{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T13:41:08Z","timestamp":1770990068219,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T00:00:00Z","timestamp":1640649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The aim of this study was to investigate the histopathologic findings in parotid and parapharyngeal pleomorphic adenomas and draw conclusions concerning the surgical strategy. Methods: Retrospective study of medical charts of patients with resected pleomorphic adenomas (PA) between 2005 and 2020 at two tertiary medical referral centers. Histologic specimens were reexamined by an experienced head and neck pathologist. Patients with insufficient\/incomplete data were excluded from our study sample. Results: A total of 844 patients formed our study sample (291 men, 553 women, average age 48.9 years); 786 cases had a PA in the parotid gland (PG) (93.1%), and the remaining 58 cases had a PA in the parapharyngeal space (PS) (6.9%). Recurrences were detected in 8\/844 cases (7\/786 in the PG, 1\/58 in the PS, 0.94% in total) with a mean follow-up time of 86.7 months (10\u2013189 months) with no statistically significant differences between the study groups (p = 0.527). Our analysis showed that parapharyngeal pleomorphic adenomas are characterized by a lower incidence of an intact anatomical capsule (71.4% vs. 82.6%, p = 0.035) and a remarkably more frequent occurrence of satellite nodules (20.7% vs. 7.5%, p &lt; 0.001). Conclusions: The more challenging histopathologic profile of parapharyngeal pleomorphic adenomas points towards the fact that parapharyngeal surgery should remain in the hands of experienced surgeons at high-volume centers.<\/jats:p>","DOI":"10.3390\/jcm11010142","type":"journal-article","created":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T01:18:15Z","timestamp":1640654295000},"page":"142","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pleomorphic Adenoma of the Parotid Gland and the Parapharyngeal Space: Two Diametrically Opposing Surgical Philosophies for the Same Histopathologic Entity?"],"prefix":"10.3390","volume":"11","author":[{"given":"Benita","family":"Hornung","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jannis","family":"Constantinidis","sequence":"additional","affiliation":[{"name":"1st Deparment of ORL, Head & Neck Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7631-7336","authenticated-orcid":false,"given":"Vivian","family":"Thimsen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0445-8161","authenticated-orcid":false,"given":"Abbas","family":"Agaimy","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7838-6490","authenticated-orcid":false,"given":"Michael","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9448-1882","authenticated-orcid":false,"given":"Antoniu-Oreste","family":"Gostian","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matti","family":"Sievert","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5790-0841","authenticated-orcid":false,"given":"Sarina","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinrich","family":"Iro","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4948-8882","authenticated-orcid":false,"given":"Konstantinos","family":"Mantsopoulos","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3389\/fsurg.2017.00026","article-title":"Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables","volume":"4","author":"Dulguerov","year":"2017","journal-title":"Front. Surg."},{"key":"ref_2","first-page":"415","article-title":"A pathological classification of pleomorphic adenoma of the salivary glands (author\u2019s transl)","volume":"24","author":"Seifert","year":"1976","journal-title":"HNO"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1002\/hed.10281","article-title":"A histological comparison of deep and superficial lobe pleomorphic adenomas of the parotid gland","volume":"25","author":"Harney","year":"2003","journal-title":"Head Neck"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1002\/hed.20569","article-title":"Pleomorphic adenoma of the parotid gland: Histopathologic analysis of the capsular characteristics of 218 tumors","volume":"29","author":"Zbaren","year":"2007","journal-title":"Head Neck"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"105218","DOI":"10.1016\/j.oraloncology.2021.105218","article-title":"Satellite nodules in pleomorphic adenomas of the parotid gland: A nightmare for less invasive parotid surgery?","volume":"115","author":"Iro","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mantsopoulos, K., Iro, A.K., Sievert, M., Muller, S.K., Agaimy, A., Schapher, M., Koch, M., and Iro, H. (2021). Is extracapsular dissection for pleomorphic adenoma rather a euphemism for enucleation that jeopardises the intactness of the capsule?. Br. J. Oral Maxillofac. Surg.","DOI":"10.1016\/j.bjoms.2021.03.002"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mantsopoulos, K., Sievert, M., Iro, A.K., Muller, S.K., Koch, M., Schapher, M., Agaimy, A., and Iro, H. (2021). Histopathological comparison of pleomorphic adenomas of the parotid and submandibular gland. Oral Dis.","DOI":"10.1111\/odi.13858"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"104986","DOI":"10.1016\/j.oraloncology.2020.104986","article-title":"Tumour spillage of the pleomorphic adenoma of the parotid gland: A proposal for intraoperative measures","volume":"112","author":"Mantsopoulos","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_9","unstructured":"Buchta, P., Thimsen, V., Iro, A.K., Agaimy, A., Iro, H., and Mantsopoulos, K. (2021). The influence of the capsular defect as a risk factor for recurrence in pleomorphic adenoma. Laryngo Rhino Otol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1002\/hed.26137","article-title":"Natural history of recurrent pleomorphic adenoma: Implications on management","volume":"42","author":"Valstar","year":"2020","journal-title":"Head Neck"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Carlson, R.E., and Ord, R.A. (2021). Salivary Gland Pathology, Diagnosis and Management, John Wiley & Sons.","DOI":"10.1002\/9781119730248"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1007\/s00405-011-1855-9","article-title":"Extracapsular dissection for minimal resection of benign parapharyngeal tumor","volume":"269","author":"Yang","year":"2012","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Horowitz, G., Ben-Ari, O., Wasserzug, O., Weizman, N., Yehuda, M., and Fliss, D.M. (2014). The transcervical approach for parapharyngeal space pleomorphic adenomas: Indications and technique. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0090210"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1007\/s00405-016-4253-5","article-title":"Pleomorphic adenomas of the salivary glands: Retrospective multicentric study of 130 cases with emphasis on histopathological features","volume":"274","author":"Lopes","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.bjoms.2017.05.013","article-title":"Extracapsular dissection in the parapharyngeal space: Benefits and potential pitfalls","volume":"55","author":"Mantsopoulos","year":"2017","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1002\/lary.20496","article-title":"Parapharyngeal space pleomorphic adenoma: A 30-year review","volume":"119","author":"Mendelsohn","year":"2009","journal-title":"Laryngoscope"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/01.mlg.0000200741.37460.ea","article-title":"Parotidectomy for benign parotid disease at a university teaching hospital: Outcome of 963 operations","volume":"116","author":"Klussmann","year":"2006","journal-title":"Laryngoscope"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/j.joms.2004.01.025","article-title":"Results of extracapsular dissection of pleomorphic adenoma of parotid gland","volume":"62","author":"Piekarski","year":"2004","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"104872","DOI":"10.1016\/j.oraloncology.2020.104872","article-title":"Selection of the surgical approach for lesions with parapharyngeal space involvement: A single-center experience on 153 cases","volume":"109","author":"Lombardi","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/MOO.0000000000000134","article-title":"Recent advances in surgical management of parapharyngeal space tumors","volume":"23","author":"Paderno","year":"2015","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Fermi, M., Serafini, E., Ferri, G., Alicandri-Ciufelli, M., Presutti, L., and Mattioli, F. (2021). Management of parapharyngeal space tumors with transparotid-transcervical approach: Analysis of prognostic factors related with disease-control and functional outcomes. Eur. Arch. Otorhinolaryngol.","DOI":"10.1007\/s00405-021-07074-z"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.oraloncology.2014.02.007","article-title":"A systematic review of 1143 parapharyngeal space tumors reported over 20 years","volume":"50","author":"Riffat","year":"2014","journal-title":"Oral Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.amjsurg.2012.05.026","article-title":"Pleomorphic adenoma of the parotid: Formal parotidectomy or limited surgery?","volume":"205","author":"Zbaren","year":"2013","journal-title":"Am. J. Surg."},{"key":"ref_24","unstructured":"Grant, J. (1972). An Atlas of Anatomy, Williams & Wilkins. [6th ed.]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1002\/bjs.18004418605","article-title":"The pathological anatomy and treatment of parotid tumours with retropharyngeal extension (dumb-bell tumours); with a report of 4 personal cases","volume":"44","author":"Patey","year":"1957","journal-title":"Br. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1097\/00005537-200112000-00024","article-title":"Histopathology of pleomorphic adenoma in the parotid gland: A prospective unselected series of 100 cases","volume":"111","author":"Stennert","year":"2001","journal-title":"Laryngoscope"},{"key":"ref_27","unstructured":"Cotran, R.S., Kumar, V., and Collins, T. (1998). Robbins\u2019 Pathologic Basis of Disease, Saunders. [6th ed.]."},{"key":"ref_28","unstructured":"Evans, R.W., and Cruickshanks, A.H. (1970). Epithelial Tumours of the Salivary Glands, Saunders."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1177\/000348946507400403","article-title":"Mixed tumors of major salivary glands: Prognostic role of capsular structure","volume":"74","author":"Eneroth","year":"1965","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/lary.29726","article-title":"Histopathology of Parotid Pleomorphic Adenomas: A \u201cPleomorphic Approach\u201d to a Demanding Lesion","volume":"132","author":"Mantsopoulos","year":"2022","journal-title":"Laryngoscope"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cancergencyto.2007.04.006","article-title":"Heterogeneity of PLAG1 gene rearrangements in pleomorphic adenoma","volume":"177","author":"Kandasamy","year":"2007","journal-title":"Cancer Genet. Cytogenet"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Agaimy, A., Ihrler, S., Baneckova, M., Costes Martineau, V., Mantsopoulos, K., Hartmann, A., Iro, H., Stoehr, R., and Skalova, A. (2021). HMGA2-WIF1 Rearrangements Characterize a Distinctive Subset of Salivary Pleomorphic Adenomas With Prominent Trabecular (Canalicular Adenoma-like) Morphology. Am. J. Surg. Pathol.","DOI":"10.1097\/PAS.0000000000001783"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s12105-014-0581-1","article-title":"Functional Histology of Salivary Gland Pleomorphic Adenoma: An Appraisal","volume":"9","author":"Triantafyllou","year":"2015","journal-title":"Head Neck Pathol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"592","DOI":"10.18632\/oncotarget.27900","article-title":"The role of immune surveillance in malignant transformation of benign salivary gland tumors","volume":"12","author":"Linxweiler","year":"2021","journal-title":"Oncotarget"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/142\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:54:30Z","timestamp":1760169270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,28]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["jcm11010142"],"URL":"https:\/\/doi.org\/10.3390\/jcm11010142","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,28]]}}}