Pleomorphic Adenoma of

parotid gland
Benign: Pleomorphic Adenoma,
Malignant: carcinoma ex pleomorphic
adenoma
 Pleomorphic adenoma consists of
mixed epithelial (left) and mesenchymal
cell components(right)
• This is the commonest tumor of salivary
glands and commonly occurs in parotid.
• They are benign tumors derived from
mixture of epithelial (ductal epithelium) and
myoepithelial cells and therefore show both
epithelial and mesenchymal differentiation
• It is somewhat commoner in females,
presenting in fourth to sixth decades.
• Patients present with a small, firm, freely
movable, painless swelling which slowly
increases in size.
• Patient has complaints of difficulty in
mastication, talking and breathing so is
detected early.
•Being radioresistant these tumors have to
be surgically resected. They have a
tendency to recur after excision.
•Benign pleomorphic adenomas have 3 to
15% chances of malignant
transformation. The incidence of
malignant transformation increases
with duration of tumor.
•The malignant tumor is called as
carcinoma ex pleomorphic adenoma.
They are highly aggressive and show
high mortality rates.
 GROSS APPEARANCE
• The tumor is well circumscribed
psuedoencapsulated, rounded multilobulated,
firm mass rarely exceeding 6cm in greatest
dimension.
• Although they are encapsulated at some
locations the capsule is not fully developed
(psuedoencapsulated) giving protrusions in
surrounding gland rendering enucleation
hazardous.
• The cut surface is gray white with myxoid and
blue translucent areas of chondroid.
 Histopathology
• The diverse histologic pattern is in
fact the characteristic feature of this
neoplasm.
• Inside fibrous capsule some areas
have cuboidal cells arranged in tubes
or ductlike structures or strands or
sheets of cells.
• These elements are typically
dispersed in a mesenchyme like
background of loose myxoid
connective tissue stroma containing
islands of chondroid tissue .
• Sometimes well developed ducts
lined by cuboidal to columnar cells
with an underlying layer of deeply
chromatic small myoepithelial cells
are seen.
• Loose myxoid tissue is predominant
feature while foci of hyalinised
connective tissue or cartilage like
material and even bone may occur.
• Islands of well differentiated squamous
epithelium may also occur.
• Sometimes tumor cells assume a stellate,
polyhedral or spindle form.
• In most cases there is no epithelial
dysplasia or mitotic activity.
Epithelial elements

Myxoid tissue
Biphasic appearance resulting from the admixture of epithelium & stroma.
 epithelium

myxoid
stroma

(20X) 】 Epithelial
component. 　
 Epithelial proliferation

(20X) 】 Epithelial component.

 DUCT

(40X) 】 Glandular (ductal) component.

 Epithelium

stroma