Reem Ahmed, Prateek Biyani, Cristina Frezzini
Polymorphous Low Grade Adenocarcinomas (PLGA) were first described in 1983 by Freedman and Lunderman as a rare histological entity. Histological appearance can vary from tubular, papillary, cribriform or pseudoadenoid cystic with infiltrative boarders and varying growth rates. Historically, they have been characterised as indolent tumours of the minor salivary glands, with a predominance of presentation in the palate, and little tendency for regional lymph node metastasis (6-10%). Although they can present in the mouth, no cases have been reported of tumour extension across multiple intraoral sites.
We present a case of an 88-year-old male that was referred with a 5 months history of a mass bulging through the soft tissues of the left cheek. Histological and CT investigations confirmed the diagnosis of a predominantly cribriform polymorphous low grade adenocarcinoma extending from the retromolar trigone anteriorly to the buccal tissues, with masseter infiltration. Although surgical excision is the treatment of choice for these tumours, the patient’s multiple co-morbidities precluded this treatment modality. The patient continues to be monitored, giving our team an insight into the biological behaviour of this lesion.
Polymorphous low grade adenocarcinomas pose a diagnostic dilemma due to the varying histopathological appearance. Although complete resection has been proven to be the treatment of choice, this may not be possible in all cases. We present a case of PLGA and review the literature in relation to our patient’s clinical presentation.