Page 64 - New epidemiological and PSMA-expression based paradigms in salivary gland tumors

Chapter 4
Material and Methods
Case: A 35-year old female presented with a painful parotid tumor in the deep lobe without facial nerve palsy. Fine needle aspiration cytology (FNAC) revealed a salivary gland tumor, possibly SGPA, uncertainly benign (Milan classification 4b). After a superficial parotidectomy, the tumor was removed with (where possible) surrounding gland. Histology showed a SGPA (Figure 1A, D), 4 cm in diameter, with a large epithelial component, completely removed without margins. Infiltrative growth, mitotic figures or necrosis were not observed.
Figure 1. H&E histology (2x and 60x magnification) of the primary, first and second recurrent tumors (A and D, B and E, C and F respectively) showing progression of the pleomorphic adenoma without cytonuclear atypia to a carcinoma with more nuclear atypia and mitoses (mitosis in left upper quadrant of F). Pre- existent pleomorphic adenoma is seen at the asterisk in B. Infiltrative growth in skeletal muscle (asterisks) is present in C.
Three years later the patient presented with a painful recurrent tumor and paresthesia of the tongue. FNAC was unsuccessful due to extreme pain. An MRI showed a local recurrence, 5.7 cm in diameter. The tumor and remnant of the deep lobe were resected after a lateral mandibulotomy. The facial nerve was sacrificed and reconstructed. At pathology, a cellular salivary gland tumor was seen, without obvious mitosis or necrosis and with areas clearly classifying as pleomorphic adenoma (Figure 1B, E). Infiltrative growth could not be evaluated as the lesion was excised without margins. The lesion was classified as a benign recurrence reaching into the resection surface. Postoperative radiotherapy (RT, 66 Gray) was administered.
62