Why is simple enucleation of a pleomorphic adenoma of the parotid gland considered inadequate treatment?

• A The tumour lacks any capsule and always infiltrates surrounding fat
• B Enucleation invariably injures the facial nerve trunk
• C Tumour cell extensions beyond the capsule form satellite nodules, leaving residual disease behind ✓
• D The tumour is radiosensitive, so enucleation adds no benefit

Explanation

Although a pleomorphic adenoma appears encapsulated, the capsule is incomplete and tumour cell processes extend through it as pseudopodia, producing microscopic satellite nodules in apparently normal gland tissue. Enucleation shells out along the false capsule and leaves these nodules behind, giving recurrence rates up to 20 percent, hence formal superficial or total parotidectomy is preferred. Enucleation does not inherently damage the facial nerve, and the tumour is radioresistant.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.