The rapid growth of a pleomorphic adenoma of the parotid gland in the third trimester of pregnancy
© Palluch et al; licensee BioMed Central Ltd. 2011
Received: 4 January 2010
Accepted: 9 April 2011
Published: 9 April 2011
We report a case highlighting the multidisciplinary management of a giant pleomorphic adenoma of the parotid gland that showed rapid growth in the third trimester of pregnancy.
A 43-year-old Caucasian woman presented in her 32nd week of gestation with a tumor of the parotid gland. Ultrasonography of her neck showed a parotid lesion of 40 × 30 × 27.5 mm. A follow-up magnetic resonance imaging scan of the neck four weeks later revealed that the tumor had grown to 70 × 60 × 60 mm, reaching the parapharyngeal space with marked obstruction of the oropharynx of about 50%. After discussing the case with our multidisciplinary tumor board and the gynecologists it was decided to deliver the baby by caesarean section in the 38th week of gestation, and then to perform a surgical resection of the tumor.
Indications for early surgical intervention of similar cases should be discussed on an individual patient basis in a multidisciplinary setting.
With an incidence of 65%, pleomorphic adenoma is the most common tumor of the salivary glands , and 80% of the pleomorphic adenomas are located in the parotid gland. These tumors are characterized by slow growth over a period of years, and tend to remain asymptomatic. In 4% of cases, they turn into malignant tumors. In the following case report, we describe a pleomorphic adenoma of the parotid gland that showed rapid growth within the third trimester of pregnancy.
A 43-year-old Caucasian woman presented in her 32nd week of gestation with a tumor of the parotid gland. She had noticed the swelling increasing over the past six months. She was otherwise asymptomatic, without any pain, mouth-opening difficulties or facial nerve dysfunction. Ultrasonography of her neck showed a parotid lesion 40 × 30 × 27.5 mm in size, with an heterogeneous appearance. Considering her advanced state of pregnancy, we advised conservative management in the form of watchful waiting and regular review until the birth.
After discussing this case with the gynecologists at our interdisciplinary tumor board meeting, it was decided to deliver the baby by caesarean section in the 38th week of gestation with epidural anesthesia using mepivacain and sufentanil. The surgical resection of the tumor was performed four days later. It was possible to completely remove the tumor via a standard cervicofacial incision without the need to resect the mandible. Although the tumor had stretched the facial nerve to double its usual length, there was no postoperative nerve dysfunction (House Brackmann grade I).
The incidence of head and neck cancers during pregnancy is rising . Pleomorphic adenomas are characterized by slow growth over a term of several years. Rapid increase or the appearance of facial nerve dysfunction may indicate malignant transformation, which has been reported in 4% of cases. Rapid growth during the third trimester of pregnancy may indicate a possible hormonal influence on pleomorphic adenomas. A scientifically based relationship is not proven [4–8]. There may be a prognostic association between the expression of progesterone receptors and recurrent pleomorphic adenoma of the parotid gland . Although in this case described here, we could not establish such a relationship, it is possible that unknown factors (e.g. insulin-like growth factor, vascular endothelial growth factor human placental lactogen).are released by the fetoplacental unit, and that these stimulate growth in other end organs such as the parotid
We recommend frequent monitoring of tumors of the salivary glands diagnosed during pregnancy. Indications for early surgical intervention should be discussed on a individual patient basis in a multidisciplinary setting.
Written informed consent was obtained from the patient for publication of the manuscript and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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