Pleomorphic adenoma of the lower lip - North American Journal of ...

www.najms.org North American Journal of Medical Sciences 2011 June, Volume 3. No. 6.
Case Report
Pleomorphic adenoma of the lower lip:
A rare site of location
Ilker Sengul 1 , M.D., Demet Sengul 2 ,M.D., Duygu Aribas 3 ,M.D.
1 Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey.
2 Department of Pathology, Prof. Dr. A. Ilhan Ozdemir State Hospital, Giresun, Turkey.
3 The Clinic of Pathology, Sistem Laboratories, Demetevler, Ankara, Turkey.
Citation: Sengul I, Sengul D, Arıbas D. Pleomorphic adenoma of the lower lip: A rare site of location.North Am J Med
Sci 2011; 3: 299-301. doi: 10.4297/najms.2011.3299
Abstract
Context: Pleomorphic adenoma is the most common neoplasm of the minor salivary glands which are uncommon among
the entire salivary gland tumors. The lower lip is a very rare site of occurrence for pleomorphic adenoma. We intended to
present a case of pleomorphic adenoma of the lower lip. Case Report: A 49-year-old Turkish man presented with the
painless mass on his lower lip. A total excision was choiced for the mass by both we and the patient because of some
cosmetic reasons. The histopathological evaluation revealed the diagnosis of pleomorphic adenoma and neither
complication nor recurrence was observed during a clinical follow-up for 40 months. Conclusions: A clinician should be
vigilant for the possibility of existence of a pleomorphic adenoma located on the lower lip even it is rare. Once it is
diagnosed concisely, a wide excision is suggested in general if there is no cosmetic care and no risk of damage to
functional structures of head and neck.
Keywords: Salivary glands, lip, pleomorphic, adenoma.
Correspondence to: Dr. Ilker Sengul, Vice Dean, The Founder Chairman of Department of General Surgery, Substitute
Surgeon General (Head-Doctor) of Giresun University Health Practicing and Research Hospital, Substitute Chairman of
Department of Radiodiagnostics, Giresun University Faculty of Medicine, 28100 Giresun, Turkey. Tel.: +90 454 214 14 96,
Fax: +90 454 214 02 47, Email: dr.ilker52@mynet.com, ilker.sengul@giresun.edu.tr
Introduction
The majority of oral soft tissue masses have benign nature.
However, appearance of these benign masses may
resemble the malignant tumors. Thus, distinguishing
benign masses from the malign masses is critical to further
prognosis and treatment [1]. Tumors of minor salivary
glands are not common and accounts for 10-25% of whole
salivary glands tumors. Pleomorphic adenoma (benign
mixed tumor) is the most common neoplasm of the minor
salivary glands [2]. This benign lesion also may be
misdiagnosed as malignant due to increased cellularity,
nuclear atypia in the often predominant myoepithelial
component, or preudoepitheliomatous hyperplasia of the
overlying mucosa. We aimed to present an unusual case of
pleomorphic adenoma on the lower lip in a male.
Case Report
A 49-year-old Turkish man presented with the complaint
of painless swelling just beneath the lower lip. His medical
and family history was uneventful. On the physical
299
examination, the mass was sized approximately in 1.5x0.7
Cm. having an appearance of lobulating and protruding
from the skin. No any hyperemia or changing of color
inspected on the surface of the skin. It was located on the
left side, adjacent to the lower lip (Figure 1). Any other
mass or lesion notable was not observed in the oral cavity
even on the region of head and neck. The mass was
palpable, protruded from the skin, and giving a sense of
lobulation, but not firm in nature. It was a soft mass, but it
had neither fluctuated region nor a fistula and/or leakage
on it. Furthermore, examination of the other systems were
normal. After having an informed consent from the patient,
an excisional biopsy was performed under local anesthesia
by means of a transverse incision parallel to the inferior
border of the lower lip. It was not extended from the
subcuticular tissue to the deep compartments of the soft
tissue and the fascial layers (Figure 1). The resected mass
was sized as 1.5 cm in diameter in its long axis (Figure 2).
After total resection, incision was sutured primarily. The
histopathological examination with haematoxylin and
eosin revealed the diagnosis of pleomorphic adenoma

www.najms.org North American Journal of Medical Sciences 2011 June, Volume 3. No. 6.
(Figure 3). The patient recovered uneventfully and clinical
follow-up for 40 months after resection exhibited no
evidence of local recurrence or other occurrence on the
head and neck and the other parts of the body.
Fig. 1 Exploration of the mass after a transverse incision, parallel
to the inferior border of the lower lip.
Fig. 2 The size of the long axis of the resected mass is seen as 1.5
cm in diameter.
Fig. 3 The glandular structures having basal myoepithelial
components on the chondromyxoid background (Haematoxylin
and Eosin, Original magnification, 5x10) .
Discussion
The most common tumor of minor salivary glands,
accounting 40 %, may be found in larynx, nasal cavity,
and paranasal sinuses. In the term of extra-major salivary
gland pleomorphic adenoma, the most frequent occurrence
was reported as palate, followed by upper lip. Pleomorphic
adenoma of minor salivary glands mostly seen in female
gender [3]. So, we purposed to present a pleomorphic
adenoma, located on the lower lip and found in a male.
This location is a rare site of occurrence for pleomorphic
adenoma. Al-Khateeb et al [1] evaluated the relative
frequencies, types and distribution of benign oral masses
in North Jordanians. A total of 818 cases with benign oral
soft tissue masses retrospectively analyzed for an 11-year
period and the parameters of age, sex, mass type and
location were measured. Common benign neoplasms were
salivary pleomorphic adenoma and lipoma. Most frequent
non-neoplastic lesion was traumatic (43%). Male to
female ratio and the mean age was detected as 1:1.5 and
33 years, respectively. The palate, tongue, upper lip and
buccal mucosa, were the sites commonly affected by
benign neoplasms in a descending order. Of 818 cases a
sum of 13 pleomorphic adenoma (2%) were determined,
mostly in the patients between the ages of 21-30 years
(6/13). The cases of pleomorphic adenoma were located
mostly in the palate (8/13). Three of them was on the
upper lip and only one found in the gingiva (1/13) and one
in the lower lip (1/13). In general, only one patient (1/818)
was the case of pleomorphic adenoma of the lower lip in
that wide analysis of benign oral masses in a North
Jordanian population during an 11-year period. According
to our knowledge, the number of the cases of pleomorphic
adenoma of the lower lip which were presented in the
literature, indexed in Medline have been a very limited
number. Besides, our case is the first case from Turkey
among the mentioned literature [4].
In the treatment of pleomorphic adenoma, wide resection
with negative margins is frequently recommended as an
optimal choice. Because, almost half of all tumors
originating from minor salivary glands are proclaimed as
malignant. So, even fine-needle aspiration or incisional
biopsy was suggested before the definitive surgery.
Additionally, a recurrence rate of 2-44 % has been
declared in the literature since 1939 [3]. Krolls et al [5]
asserted that inefficient first surgical intervention was the
main cause of recurrences. However, Dongre et al [6]
propounded that simple excision was the only treatment
for it. Disadvantages of wide excision of extra-major
salivary gland pleomorphic adenoma may be summarized
as cosmetic care particularly for upper and lower lips, eyes,
and face in general, and probability of injury to functional
structures of head and neck such as upper and lower lip,
and palate. So, we and the patient choiced just a total
excision for the mass of the presented case due to some
cosmetic reasons. The patient recovered uneventfully and
no recurrence was observed during a clinical follow-up for
40 months. However, we offer wide excision for the
treatment of extra-major salivary gland pleomorphic
adenoma especially for the selected cases.
In summary, tumors of the minor salivary glands are
uncommon among entire salivary glands tumors.
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www.najms.org North American Journal of Medical Sciences 2011 June, Volume 3. No. 6.
Pleomorphic adenoma is the most frequent neoplasm of
the minor salivary glands, mostly seen in women. The lip
is a rare site of occurrence for pleomorphic adenoma.
Besides, the lower lip is a more seldom location than the
upper lip. So, we presented a pleomorphic adenoma of the
lower lip in a man. Wide surgical excision is
recommended due to possibility of both recurrence and
being a malignant tumor after a pathological examination.
However, this technique may be compromised and
problematic because of cosmetic reasons and likelihood of
damage to functional structures.
We would like to emphasize that a clinician must be
vigilant for the possibility of a mass on the lower lip may
being a pleomorphic adenoma or a malignant form of it
though it is a rare site of occurrence. Besides this,
approximately 50 % of all tumors derived from the minor
salivary glands are malignant.
Acknowledgement
It is not used an funding for the present work. All authors
contributed equally and were involved in writing the paper
and finally approved the submitted and published versions
without any conflict of interest.
References
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