Ritwik and Brannon Journal of Medical Case Reports 2012, 6:287 http://www.jmedicalcasereports.com/content/6/1/287 and generally lack ductal differentiation [36]. While some investigators consider it to be a distinct entity, others believe that it represents one end of the spectrum of the PA and is therefore a variant of PA [27,36]. Re- gardless of its specific classification, it possesses a similar if not identical biologic behavior to a PA [36]. There are too few cases reported to define its characteristics in the first and second decade of life. However, based on four cases, it does appear to possess similar clinical character- istics and biologic behavior to a PA (Additional file 1: Table S2). Minor salivary gland cystadenomas are rare benign well-circumscribed tumors composed of cystic and pap- illary structures lined with cuboidal or columnar ductal epithelium that appears benign on histology [30]. The average age of incidence is 57 years; they are exceed- ingly rare below the age of 20 years. The youngest pa- tient reported to have a cystadenoma was 12 years old [7]. Lastly, a sialadenoma papilliferum is a benign exo- phytic papillary tumor arising from the salivary gland duct. It too is rare below the age of 20 years with only one case reported, in the upper lip of an 18-year-old man [24]. Although minor salivary gland tumors are decidedly uncommon in the first two decades of life, they should be considered in the clinical differential diagnosis for any submucosal nodule or mass in a salivary gland- bearing area. In this study, the average duration of 16 PAs with reliable historical information was 2.1 years be- fore definitive diagnosis. As with any benign or malig- nant tumor, early definitive diagnosis and appropriate treatment afford a better chance for a cure. This is espe- cially important for minor salivary gland tumors because a high percentage are malignant [1,2]. Conclusions The following may be concluded from the results of this study regarding benign epithelial (parenchymal) minor salivary gland tumors in children and adolescents (ages 19 months to 18 years): 1. The prevalence of benign epithelial minor salivary gland tumors in the LSUSD series was 2.3%. 2. Minor salivary gland tumors are more common in female patients. 3. Minor salivary gland tumors have a high predilection for the hard and/or soft palate and have been well- documented in lesser numbers in the upper lip, buccal mucosa, and tongue. 4. Minor salivary gland tumors involving the hard palate may resorb underlying bone. 5. The long duration of a painless submucosal mass in a salivary gland-bearing area does not preclude a minor salivary gland neoplasm. Page 4 of 6 6. The recurrence rate of minor salivary gland PAs in the first two decades of life is low (13.0%) based on this review of 24 well-documented cases with two or more years follow-up. 7. Complete surgical excision is the most important factor in preventing recurrence of a benign minor salivary gland neoplasm. 8. Long-term clinical follow-up of at least 5 years and the possibility of recurrence should be discussed with the patient and parents when benign minor salivary gland tumors are diagnosed in pediatric and adolescent patients. Methods The archived oral pathology cases from the LSUSD Div- ision of Oral and Maxillofacial Pathology diagnosed as benign salivary gland tumors from January 1 1969 to December 31 2004 were reviewed and patients aged below 19 years with any type of intra-oral benign minor salivary gland neoplasm were selected. The search fo- cused on all types of benign minor salivary gland neo- plasms in this age group. All cases consisted of hematoxylin and eosin-stained microscopic slides and the accompanying pathology request form. No cases were rejected for lack of detailed clinical or treatment information. There were no missing specimens or reports in the LSUSD archives. All of the cases in this study were submitted by oral and maxillofacial surgeons in private practice in the state of Louisiana with the ex- ception of one case, which was from the LSUSD Depart- ment of Oral and Maxillofacial Surgery. The Louisiana State University Health Sciences Center Institutional Re- view Board (LSUHSC IRB) approved the research proto- col (IRB #6450). Demographic, clinical, and treatment information was recorded for each patient. All of the microscopic diagnoses were made by American Board of Oral and Maxillofacial Pathology-certified pathologists. Additionally, the microscopic diagnosis of each case was reviewed and verified by one of the authors (RBB), an American Board of Oral and Maxillofacial Pathology- certified pathologist, using the diagnostic criteria for PAs and cystadenomas set forth by Ellis and Auclair [36]. A search was performed of the English-language medical and dental literature for well-documented minor salivary gland neoplasms in the pediatric and adolescent age group. It should be noted that, although numerous investigators have published series of salivary gland neo- plasms, they provide an age range only and do not cor- relate the age of the patient to the location of the lesion or offer other demographic and clinical information. Some of these series did indicate that at least one patient was in the first or second decade of life; however, we did not include them in this study because they lacked the adequate detail we required.