A Giant Pleomorphic Adenoma of the Submandibular Salivary Gland: A Case Report
A 20-year-old black woman of cross-border nationality, presented to our maxillofacial and oral surgery department seeking medical attention for a large swelling on the left side of her jaw (Figs. 1A and and1B). The swelling was painless with a history of having increased in size over an 8-year period. She noticed the swelling for the first time at the age of 12. The patient was otherwise healthy with no other significant medical history or findings.
On examination, the weight of the swelling tilted the patient’s head to the left. The swelling was multinodular, nontender, hard, and mobile. Movement of the tumor mass could be elicited and palpated bimanually both intraorally (in the region of the left submandibular salivary gland) and extraorally over the mass simultaneously.
The advancing “apex” of the tumor had ulcerations and scars suggestive of previous biopsies having been done in her country of origin (Fig. 2C). The patient confirmed having had an unreported previous biopsy. Submandibular lymph nodes could not be palpated due to the tumor mass. No other supraclavicular nodes were palpable. The lesion was diagnosed clinically as a PA
(A) Computed tomography scan showing the superior, inferior, and mesial extent of the tumor mass with scattered calcifications within the lesion (arrows). (B) Micrograph showing the myxochondroid and cellular nature of the tumor. (C) Arrow indicates area of sacrificed skin with ulceration (site of previous biopsy). (D) Planned marked incision line.
Micrograph of the incisional biopsy that was done showed features of a myxochondroid and cellular PA. The cartilage and myxoid areas grew in nodules with cellular areas in between. No mitotic activity was present and the tumor capsule could not be identified (Fig. 2B). The diagnosis of PA was confirmed.
Imaging studies included an orthopantomograph, PA mandible, and computed tomography (CT; Figs. 1A, ,1D, and and 2A).
CT showed a large homogenous mass involving the left submandibular space and left anterior cervical space with superior abutment of the left parotid gland. Diffuse calcifications were found within the lesion. The epicenter of the tumor was within the submandibular gland. There was medial extension to the left parapharyngeal space. Bony elements of the maxilla and mandible were within normal limits.
An en bloc resection of the tumor was done with preservation of the overlying nonulcerated skin (Figs. 2D and and 3 to 3D).
(A to D) Sequential surgical excision of the tumor mass.
The patient recovered well and was discharged on day 4 postoperatively. Patient review was uneventful and the incision wound healed well.
Figure 4
(A) Specimen after removal. (B) Return to almost complete aesthetic normalcy with no skin contouring being done. This demonstrates the tremendous elasticity of the skin, which had shrunk. (C, D) Wound closure and postoperative view of the patient.