Trans-oral resection of Nasopharyngeal Pleomorphic Adenoma : a case report

Abstract

Introduction: Around 80% of all salivary gland tumours are pleomorphic adenomas, most commonly found in the parotid gland. This case report regards the rare finding of a pleomorphic adenoma in the nasopharynx.

Case Presentation: a 29 year old lady presented to the ENT department with a 4 month history of worsesning and non-resolving nasal obstruction, change in voice, snoring and right aural congestion. A smooth mass pushing the uvula forward was seen on oral examination, and flexible nasoendoscopy revealed an exophytic mass from the right nasopharynx. CT and MRI showed a non-erosive mass in the right nasopharynx. Incisional biopsy was carried out which showed features of pleomorphic adenoma. Lesion was excised using transoral technique to remove the tumour with an intact capsule.

Literature Review and Discussion: A PubMed search found only 12 previously reported cases of pleomorphic adenoma from 1970 to 2015. The treatment of choice was surgical in all cases, one case reports the use of radiotherapy, without affect. The trans-oral technique used in this case ensured that the tumour was removed with the surrounding capsule intact, thus reducing risk of recurrence.

Conclusion: This is the first reported case of nasopharyngeal pleomorphic adenoma from Malta. Diagnosis was made by the triple assessment – examination, radiology and histology. The tumour was excised completely and the plan is for the patient to have regular follow up.