Pleomorphic adenoma palate: Major tumor in a minor gland
A 45-year-old female presented with a slow growing swelling, of approximately 20 years duration involving her hard and soft palate junction on the left side, which was peanut sized when she first observed. The lesion always had been asymptomatic, with no associated pain or paresthesia. The patient's medical history was noncontributory. She had no known allergies and had not undergone any surgeries of head and neck. She had no complaints of pharyngeal or airway obstruction. General physical examination revealed a well oriented and moderately built individual with no signs of any systemic illness. The patient presented a typical ‘hot potato in mouth’ speech. The clinical examination revealed nonulcerated, dome-shaped, palatal swelling on her hard and soft palate junction, crossing the midline []. The mass had a bosselated surface and overlying mucosa was cherry red and stretched. The lesion was multinodular, firm, and nontender on palpation. Magnetic resonance imaging (MRI) report revealed a well-defined, multilobulated mass measuring 3.2 × 5.5 × 6.3 cm Antero-Posterior × Transverse × Cranio-Caudal (AP × TR × CC) and is hypointense on T1W1 and heterogeneously hyperintense on T2W1 with multiple well-defined areas of low cellularity within. The mass had well-enhanced soft tissue density without any invasion to adjacent tissues, displacing posterior third of the tongue downward [].\nFNA biopsy was performed, which was suggestive of PA. All preoperative blood and urine investigations were done, which were within normal limits. The patient was intubated through endotracheal tube by fiber-optic guidance and was operated for wide local excision of the mass and primary closure of adjacent mucosa. The excised mass was 7 × 6 cm []. Following excision of tumor, surgical wound [] was closed in layers in a tension-free water tight fashion []. The excised mass was sent for histopathological examination, which revealed stratified squamous epithelium covering connective tissue and underlying connective tissue showed the cells arranged in sheets and duct-like pattern with a mucoid background []. This was confirmatory of PA. The specimen was weighed 95g []. The patient's postoperative course was uneventful. The healing was satisfactory. No recurrence was observed after a follow-up period of 1 year [].