Atypical Presentation of an Upper Lip Pleomorphic Adenoma: Case Report

Abstract

The pleomorphic adenoma (PA) or mixed tumor is the most common neoplasm of the salivary glands, usually presenting with a non-specific clinical manifestation and a diverse histopathological pattern. The region of the lips is the second most common site for minor gland neoplasms. The aim of this paper is to report the case of a 39 year old caucasian woman presenting with a swelling on the right side of the upper lip combined with a history of trauma in the region of the upper right central incisor, eight years ago. The swelling was attributed to the periapical lesion of the upper right central incisor that was observed on the orthopantomography. Intraoperatively the surgeon came upon a nodule of firm consistency in the mucolabial fold. The histopathologic diagnosis of this lesion was benign mixed tumor of salivary gland. This report discusses the deviation in frequency of mixed salivary gland tumor between upper and lower lip, the clinical differential diagnosis, the histopathological pattern and the appropriate treatment.

Lip pleomorphic adenomas: case series and literature review

“…We conducted a search of the literature on lip PAs (in Japan and worldwide) and found 35 cases described in 31 reports since 2000 (Table 2) (10,11,14-17,19-22,26-39,41). Of the 35 past cases of lip PA, 30 (85.7%) were in the upper lip (10,11,13,15,17,(19)(20)(21)(23)(24)(25)(26)(28)(29)(30)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) and only five (14.3%) were in the lower lip (14,16,22,27,31). The male-tofemale ratio of the lip PAs was 4:3 (a nonsignificant difference), and the age range was from 10 to 72 years (Table 2).…”

Benign mixed tumour of the upper lip – Report of a rare case

“…In cases of initially benign PAs that display alterations in their morphological characteristics, like accelerated size expansion or painful ulceration; malignant transformation should be suspected and histopathological examination should be performed for checking potential cellular atypia that indicates malignancy of PAs [4]. Carcinoma ex pleomorphic adenoma, true malignant mixed tumour or carcinosarcoma and metastasizing mixed tumour are the most common types of cancerous pleomorphic adenomas [30] and their existence has been attributed to neglected, untreated nonmalignant PAs or after incomplete surgical removal [25,31].…”

“…Therefore, the treatment option for benign PAs is not simple tumour enucleation, but complete surgical incision of the neoplasm and its capsule with sufficient normal surrounding tissue margins, followed by biopsy and histopathological examination [31]. Otherwise, especially when leaving residual tumor, there is a higher risk of recurrence [23,[30][31].…”

“…Apart from incomplete neoplasm incision, or insufficient surgical procedure such as enucleation alone, recurrence of PAs may also be the result of pseudopods in the capsule or intraoperative tumor implantation [30][31].…”

Pleomorphic Adenoma and Trauma: a Case Report With Rare Clinical Presentation

“…This is in addition to a case reported by Singh et al [22] of a male patient having an upper labial PA with a history of trauma 7 years earlier in the same location, and another case of a female patient reporting a history of trauma 8 years ago before developing a PA on the upper right side of the lip. [23] Only two case reports were recorded by Jiménez [24] and Dyalram et al [25] for patients wearing maxillary dentures where PAs developed on the hard palate and upper labial sulcus, respectively. However, the denture status in terms of tting, stability, and duration of wearing the dentures were not stated.…”