1
Poster Design & Printing by Genigraphics ® - 800.790.4001 Bettina Carvalho Hospital de Clínicas da Universidade Federal do Paraná (Clinical Hospital of Federal University of Parana, Brazil) Email: [email protected] Phone: +55 41 9919-9977 Introduction: The Pleomorphic Adenoma is the most common benign neoplasm of the salivary glands, and it occurs most commonly on the palate. Methods: report of 2 cases of Plemorphic Adenoma in unusual places. Results: Case 1: for 20 years, the patient complained of frequent choking and progressive growth of lesions in the uvula, then underwent uvuloplasty with total excision of the lesion. Case 2: patient complaining of progressive nasal obstruction in the right nasal cavity, had septoplasty and turbinectomy performed. CT of the paranasal sinuses revealed extensive mass of inferior nasal turbinate to the right choana. Endoscopic right Turbinectomy procedure was conducted. The pathological exam suggested Pleomorphic Adenoma. Conclusion: Pleomorphic Adenoma located both in the uvula as in the inferior nasal turbinate are rare. This neoplasm should always be considered in the differential diagnosis of head and neck injuries so that, with early surgical treatment, prevention of its progression to malignancy is possible. Atypical presentations of Plemorphic Adenoma Annelyse Cristine Ballin, M.D.; Bettina Carvalho, M.D.; Marcelo Bettega; Carlos Roberto Ballin, M.D.; Silvio Bettega, M.D.; Marcos Mocellin, M.D., Ph.D. Hospital de Clínicas da Universidade Federal do Paraná (Curitiba, Brazil) The Pleomorphic Adenoma occurs most frequently between the third and sixth decades of life and in female patients (3). We found only two published cases of Pleomorphic Adenoma of the uvula, one presenting with otalgia, and another one with Obstructive Sleep Apnea Syndrome (5,7). Our literature review revealed that there were only six reported cases of Pleomorphic Adenoma (8,9,10,11) of the inferior nasal concha. The typical clinical presentation of the patient with intranasal Pleomorphic Adenoma is progressive unilateral nasal obstruction and occasional epistaxis (1,2,3,12). Its Malignization and Mortality rate are shown on Chart 1. Case 1: patient complaining for about 20 years of frequent choking and progressive growth of lesion in the uvula. The patient underwent Uvuloplasty with total excision of the lesion. The anatomo-pathological exam suggested Pleomorphic Adenoma. The patient remains asymptomatic and without signs of tumor recurrence after six months post operatory follow up. Case 2: patient complaining of progressive nasal obstruction in right nasal cavity for 12 months. Physical exam showed deviation of the septum and inferior nasal turbinate hypertrophy. Septoplasty and Parcial inferior right Turbinectomy were performed. The pathology suggested Pleomorphic Adenoma and CT of the paranasal sinuses revealed extensive mass of the inferior nasal concha extending to the right choana. Total inferior right Turbinectomy by Endoscopic Nasal surgery was the complementary procedure chosen. Twelve months after surgery the patient remains asymptomatic and without signs of tumor recurrence. Report of two cases of Pleomorphic Adenoma with different clinical presentations and unusual locations: the uvula and inferior nasal concha (inferior turbinate) and discussion of the variety of presentations in this type of tumor. Pleomorphic Adenoma located both in the uvula as in the inferior nasal concha is rare. This neoplasm should be always considered in the differential diagnosis of head and neck injuries in order to prevent its progression to malignancy with early surgical treatment. The Pleomorphic Adenoma is the most common benign neoplasm in the salivary glands (1,2,3,4). Occasionally it may be present in the external auditory canal, soft palate, hard palate, oral mucosa, larynx and nasal cavity (1,2,4). The most common location of the intraoral PA is on the palate, followed by upper lip and oral mucosa (5,6). Most cases (82.5 - 90%) of intranasal lesions occur in the septum (2). INTRODUCTION METHODS AND MATERIALS 1. Karakus MF, Ozcan KM, Dere H. Endoscopic resection of pleomorphic adenoma of the nasal septum. Tumori. 2007;93(3):300-1. 2. Sciandra D, Dispenza F, Porcasi R, Kulamarva G, Saraniti C. Pleomorphic adenoma of the lateral nasal wall: case report. Acta Otorhinolaryngol Ital. 2008 Jun;28(3):150-3. 3. Rocha MP, Campagnolo AM, Macedo VS, Scarton FB, Rocha HP, Kuhl G. Adenoma pleomórfico de septo nasal: relato de caso. Rev. Bras. Otorrinolaringol. 2004;70(3):416-418. 4. Ribeiro-Rotta RF, Cruz ML, Paiva RR, Mendonça EF, Spini TH; Mendonça, AR. O papel da ressonância magnética no diagnóstico do adenoma pleomórfico: revisão da literatura e relato de casos. Rev. bras. otorrinolaringol. 2003;69(5): 699-707 5. Fidan V, Yoruk O, Sutbeyaz Y. Otalgia due to pleomorphic adenoma of úvula. The Journal of Craniofacial Surgery 2009;20:571-3. 6. Clauser L, Mandrioli S, Dallera V, Sarti E, Galiè M, Cavazzini L. Pleomorphic adenoma of the palate. J Craniofac Surg. 2004 Nov;15(6):1026-9. 7. Motomura H, Harada T, Muraoka M, Taniguchi T. Elongated uvula with a pleomorphic adenoma: a rare cause of obstructive sleep apnea syndrome. Ann Plast Surg. 2000 Jul;45(1):61-3. 8. Narozny W, Przewozny T, Stankiewicz C, Kuczkowski J. Pleomorphic adenomas of the nasal cavity. Otolaryngol Pol 2003;57(5):661-5. 9. Carriero E, Almadori G, Cadoni G. Pleomorphic adenoma of the lower turbinates: clinical case and review of literature. Acta Otorhinolaryngol Ital 1997;17(5):377-81. 10. Baraka ME, Sadek SA, Salem MH. Pleomorphic adenoma of the inferior turbinate. J Laryngol Otol 1984;98(9):925-8. 11. Unlu HH, Celik O, Demir MA, Eskiizmir G. Pleomorphic adenoma originated from the inferior nasal turbinate. Auris Nasus Larynx 2003;30:417-20. 12. Felix J, Tonon S, Saddy J, Meirelles R, Felix F. Adenoma pleomórfico do septo nasal: relato de caso e revisão de literatura. Rev. Bras. Otorrinolaringol. 2000;66:276-9. CONCLUSIONS CASE REPORTS REVIEW REFERENCES ABSTRACT CONTACT Figures 5 and 6 . Extensive mass in the right inferior nasal concha, CT scan: coronal and axial Figures 7 and 8 . Post operatory of Endoscopic right Turbinectomy, CT scan: coronal and axial Chart 1. Figure 1. Lesion in the inferior third of uvula. Figure 2. Uvuloplasty. Figure 3. Macroscopic view of lesion. Figure 4. Post operatory.

Atypical presentations of Plemorphic Adenoma · Poster Design & Printing by Genigraphics® - 800.790.4001 Bettina Carvalho Hospital de Clínicas da Universidade Federal do Paraná

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Page 1: Atypical presentations of Plemorphic Adenoma · Poster Design & Printing by Genigraphics® - 800.790.4001 Bettina Carvalho Hospital de Clínicas da Universidade Federal do Paraná

Poster Design & Printing by Genigraphics® - 800.790.4001

Bettina CarvalhoHospital de Clínicas da Universidade Federal do Paraná (Clinical Hospital of Federal University of Parana, Brazil)Email: [email protected]: +55 41 9919-9977

Introduction: The Pleomorphic Adenoma is the most common benign neoplasm of the salivary glands, and it occurs most commonly on the palate. Methods: report of 2 cases of Plemorphic Adenoma in unusual places.Results: Case 1: for 20 years, the patient complained of frequent choking and progressive growth of lesions in the uvula, then underwent uvuloplasty with total excision of the lesion. Case 2: patient complaining of progressive nasal obstruction in the right nasal cavity, had septoplasty and turbinectomy performed. CT of the paranasal sinuses revealed extensive mass of inferior nasal turbinate to the right choana. Endoscopic right Turbinectomy procedure was conducted. The pathological exam suggested Pleomorphic Adenoma. Conclusion: Pleomorphic Adenoma located both in the uvula as in the inferior nasal turbinate are rare. This neoplasm should always be considered in the differential diagnosis of head and neck injuries so that, with early surgical treatment, prevention of its progression to malignancy is possible.

Atypical presentations of Plemorphic Adenoma Annelyse Cristine Ballin, M.D.; Bettina Carvalho, M.D.; Marcelo Bettega; Carlos Roberto Ballin, M.D.; Silvio Bettega, M.D.; Marcos Mocellin, M.D., Ph.D.

Hospital de Clínicas da Universidade Federal do Paraná (Curitiba, Brazil)

The Pleomorphic Adenoma occurs most frequently between the third and sixth decades of lifeand in female patients (3).

We found only two published cases of Pleomorphic Adenoma of the uvula, one presenting with otalgia, and another one with Obstructive Sleep Apnea Syndrome (5,7).

Our literature review revealed that there were only six reported cases of Pleomorphic Adenoma (8,9,10,11) of the inferior nasal concha. The typical clinical presentation of the patient with intranasal Pleomorphic Adenoma is progressive unilateral nasal obstruction and occasional epistaxis (1,2,3,12).

Its Malignization and Mortality rate are shown on Chart 1.

Case 1: patient complaining for about 20 years of frequent choking and progressive growth of lesion in the uvula. The patient underwent Uvuloplasty with total excision of the lesion. The anatomo-pathological exam suggested Pleomorphic Adenoma. The patient remains asymptomatic and without signs of tumor recurrence after six months post operatory follow up.Case 2: patient complaining of progressive nasal obstruction in right nasal cavity for 12 months. Physical exam showed deviation of the septum and inferior nasal turbinate hypertrophy. Septoplasty andParcial inferior right Turbinectomy were performed. The pathology suggested Pleomorphic Adenoma and CT of the paranasal sinuses revealed extensive mass of the inferior nasal concha extending to the right choana. Total inferior right Turbinectomy by Endoscopic Nasal surgery was the complementary procedure chosen. Twelve months after surgery the patient remains asymptomatic and without signs of tumor recurrence.

Report of two cases of Pleomorphic Adenoma with different clinical presentations and unusual locations: the uvula and inferior nasal concha (inferior turbinate) and discussion of the variety of presentations in this type of tumor.

Pleomorphic Adenoma located both in the uvula as in the inferior nasal concha is rare. This neoplasm should be always considered in the differential diagnosis of head and neck injuries in order to prevent its progression to malignancy with early surgical treatment.

The Pleomorphic Adenoma is the most common benign neoplasm in the salivary glands (1,2,3,4).

Occasionally it may be present in the external auditory canal, soft palate, hard palate, oral mucosa, larynx and nasal cavity (1,2,4).

The most common location of the intraoral PA is on the palate, followed by upper lip and oral mucosa (5,6). Most cases (82.5 - 90%) of intranasal lesions occur in the septum (2).

INTRODUCTION

METHODS AND MATERIALS

1. Karakus MF, Ozcan KM, Dere H. Endoscopic resection of pleomorphic adenoma of the nasal septum. Tumori. 2007;93(3):300-1.2. Sciandra D, Dispenza F, Porcasi R, Kulamarva G, Saraniti C. Pleomorphic adenoma of the lateral nasal wall: case report. Acta Otorhinolaryngol Ital. 2008 Jun;28(3):150-3. 3. Rocha MP, Campagnolo AM, Macedo VS, Scarton FB, Rocha HP, Kuhl G. Adenoma pleomórfico de septo nasal: relato de caso. Rev. Bras. Otorrinolaringol. 2004;70(3):416-418. 4. Ribeiro-Rotta RF, Cruz ML, Paiva RR, Mendonça EF, Spini TH; Mendonça, AR. O papel da ressonância magnética no diagnóstico do adenoma pleomórfico: revisão da literatura e relato de casos. Rev. bras. otorrinolaringol. 2003;69(5): 699-7075. Fidan V, Yoruk O, Sutbeyaz Y. Otalgia due to pleomorphic adenoma of úvula. The Journal of Craniofacial Surgery 2009;20:571-3.6. Clauser L, Mandrioli S, Dallera V, Sarti E, Galiè M, Cavazzini L. Pleomorphic adenoma of the palate. J Craniofac Surg. 2004 Nov;15(6):1026-9.7. Motomura H, Harada T, Muraoka M, Taniguchi T. Elongated uvula with a pleomorphic adenoma: a rare cause of obstructive sleep apnea syndrome. Ann Plast Surg. 2000 Jul;45(1):61-3. 8. Narozny W, Przewozny T, Stankiewicz C, Kuczkowski J. Pleomorphic adenomas of the nasal cavity. Otolaryngol Pol 2003;57(5):661-5.9. Carriero E, Almadori G, Cadoni G. Pleomorphic adenoma of the lower turbinates: clinical case and review of literature. Acta Otorhinolaryngol Ital 1997;17(5):377-81.10. Baraka ME, Sadek SA, Salem MH. Pleomorphic adenoma of the inferior turbinate. J Laryngol Otol 1984;98(9):925-8.11. Unlu HH, Celik O, Demir MA, Eskiizmir G. Pleomorphic adenoma originated from the inferior nasal turbinate. Auris Nasus Larynx 2003;30:417-20.12. Felix J, Tonon S, Saddy J, Meirelles R, Felix F. Adenoma pleomórfico do septo nasal: relato de caso e revisão de literatura. Rev. Bras. Otorrinolaringol. 2000;66:276-9.

CONCLUSIONS

CASE REPORTSREVIEW

REFERENCES

ABSTRACT

CONTACT

Figures 5 and 6 . Extensive mass in the right inferior nasal concha, CT scan: coronal and axial

Figures 7 and 8 . Post operatory of Endoscopic right Turbinectomy, CT scan: coronal and axial

Chart 1.

Figure 1. Lesion in the inferior third of uvula.

Figure 2. Uvuloplasty.

Figure 3. Macroscopic view of lesion.

Figure 4. Post operatory.