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National Journal of Maxillofacial Surgery
 
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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 225-227  

A rare case report of pleomorphic adenoma of the upper lip: An unusual clinical presentation


1 Department of Oral and Maxillofacial Surgery, Sr. Lect. Teerthankar Dental College, Muradabad, Uttar Pradesh, India
2 Department of Periodontics, PGIDS, Rohtak, Haryana, India
3 Department of Oral Pathology, PGIDS, Rohtak, Haryana, India
4 Department of Oral Medicine and Radiology, Dental Surgeon, GH, Mewat, Haryana, India

Date of Submission18-May-2020
Date of Acceptance04-Jan-2021
Date of Web Publication20-Aug-2022

Correspondence Address:
Dr. Nishi Tanwar
Department of Periodontics, PGIDS, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.NJMS_92_20

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   Abstract 


Pleomorphic adenoma is the most common salivary gland tumor which accounts for about 60% of all salivary neoplasms. It is also known as “mixed tumor because of its wide cytomorphologic diversity”. Pleomorphic adenoma salivary glands mostly occurs on the palate, but the involvement of the upper lip is rare. The present report describes a case of a 62-year-old male with asymptomatic firm nodular swelling attached with upper lip which was later diagnosed as pleomorphic adenoma in the excisional biopsy.

Keywords: Minor salivary gland tumor, mixed tumor, pleomorphic adenoma, upper lip


How to cite this article:
Prakash C, Tanwar N, Dhokwal S, Devi A. A rare case report of pleomorphic adenoma of the upper lip: An unusual clinical presentation. Natl J Maxillofac Surg 2022;13, Suppl S1:225-7

How to cite this URL:
Prakash C, Tanwar N, Dhokwal S, Devi A. A rare case report of pleomorphic adenoma of the upper lip: An unusual clinical presentation. Natl J Maxillofac Surg [serial online] 2022 [cited 2022 Sep 28];13, Suppl S1:225-7. Available from: https://www.njms.in/text.asp?2022/13/4/225/353962




   Introduction Top


Salivary gland neoplasms account for 2%–6.5% cases of all head-and-neck malignancies.[1] Pleomorphic adenoma is the most common salivary gland tumor and accounts for about 60% of all salivary neoplasms.[2] About 80% of pleomorphic adenomas arise in the parotid, 10% in the submandibular gland and 10% in the minor salivary glands of the oral cavity, nasal cavity and paranasal sinuses and the upper respiratory and alimentary tracts. Minor salivary gland tumors are rare and constitute 15%–20% of salivary gland neoplasms. The hard palate is the most common site among minor glands accounting for approximately 50%–60%, followed by the upper lip (15%–20%) and buccal mucosa (8%–10%). The importance of lesions lies in the fact that they are more likely to be malignant when associated with minor salivary glands.[3],[4] Patients with pleomorphic adenomas of minor salivary glands usually present in the fourth to sixth decades with a slight predominance in female patients. The unknown etiology of pleomorphic adenoma (PA) is still found to be elusive. It is epithelial in origin, and clonal chromosome abnormalities with aberrations involving 8q12 and 12q15 have been described.[5] This case report describes diagnosis and management of an asymptomatic, slowly growing, firm mass with origin in the upper lip of an old edentulous male thereby reporting a common neoplasm in a unusual site.


   Case Report Top


A 65-year-old edentulous male presented in outpatient department of our hospital for the fabrication of complete denture with a complaint of the painless, mobile hanging mass originated from the middle of the upper lip from the past 15 years when the patient was having teeth. This swelling got slowly increased in size from the past 5 years after the full mouth extractions. At the time of presentation, mouth opening was obstructed by the mass like the hinged barrier originating from the vermilion of the upper lip and completely obliterating the upper vestibule. On clinical examination, there was a well-defined, round, hard, non-tender, non-fluctuant, non-pulsatile, firm consistency mobile mass with a size of approximately 3 cm × 5 cm in diameter. The mass was on the middle of the upper lip with attachments toward the right side. The pink color of the overlying mucosa was showing unanimous evidence of superficial vascularity. [Figure 1] shows the preoperative view of the tumor for the abovementioned lesion. The skin over the tumor was not fixed. There was no remarkable medical history. X-ray PA mandible obtained which revealed no bony involvement. FNAC was performed, which was suggestive of PA. All preoperative blood and urine investigations were within normal limits. The well encapsulated and mobility in relation to the tumor was showing its benign nature therefore the excisional biopsy was planned for final diagnosis and management. The tumor was completely excised with lip splitting incision with careful dissection and attained the clinically normal margin because the mass was fully encapsulated. The excised mass was 3 cm × 5 cm [Figure 2]. After complete excision of tumor, surgical wound was closed in layers in a tension-free watertight closure with 3-0 silk suture. The excised mass [Figure 3] was sent for histopathological examination and confirmed for PA. The patient's postoperative course was uneventful [Figure 4]. The healing after 2 weeks was satisfactory. Subsequent follow-up after the 1st and 2nd year showed no signs of recurrence.
Figure 1: Preoperative photograph of the lesion

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Figure 2: Posteroanterior projection radiograph

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Figure 3: Excised mass

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Figure 4: Postoperative photograph

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Histopathology

Histopathologic examination shows subepithelial capsulated neoplasm of salivary gland origin [Figure 5]a, [Figure 5]b, [Figure 5]c, [Figure 5]d.
Figure 5: Histopathological examination reveals. (a) Well encapsulated subepithelial tumor mass composed of ductal and myoepihtelial cells arranged in varied pattern. (b) hyalinized areas with intermixed ductal structures filled with eosinophillic coagulum. (c) Plasmacytoid cells with intervening stroma. (d) Spindle cells arranged in sheets with interspersed small and large vessels filled with red blood cells

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   Discussion Top


Pleomorphic adenoma arising from minor salivary glands of the lips starts at an earlier age compared to other sites. Bernier found the peak incidence of pleomorphic adenoma of the lips was in the 3rd and 4th decades, with an average age of 33.2 years[6] although in our case the origin of the nodule started at the age of 42 years and clinically manifested as slow-growing, painless, firm growth and expanded to the above said size in 20 years. From the past 20 years, patient has gone for multiple extractions by some local quacks nearby villages considering the swelling as possible cause due to infected teeth in the upper jaw and later on lower teeth due to constant traumatic ulceration to the upper growth. There is a propensity for the benign tumor to occur in the upper lip may be due to differences in embryonic development between upper and lower lips.[7] whereas malignant lesions to predominate in the lower lip.[8],[9] We have reviewed the few clinical differential diagnosis of a swelling of the upper lip, as likelihood like in Canalicular adenoma, pleomorphic adenoma, lipoma, fibroma, adenoid cystic carcinoma, mucoepidermoid carcinoma, and nasolabial cyst. The most successful treatment for PA in major salivary glands is the surgical excision of the tumor with the involved lobe or the entire gland depending upon case. In our case, the tumor was excised en mass with disease-free margins. Our case was also being followed up for 2 years without any evidence of recurrence.


   Conclusion Top


Though the Solid mass with a long history of its presence is pointing toward the benign tumor, further clinical and thorough histopathological examination and differentiation is extremely important keeping in view of leaving the important findings which may lend up into misdiagnosis. Such tumors are usually encapsulated so excisional biopsy with adequate surrounding tissue margins should be the treatment of choice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Moshy J, Owibingire S, Mwakyoma H. Intraoral minor salivary glands neoplasms. The pattern and management. Prof Med J 2010;17:483-9.  Back to cited text no. 1
    
2.
Spiro RH. Salivary neoplasms: Overview of a 35 year experience with 2,807 patients. Head Neck Surg 1986;8:177-84.  Back to cited text no. 2
    
3.
Ellis GL, Auclair PL. Tumours of the Salivary Glands, Atlas of Tumour Pathology. 3rd Ser., Facsicle 17. Washington: Armed Forces Institute of Pathology; 1996.  Back to cited text no. 3
    
4.
Ghosh SK, Saha J, Chandra S, Datta S. Pleomorphic adenoma of the base of the tongue – A case report. Indian J Otolaryngol Head Neck Surg 2011;63:113-4.  Back to cited text no. 4
    
5.
Farina A, Pelucchi S, Grandi E, Carinci F. Histological subtypes of pleomorphic adenoma and age-frequency distribution. Br J Oral Maxillofac Surg 1999;37:154-5.  Back to cited text no. 5
    
6.
Bernier JL. Mixed tumors of lips. J Oral Surg 1946;4:193.  Back to cited text no. 6
    
7.
Metgud R, Neelesh BT, Ranjitha R, Goel S, Naik S, Tak A. Pleomorphic adenoma of the upper lip: A case report and review of literature. IJDR 2016;4:8-10.  Back to cited text no. 7
    
8.
Waldron CA, el-Mofty SK, Gnepp DR. Tumors of the intraoral minor salivary glands: A demographic and histologic study of 426 cases. Oral Surg Oral Med Oral Pathol 1988;66:323-33.  Back to cited text no. 8
    
9.
Owens OT, Calcaterra TC. Salivary gland tumors of the lip. Arch Otolaryngol 1982;108:45-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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