Clinicopathologic characteristics and prognostic factors of primary and recurrent pleomorphic adenoma: A single institution retrospective study of 705 cases Journal Article
| Authors: | Alzumaili, B.; Xu, B.; Saliba, M.; Abuhashem, A.; Ganly, I.; Ghossein, R.; Katabi, N. |
| Article Title: | Clinicopathologic characteristics and prognostic factors of primary and recurrent pleomorphic adenoma: A single institution retrospective study of 705 cases |
| Abstract: | Although pleomorphic adenoma (PA) is benign, it may recur and prompt further treatment with radiotherapy (RT). This study investigated the prognostic features of primary and recurrent PAs. A total of 705 PAs (613 primary and 92 recurrent) were analyzed. The following parameters: age, site and size, status of resection, histologic features, and clinical management were documented and correlated with recurrence-free survival. For primary PAs: The mean patient age was 50 years (female/male: 2/1), the median size was 2.1 cm (range: 0.5 to 9.0 cm), and the most common location was the parotid (92%). Tumors showed the following: complete encapsulation (25%), involvement of the surrounding salivary gland/fat (74%), hypercellularity (26%), >= 10 pseudopods (15%), squamous metaplasia (43%), mitoses (49%), intravascular tumor deposit (n=1), close proximity to nerves (n=2), positive margin (15%), and suboptimal resection (2%). The recurrence rate was 3.4% and malignant transformation was <1%. On univariate analysis, age below 30, mitosis >= 3/10 HPFs, squamous metaplasia, hypercellularity, and suboptimal resection correlated with recurrence-free survival. On multivariate analysis, only age below 30, mitosis >= 3/10 HPF and suboptimal resection predicted recurrence. For recurrent PAs: The resected primary PAs were fragmented in 58%. Forty-eight percent of patients had subsequent recurrences, mostly within 10 years, and 1 patient developed a subsequent malignant transformation. Forty-two percent of patients received RT. On univariate analysis, only RT was associated with better outcome (P=0.033). Young age, high mitoses, and specimen integrity predicted recurrence in primary PA. Recurrent PAs are difficult to eradicate, and 48% of these recurred for the second time, mostly within 10 years. |
| Keywords: | radiotherapy; irradiation; invasion; recurrent; risk-factors; pleomorphic adenoma; salivary-glands; parotid-gland; mixed tumors; nationwide; atypical features; intravascular tumor |
| Journal Title: | American Journal of Surgical Pathology |
| Volume: | 46 |
| Issue: | 6 |
| ISSN: | 0147-5185 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2022-06-01 |
| Start Page: | 854 |
| End Page: | 862 |
| Language: | English |
| ACCESSION: | WOS:000794948700015 |
| DOI: | 10.1097/pas.0000000000001837 |
| PROVIDER: | wos |
| PMCID: | PMC9106806 |
| PUBMED: | 34772841 |
| Notes: | Article -- Source: Wos |
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