A gigantic unilateral neck mass in the submandibular region

Abstract

Pleomorphic adenoma (PA) is the most common salivary gland neoplasm, mainly affecting the major rather than the minor salivary glands. The parotid gland is the most commonly affected site (75-80%), followed by the submandibular (10%) and minor (10%) salivary glands.1-4 Intra-orally, the palate represents the most common location of PA, followed by the lip, cheeks, tongue, floor of the mouth
and oropharynx.5-6 Histogenesis of PA is characterised by simultaneous proliferation of parenchymatous glandular cells along with myoepithelial components.7 Cells of epithelial origin give rise to ductal structures and are closely intermingled with mesenchymal elements that may give rise to myxoid, hyaline, cartilaginous and osseous change. The expression of varying proportions of epithelial and mesenchymal features give rise to a wide spectrum of histological findings, hence the term “pleomorphic”. It is also called a “mixed tumour”, because it possesses a mixture of ductal and myoepithelial elements in one single tumour. Unlike in minor salivary glands, PA is usually encapsulated when it arises in the major salivary glands.  As are most prevalent in the fourth to six decades, with a slight predominance in women.8,10 PA appears as a painless, slow growing round or ovoid rubbery tumour with a smooth surface, exhibiting firm consistency and variable dimensions. Treatment of choice for PA is surgical excision. Untreated or recurrent PAs may reach giant proportions, especially in major salivary glands. We report on a case of a giant pleomorphic adenoma of the submandibular gland of 10 years’ duration.