Carcinoma Ex Pleomorphic Adenoma Research Articles

Carcinoma ex-pleomorphic adenoma of the nasal cavity: a report of two cases

Carcinoma ex-pleomorphic adenoma is exceedingly rare in sites other than the major salivary glands and the oral cavity. We present the first two histopathologically documented examples to occur in the nasal cavity.

Epstein-Barr virus (EBV) infection and undifferentiated carcinoma of the parotid gland in Caucasian patients.

The Epstein-Barr virus (EBV) has been detected in certain types of lymphoma and some epithelial neoplasms such as nasopharyngeal lymphoepithelioma and occasional undifferentiated carcinomas in several organs including the salivary glands. However, clonal EBV genomes have been detected in undifferentiated carcinomas of the parotid gland exclusively in Alaskan natives and Eskimos, both groups being at the highest risk for nasopharyngeal carcinoma. The authors investigated the possibility that EBV may be present in undifferentiated parotid carcinomas in Caucasian subjects. To test this hypothesis, in situ hybridization (ISH) technique with biotinylated EBV-DNA probes was utilized on routinely processed, paraffin-embedded tissues from 7 cases of undifferentiated carcinomas of the parotid gland. EBV genomes were demonstrated in the cytoplasm of tumor cells from 3 out of 7 specimens tested. Surprisingly, EBV genomes were found in 3 out of 5 (60%) undifferentiated carcinomas that had developed in patients with a history of a long-persisting asymptomatic parotid mass, which had suddenly increased in size. Conversely, none of the undifferentiated carcinomas with continuous and rapid growth studied was found to be positive for EBV-DNA by ISH technique. Taken together, these data might suggest a possible role of EBV in the transformation of benign parotid gland lesions into malignant and aggressive undifferentiated carcinoma of the parotid gland, the so-called carcinoma expleomorphic adenoma.

Unusual variant of a metastasizing malignant mixed tumor of the parotid gland

A 61-year-old man with a malignant mixed tumor of the parotid gland with metastasis to two lymph nodes of the digastric triangle is presented. This represents the first case of carcinoma expleomorphic adenoma in which the metastases simultaneously contain elements that have both benign- and malignant-appearing histologic patterns.

Karyotypic variability and evolutionary characteristics of a polymorphous low grade adenocarcinoma in the parotid gland

The chromosomes of a polymorphous low-grade adenocarcinoma originating from a pleomorphic adenoma of the parotid gland were studied. Three successful preparations were performed. A minor fraction of cells showed normal karyotypes and some cells only inconsistent, usually numerical, deviations. The remaining cells constituted an abnormal monoclonal population with an unusual and very extensive karyotypic variability. The origin of most marker chromosomes could be wholly or partly clarified. Five different subclones could be distinguished on basis of different specific marker chromosomes. The characteristics of the marker sets suggested a closely interrelated derivation of the subclones. The results also provide insight as to the influence of random factors and/or differential growth rate on the chromosomal picture observed in in vitro systems. The present chromosomal observations showed no similarities either to the cytogenetical findings in the five previously reported salivary gland adenocarcinomas or to the deviations seen in the single studied case of carcinoma ex-pleomorphic adenoma.

Fine needle aspiration cytology in the evaluation of head and neck masses

One hundred eighty-two fine needle aspirations (FNAs) of head and neck masses performed between the years 1981 and 1987 were studied retrospectively. Seventeen FNAs were unsatisfactory. Of the remaining 165, 148 (90%) were followed up with either surgery or clinical follow-up of at least 12 months' duration. Seventy-one of these aspirates were malignant. Fifty-six cases of metastatic carcinoma and 13 cases of lymphoma were diagnosed. The positive predictive value for metastatic carcinoma and lymphoma was 100%, and the sensitivities were 92% and 100%, respectively. For benign salivary gland lesions, the positive predictive value was 94%, whereas for malignant lesions it was 100%. One case of carcinoma ex-pleomorphic adenoma was missed by FNA. No complications were associated with FNA. We conclude that FNA is a safe and accurate technique, well suited to the in-office evaluation of neck masses of differing causes.

True malignant mixed tumour of the parotid gland

Carcinoma ex-pleomorphic adenoma is an uncommon tumour of the parotid gland. True malignant mixed tumours of the parotid are rare and we could find only 14 such cases reported. A case of a 76-year-old man diagnosed as suffering from this entity is presented. The diagnosis was based on a series of immunohistochemical studies demonstrating the existence of two separate sarcomatous and carcinomatous elements. The clinical and histological data are presented and the literature is reviewed.

Intra-oral salivary gland neoplasms: a retrospective study of 98 cases.

The findings of a retrospective study of 98 minor salivary neoplasms are reported. The patient's ages ranged from 13-79 years and there was an equal sex distribution. Sixty-one of the lesions were benign, 53 being pleomorphic adenomas and 8 monomorphic adenomas. Of the malignant tumors, 19 were muco-epidermoid tumors, 12 adenoid cystic carcinomas, 4 adenocarcinomas, 1 carcinoma ex-pleomorphic adenoma and 1 epidermoid carcinoma. One striking finding was the difference in age at the time of presentation for patients with muco-epidermoid tumors compared with those with adenoid cystic carcinomas. Seventy-four percent of the patients with muco-epidermoid tumors were under 50 years of age, but 75% of those with adenoid cystic carcinomas were over 50 years.

Experience with the resection of parapharyngeal cancers via the infratemporal fossa approach.

Between 1982 and 1984, a modified infratemporal fossa approach was used to resect cancers with extensive primary or secondary involvement of the infratemporal fossa and parapharynx in 10 patients. Nine patients exhibited persistent or recurrent disease of the upper aerodigestive tract and posterior cranial fossa following planned, curative-intent therapy; the remaining patient had a carcinoma ex-pleomorphic adenoma of the deep lobe of the parotid gland with a significant infratemporal fossa extension. Considered to have "unresectable" tumors, by traditional methods, 7 of the 10 patients underwent an en-bloc resection of their lesions with tumor-free margins. Tumor was present at the margins of the specimens in the other 3 patients. Two of the 10 patients died early in the postoperative period of medical complications. Another died 5 months postoperatively of a tumor-induced internal carotid artery rupture at the level of the foramen lacerum. A fourth patient died of his disease 6 months following his resection. One patient is alive, but has metastatic meningioma 2 years after surgery. The 5 remaining patients are without evidence of disease, with a mean follow up of 2 years. Indications for and refinements of the operative technique, particularly those related to the repair of such extensive ablative defects, are outlined on the basis of this early experience.

The pathology of head and neck tumors: Salivary glands, part 3

The term adenoma is applied to a rather wide variety of histopathologic entities in the salivary glands. These include tumors derived from the ductal epithelium and/or from myoepithelial cells and other salivary-gland elements, such as the sebaceous glands. Within the categories of mixed tumor (pleomorphic adenoma), monomorphic adenoma, clear-cell tumor, and sebaceous lesions, there are also several subtypes, each of which lends further credence to the germinative potential of the salivary tissues. Presented in this report is a clinicopathologic and histogenetic analysis of these lesions. Specifically discussed are mixed tumor, monomorphic adenoma, carcinoma ex-pleomorphic adenoma, clear-cell tumor, sebaceous lymphadenoma, and sebaceous carcinoma.

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

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. 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. 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. 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.