Adenocarcinoma polimorfo de paladar blando

Abstract

Introduction: Salivary gland tumors constitute about 3% of tumors of the head and neck. More infrequent are malignant epithelial tumors, which account for less than 20% of salivary gland tumors. In particular, low-grade polymorphous adenocarcinoma is very rare and occurs almost exclusively in the area of minor salivary glands. Clinical case: A 89-year-old patient who was admitted to the Emergency Department due to a tumor on the soft palate that had been growing for months and bleeding in the last few days. On examination, a large excrecent tumor was seen at the level of the right oropharynx that appeared to be implanted in the upper pole of the right tonsil and soft palate; no palpable cervical masses. CT scan with contrast of the neck was performed, showing solid nodular excrescence of 22x22 mm, depending on the soft palate and right lateral wall of the oropharynx, with mild and heterogeneous contrast uptake, lobulated and slightly irregular contours; no cervical pathological adenopathies. The biopsy of the tumor revelated a low-grade salivary glandular carcinoma. Surgical treatment was performed by intraoral resection of the tumor. The histological study of the piece reveals an infiltrating polymorphous adenocarcinoma with areas of ulceration on the surface, 2.1x0.8 cm, with free surgical margins. Follow-up at 9 months didn´t showed local or regional recurrence. Discussion: Low-grade polymorphous adenocarcinoma was described for the first time in 1983. It is located on the hard or soft palate. It is more common in adults between the sixth and eighth decade of life and predominates in women. Although it is a slow-growing tumor, it can erode or infiltrate the adjacent bone. The treatment of choice is surgical resection. Metastases to regional lymph nodes occur in only 10% of cases, so neck dissection is not justified unless there are pathological lymphadenopathies at the time of diagnosis. The prognosis is good, with recurrence rates of 17-24%.