Clinicopathologic characteristics and prognostic factors of primary and recurrent pleomorphic adenoma a single institution retrospective study of 705 cases

Bayan Alzumaili, Bin Xu, Maelle Saliba, Abderhman Abuhashem, Ian Ganly, Ronald Ghossein, Nora Katabi

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1 Scopus citations

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.

Original languageEnglish
JournalAmerican Journal of Surgical Pathology
DOIs
StateAccepted/In press - 2021
Externally publishedYes

Keywords

  • Pleomorphic adenoma
  • Radiotherapy
  • Recurrent

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