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Abstract
Introduction
Pleomorphic adenoma is the most common benign neoplasm of the salivary glands. Extensive
lipomatous involvement of the tumor is, however, a very rare finding.
Case report
Herein, a rare case of lipomatous pleomorphic adenoma arising in the parotid gland
of a 14-year-old Japanese woman is presented.
Conclusion
This is the sixth case of lipomatous pleomorphic adenoma in the English literature.
Recognition of this rare subtype of pleomorphic adenoma is important for clinical
diagnosis and management. On CT scan, it may not be detected possibly due to the extensive
fatty component.
Lipomatous pleomorphic adenoma is an unusual subtype with a lipomatous stromal component of more than 90% of the tumour tissue. This special type of pleomorphic adenoma must be distinguished from other types of lipomatous tumours or non-tumourous lipomatosis of the salivary glands. Until now only two cases of lipomatous pleomorphic adenoma have been reported in the literature. We report of a 36-year old woman who developed a well circumscribed nodule measuring 3.5 x 2.5 x 2 cm in the right parotid gland. The cut surface was grey-yellowish. Histologically, more than 90% of the tumour tissue was fatty tissue with univacuolar adipocytes. The pleomorphic epithelial elements were duct-like cells forming small lumina and spindle-shaped myoepithelial cell with surrounding mucoid stroma. Components of pleomorphic adenoma were intermingled with mature adipose tissue which was more concentrated in the central portion of the adenoma. Some compressed epithelial cords in the adipose tissue formed a septa-like pattern. The differential diagnosis to other lipomatous tumours (lipoadenoma, lipoma) and to non-tumourous interstitial lipomatosis as well as the possible pathogenesis as metaplastic change or epithelial-mesenchymal transdifferentiation are discussed.
The first case of a myxoid variant of lipomatous pleomorphic adenoma arising in the intraoral minor salivary gland is presented. A well-encapsulated tumor was composed almost entirely of myxolipomatous tissue with honeycomb-like spindled cellular areas, which contained only a scant glandular element. Immunohistochemistry confirmed the myoepithelial nature of spindle cells intimately admixed with mucoadipose component. We propose the term myxolipomatous pleomorphic adenoma for this peculiar lesion.
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