Pleomorphes Adenom

Pleomorphic adenomas, also known by the misnomer benign mixed tumors (BMTs), are benign epithelial neoplasms related to glandular tissue. They have a small but real risk of malignant transformation.

For a discussion of specific sites of pleomorphic adenoma, please refer to

Terminology

Historically pleomorphic adenomas have also been called benign mixed tumors, however this name is now discouraged. It was previously thought that these were a form of teratoma, however it is now clear that the neoplasm forms from a single layer of germ cells and is purely epithelial in nature .

Pathology

Location

Pleomorphic adenoma most commonly occurs in salivary glands (especially parotid gland) but can arise in any tissue that has glandular myoepithelial tissue. Other reported sites include lacrimal glands, external auditory canal, skin, breast, and vulva .

Microscopic appearance

These tumors characteristically have a mix of epithelial and mesenchymal tissues . There is a spectrum of histological appearances (thus the term pleomorphic) but commonly includes ductal epithelium, myoepithelial cells, and myxoid stroma.

Treatment and prognosis

A large pleomorphic adenoma can be disfiguring or exert mass effect on important structures. More importantly, they have a proven risk (5-15%) of undergoing malignant transformation (carcinoma ex pleomorphic adenoma, or malignant mixed tumor) . Thus, complete surgical resection is the treatment of choice.

Local recurrent pleomorphic adenoma (RPA) occurs in a small proportion (<5%), up to 20 years after excision .