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 Table of Contents  
CASE REPORT
Year : 2011  |  Volume : 3  |  Issue : 6  |  Page : 299-301

Pleomorphic adenoma of the lower lip: A rare site of location


1 Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
2 Department of Pathology, Prof. Dr. A. Ilhan Ozdemir State Hospital, Giresun, Turkey
3 The Clinic of Pathology, Sistem Laboratories, Demetevler, Ankara, Turkey

Date of Web Publication9-Nov-2011

Correspondence Address:
Ilker Sengul
Vice Dean, The Founder Chairman of Department of General Surgery, Substitute Surgeon General (Head-Doctor) of Giresun University Health Practicing and Research Hospital, Substitute Chairman of Department of Radiodiagnostics, Giresun University Faculty of Medicine, 28100 Giresun
Turkey
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Source of Support: None, Conflict of Interest: None


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  Abstract 

Context: Pleomorphic adenoma is the most common neoplasm of the minor salivary glands which are uncommon among the entire salivary gland tumors. The lower lip is a very rare site of occurrence for pleomorphic adenoma. We intended to present a case of pleomorphic adenoma of the lower lip. Case Report: A 49-year-old Turkish man presented with the painless mass on his lower lip. A total excision was choiced for the mass by both we and the patient because of some cosmetic reasons. The histopathological evaluation revealed the diagnosis of pleomorphic adenoma and neither complication nor recurrence was observed during a clinical follow-up for 40 months. Conclusions: A clinician should be vigilant for the possibility of existence of a pleomorphic adenoma located on the lower lip even it is rare. Once it is diagnosed concisely, a wide excision is suggested in general if there is no cosmetic care and no risk of damage to functional structures of head and neck.

Keywords: Salivary glands, lip, pleomorphic, adenoma


How to cite this article:
Sengul I, Sengul D, Aribas D. Pleomorphic adenoma of the lower lip: A rare site of location. North Am J Med Sci 2011;3:299-301

How to cite this URL:
Sengul I, Sengul D, Aribas D. Pleomorphic adenoma of the lower lip: A rare site of location. North Am J Med Sci [serial online] 2011 [cited 2019 Nov 19];3:299-301. Available from: http://www.najms.org/text.asp?2011/3/6/299/86163


  Introduction Top


The majority of oral soft tissue masses have benign nature. However, appearance of these benign masses may resemble the malignant tumors. Thus, distinguishing benign masses from the malign masses is critical to further prognosis and treatment [1] . Tumors of minor salivary glands are not common and accounts for 10-25% of whole salivary glands tumors. Pleomorphic adenoma (benign mixed tumor) is the most common neoplasm of the minor salivary glands [2] . This benign lesion also may be misdiagnosed as malignant due to increased cellularity, nuclear atypia in the often predominant myoepithelial component, or preudoepitheliomatous hyperplasia of the overlying mucosa. We aimed to present an unusual case of pleomorphic adenoma on the lower lip in a male.


  Case Report Top


A 49-year-old Turkish man presented with the complaint of painless swelling just beneath the lower lip. His medical and family history was uneventful. On the physical examination, the mass was sized approximately in 1.5x0.7 Cm. having an appearance of lobulating and protruding from the skin. No any hyperemia or changing of color inspected on the surface of the skin. It was located on the left side, adjacent to the lower lip [Figure 1]. Any other mass or lesion notable was not observed in the oral cavity even on the region of head and neck. The mass was palpable, protruded from the skin, and giving a sense of lobulation, but not firm in nature. It was a soft mass, but it had neither fluctuated region nor a fistula and/or leakage on it. Furthermore, examination of the other systems were normal. After having an informed consent from the patient, an excisional biopsy was performed under local anesthesia by means of a transverse incision parallel to the inferior border of the lower lip. It was not extended from the subcuticular tissue to the deep compartments of the soft tissue and the fascial layers [Figure 1]. The resected mass was sized as 1.5 cm in diameter in its long axis [Figure 2]. After total resection, incision was sutured primarily. The histopathological examination with haematoxylin and eosin revealed the diagnosis of pleomorphic adenoma [Figure 3]. The patient recovered uneventfully and clinical follow-up for 40 months after resection exhibited no evidence of local recurrence or other occurrence on the head and neck and the other parts of the body.
Figure 1: Exploration of the mass after a transverse incision, parallel to the inferior border of the lower lip.

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Figure 2: The size of the long axis of the resected mass is seen as 1.5 cm in diameter.

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Figure 3: The glandular structures having basal myoepithelial components on the chondromyxoid background (Haematoxylin and Eosin, Original magnification, 5x10).

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  Discussion Top


The most common tumor of minor salivary glands, accounting 40 %, may be found in larynx, nasal cavity, and paranasal sinuses. In the term of extra-major salivary gland pleomorphic adenoma, the most frequent occurrence was reported as palate, followed by upper lip. Pleomorphic adenoma of minor salivary glands mostly seen in female gender [3] . So, we purposed to present a pleomorphic adenoma, located on the lower lip and found in a male. This location is a rare site of occurrence for pleomorphic adenoma. Al-Khateeb et al [1] evaluated the relative frequencies, types and distribution of benign oral masses in North Jordanians. A total of 818 cases with benign oral soft tissue masses retrospectively analyzed for an 11-year period and the parameters of age, sex, mass type and location were measured. Common benign neoplasms were salivary pleomorphic adenoma and lipoma. Most frequent non-neoplastic lesion was traumatic (43%). Male to female ratio and the mean age was detected as 1:1.5 and 33 years, respectively. The palate, tongue, upper lip and buccal mucosa, were the sites commonly affected by benign neoplasms in a descending order. Of 818 cases a sum of 13 pleomorphic adenoma (2%) were determined, mostly in the patients between the ages of 21-30 years (6/13). The cases of pleomorphic adenoma were located mostly in the palate (8/13). Three of them was on the upper lip and only one found in the gingiva (1/13) and one in the lower lip (1/13). In general, only one patient (1/818) was the case of pleomorphic adenoma of the lower lip in that wide analysis of benign oral masses in a North Jordanian population during an 11-year period. According to our knowledge, the number of the cases of pleomorphic adenoma of the lower lip which were presented in the literature, indexed in Medline have been a very limited number. Besides, our case is the first case from Turkey among the mentioned literature [4] .

In the treatment of pleomorphic adenoma, wide resection with negative margins is frequently recommended as an optimal choice. Because, almost half of all tumors originating from minor salivary glands are proclaimed as malignant. So, even fine-needle aspiration or incisional biopsy was suggested before the definitive surgery. Additionally, a recurrence rate of 2-44 % has been declared in the literature since 1939 [3] . Krolls et al [5] asserted that inefficient first surgical intervention was the main cause of recurrences. However, Dongre et al [6] propounded that simple excision was the only treatment for it. Disadvantages of wide excision of extra-major salivary gland pleomorphic adenoma may be summarized as cosmetic care particularly for upper and lower lips, eyes, and face in general, and probability of injury to functional structures of head and neck such as upper and lower lip, and palate. So, we and the patient choiced just a total excision for the mass of the presented case due to some cosmetic reasons. The patient recovered uneventfully and no recurrence was observed during a clinical follow-up for 40 months. However, we offer wide excision for the treatment of extra-major salivary gland pleomorphic adenoma especially for the selected cases.

In summary, tumors of the minor salivary glands are uncommon among entire salivary glands tumors. Pleomorphic adenoma is the most frequent neoplasm of the minor salivary glands, mostly seen in women. The lip is a rare site of occurrence for pleomorphic adenoma. Besides, the lower lip is a more seldom location than the upper lip. So, we presented a pleomorphic adenoma of the lower lip in a man. Wide surgical excision is recommended due to possibility of both recurrence and being a malignant tumor after a pathological examination. However, this technique may be compromised and problematic because of cosmetic reasons and likelihood of damage to functional structures.

We would like to emphasize that a clinician must be vigilant for the possibility of a mass on the lower lip may being a pleomorphic adenoma or a malignant form of it though it is a rare site of occurrence. Besides this, approximately 50 % of all tumors derived from the minor salivary glands are malignant.


  Acknowledgement Top


It is not used an funding for the present work. All authors contributed equally and were involved in writing the paper and finally approved the submitted and published versions without any conflict of interest.

 
  References Top

1.Al-Khateeb TH. Benign Oral Masses in a Northern Jordanian Population-a Retrospective Study. Open Dent J 2009; 3:147-153.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Spiro RH. Salivary neoplasms: overview of a 35 year experience with 2807 patients. Head Heck Surg 1986; 8:177-184.  Back to cited text no. 2
    
3.Kuo YL, Tu TY, Chang CF, et al. Extra-major salivary gland pleomorphic adenoma of the head and neck: a 10-year experience and review of the literature. Eur Arch Otorhinolaryngol 2010 Dec 1. DOI 10.1007/s00405-010-1437-2 [Epub ahead of print].   Back to cited text no. 3
    
4.Sengul I, Sengul D. Pleomorphic adenoma of the lower lip. North Am J Med Sci (In Press).  Back to cited text no. 4
    
5.Krolls SO, Boyers RC. Mixed tumors of salivary glands. Long-term follow-up. Cancer 1972; 30: 276-81.   Back to cited text no. 5
[PUBMED]    
6.Dongre A, Khopkar U. Asymptomatic nodule on lip. Indian J Dermatol Venereol Leprol 2006;72:470.  Back to cited text no. 6
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    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Pleomorphic adenoma of the lower lip: A review
Sengul, I. and Sengul, D.
North American Journal of Medical Sciences. 2011; 3(12): 536-539
[Pubmed]



 

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