Pleomorphic Adenoma of the Tongue Base: A Case Report-Juniper publishers
JUNIPER PUBLISHERS-OPEN
ACCESS JOURNAL OF HEAD NECK & SPINE SURGERY
Abstract
An 86-year-old woman underwent bronchoscopy after
developing aspiration pneumonia. She was found to have a tumor of the
tongue base and was referred to our department. Fiberscopy revealed a
pendulous mass at the tongue base. On computed tomography, a smooth
pendulous mass (2cm × 1.7cm) was seen at the base of the tongue, with no
deep invasion. The biopsy report indicated possible mucoepidermoid
carcinoma. The risk of surgery was high due to her age and
co-morbidities, so the patient and her family did not agree to resection
of the tumor. Aspiration pneumonia recurred several times over several
months, after which she could not take anything orally and became
bedridden for weeks. To improve her quality of life by minimally
invasive surgery, the tumor was excised transorally under general
anesthesia. The pathological diagnosis was pleomorphic adenoma, and the
surgical margins were negative. The patient’s postoperative course was
good. Pleomorphic adenoma often arises from the major salivary glands,
especially the parotid gland, but pleomorphic adenoma of the tongue base
is rare. This case is reported along with a review of the literature.
Keywords: Pleomorphic adenoma; Tongue base; Surgery
Pleomorphic adenoma is a common benign tumor in the
field of otolaryngology/head and neck surgery. It often arises from the
major salivary glands, especially the parotid gland, but also from the
minor salivary glands of the oral cavity. Benign and malignant tumors of
the minor salivary glands are usually found
on the palate, upper lip, gums, cheek, floor of the mouth, pharynx,
larynx, and trachea [1]. In contrast, pleomorphic adenoma of the tongue
base is rare and only 13 cases have been reported (Table 1). Here we
report a patient with pleomorphic adenoma of the tongue base and review
the relevant literature.
Case Report
An 86-year-old woman had noted discomfort on swallowing
for several years. She developed slight dysphagia and fever six
months previously. Aspiration pneumonia was diagnosed by her
local physician and she was treated with antibiotics. Although
her symptoms resolved within a few days, bronchoscopy
revealed a tumor at the tongue base and she was referred to our
department. Transnasal fiberscopy demonstrated a pendulous
mass at the tongue base (Figure 1). Computed tomography
revealed a smooth-surfaced pendulous mass (2cm × 1.7cm) at
the tongue base without deep invasion (Figure 2). Biopsy of the
tumor gave a diagnosis of possible mucoepidermoid carcinoma. It
was considered that this tumor might have caused her dysphagia
and aspiration pneumonia. She had a history of diabetes mellitus,
schizophrenia, femoral fracture, and dementia.
Surgery was considered to be high risk due to her age and
co-morbidities. Because the patient and her family did not
agree to resection of the tumor, she was followed up by her local
physician. Aspiration pneumonia recurred several times over
several months, after which she could not take anything orally
and became bedridden for weeks. To improve her quality of life
by minimally invasive surgery, the tumor of her tongue base
was excised transorally under general anesthesia. The working
space in the oral cavity and pharynx is limited, so we resected
the mass by using laparoscopic instruments. The postoperative
pathological diagnosis was pleomorphic adenoma and the
surgical margins were negative (Figure 3). After surgery, she
could eat without discomfort on swallowing or recurrence of
aspiration pneumonia. The tumor has not recurred after followup
for seven months (Figure 4).
Discussion
Pleomorphic adenoma was first described by Missen in
1874. About 80% of pleomorphic adenomas arise in the parotid
gland, followed by 10% in the submandibular gland and 10%
in the minor salivary glands [2]. Tumors of the minor salivary
glands usually arise on the palate, upper lip, gums, cheek, floor
of the mouth, pharynx, and trachea [1]. The most frequent site
for pleomorphic adenomas of minor salivary glands is the palate
(50%), followed by the upper lip [3]. In contrast, pleomorphic
adenoma rarely arises from the tongue base and only 13 cases
have been reported previously (Table 1) [2,4-15].
Surgery is the accepted treatment for pleomorphic adenoma
and the tumor was subjected to surgical resection in all of the
previous reported cases. Because of its anatomical features,
approaching the tongue base for surgery raises several problems.
In particular, the site is difficult to view by direct vision and the
working space is narrow. The surgical approach depends on
the size and location of the tumor, so the surgeon should plan
treatment carefully. Various surgical approaches have been
used, including the transoral, transhyoid, transpharyngeal,
transmandibular, and combined transoral-transcervical
approaches. We performed transoral excision to minimize
surgical invasion, because the patient was elderly and had a
history of schizophrenia and dementia, suggesting that brief
hospitalization was required. The tumor was pedunculated and
not deeply infiltrative, so we decided that transoral resection
was reasonable. Because the working space in the oral cavity and
pharynx is very narrow, laparoscopic instruments were used.
However, the devices were actually too long for the transoral
approach, so a new approach such as robot support is needed for
resection of tongue base tumors [16].
To know more about Open Access Journal of
Head Neck & Spine Surgery please click on:
Comments
Post a Comment