Synchronous Parotid and Homolateral Submandibular Gland Pleomorphic Adenoma

Abstract

Introduction: Pleomorphic adenomas are benign neoplasms of salivary glands. The simultaneous homolateral occurrence of these tumors in salivary glands is exceedingly rare.

Case report: An adult female presenting to our OPD with the swelling of right-sided preauricular and submandibular regions was diagnosed with the pleomorphic adenoma based on fine needle aspiration cytology. The patient was subjected to the excision of both swellings under general anesthesia. Postoperative facial nerve functions were within normal limits and final histopathology confirmed pleomorphic adenoma involving both the sites. A pertinent detailed literature review of English and non-English studies was indicative of only nine such cases.

Conclusion: Simultaneously occurring pleomorphic adenoma involving homolateral parotid and submandibular glands is a rare phenomenon that should be kept in mind when examining the swelling of the unifocal salivary gland.

Keywords: Pleomorphic adenoma; Salivary glands; Surgical treatment; Synchronous.

Fig 1

(A) Well-defined, slightly lobulated, firm mass lesion involving right parotid (arrow) and submandibular gland region (arrowhead) (encircled by dotted blue lines), (B) Intraoperative view showing the parotid bed, post superficial parotidectomy (arrow) with intact facial nerve, and submandibular gland tumour (arrowhead) in the process of removal, (C) Post-excision specimen indicating both the tumors excised in entirety with a surrounding cuff of normal tissue

Fig 2

A 3.2×2.5-cm well-defined, slightly lobulated, iso to hypodense lesion with small areas of calcific foci involving the right superficial lobe of the parotid gland (white arrow) with mild focal heterogeneous contrast enhancement and central hypodense areas, and another 2.5×2.1 cm well defined, smoothly marginated iso to hypodense, poorly enhancing oval lesion involving right submandibular gland (arrowhead), causing smooth expansion of the gland (Tumor appearance is suggestive of benign etiology involving both the parotid and submandibular glands

Fig 3

(A) Parotid gland: Two encapsulated biphasic tumor nodules with normal salivary gland tissue at the periphery. (H & E; 10×), (B) Parotid gland: Section from tumour showing the epithelial-myoepithelial component surrounded by chondromyxoid stroma. (H & E; 20×), (C) Submandibular gland: Section indicating encapsulated biphasic tumor surrounded by normal tissue, comprising predominantly of the epithelial-myoepithelial component. (H & E; 10×).