PLEOMORPHIC ADENOMA LOCATED OVER THE NASAL

DORSUM: A RARE PRESENTATION

*Ehrlson de Sousa, **Sai Spoorthi Naik, ***Manu Wilfred, ****Saumyata Neeraj

INTRODUCTION
Pleomorphic adenoma is the commonest benign
tumour of the salivary gland. It is usually found in the
major glands namely the parotid followed by the
submandibular gland. Besides that , minor salivary
glands which are scattered in the upper aerodigestive
tract e.g. in the oral cavity, oropharynx and
hypopharynx are also subjected to this benign pathology
. Pleomorphic adenoma occurring in the skin of the
head and neck area is extremely rare.
These neoplasms affect females more than males
and are commonly seen in the 3rd to the 6th decades of
life. While pleomorphic adenomas are highly
uncommon in the nasal cavity, approximately 80% of
nasal pleomorphic adenomas are detected in the nasal
septum while the remaining 20% are found in the lateral
wall or turbinate despite the fact that a significant
proportion of mucous and serous glands are confined
to the lateral nasal wall.
CASE REPORT
A 27 year old male presented with a 6 month
history of painless swelling over the nasal dorsum. The
swelling had gradually increased in size. There was no
history of nasal obstruction, discharge, epistaxis or any
constitutional symptoms. Examination revealed a 2 x2
cm mobile cystic mass over the nasal dorsum. The mass
was firm in consistency and non tender and surrounding
skin was healthy. No pus, discharge or fistula was noted.
Intranasal endoscopy revealed normal findings .
CT scan revealed a superficial cyst with intact
underlying nasal bone. The patient underwent excision
biopsy of the mass under local anaesthesia.

Histopathological examination showed features of a

pleomorphic adenoma of minor salivary gland.
Histologically the specimen showed a fairly well
circumscribed nodular mass composed of tubular
structures surrounded by fibromyxoid stroma with
clear histological margins. The tubules were lined by 2
layers of cells (ductal cells and myoepithelial cells) with
foci of squamous differentiation. There was no evidence
of malignancy. The incision site healed well with
minimal scar visible at 1 month follow up(Fig.1,2,3).
DISCUSSION
Tumours arising in the minor salivary gland
accounts for 22% of all salivary gland neoplasm.
Majority of them are malignant with only 18% of them
being benign. Of the benign tumours, pleomorphic
adenoma is the commonest.(1) Pleomorphic adenoma is
a benign slow growing tumour that affects the major
salivary glands. Besides parotid and submandibular,
involvement of minor salivary gland does occur. The
commonest site for pleomorphic adenoma in the upper
respiratory tract is the nasal cavity.[2]
Although most of the minor salivary glands are
located in the lateral nasal wall, intranasal pleomorphic
adenoma usually arises from the septum.[3,4]
Affiliations:
*Senior Resident Department of ENT, **Senior Resident,
***Junior resident, ****Junior resident
Goa Medical College Bambolim, Goa- 403202
Address of Correspondence:
Dr. Ehrlson de Sousa
Junior Resident Department of ENT
Goa Medical College, Bambolim
Goa- 403202, Mob: 9822920729
Email: ehrl218@gmail.com

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Vol.-9, Issue-II, July-Dec. - 2015

ABSTRACT
Pleomorphic adenoma predominantly occurs in major salivary glands. Besides parotid being its commonest site,
few case of pleomorphic adenoma in submandibular gland and other minor salivary glands have been reported.
We report a rare case of a swelling over nasal dorsum which clinically was a superficial cyst. Complete excision
was performed and histopathological examination of the specimen showed findings suggestive of pleomorphic
adenoma.
Keywords: Nasal dorsum, minor salivary glands, pleomorphic adenoma.

Fig.1: Clinical photograph showing swelling over nasal dorsum.

Fig.2 : Intraoperative finding of cystic lesion over nasal

dorsum.

Vol.-9, Issue-II, July-Dec. - 2015

Fig.3 : Histopathological picture showing tubular

structures surrounded by fibromyxoidstroma.
Pleomorphic adenoma in the skin are rare but can
be found in various sites in the head and neck region
including scalp , eyelids, nose , cheek , upper lip ,
external ear and external auditory canal .[5]
Histopathologically, pleomorphic adenoma is an
epithelial tumor of complex morphology possessing
epithelial and myoepithelial elements arranges in a
variety of patterns and embedded in a
mucopolysaccharide stroma. Formation of the capsule
is a result of fibrosis of the surrounding salivary
parenchyma which is compressed by the tumour and
is referred to as False capsule(6)
Histologically, pleomorphic adenomas of the nasal
cavity differ in certain characteristics. The nasal cavity
tumours have greater cellularity and contain more
44

epithelial components than the chondroid, myxoid and

collagenous stromal components that are seen in
pleomorphic adenomas of the parotid gland.
If the lesion is diagnosed preoperatively, attempt
should be made to do a complete surgical excision with
histological clear margins as there is a potential
recurrence. In this case the mass was excised completely.
However the patient still needs a long follow up as
recurrence has been reported.[7]
CONCLUSION
Pleomorphic adenomas of the nasal cavity are
extremely rare. All attempts should be made to do a
complete surgical excision with histological clear
margins. Nevertheless, post operative follow up is
mandatory in view of its potential for recurrence.
DISCLOSURES
(a) Competing interests/Interests of Conflict- None
(b) Sponsorships - None ,
(c) Funding - None
(d) No financial disclosures
REFERENCES
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Tumoral mass presenting in the nasomalar region
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Pleomorphic adenoma of the auricle .Eur.Arch
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