title: Polymorphous low grade adenocarcinoma: case series and review of surgical management.
abstract: OBJECTIVE
  The aim of the present study was to review the published data regarding the management of polymorphous low-grade adenocarcinoma (PLGA) and present our experience in the treatment of patients diagnosed with PLGA.
  
  
  METHODS
  We performed a review of the published data of the treatment possibilities for PLGA, and report on a case series of 4 patients diagnosed with palatal PLGA.
  
  
  RESULTS
  The mean age at diagnosis was 61.75 years. All cases were localized on the hard palate. The male/female ratio was 1:3. One patient had an ulcerative painful lump. In correlation with the published data, most of our patients presented initially with a diagnosis that was not conclusive for the presence of PLGA. The most common initial diagnostic findings were adenoid cystic carcinoma and pleomorphic adenoma. The treatment of choice was surgical excision of the tumor with safe margins of 1.5 cm. One patient had a positive cervical lymph node metastasis and underwent an elective neck dissection followed by radiotherapy. Local recurrence was diagnosed in 1 patient 6 years after the surgical management. Most cases were reconstructed using an obturator, except for 1 patient who underwent reconstruction using the temporalis myofascial flap.
  
  
  CONCLUSIONS
  PLGA is a slow-growing, distinct, uncommon neoplasm of the minor salivary glands. Because it is characterized by a diverse morphologic pattern that resembles adenoid cystic carcinoma or pleomorphic adenoma, the initial diagnosis is usually inconclusive. Until a final diagnosis has been made, we believe that the reconstruction possibilities should be mainly obturators to allow a good visualization of the surgical site. The use of microvascular free flaps or rotational flaps should be reserved to patients with clearer pathologic diagnosis.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Medical Center, and Technion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Imad
authors.initials: I
authors.lastname: Abu El-Naaj
authors.forename: Yoav
authors.initials: Y
authors.lastname: Leiser
authors.forename: Amir
authors.initials: A
authors.lastname: Wolff
authors.forename: Micha
authors.initials: M
authors.lastname: Peled
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008949:Adenoma, Pleomorphic / Q000175:diagnosis; D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010157:Palatal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012468:Salivary Gland Neoplasms / Q000175:diagnosis* / Q000601:surgery; D012470:Salivary Glands, Minor / Q000473:pathology* / Q000601:surgery