgers FJ, Keus RB, Zoetmulder FA, Loftus BM. Metastasizing pleomorphic adenoma: a report of three cases. Eur J Surg Oncol. 1998; 10. 24(5):452–455. PMID: 9800983.

18. Klijanienko J, El-Naggar AK, Servois V, Rodriguez J, Validire P, Vielh P. Clinically aggressive metastasizing pleomorphic adenoma: report of two cases. Head Neck. 1997; 10. 19(7):629–633. PMID: 9323153.

19. Sunardhi-Widyaputra S, Van Damme B. Immunohistochemical pattern of Bcl-2- and PTHrP-positive cells in primary, in recurrent and in carcinoma in pleomorphic adenomas. Pathol Res Pract. 1995; 12. 191(12):1186–1191. PMID: 8927564.

20. McGregor AD, Burgoyne M, Tan KC. Recurrent pleomorphic salivary adenoma: the relevance of age at first presentation. Br J Plast Surg. 1988; 3. 41(2):177–181. PMID: 2832025.

21. Fee WE Jr, Goffinet DR, Calcaterra TC. Recurrent mixed tumors of the parotid gland results of surgical therapy. Laryngoscope. 1978; 2. 88(2 Pt 1):265–273. PMID: 202823.

22. Laskawi R, Schott T, Schroder M. Recurrent pleomorphic adenomas of the parotid gland: clinical evaluation and long-term follow-up. Br J Oral Maxillofac Surg. 1998; 2. 36(1):48–51. PMID: 9578257.

23. Phillips PP, Olsen KD. Recurrent pleomorphic adenoma of the parotid gland: report of 126 cases and a review of the literature. Ann Otol Rhinol Laryngol. 1995; 2. 104(2):100–104. PMID: 7857010.

24. Glas AS, Hollema H, Nap RE, Plukker JT. Expression of estrogen receptor, progesterone receptor, and insulin-like growth factor receptor-1 and of MIB-1 in patients with recurrent pleomorphic adenoma of the parotid gland. Cancer. 2002; 4. 94(8):2211–2216. PMID: 12001119.

25. Naeim F, Forsberg MI, Waisman J, Coulson WF. Mixed tumors of the salivary glands: growth pattern and recurrence. Arch Pathol Lab Med. 1976; 5. 100(5):271–275. PMID: 178290.