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Adenoma pleomórfico VS carcinoma ex-adenoma pleomórfico
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Abstract(s)
A cavidade oral humana possui 3 pares de glândulas salivares major, duas parótidas, duas submandibulares e duas sublinguais, e cerca de 600-1000 glândulas salivares minor. As glândulas salivares, por serem responsáveis pela produção de saliva, possuem um importante papel, principalmente na proteção da cavidade oral e manutenção da homeostasia.
As neoplasias das glândulas salivares, ainda que pouco frequentes, podem desenvolver-se. Representam cerca de 2% a 6,5% de todos os tumores da cabeça e pescoço e dividem-se em benignas e malignas.
O Adenoma Pleomórfico (AP) é a neoplasia benigna mais comum das glândulas salivares. Caracteriza-se como uma lesão assintomática. É mais comum no sexo feminino e o pico de incidência do Adenoma Pleomórfico é entre a 4.ª e a 6.ª décadas de vida, contudo, pode desenvolver-se tanto no sexo feminino como no masculino, em qualquer idade. Encontra-se mais frequentemente na glândula parótida (GP), ainda que as glândulas submandibular, sublingual e minor também sejam afectadas, porém, com uma percentagem menor.
O diagnóstico e tratamento adequados são essenciais para o tratamento do Adenoma Pleomórfico, de modo a evitar recorrências ou transformações malignas. Visto que as recorrências são comumente associadas à ruptura da pseudocapsula do tumor, o procedimento cirúrgico é determinante para evitar as mesmas.
A transformação maligna do Adenoma Pleomórfico normalmente ocorre sobre a forma de Carcinoma ex-Adenoma Pleomórfico (Ca-ex-AP). Este é raro e derivado de um Adenoma Pleomórfico preexistente. É mais frequente entre a 6ª e 8ª décadas de vida com uma predilecção para o sexo feminino. É muito semelhante ao Adenoma Pleomórfico ainda que possua características malignas como, por exemplo, necrose ou ulceração. É muito agressivo tendo uma esperança média de vida baixa, pelo que o diagnóstico (ainda que difícil), um interrogatório adequado e um exame físico completo são de elevada importância para diminuir o risco de morbilidade do paciente.
O tratamento do AP e do Ca-ex-AP passa obrigatoriamente pela excisão cirúrgica.
The human oral cavity has 3 pairs of major salivary glands, two parotid glands, two subandibular and two sublingual glands, and about 600-1000 minor salivary glands. The salivary glands play an important role by being responsible for the production of the saliva, mainly in oral cavity protection and maintenance of homeostasis. Although not being very frequent, salivar gland neoplams may occur. It represents about 2% to 6,5% of all head and neck tumors and it’s divided into bening and malignant tumors. The Pleomorphic Adenoma is the most common benign neoplasia of the salivary glands. It is characterized as an asymptomatic lesion. It is more common in females and has an incidence peak between the 4th and the 6th decades of life, however, it can develop in both the female and the male at any age. It is more frequently found in the parotid gland, although the submandibular, sublingual and minor glands are also affected, but in a smaller percentage. Proper diagnosis and treatment are essential for the treatment of Pleomorphic Adenoma in order to avoid malignant recurrences or transformations. Recurrences are usually associated with the rupture of the tumor pseudocapsula, thus, the surgical procedure is determinant to avoid recurrences. The malignant transformation of Pleomorphic Adenoma usually occurs on the form of Carcinoma ex-Pleomorphic Adenoma. This is rare and derived from a preexisting Pleomorphic Adenoma. It is more frequent between the 6th and 8th decades of life with a predilection for the female sex. It is very similar to the Pleomorphic Adenoma although it has malignant characteristics such as, for example, necrosis or ulceration. It is very aggressive with a low average life expectancy so the diagnosis, although difficult, an adequate questioning and a complete physical examination have a great importance to reduce the patient's risk of morbidity. The treatment of Pleomorphic Adenoma and Carcinoma ex-Pleomorphic Adenoma is obligatorily due to surgical excision.
The human oral cavity has 3 pairs of major salivary glands, two parotid glands, two subandibular and two sublingual glands, and about 600-1000 minor salivary glands. The salivary glands play an important role by being responsible for the production of the saliva, mainly in oral cavity protection and maintenance of homeostasis. Although not being very frequent, salivar gland neoplams may occur. It represents about 2% to 6,5% of all head and neck tumors and it’s divided into bening and malignant tumors. The Pleomorphic Adenoma is the most common benign neoplasia of the salivary glands. It is characterized as an asymptomatic lesion. It is more common in females and has an incidence peak between the 4th and the 6th decades of life, however, it can develop in both the female and the male at any age. It is more frequently found in the parotid gland, although the submandibular, sublingual and minor glands are also affected, but in a smaller percentage. Proper diagnosis and treatment are essential for the treatment of Pleomorphic Adenoma in order to avoid malignant recurrences or transformations. Recurrences are usually associated with the rupture of the tumor pseudocapsula, thus, the surgical procedure is determinant to avoid recurrences. The malignant transformation of Pleomorphic Adenoma usually occurs on the form of Carcinoma ex-Pleomorphic Adenoma. This is rare and derived from a preexisting Pleomorphic Adenoma. It is more frequent between the 6th and 8th decades of life with a predilection for the female sex. It is very similar to the Pleomorphic Adenoma although it has malignant characteristics such as, for example, necrosis or ulceration. It is very aggressive with a low average life expectancy so the diagnosis, although difficult, an adequate questioning and a complete physical examination have a great importance to reduce the patient's risk of morbidity. The treatment of Pleomorphic Adenoma and Carcinoma ex-Pleomorphic Adenoma is obligatorily due to surgical excision.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Glândulas salivares Neoplasias Adenoma pleomórfico Carcinoma ex-adenoma pleomórfico