Polymorphous Low Grade Adenocarcinoma: A Case Report

Abstract

Background: Polymorphous low grade adenocarcinoma (PLGA) is a malignancy arising from minor salivary glands. It grows slowly and rarely  metastasises. It presents as a firm, painless mass, rarely ulcerates with predilection in females 50 years or older. PLGA can be mistaken for a  pleomorphic adenoma (PA).

Case Report: A 65-year old female presented with an asymptomatic lump in the buccal area for 3 years. Lump was biopsied a year prior and  identified as PA, at which she was unfit for intervention. She recovered and was discharged. A year later, she reported increase in size of the mass with dull pain and associated feeding difficulties with constitutional symptoms. Medical history include multiplesclerosis, controlled asthma ,
hypothyroidism and on multiple drugs and prophylactic antibiotics. She ceased smoking a year prior with no alcohol intake. Examination findings  revealed performance and ASA score of IV, and a right, firm, tender fixed buccal mucosa mass measuring over 4cm in diameter, with irregular margins. Biopsy showed PLGA with perineural but no vascular invasion. CT and Ultrasound scan yielded T3N0M0.A low posterior partial  maxillectomy and temporalis local flap was performed she is on close surveillance.

Conclusion: Multidisciplinary approach is vital in diagnosis and management of oral malignancies. Higher index of suspicion is needed concerning malignancies with the potential to be misdiagnosed. PLGA is frequently misdiagnosed as PA, especially with limited resources. Cellular atypia and invasion are useful in distinguishing it from its mimicker. Recurrence is rare and prognosis is excellent. Awareness may bring about appropriate management of PLGA.