Surgical management of pleomorphic adenoma of parotid gland inelderly patients: Role of morphological features

The neoplasms of the salivary glands account for 2% of head and neck tumors and the most commonform is the pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly thesetumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cellsthat are arranged with various morphological patterns and subtypes. The classification of these tumors isalso based on the amount and nature of the stroma. In literature there is an almost complete consensusthat, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called “capsule” butthere is disagreement about the form, extension and thickness of this layer. The treatment is surgical andthere are two main different surgical approaches: an enucleation (local dissection) or so-called subtotalsuperficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristicsof PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration,satellite nodules and pseudopodia in the different subtypes are important for the choice ofsurgical treatment and the first explanation for tumor recurrence. In our study we describe a morphologicalfeatures of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by asurgical “enucleation like” method called nucleoresection.