Rare presentation of pleomorphic adenoma originating from the buccal minor salivary gland

Rare presentation of pleomorphic adenoma originating from the buccal minor salivary gland | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Rare presentation of pleomorphic adenoma originating from the buccal minor salivary gland Shivendra Choudhary, Sibgutulah Rashid, Naqoosh Haidry, Rudra Deo Kumar, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8474657/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Pleomorphic adenoma (PA) of the buccal minor salivary gland is a rare clinical entity that may mimic other benign cheek swellings, often leading to diagnostic uncertainty. We report the case of a woman in her forties who presented with a 14-year history of a painless, slow-growing swelling in the left cheek. Clinical and radiological findings suggested a benign soft tissue lesion, and a provisional diagnosis of fibrolipoma was made. Intraoral excision was performed with special attention to avoid injury to the parotid duct and facial nerve branches. A well-encapsulated mass measuring 3 × 2.3 × 1.5 cm was completely excised. Histopathological analysis confirmed the diagnosis of pleomorphic adenoma. No recurrence was observed at the 18-month follow-up. This case highlights the importance of considering PA in the differential diagnosis of intraoral swellings, the need for meticulous surgical technique, and the value of long-term follow-up in preventing recurrence or development of carcinoma ex pleomorphic adenoma. Pleomorphic adenoma Minor salivary gland tumor Mixed tumor Case report Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Pleomorphic adenoma (PA) is the most common benign neoplasm of the salivary glands, accounting for nearly 50% of all salivary gland tumors. While the majority of PAs arise in the parotid gland, approximately 10–15% occur in minor salivary glands, most frequently in the palate[ 1 ]. In contrast, pleomorphic adenomas originating from the buccal minor salivary glands are exceedingly rare, representing only about 5.5% of all minor salivary gland PAs[ 2 ]. Their uncommon location, coupled with nonspecific clinical features, often makes diagnosis challenging. In cheek region, PA typically presents as a slow-growing, painless, firm, and mobile submucosal swelling with intact overlying mucosa. However, due to their rarity and resemblance to other benign or reactive soft tissue lesions—such as fibromas, lipomas, or mucoceles—these tumors can be easily misdiagnosed preoperatively. Diagnostic ambiguity is further complicated by the limited accessibility and inconclusive findings from imaging and fine-needle aspiration cytology in certain cases[ 2 , 3 ]. Although pleomorphic adenomas are histologically benign, they necessitate complete surgical excision due to a known risk of recurrence (ranging from 0.5% to 10%) and potential for malignant transformation into carcinoma ex-pleomorphic adenoma, which occurs in approximately 1.5% of cases within five years, increasing up to 9.5% over a 15-year period[ 3 ]. In the buccal mucosa, early detection is more likely due to the superficial location; however, excision demands careful dissection to avoid injury to adjacent facial structures, particularly branches of the facial nerve and the parotid duct[ 4 ]. Recent literature, including isolated case reports and small case series, has reported rare histopathological features such as perineural involvement in otherwise benign buccal pleomorphic adenomas, underscoring the need for meticulous histopathological evaluation. Given their potential for recurrence and rare malignant transformation, cheek PAs should be considered a key differential in the assessment of intraoral swellings[ 5 ]. Prompt recognition and definitive histopathological diagnosis are essential for appropriate management and long-term surveillance. Case Presentation A female in her forties presented to our tertiary center, with a complaint of a slow-growing painless swelling in the left cheek region, persisting for the past 14 years. There was no associated history of trauma, difficulty in chewing, or swallowing. On examination facial asymmetry was observed due to an oval-shaped swelling on the left cheek, with normal overlying skin color and texture. The swelling extended from the malar prominence to the oral commissure and was firm, non-tender, non-compressible, and non-pulsatile on palpation, with no associated bruit or thrill. It exhibited well-defined margins, was freely mobile, and not adherent to underlying structures. Intraorally, it extended from 1 cm inferior to the left maxillary buccal vestibule to 1.5 cm superior to the occlusal plane, and anteroposteriorly from tooth 24 to 27. A contrast-enhanced computed tomography (CECT) scan revealed a heterogeneously enhancing mass connected to the left buccinator muscle, with no invasion of adjacent critical structures (Figs. 1 and 2 ). Clinical and radiographic examination directed us to a provisional diagnosis of fibrolipoma. Informed surgical consent was obtained from the patient. Under general anesthesia and strict aseptic precautions, an intraoral incision was made in the left buccal mucosa, parallel to the occlusal plane, extending from the region of teeth 24 to 27. The incision was strategically planned with careful consideration of the parotid (Stensen’s) duct to avoid iatrogenic injury. Blunt dissection was performed through the buccinator muscle fibers to access the lesion (Fig. 3 ). The buccal branch of the facial nerve and its divisions were not encountered during the procedure. The encapsulated mass was fully mobilized and excised in toto without disruption of surrounding vital structures. The surgical site was closed in layers using 3 − 0 vicryl. The excised mass measured 3 × 2.3 × 1.5 cm, was firm and rubbery in consistency, and was submitted for histopathological examination (Fig. 4 ). Histopathological examination revealed a well-circumscribed tumor composed of three distinct components. The epithelial component consisted of ductal epithelial cells with basaloid morphology arranged in glandular and tubular patterns. The myoepithelial component displayed variable morphology, including oval, spindle-shaped, and plasmacytoid cells, merging into a chondromyxoid stromal background. Abundant chondromyxoid matrix with areas of collagenization was also observed. These features were consistent with a diagnosis of pleomorphic adenoma (Fig. 5 ). Discussion PA of the cheek typically presents as a mobile, slow-growing, painless, firm, and lobulated submucosal swelling, generally well-circumscribed and exhibit a round or oval shape. The PA has three histological subtypes: myxoid (80% stroma), cellular (myoepithelial cells predominating), and mixed (classic).Histologically, pleomorphic adenomas consist of both epithelial and mesenchymal components. In the minor salivary glands, these lesions tend to be more solid and cellular compared to those in the major glands[ 6 ]. The buccal space, which forms the bulk of the cheek, contains adipose tissue known as the buccal fat pad, along with the parotid duct, minor salivary glands, accessory parotid lobules, the facial and buccal arteries, the facial vein, lymphatic channels, and branches of the facial and mandibular nerves[ 7 ]. Lesions in this area can arise from any of these anatomic structures. In the present case report, the lesion is believed to originate from the minor salivary glands which are generally present in a submucosal plane. However, Lesser et. al stated that the buccal glands are always located on the lateral surface of buccinator muscle and may occasionally be embedded in the buccinator[ 7 , 8 ]. Pleomorphic adenoma, although benign, carries a well-documented risk of malignant transformation, particularly when left untreated for prolonged period. The most feared sequela is carcinoma ex pleomorphic adenoma, an aggressive malignancy arising from a pre-existing benign tumor[ 5 ]. This transformation may present insidiously, often beginning as a small, firm nodule within the original lesion, but can rapidly progress in size and exhibit invasive behavior. Given the potential for such a change even many years after the initial diagnosis or surgical excision, long-term clinical surveillance is imperative[ 5 , 8 ]. Regular follow-up facilitates early detection and timely intervention, which are critical for improving prognosis in cases of malignant transformation. Wide local excision is the preferred treatment for PA of the cheek[ 8 ]. In our case, the lesion was completely excised along with its capsule. Incomplete excision, capsular rupture, or tumor spillage during surgery can result in the dissemination of tumor cells into the surrounding tissues, increasing the likelihood of recurrence[ 9 ]. This occurs because these tumors often exhibit microscopic pseudopod-like extensions that penetrate the capsule and invade adjacent tissues. Kokubun et al. demonstrated that adequate excision of benign lesions is associated with excellent local control, approaching 100% for benign minor salivary gland tumors treated with standard surgical excision [ 10 ]. Similarly, in our case, no recurrence was observed during a follow-up period of up to 18 months. Conclusion PA of the buccal minor salivary gland is a rare entity that should be considered in the differential diagnosis of painless cheek swellings. Accurate diagnosis requires careful clinical, radiographic, and histopathological evaluation. Complete excision with an intact capsule is essential to minimize recurrence risk. Due to the proximity of the buccal branch of the facial nerve and the parotid duct, precise dissection is critical to prevent iatrogenic injury. This case emphasizes the importance of anatomical awareness during surgery and the need for long-term follow-up. No recurrence was observed after 18 months, highlighting the effectiveness of thorough excision and surgical planning in managing this uncommon tumor. Abbreviations PA -Pleomorphic Adenoma, CECT -Contrast-Enhanced Computed Tomography Declarations Patient Perspective “I had noticed a small swelling on my left cheek many years ago, but since it was painless and grew very slowly, I did not feel the need to seek treatment. Over time, it became more noticeable and started affecting my appearance, which made me concerned. After coming to the hospital, the doctors explained the condition to me in detail and reassured me about the treatment plan. The surgery went smoothly, and I did not experience any facial weakness or major discomfort afterward. I am satisfied with the outcome and relieved that the swelling has been completely removed. Regular follow-up visits have given me confidence that the problem has been properly treated.” Author information Shivendra Choudhary and Sibgutulah Rashid have contributed equally to the case study. Author Contributions Shivendra Choudhary, Sibgutulah Rashid, Naqoosh Haidry, and Rudra Deo Kumar contributed to the conception and formulation of the treatment plan. Shivendra Choudhary, Naqoosh Haidry and Sibgutulah Rashid was involved in clinical management of the patient. Sibgutulah Rashidwas involved in preparation of the initial draft of the manuscript. Shreekant Bharti performed the histopathological evaluation and contributed to interpretation of the pathological findings. Rajni Mishra assisted in clinical data collection and patient follow up. All authors critically reviewed the manuscript and approved the final version for submission. Acknowledgement: The authors express their sincere gratitude to the patient and to all clinical staff who contributed to the patient’s management. Funding The authors received no financial support for the research, authorship, or publication of this case report. Clinical trial number: Not applicable Data Availability The anonymized clinical and imaging data supporting the findings of this case report are securely maintained at the All India Institute of Medical Sciences, Patna, India. In accordance with patient privacy requirements and institutional policies, the complete dataset is not publicly accessible. However, de-identified data may be made available by the corresponding author upon reasonable request. No additional datasets were generated or analyzed during the course of this study. Ethics Approval and Consent to Participate Ethical approval was waived by the Institute Ethics Committee of the All-India Institute of Medical Sciences (AIIMS), Patna, India, as the present work constitutes a single case report. The study was conducted in accordance with the ethical standards and guidelines of the Institute Ethics Committee and in compliance with the institutional regulations. Written informed consent was obtained from the patient for participation in the study as well as for publication of anonymized clinical information and images. Consent for Publication Written informed consent was obtained from the patient for the publication of anonymized clinical information and images. Competing Interests The authors declare that they have no competing interests. References Singh S, Chaudhary P, Tyagi MS, Gulati P. Pleomorphic adenoma of the hard palate – usual tumor at an uncommon site: a cytological diagnosis. Santosh Univ J Health Sci. 2023;9(2):231–3. https://doi.org/10.18231/sujhs.v9i2.123 . Kalwaniya DS, Meena R, Kumar D, Tolat A, Arya SV. A review of the current literature on pleomorphic adenoma. Cureus. 2023;15(7):e42777. https://doi.org/10.7759/cureus.42777 . Matsumiya-Matsumoto Y, Morita Y, Uzawa N. Pleomorphic adenoma of the salivary glands and epithelial–mesenchymal transition. J Clin Med. 2022;11(14):4210. https://doi.org/10.3390/jcm11144210 . Abdelhamid AS, Elzayat S, Essa AA, Elsherief H, Amer M. Pleomorphic adenoma of the cheek: a case presentation. Egypt J Otolaryngol. 2022;38:165. https://doi.org/10.1186/s43163-022-00378-6 . Valstar MH, Mast H, Ten Hove I, Moonen LR, Balm AJ, Smeele LE, Koljenović S, Dinjens WN, van Velthuysen ML. Malignant transformation of salivary gland pleomorphic adenoma: proof of principle. J Pathol Clin Res. 2021;7(5):432–7. https://doi.org/10.1002/cjp2.227 . Uploankar SV, Alvi U, Begum Z. Histopathological study of salivary gland lesions: an institutional study. IP J Diagn Pathol Oncol. 2023;6(1):32–7. https://doi.org/10.18231/j.jdpo.2023.007 . Lesser ER, Chaiyamoon A, Tubbs RS, Iwanaga J. Buccal gland within the buccinator muscle. Anat Cell Biol. 2024;57(1):152–4. https://doi.org/10.5115/acb.23.211 . Bahbah S, Chbicheb S. Pleomorphic adenoma of the cheek: case report with review. Int J Odontostomat. 2020;14(4):653–7. https://doi.org/10.4067/S0718-381X2020000400653 . Grasso M, Fusconi M, Cialente F, de Soccio G, Ralli M, Minni A, Agolli G, De Vincentiis M, Remacle M, Petrone P, Di Maria D. Rupture of the pleomorphic adenoma of the parotid gland: what to know before, during and after surgery. J Clin Med. 2021;10(22):5368. https://doi.org/10.3390/jcm10225368 . Kokubun K, Chujo T, Yamamoto K, et al. Intraoral minor salivary gland tumors: a retrospective, clinicopathologic, single-center study of 432 cases in Japan and a comparison with epidemiological data. Head Neck Pathol. 2023;17(3):739–50. https://doi.org/10.1007/s12105-023-01551-z . Additional Declarations No competing interests reported. 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10:21:14","extension":"html","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51804,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/d9651aa72e77b27975780a2b.html"},{"id":100367687,"identity":"bf61282a-19f0-4e3a-ae03-3d7e2e5aba87","added_by":"auto","created_at":"2026-01-16 07:57:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1446814,"visible":true,"origin":"","legend":"\u003cp\u003eHeterogeneously enhancing mass attached to the left buccinator muscle without invasion of surrounding vital structures in coronal of a CECT face.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/f1b3f5dbccc3c44baabe6901.png"},{"id":100366452,"identity":"d4f05c2d-03e5-4563-a2ad-24a24c2e3bb4","added_by":"auto","created_at":"2026-01-16 07:56:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":894110,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eHeterogeneously enhancing mass in axial section of a CECT face.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/48bd30eab727e44febfd8dcd.png"},{"id":100131790,"identity":"0630b3dd-5f68-41fe-ab60-db8d3c8c2ea2","added_by":"auto","created_at":"2026-01-13 10:21:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1280429,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eExposure of the lesion.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/40427e23d74d3a407f381edd.png"},{"id":100131802,"identity":"f56843b2-a2d1-4adc-8ca8-2cc59ba3c0f5","added_by":"auto","created_at":"2026-01-13 10:21:14","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1456040,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe excised lesion measuring approximately 3 × 2.3 × 1.5 cm in size.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/7b0389b0f7a1875431329821.png"},{"id":100131801,"identity":"ae894ba5-7f5c-491d-a050-01807c154b72","added_by":"auto","created_at":"2026-01-13 10:21:14","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2090765,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eHistopathological sections depicting myoepithelial cells in chondromyxoid stroma and ductal epithelial cells arranged in glands and tubules.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/dff315956aaef82c2f9e50c2.png"},{"id":104421667,"identity":"39c889ff-6e23-4d9d-bf43-f8d9906f8a6b","added_by":"auto","created_at":"2026-03-11 13:58:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":13941882,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/dce9f32c-96dc-469d-8590-9e8d1f850478.pdf"},{"id":100367773,"identity":"7ae73d53-085a-4321-a21c-d98187cab01b","added_by":"auto","created_at":"2026-01-16 07:57:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":696921,"visible":true,"origin":"","legend":"","description":"","filename":"CareChecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8474657/v1/cef55be89dd932cfd8970a43.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rare presentation of pleomorphic adenoma originating from the buccal minor salivary gland","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePleomorphic adenoma (PA) is the most common benign neoplasm of the salivary glands, accounting for nearly 50% of all salivary gland tumors. While the majority of PAs arise in the parotid gland, approximately 10\u0026ndash;15% occur in minor salivary glands, most frequently in the palate[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In contrast, pleomorphic adenomas originating from the buccal minor salivary glands are exceedingly rare, representing only about 5.5% of all minor salivary gland PAs[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Their uncommon location, coupled with nonspecific clinical features, often makes diagnosis challenging.\u003c/p\u003e \u003cp\u003eIn cheek region, PA typically presents as a slow-growing, painless, firm, and mobile submucosal swelling with intact overlying mucosa. However, due to their rarity and resemblance to other benign or reactive soft tissue lesions\u0026mdash;such as fibromas, lipomas, or mucoceles\u0026mdash;these tumors can be easily misdiagnosed preoperatively. Diagnostic ambiguity is further complicated by the limited accessibility and inconclusive findings from imaging and fine-needle aspiration cytology in certain cases[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough pleomorphic adenomas are histologically benign, they necessitate complete surgical excision due to a known risk of recurrence (ranging from 0.5% to 10%) and potential for malignant transformation into carcinoma ex-pleomorphic adenoma, which occurs in approximately 1.5% of cases within five years, increasing up to 9.5% over a 15-year period[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the buccal mucosa, early detection is more likely due to the superficial location; however, excision demands careful dissection to avoid injury to adjacent facial structures, particularly branches of the facial nerve and the parotid duct[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent literature, including isolated case reports and small case series, has reported rare histopathological features such as perineural involvement in otherwise benign buccal pleomorphic adenomas, underscoring the need for meticulous histopathological evaluation. Given their potential for recurrence and rare malignant transformation, cheek PAs should be considered a key differential in the assessment of intraoral swellings[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Prompt recognition and definitive histopathological diagnosis are essential for appropriate management and long-term surveillance.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA female in her forties presented to our tertiary center, with a complaint of a slow-growing painless swelling in the left cheek region, persisting for the past 14 years. There was no associated history of trauma, difficulty in chewing, or swallowing. On examination facial asymmetry was observed due to an oval-shaped swelling on the left cheek, with normal overlying skin color and texture. The swelling extended from the malar prominence to the oral commissure and was firm, non-tender, non-compressible, and non-pulsatile on palpation, with no associated bruit or thrill. It exhibited well-defined margins, was freely mobile, and not adherent to underlying structures. Intraorally, it extended from 1 cm inferior to the left maxillary buccal vestibule to 1.5 cm superior to the occlusal plane, and anteroposteriorly from tooth 24 to 27.\u003c/p\u003e \u003cp\u003eA contrast-enhanced computed tomography (CECT) scan revealed a heterogeneously enhancing mass connected to the left buccinator muscle, with no invasion of adjacent critical structures (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Clinical and radiographic examination directed us to a provisional diagnosis of fibrolipoma.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eInformed surgical consent was obtained from the patient. Under general anesthesia and strict aseptic precautions, an intraoral incision was made in the left buccal mucosa, parallel to the occlusal plane, extending from the region of teeth 24 to 27. The incision was strategically planned with careful consideration of the parotid (Stensen\u0026rsquo;s) duct to avoid iatrogenic injury. Blunt dissection was performed through the buccinator muscle fibers to access the lesion (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe buccal branch of the facial nerve and its divisions were not encountered during the procedure. The encapsulated mass was fully mobilized and excised in toto without disruption of surrounding vital structures. The surgical site was closed in layers using 3\u0026thinsp;\u0026minus;\u0026thinsp;0 vicryl. The excised mass measured 3 \u0026times; 2.3 \u0026times; 1.5 cm, was firm and rubbery in consistency, and was submitted for histopathological examination (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHistopathological examination revealed a well-circumscribed tumor composed of three distinct components. The epithelial component consisted of ductal epithelial cells with basaloid morphology arranged in glandular and tubular patterns. The myoepithelial component displayed variable morphology, including oval, spindle-shaped, and plasmacytoid cells, merging into a chondromyxoid stromal background. Abundant chondromyxoid matrix with areas of collagenization was also observed. These features were consistent with a diagnosis of pleomorphic adenoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePA of the cheek typically presents as a mobile, slow-growing, painless, firm, and lobulated submucosal swelling, generally well-circumscribed and exhibit a round or oval shape. The PA has three histological subtypes: myxoid (80% stroma), cellular (myoepithelial cells predominating), and mixed (classic).Histologically, pleomorphic adenomas consist of both epithelial and mesenchymal components. In the minor salivary glands, these lesions tend to be more solid and cellular compared to those in the major glands[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe buccal space, which forms the bulk of the cheek, contains adipose tissue known as the buccal fat pad, along with the parotid duct, minor salivary glands, accessory parotid lobules, the facial and buccal arteries, the facial vein, lymphatic channels, and branches of the facial and mandibular nerves[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Lesions in this area can arise from any of these anatomic structures. In the present case report, the lesion is believed to originate from the minor salivary glands which are generally present in a submucosal plane. However, Lesser et. al stated that the buccal glands are always located on the lateral surface of buccinator muscle and may occasionally be embedded in the buccinator[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePleomorphic adenoma, although benign, carries a well-documented risk of malignant transformation, particularly when left untreated for prolonged period. The most feared sequela is carcinoma ex pleomorphic adenoma, an aggressive malignancy arising from a pre-existing benign tumor[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This transformation may present insidiously, often beginning as a small, firm nodule within the original lesion, but can rapidly progress in size and exhibit invasive behavior. Given the potential for such a change even many years after the initial diagnosis or surgical excision, long-term clinical surveillance is imperative[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Regular follow-up facilitates early detection and timely intervention, which are critical for improving prognosis in cases of malignant transformation.\u003c/p\u003e \u003cp\u003eWide local excision is the preferred treatment for PA of the cheek[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In our case, the lesion was completely excised along with its capsule. Incomplete excision, capsular rupture, or tumor spillage during surgery can result in the dissemination of tumor cells into the surrounding tissues, increasing the likelihood of recurrence[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This occurs because these tumors often exhibit microscopic pseudopod-like extensions that penetrate the capsule and invade adjacent tissues. Kokubun et al. demonstrated that adequate excision of benign lesions is associated with excellent local control, approaching 100% for benign minor salivary gland tumors treated with standard surgical excision [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Similarly, in our case, no recurrence was observed during a follow-up period of up to 18 months.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePA of the buccal minor salivary gland is a rare entity that should be considered in the differential diagnosis of painless cheek swellings. Accurate diagnosis requires careful clinical, radiographic, and histopathological evaluation. Complete excision with an intact capsule is essential to minimize recurrence risk. Due to the proximity of the buccal branch of the facial nerve and the parotid duct, precise dissection is critical to prevent iatrogenic injury. This case emphasizes the importance of anatomical awareness during surgery and the need for long-term follow-up. No recurrence was observed after 18 months, highlighting the effectiveness of thorough excision and surgical planning in managing this uncommon tumor.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePA -Pleomorphic Adenoma, CECT -Contrast-Enhanced Computed Tomography\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePatient Perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I had noticed a small swelling on my left cheek many years ago, but since it was painless and grew very slowly, I did not feel the need to seek treatment. Over time, it became more noticeable and started affecting my appearance, which made me concerned. After coming to the hospital, the doctors explained the condition to me in detail and reassured me about the treatment plan. The surgery went smoothly, and I did not experience any facial weakness or major discomfort afterward. I am satisfied with the outcome and relieved that the swelling has been completely removed. Regular follow-up visits have given me confidence that the problem has been properly treated.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShivendra Choudhary and Sibgutulah Rashid have contributed equally to the case study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShivendra Choudhary, Sibgutulah Rashid, Naqoosh Haidry, and Rudra Deo Kumar contributed to the conception and formulation of the treatment plan. Shivendra Choudhary, Naqoosh Haidry and Sibgutulah Rashid was involved in clinical management of the patient. Sibgutulah Rashidwas involved in preparation of the initial draft of the manuscript. Shreekant Bharti performed the histopathological evaluation and contributed to interpretation of the pathological findings. Rajni Mishra assisted in clinical data collection and patient follow up. All authors critically reviewed the manuscript and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eThe authors express their sincere gratitude to the patient and to all clinical staff who contributed to the patient\u0026rsquo;s management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, or publication of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe anonymized clinical and imaging data supporting the findings of this case report are securely maintained at the All India Institute of Medical Sciences, Patna, India. In accordance with patient privacy requirements and institutional policies, the complete dataset is not publicly accessible. However, de-identified data may be made available by the corresponding author upon reasonable request. No additional datasets were generated or analyzed during the course of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was waived by the Institute Ethics Committee of the All-India Institute of Medical Sciences (AIIMS), Patna, India, as the present work constitutes a single case report. The study was conducted in accordance with the ethical standards and guidelines of the Institute Ethics Committee and in compliance with the institutional regulations. Written informed consent was obtained from the patient for participation in the study as well as for publication of anonymized clinical information and images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for the publication of anonymized clinical information and images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSingh S, Chaudhary P, Tyagi MS, Gulati P. Pleomorphic adenoma of the hard palate \u0026ndash; usual tumor at an uncommon site: a cytological diagnosis. 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Rupture of the pleomorphic adenoma of the parotid gland: what to know before, during and after surgery. J Clin Med. 2021;10(22):5368. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jcm10225368\u003c/span\u003e\u003cspan address=\"10.3390/jcm10225368\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKokubun K, Chujo T, Yamamoto K, et al. Intraoral minor salivary gland tumors: a retrospective, clinicopathologic, single-center study of 432 cases in Japan and a comparison with epidemiological data. Head Neck Pathol. 2023;17(3):739\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12105-023-01551-z\u003c/span\u003e\u003cspan address=\"10.1007/s12105-023-01551-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pleomorphic adenoma, Minor salivary gland tumor, Mixed tumor, Case report","lastPublishedDoi":"10.21203/rs.3.rs-8474657/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8474657/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePleomorphic adenoma (PA) of the buccal minor salivary gland is a rare clinical entity that may mimic other benign cheek swellings, often leading to diagnostic uncertainty. We report the case of a woman in her forties who presented with a 14-year history of a painless, slow-growing swelling in the left cheek. Clinical and radiological findings suggested a benign soft tissue lesion, and a provisional diagnosis of fibrolipoma was made. Intraoral excision was performed with special attention to avoid injury to the parotid duct and facial nerve branches. A well-encapsulated mass measuring 3 \u0026times; 2.3 \u0026times; 1.5 cm was completely excised. Histopathological analysis confirmed the diagnosis of pleomorphic adenoma. No recurrence was observed at the 18-month follow-up. This case highlights the importance of considering PA in the differential diagnosis of intraoral swellings, the need for meticulous surgical technique, and the value of long-term follow-up in preventing recurrence or development of carcinoma ex pleomorphic adenoma.\u003c/p\u003e","manuscriptTitle":"Rare presentation of pleomorphic adenoma originating from the buccal minor salivary gland","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 10:21:05","doi":"10.21203/rs.3.rs-8474657/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce405891-5e97-4c4a-a0af-6b7d569d4565","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T13:57:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 10:21:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8474657","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8474657","identity":"rs-8474657","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}