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Case Reports
. 2010 Mar 30:8:24.
doi: 10.1186/1477-7819-8-24.

Carcinoma ex pleomorphic adenoma of soft palate with cavernous sinus invasion

Hsuan-Ho Chen  1 , Li-Yu Lee, Shy-Chyi Chin, I-How Chen, Chun-Ta Liao, Shiang-Fu Huang
Affiliations
Case Reports

Carcinoma ex pleomorphic adenoma of soft palate with cavernous sinus invasion

Hsuan-Ho Chen et al. World J Surg Oncol. .

Abstract

Background: Carcinoma ex pleomorphic adenoma (CXPA) is an aggressive salivary gland malignancy and rare in minor salivary gland. A soft palate CXPA initially presenting as direct cavernous sinus (CS) invasion is very rare.

Case presentation: A 60-year-old male had a 3-month history of a small soft palatal mass with progressing left cheek numbness, proptosis, and disturbed vision. Biopsy of soft palatal tumor showed pleomorphic adenoma. Magnetic resonance imaging showed a tumor involving left maxilla, and extended from pterygopalatine fossa, inferior orbital fissure to CS. Excision of tumor revealed CXPA. Adjuvant concomitant chemo-radiation therapy (CCRT) was given. The tumor recurred 5 months later in left CS which was re-treated with CCRT. The disease status was stable at 2 years after the diagnosis of CXPA.

Conclusion: We present this case to emphasize that patients with symptoms such as facial numbness, proptosis and disturbed vision should be carefully investigated for lesions invading CS by perineural spread.

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Figures

Figure 1
Figure 1
A tumor measuring 1.2 × 1.0 cm located in left soft palate (arrow).
Figure 2
Figure 2
T1-weighted magnetic resonance imaging scans (A) Axial section shows irregular soft tissue mass in left cavernous sinus (arrows) before treatment, (B) Coronal section shows swelling of left parapharynx and masticator space and tumor invading into left cavernous sinus (arrows) before treatment, (C) Axial section shows remission of tumor 3 months after CCRT, (D) Coronal section shows remission of tumor 3 months after CCRT.
Figure 3
Figure 3
Microscopic findings. (A) Pleomorphic adenoma in a chondromyxoid, fibrotic and sclerotic stroma with the malignant areas of carcinoma component consisting epithelial clusters with necrosis. (H&E, 40×), (B) Carcinoma component is composed of cells with pleomorphic nucleus, mitotic activity and comedo-like necrosis. (H&E, 100×), (C) The carcinoma ex pleomorphic adenoma consisting benign pleomorphic adenoma and poorly differentiated carcinoma with the ulcerative epithelial surface. (H&E, 40×), (D) Tumor cells presented the perineural invasion (H&E, 400×).
See this image and copyright information in PMC

References

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