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Introduction

The most common salivary gland tumor is

Pleomorphic adenoma (PA), which accounts for 60-

65% of such diseases. It mainly affects women in their

fourth to sixth decade of life, and has a natural history

of asymptomatic slow growth over a long period.1 It

usually involves major salivary glands, most commonly

being the tail of parotid. It also involves minor salivary

glands. The lips are commonly affected sites, second

only to the palate, and accounting for about 20-40 %

of all intraoral Pleomorphic adenoma. 2,3

The aetiology of PA is unknown. It is epithelial in

origin, and clonal chromosome abnormalities with

aberrations involving 8q12 and 12q15 have been

described.4

This paper describes the diagnosis and

management of an asymptomatic, slowly growing,

pleomorphic adenoma in the upper lip of middle aged

female. A brief review of the relevant literatures is also

presented

Case report

A 27-year old female presented in ENT O.P.D.

of this hospital with a complaint of painless, mobile

lump in upper lip. The mass slowly increased in size

during the past 3 years. At the time of presentation,

nasal vestibule was almost obstructed by the mass as

shown in fig-1. On examination, the mass was

circumscribed, mobile, sessile, and rubbery in

consistency and 4.5- 5 cm in diameter as shown in fig-

2. The overlying mucosa was smooth with pinkish-

purple color showing evidence of superficial

vascularity. Skin over the tumor was not fixed. There

was no pain or bleeding on palpation. Head and neck

abnormalities were not noted on clinical examination.

The medical history was unremarkable, and no other

abnormalities were found on clinical examination. Thus,

the clinical diagnosis was benign minor salivary gland

tumor. FNAC showed the features of pleomorphic

adenoma.

Correspondence: Dr. A. Shrestha

Email: dr_amar2003@yahoo.com

Case Report, 51-53

Pleomorphic adenoma of the upper lip: A case report

A. Shrestha1, N.S. Reddy2, S. N. Ganguly3

1Lecturer, 2 Prof. & Head,3 Professor Department of ENT, College of Medical Sciences, Bharatpur, Chitwan, Nepal

Abstract:

This case report describes a rare and unusual lesion found in 27 year old female, which was diagnosed as

pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large

firm mass, about 5 cm in diameter, almost obstructing the nasal vestibule and characterized by slow

growth. Complete excision was performed and the histopathological analysis showed pleomorphic

adenoma. The tumor did not recur. A brief review of the relevant literature is also presented.

Keywords: Pleomorphic adenoma; minor salivary gland tumors, nasal vestibule.

Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1

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Fig- 1  Fig-2

The tumor was completely removed with lip splitting incision as shown in fig-3. During the surgical procedure,

the lesion was excised without difficulty with clinically normal margin because the mass was fully encapsulated.

Subsequent follow up after one year showed no signs of recurrence.

Discussion

Kroll and Hick 5 reviewed 4042 cases of

pleomorphic adenomas of the salivary glands. Of these,

445 originated in the minor salivary glands, only 16.9%

were located in the upper lip and 2.9% in lower lip.

Pleomorphic adenoma in the upper lip exceeds that of

the lower lip by the ratio of 6:1. The reason for this

Fig-3 Fig-4

Hstopathological analysis of the surgical specimen revealed pleomorphic adenoma and there was no evidence of

malignancy. Fig-4 is 7th post-operative day photo of the same patient.

difference has been thought to be due to the differences

in embryonic development between the upper and

lower lips.

Pleomorphic adenoma arising from minor salivary

glands of the lips tends to occur at an earlier age than

it does at other sites. Bernier 6 found that the peak

incidence of pleomorphic adenoma of the lips was in

Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1

52



the third and fourth decades, with an average age of

33.2 years. There is a propensity for benign tumor to

occur in the upper lip, whereas malignant lesions to

predominate in the lower lip.3,7 Owens and Calcaterra8

found 90% of the upper lip tumors to be benign in

reports in the literature. Eveson and Cawson3

documented 75% of upper lip tumors as benign. In

the study by Neville et al9, 92% of the upper lip tumors

were monomorphic adenoma (canalicular adenoma

and basal cell adenoma) and pleomorphic adenoma,

whereas sporadic cases of adenoid cystic carcinoma,

acinic carcinoma, and adenocarcinoma constitute the

remainder. Malignant tumors tend to predominate in

the lower lip. Owens and Calcaterra8 found that 7 of

the 13 malignant tumors in the lower lip were

mucoepidermoid carcinoma. This finding was also

consistent with the report from Neville et al9, which

confirmed mucoepidermoid carcinoma to be compose

more than 80% of lower lip tumors.

Minor salivary gland tumor presents as soft or firm

masses, with most having a nodular, exophytic

component. Ulceration of the nodular mass may occur,

but the presence of ulcer provides no clue to the

invasiveness of the tumor. Those that are soft on

palpation usually have large cystic cavities and an

abundance of mucin. The more solid tumors, especially

pleomorphic adenoma with bone and cartilage

formation, are firm on palpation. Differentiation

between benign and malignant tumors is not possible

without histopathology. However, suspicion of

malignancy necessitates a biopsy before surgical

treatment. When a lip mass is freely movable and

submucosal, an excision of the mass with surrounding

tissue may be adequate. On the other hand, a

multilobulated mass fixed to the underlying tissue is more

likely to be malignant. A wide local excision with a 1.5

cm margin and resection of 1 anatomic barrier beyond

the tumor are necessary for surgical clearance. This

will sacrifice the overlying and adjacent mucosa, the

orbicularis oris muscle, and even the involved external

skin of the lip. Reconstruction is effected by local tissue

advancement or Abbe flaps. 10

References:
1. Forty MJ, Wake MJC. Pleomorphic salivary adenoma

in an adolescent. Br Dent J 2000; 188: 545-6

2. Chaudhry AP, Vickers RA, Gorlin RJ. Intraoral minor

salivary gland tumors: An analysis of 1414 cases. Oral

Surg 1961;14: 1194

3. Eveson JW, Cawson RA. Tumors of the minor

(oropharyngeal) salivary glands: A demographic study

of 336 cases. J Oral Pathol 1985;14: 500

4. Farina A, Pelucchi S, Grandi E, Carinci F. Histological

subtypes of Pleomorphic adenoma and age frequency

distribution. Br J Oral Maxillofac Surg 1999;37: 154-5

5. Krolls SO, Hicks JL. Mixed tumors of the lower lip.

Oral Surg 1973;35: 212

6. Bernier JL. Mixed tumors of lips. J Oral Surg 1946; 4:

193

7. Waldron CA, el-Mofty SK, Gnepp DR. Tumors of the

intraoral minor salivary glands: A demographic and

histologic study of 426 cases. Oral Surg Oral Med

Pathol 1988;66: 323

8. Owens OT, Calcaterra TC. Salivary gland tumors of

the lip. Arch Otolaryngol 1982;108: 45

9. Neville BW, Damm DD, Weir JC, et al. Labial salivary

gland tumors. Cancer 1988;61:2113

10. Ord RA. Management of Intraoral salivary gland

tumors. Oral Maxillofac Surg Clin North Am

1994;6:499

A. Shrestha et al. Pleomorphic adenoma of the upper lip: A case report

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