Perineural Involvement in Benign Mixed Tumor

Se Jin Jung; Jong Cheol Lee; Hye Jeong Choi; Hee Jeong Cha; Young Min Kim; Young Wha Koh; Jae Hee Suh

doi:10.4132/KoreanJPathol.2013.47.5.403

Articles

Page Path: HOME > J Pathol Transl Med > Volume 47(5); 2013 > Article

Letter to the Editor Perineural Involvement in Benign Mixed Tumor: Se Jin Jung, Jong Cheol Lee¹, Hye Jeong Choi, Hee Jeong Cha, Young Min Kim, Young Wha Koh, Jae Hee Suh; Korean Journal of Pathology 2013;47(5):403-404.
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.403
Published online: October 25, 2013

Department of Pathology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.

¹Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.

Corresponding Author: Jae Hee Suh, M.D. Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 682-714, Korea. Tel: +82-52-250-7263, Fax: +82-52-252-3024, 'drjhs@uuh.ulsan.kr'

• Received: July 4, 2013 • Revised: September 13, 2013 • Accepted: September 24, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

5,368 Views
40 Download
2 Crossref
1 Scopus

Full Article

Download PDF

Notes
References

Perineural invasion is a diagnostic clue of malignancy and may be indicative of a poor prognosis. Perineural involvement of a benign tumor is diagnostically confusing, however, and should not be considered a malignant feature. We report a case of benign mixed tumor of the salivary gland with two foci of perineural involvement. A 31-year-old man complained of a right parotid mass which had been present for three months. He had no relevant medical history. On physical examination, there was a movable, round mass that was not accompanied by tenderness or redness. Computed tomography revealed an ovoid mass in the deep lobe of the right parotid gland with strong, early, heterogeneous enhancement. There was no evidence of tumor invasion into the surrounding tissue. Right parotidectomy was carried out; the specimen was a well-demarcated, firm, ovoid mass (2.5×2.0×1.5 cm). Grossly, the mass was grayish-tan and solid, with multifocal hemorrhages. Microscopic findings were those of a typical benign mixed tumor of the salivary gland, consisting of mixed epithelial and myoepithelial cells with chondromyxoid stroma. No lymphovascular invasion was identified. Interestingly, two foci of small tumor cell nests were present around and within nerve twigs, which were located in the subcapsular space and the fibrous tumor capsule (Fig. 1). Five months after the operation, neither recurrence nor metastasis was evident on follow-up examination. Perineural invasion is an important pathologic feature of malignancy and is related to poor outcome. However, certain benign neoplasms and reactive conditions can reveal perineural involvement. Mixed tumor is the most common type of salivary gland tumors and, in most patients, is benign, except for rare secondary malignant transformation. Typical features of malignancy are infiltrative growth, nuclear pleomorphism, atypical mitosis, necrosis, and lymphovascular or perineural invasion. The presented case had perineural involvement of benign tumor cells; otherwise it exhibited characteristics of a benign mixed tumor. The important thing to consider here is the significance of perineural involvement in the biologic behavior of the tumor. Perineural involvement of benign lesions has been documented not only in the head and neck, but also in other sites. Benign mammary glandular deposits in nerves were first described by Ali and Epstein1 and other cases of benign tumor deposits of the breast, prostate, pancreas, gallbladder, endometrium, and skin have been reported in the literature. There have been no reported cases of benign mixed tumor of salivary gland with perineural involvement in Korea. Although the cause and mechanism of perineural involvement cannot be clearly defined, Skidmore et al.2 suggested a mechanical stress origin for perineural involvement of benign tumors, but theories regarding the mechanism of its development have yet to be proven. In the present case, fine needle aspiration was performed on the tumor a month prior to the operation, which may be a potential cause of mechanical stress. In conclusion, a histologically-benign mixed tumor of the salivary gland with perineural involvement should not be diagnosed as a malignant tumor without other evidence of malignancy.

Notes

No potential conflict of interest relevant to this article was reported.

References

1. Ali TZ, Epstein JI. Perineural involvement by benign prostatic glands on needle biopsy. Am J Surg Pathol 2005; 29: 1159–1163. PMID: 16096404. Article PubMed
2. Skidmore RA, Woosley JT, Tomsick RS. Renaut bodies: benign disease process mimicking neurotropic tumor infiltration. Dermatol Surg 1996; 22: 969–971. PMID: 9063513. Article PubMed

Fig. 1

Histologic findings. Two peripheral nerve twigs with perineural (A) and neural (B) tumor involvement in the subcapsular space and the fibrous tumor capsule.

Figure & Data

References

Citations

Citations to this article as recorded by

Benign Pleomorphic Adenoma in the Facial Nerve
Gemma E. Hogg, Richard A. Steven, Patrick M. Spielmann
Ear, Nose & Throat Journal.2020; 99(6): 361. CrossRef
Benign pleomorphic adenoma of minor salivary gland showing perineural invasion: a rare entity
Rahul Jayaram, Dipen Patel, Vijay Santhanam
British Journal of Oral and Maxillofacial Surgery.2015; 53(1): 81. CrossRef

PubReader
ePub Link

Cite this Article

Cite this Article: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Perineural Involvement in Benign Mixed Tumor

Korean J Pathol. 2013;47(5):403-404. Published online October 25, 2013

DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.403

XML Download

Figure