Ritwik and Brannon Journal of Medical Case Reports 2012, 6:287 http://www.jmedicalcasereports.com/content/6/1/287 Introduction Only 3% to5% of all salivary gland neoplasms occur in children and adolescents [1,2]. Two types of neoplasms are found in the salivary glands of pediatric age group patients: neoplasms of epithelial or parenchymal origin and neoplasms of mesenchymal or interstitial origin. The vast majority of the mesenchymal neoplasms occurring in the parotid gland are vasoformative, that is, hemangiomas [1], while the most common types of salivary gland neo- plasms of epithelial (parenchymal) origin are pleomorphic adenomas and mucoepidermoid carcinomas. Most of these epithelial neoplasms are found in the parotid gland; only a limited number of cases occurring in the minor glands of children and adolescents have been well-documented [2]. In fact, a review of the litera- ture revealed only 40 well-documented cases of benign minor salivary gland tumors in this age group [3-28]. Therefore, the purpose of this retrospective analysis was to investigate the clinical features and biologic behavior of a series of benign epithelial minor salivary gland neo- plasms occurring in children and adolescents, aged 19 months to 18 years. Case presentation Prevalence A total of nine benign minor salivary gland neoplasms were found in patients aged below 19 years out of a total of 396 minor salivary gland neoplasms accessioned over a 35-year period. This is a prevalence of 2.3% in the Louisiana State University School of Dentistry (LSUSD) material. The neoplasms consisted of eight pleomorphic adenomas (PA) and one cystadenoma. Page 2 of 6 Summary of findings A search of the English-language literature revealed 34 PAs [3-23], four myoepitheliomas [25-28], one cystade- noma [7], and one sialadenoma papilliferum [24]. PAs were found to be by far the most commonly occurring benign lesions of minor salivary glands in this age group. A summary of the demographics, clinical findings, treat- ment and follow-up of the well-documented benign minor salivary gland neoplasms in the literature, in addition to the nine new cases from LSUSD, is shown in Additional file 1: Tables S1 and S2, for a total of 49 cases. Pleomorphic adenomas Data for the combined 42 PAs are in Additional file 1: Table S1. The age range was 19 months to 18 years, with a mean of 12 years; 35.7% of the tumors occurred in patients 10 years of age or younger. There was a marked peak in incidence at age 12 years and then again in the later teenage years (Figure 1). The female-to-male ratio was calculated to be 2.8:1. Race was not stated for 21 patients (50%); for the cases reporting race there was es- sentially an equal distribution between black and white patients. Of the 42 neoplasms, 29 (69.1%) occurred in the minor salivary glands of the hard and/or soft palate, six (14.3%) in the upper lip, four (9.5%) in the buccal mucosa, and three (7.1%) in the tongue. Seven of the palatal neo- plasms caused pressure erosion, a smooth depression, or perforation of the under lying bone. One of these palatal neoplasms perforated the palatal bone and extended into the nasal cavity. The majority of PAs were painless, firm submucosal masses or nodules ranging in size from 0.5cm Figure 1 Age distribution of patients with pleomorphic adenoma arising from minor salivary glands.