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Review
. 2019 Dec;19(4):3253-3263.
doi: 10.4314/ahs.v19i4.50.

Carcinoma ex pleomorphic adenoma: a case report and review of literature

Deepak Khanna  1 , Tanay Chaubal  2 , Ranjeet Bapat  2 , Anshad Mohamed Abdulla  3 , Sunil Thomas Philip  4 , Suraj Arora  5
Affiliations
Review

Carcinoma ex pleomorphic adenoma: a case report and review of literature

Deepak Khanna et al. Afr Health Sci. 2019 Dec.

Abstract

Background: Carcinoma ex pleomorphic adenoma (CA-ex-PA) is extremely unusual in minor salivary glands of oral cavity. CAex-PA is a carcinomatous change as a primary or as a recurrence of pleomorphic adenoma.

Objective: Due to resemblance of clinical symptoms of Ca ex PA and benign pleomorphic adenoma, it is mandatory for surgeons to keep high degree of clinical alertness, considering the peculiarity of this tumor.

Case report: 54-year-old male presented with swelling on left side in the pre-auricular region from the middle of zygomatic arch to mastoid process and from tragus of the ear up to angle of mandible. Fine needle aspiration cytology revealed a mixture of benign and malignant components. Total left parotidectomy with left radical neck dissection followed by reconstruction with cervicodeltopectoral flap was performed. Combination of chemotherapy and radiotherapy were given to patient. Histologic examination and pre-operative fine needle aspiration cytology confirmed the diagnosis of Carcinoma ex pleomorphic adenoma (CA-ex-PA). Two-year follow-up of patient showed no recurrence of the lesion.

Conclusion: Due to the similarity in the clinical symptoms of CA-ex-PA and benign pleomorphic adenoma, it is vital that clinicians maintain a high degree of clinical vigilance, considering the oddity of this malignancy.

Keywords: Carcinoma ex pleomorphic adenoma; Fine needle aspiration cytology; parotidectomy.

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Figures

Fig. 1
Fig. 1
Carcinoma ex Pleomorphic adenoma of left parotid gland
Fig. 2
Fig. 2
FNAC showing cellular smear with clusters of benign (white arrow) and malignant cells (black arrow) – PAP stain 10 X
Fig. 3
Fig. 3
FNAC showing large cells with large pleomorphic nuclei having coarse chromatin- PAP stain – 40X (white arrow)
Fig. 4
Fig. 4
Intraoperative view of Parotidectomy and radical neck surgery
Fig. 5
Fig. 5
Areas of pleomorphic adenoma (Black arrow) with infiltrating foci of carcinoma (grey arrow) – H&E stain-10 X
Fig 6
Fig 6
Pleomorphic adenoma composed of biphasic population of cells in chondromyxoid matrix-H&E stain-10 X
Fig 7
Fig 7
Foci of carcinoma composed of pleomorphic cells arranged in nests and vague glandular pattern- H & E stain-40 X
Fig. 8
Fig. 8
Immunostain for HMGA-2 gene
Fig 9
Fig 9
24 months' postoperative view without any recurrence of the lesion
See this image and copyright information in PMC

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