J Korean Soc Radiol.  2016 Mar;74(3):204-209. 10.3348/jksr.2016.74.3.204.

Multimodality Imaging of Metastasizing Pleomorphic Adenoma Presenting as a Solitary Pulmonary Nodule without Local Tumor Recurrence: A Case Report

• Choi SY
• Kwon W
• Hong IS
• Jung SH

• KMID: 2155282
• DOI: http://doi.org/10.3348/jksr.2016.74.3.204

Abstract

Pleomorphic adenoma is the most common neoplasm of the salivary gland. It is usually a well-circumscribed and slow-growing benign tumor. In rare instances, benign pleomorphic adenomas may metastasize and spread to distant sites in which case they are described as metastasizing pleomorphic adenomas. So far, there has been no case report of metastasizing pleomorphic adenoma focusing on radiologic features of the tumor using several different imaging tools. Furthermore, only a few cases of pleomorphic adenoma with metastasis to pulmonary sites have been reported, which usually present as multiple lung nodules. We report a rare case of metastasizing pleomorphic adenoma presenting as a solitary pulmonary nodule without prior history of local tumor recurrence with a particular focus on multimodality imaging of the tumor.

MeSH Terms

Adenoma, Pleomorphic*
Lung
Neoplasm Metastasis
Recurrence*
Salivary Glands
Solitary Pulmonary Nodule*

Figure

• 

  Fig. 1 CT scan of the neck of a 46-year-old female with a history of left submandibular pleomorphic adenoma 9 years prior. Axial post-contrast image reveals a 4.1 × 5.1 cm well-defined non-homogenous enhancing mass in the left submandibular gland with internal calcifications (arrow).

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  Fig. 2 Chest radiograph of a 46-year-old female with metastasizing pleomorphic adenoma. A, B. Chest radiograph of posterior-anterior projection (A) and right lateral projection (B) show a 2.4 cm, oval, well-defined solitary pulmonary nodule in the right upper lobe (arrows).

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  Fig. 3 CT images of metastasizing plemorphic adenoma. A, B. Axial pre-contrast image (A) and post-contrast image (B) show a 2.2 × 2.0 × 2.2 cm well-defined nodule with lobulated margin and relatively homogenous enhancement (12 to 44 Hounsfield units) in the anterior segment of the right upper lobe without cavitation, necrosis, or calcification. CT = computed tomography

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  Fig. 4 MR images of metastasizing plemorphic adenoma. A-C. Axial T1-weighted (A), T2-weighted (B), and post-contrast enhanced T1-weighted image (C) of the lung show a solitary pulmonary nodule in the anterior segment of the right upper lobe with intermediate to high signal intensity on T1-weighted images, heterogenous high signal intensity on T2-weighted images, and with strong enhancement on gadolinium-enhanced T1-weighted images. MR = magnetic resonance

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  Fig. 5 FDG PET-CT image of metastasizing pleomorphic adenoma. Axial fusion image shows increased FDG uptake (maximum standardized uptake value of 4.98) in the right upper lobe. FDG = fluorodeoxyglucose, PET-CT = positron emission tomography-computed tomography

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  Fig. 6 Microscopic findings of pathologically confirmed metastasizing pleomorphic adenoma. A, B. Low power micrograph (A) of the metastasizing pleomorphic adenoma shows an intrapulmonary well-demarcated cellular nodule (hematoxylin and eosin, × 20). High power micrograph (B) of another field of the metastasizing pleomorphic adenoma shows proliferation of epithelial and myoepithelial cells immersed in a chondromyxoid stroma (arrow) (hematoxylin and eosin, × 100).

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