Indian J Surg DOI 10.1007/s12262-013-1010-5
CASE REPORT
Basal Cell Adenoma of the Parotid Gland—A Rare Entity Viswanathan Rajasenthil & Annamalai Ravi
Received: 10 October 2013 / Accepted: 15 November 2013 # Association of Surgeons of India 2013
Abstract Salivary gland tumors are uncommon and constitute about 2.0 to 6.5 % of all head and neck tumors. Incidence of basal cell adenoma is about 1 to 3 % of salivary gland tumors. We present a rare case of basal cell adenoma of the parotid and a review of literature.
Keywords Basal cell adenoma . Basaloid cells . Monomorphic adenoma . Parotid gland
Introduction A 50-year-old male came to the outpatient department with complaints of painless swelling in the region of the parotid for 2 years, insidious in onset. There was no history of any other swellings in the neck and facial nerve palsy. On examination, there was a 4×3-cm well-defined mobile swelling in the right parotid region. The surface is smooth and firm in consistency. MR Sialogram There were two well-defined vertically placed mass in the superficial part of the right parotid. Few hemorrhagic areas were seen in the lesion (Fig. 1).
V. Rajasenthil : A. Ravi Department of General Surgery, Sri Ramachandra University, Chennai, India A. Ravi e-mail: [email protected] V. Rajasenthil (*) Plot no 4 f. Nehru Street, Maruthi Nagar, Thundalam, Chennai 77, India e-mail: [email protected]
Surgery The patient underwent right superficial conservative parotidectomy. A frozen section revealed a benign lesion. The postoperative period was uneventful. Biopsy The biopsy showed monomorphic adenoma–basal cell adenoma. The surgical margins are free of tumor.
Discussion Salivary gland tumors are uncommon and constitute 2.0 to 6.5 % of all head and neck tumors. Basal cell adenoma (BCA) accounts for only 1 to 2 % of all salivary gland tumors and demonstrates a female predominance of 2:1, occurring commonly in the fifth decades of life [1]. The parotid gland is the dominant site of occurrence of the basal cell adenoma (75 %), followed by the minor salivary gland from the upper lip with 6 %, and submandibular gland with 5 % [2, 3]. Basal cell adenoma is classified as a subtype of monomorphic adenomas, which were first described as a distinct clinical and pathologic entity by Kleinsasser and Klein in 1967. The World Health Organization (WHO) defined basal cell adenoma as a benign neoplasm composed chiefly of basaloid cells with a prominent basal cell layer and distinct basement membranelike structure with no myxochondroid stromal component (Fig. 2) [4]. However, basal cells are found in various primary salivary gland tumors either as a component of the tumor or as pure basal cell neoplasms. The common clinical feature of basal cell adenoma is a slow growing, asymptomatic, freely mobile parotid swelling. Basal cell adenomas are round or oval in shape and smaller in size, usually less than 3 cm. On a cut section, they are uniform and solid, without necrosis. They can have characteristic numerous endothelial lined vascular channels, in which small capillaries and venules are prominent within the microcystic areas of the adenoma. These vascular structures can cause intratumoral hemorrhage which makes them into a cystic swelling [5].
Indian J Surg
BCA tumors have been histopathologically classified into solid (monomorphic), trabecular, tubular, and membranous types . The membranous type is multifocal, with a multinodular growth pattern, and recurrences are common (24 %) [6]. The recurrence rate for the solid and trabecular–tubular variants is nil. Malignant transformation is more common in the membranous type which is about 4.3 % [7]. Basal cell adenocarcinoma has similar histological features, but there is infiltration into adjacent structures. The other differential diagnosis is adenoid cystic carcinoma which lacks vascularity compared to basal cell adenoma, and there is perineural invasion. Basal cell adenoma can be occasionally associated with multiple synchronous dermal cylindromas, epitheliomas, and spiroadenomas. The Brooke–Spiegler syndrome is a synchronous basal cell adenoma of the salivary gland with multiple cutaneous adnexal tumors [8].
Conclusion
Fig. 1 MR sialogram showing vertically placed masses in the parotid
Fig. 2 Basal cell adenoma— basaloid cells (×100)
Basal cell adenomas are rare salivary gland tumors with good prognosis with incidence of less than 3 % of salivary gland tumors. This entity should be kept in mind in the management of salivary gland tumors.
Indian J Surg
References 1. Raul Gonzalez G, Nam Cha SH, Mario F G, C Gamallo A (2006) Basal cell adenoma of the parotid gland: case report and review of literature. Med Oral Pathol Oral Cir Bucal 11:E 206–E 209 2. Gnepp DR, Henley JD (2000) Salivary and lacrimal glands. In: Gnepp DR (ed) Diagnostic surgical pathology of the head and neck, 1st edn. Saunders, Philadelphia, pp 325–430 3. Nai-Chi C, Hsiu-Mei W, Yi-Hong C et al (2007) Basal cell adenoma versus pleomorphic adenoma of the parotid gland. Am J Roentgenol 189(5):W 254–W 261
4. Jang M, Park D, Lee SR et al (2004) Basal cell adenoma in the parotid gland: CT and MR findings. Am J Neuroradiol 25:631–635 5. Jeong AK, Lee HK, Kim SY, Cho KJ (2001) Basal cell adenoma in the parapharyngeal space: MR findings. Clin Imaging 25:392–395 6. Veeresh M, Radhika M, Bable et al (2010) Basal cell adenoma of submandibular gland. J Maxillo Facillo Oral Surg 9:289–291 7. Nagao T, Suzano I, Ishida Y, Matsuzaki O, Konno A et al (1997) Incidence of malignant transformation from basal cell adenoma to basal cell adenocarcinoma. Pathol Res Pract 193(3):171–178 8. Roberto Adrian R, Stengel F, Saadi ME et al (2007) Brooke–Spiegler syndrome—report of four families: treatment with carbon dioxide laser. Int J Dermatol 46:583–586
CASE REPORT
Basal Cell Adenoma of the Parotid Gland—A Rare Entity Viswanathan Rajasenthil & Annamalai Ravi
Received: 10 October 2013 / Accepted: 15 November 2013 # Association of Surgeons of India 2013
Abstract Salivary gland tumors are uncommon and constitute about 2.0 to 6.5 % of all head and neck tumors. Incidence of basal cell adenoma is about 1 to 3 % of salivary gland tumors. We present a rare case of basal cell adenoma of the parotid and a review of literature.
Keywords Basal cell adenoma . Basaloid cells . Monomorphic adenoma . Parotid gland
Introduction A 50-year-old male came to the outpatient department with complaints of painless swelling in the region of the parotid for 2 years, insidious in onset. There was no history of any other swellings in the neck and facial nerve palsy. On examination, there was a 4×3-cm well-defined mobile swelling in the right parotid region. The surface is smooth and firm in consistency. MR Sialogram There were two well-defined vertically placed mass in the superficial part of the right parotid. Few hemorrhagic areas were seen in the lesion (Fig. 1).
V. Rajasenthil : A. Ravi Department of General Surgery, Sri Ramachandra University, Chennai, India A. Ravi e-mail: [email protected] V. Rajasenthil (*) Plot no 4 f. Nehru Street, Maruthi Nagar, Thundalam, Chennai 77, India e-mail: [email protected]
Surgery The patient underwent right superficial conservative parotidectomy. A frozen section revealed a benign lesion. The postoperative period was uneventful. Biopsy The biopsy showed monomorphic adenoma–basal cell adenoma. The surgical margins are free of tumor.
Discussion Salivary gland tumors are uncommon and constitute 2.0 to 6.5 % of all head and neck tumors. Basal cell adenoma (BCA) accounts for only 1 to 2 % of all salivary gland tumors and demonstrates a female predominance of 2:1, occurring commonly in the fifth decades of life [1]. The parotid gland is the dominant site of occurrence of the basal cell adenoma (75 %), followed by the minor salivary gland from the upper lip with 6 %, and submandibular gland with 5 % [2, 3]. Basal cell adenoma is classified as a subtype of monomorphic adenomas, which were first described as a distinct clinical and pathologic entity by Kleinsasser and Klein in 1967. The World Health Organization (WHO) defined basal cell adenoma as a benign neoplasm composed chiefly of basaloid cells with a prominent basal cell layer and distinct basement membranelike structure with no myxochondroid stromal component (Fig. 2) [4]. However, basal cells are found in various primary salivary gland tumors either as a component of the tumor or as pure basal cell neoplasms. The common clinical feature of basal cell adenoma is a slow growing, asymptomatic, freely mobile parotid swelling. Basal cell adenomas are round or oval in shape and smaller in size, usually less than 3 cm. On a cut section, they are uniform and solid, without necrosis. They can have characteristic numerous endothelial lined vascular channels, in which small capillaries and venules are prominent within the microcystic areas of the adenoma. These vascular structures can cause intratumoral hemorrhage which makes them into a cystic swelling [5].
Indian J Surg
BCA tumors have been histopathologically classified into solid (monomorphic), trabecular, tubular, and membranous types . The membranous type is multifocal, with a multinodular growth pattern, and recurrences are common (24 %) [6]. The recurrence rate for the solid and trabecular–tubular variants is nil. Malignant transformation is more common in the membranous type which is about 4.3 % [7]. Basal cell adenocarcinoma has similar histological features, but there is infiltration into adjacent structures. The other differential diagnosis is adenoid cystic carcinoma which lacks vascularity compared to basal cell adenoma, and there is perineural invasion. Basal cell adenoma can be occasionally associated with multiple synchronous dermal cylindromas, epitheliomas, and spiroadenomas. The Brooke–Spiegler syndrome is a synchronous basal cell adenoma of the salivary gland with multiple cutaneous adnexal tumors [8].
Conclusion
Fig. 1 MR sialogram showing vertically placed masses in the parotid
Fig. 2 Basal cell adenoma— basaloid cells (×100)
Basal cell adenomas are rare salivary gland tumors with good prognosis with incidence of less than 3 % of salivary gland tumors. This entity should be kept in mind in the management of salivary gland tumors.
Indian J Surg
References 1. Raul Gonzalez G, Nam Cha SH, Mario F G, C Gamallo A (2006) Basal cell adenoma of the parotid gland: case report and review of literature. Med Oral Pathol Oral Cir Bucal 11:E 206–E 209 2. Gnepp DR, Henley JD (2000) Salivary and lacrimal glands. In: Gnepp DR (ed) Diagnostic surgical pathology of the head and neck, 1st edn. Saunders, Philadelphia, pp 325–430 3. Nai-Chi C, Hsiu-Mei W, Yi-Hong C et al (2007) Basal cell adenoma versus pleomorphic adenoma of the parotid gland. Am J Roentgenol 189(5):W 254–W 261
4. Jang M, Park D, Lee SR et al (2004) Basal cell adenoma in the parotid gland: CT and MR findings. Am J Neuroradiol 25:631–635 5. Jeong AK, Lee HK, Kim SY, Cho KJ (2001) Basal cell adenoma in the parapharyngeal space: MR findings. Clin Imaging 25:392–395 6. Veeresh M, Radhika M, Bable et al (2010) Basal cell adenoma of submandibular gland. J Maxillo Facillo Oral Surg 9:289–291 7. Nagao T, Suzano I, Ishida Y, Matsuzaki O, Konno A et al (1997) Incidence of malignant transformation from basal cell adenoma to basal cell adenocarcinoma. Pathol Res Pract 193(3):171–178 8. Roberto Adrian R, Stengel F, Saadi ME et al (2007) Brooke–Spiegler syndrome—report of four families: treatment with carbon dioxide laser. Int J Dermatol 46:583–586
