Intraosseous pleomorphic adenoma of the mandible

Rationale: Salivary gland tumors account for 3% to 6% of all head and neck tumors, with pleomorphic adenoma (PA) being the most common benign type. However, primary intraosseous PAs arising from ectopic salivary tissue within the jawbones are exceptionally rare, with only a handful of cases reported in the literature. Clinically and radiographically, these lesions often mimic odontogenic pathologies, posing significant diagnostic challenges. This rarity and diagnostic ambiguity underscore the need to document and analyze such cases to improve clinical recognition and differential diagnosis. Patient concerns: We present a case of a patient with a mandibular lesion that clinically and radiographically mimicked a common lateral periodontal cyst, raising initial suspicion of an odontogenic pathology rather than a salivary gland-derived tumor. Diagnoses: Following comprehensive clinical evaluation, radiographic imaging, and histopathological examination, the lesion was diagnosed as a primary intraosseous PA of the mandible. To contextualize this diagnosis, a literature review was conducted, synthesizing data from all 14 known cases (including the current one) in a comprehensive table. Interventions: We conducted comprehensive preoperative examinations for the patient and informed them of the surgical risks. After obtaining their informed consent, the patient underwent a left mandibular lesion removal under general anesthesia. Postoperatively, anti-infection treatment was administered. Outcomes: This case report adds to the limited body of literature on primary intraosseous PAs, providing detailed clinical, radiographic, and histopathological findings that contribute to the understanding of this rare entity. The synthesized literature table serves as a valuable reference for clinicians managing similar jaw lesions. Lessons: Our report emphasizes the critical importance of including primary intraosseous PA in the differential diagnosis of jaw radiolucencies, especially in cases presenting with cortical perforation. Clinicians should remain vigilant to the possibility of rare salivary gland tumors even when lesions exhibit features typical of more common odontogenic pathologies to avoid misdiagnosis and ensure appropriate management.