Carcinoma ex pleomorphic adenoma of the palate composed of invasive micropapillary salivary duct carcinoma and adenoid cystic carcinoma components: an unusual case with immunohistochemical approach

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

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.

Endoscopic-Assisted Palatal Surgery Via Transoral and Intranasal Approach

Palate carcinoma often challenges to the treatment options. It depends on the histologic type, local invasion, and nodal or distant metastasis. Hard palate tumors that invade the nasal cavity can be operated by midfacial degloving approach, lateral rhinotomy approach, and lip splitting incision with infrastructure maxillectomy. These approaches inevitably coincide with facial scars, nerve injuries, facial swelling, and long hospital stay. Transoral robotic assisted surgery can be applied; however, this needs high price and has a weakness of accurate handling about intranasal lesion. The authors have performed transoral and intranasal endoscopic-assisted palatal removal of recurrent palatal carcinoma for a patient and herein report their technique and result.

Pedunculated carcinoma ex pleomorphic adenoma of the nasal cavity: A unique case report

BACKGROUND

A carcinoma ex pleomorphic adenoma (CXPA) is an epithelial malignancy arising in or from a benign pleomorphic salivary adenoma. The parotid gland is the most common location of CXPAs. Minor salivary gland CXPAs of the nasal cavity are exceedingly rare, with only 6 documented in the literature.

METHODS AND RESULT

We present a 7th case: an unusual pedunculated intranasal CXPA, which had a favorable outcome after a wide endoscopic excision and the longest follow-up period reported to date. The clinical features, immunohistochemical characteristics, treatment choices, and disease outcomes of the intranasal CXPAs reported in previous studies are also reviewed.

CONCLUSION

This case demonstrates the importance of considering the possibility of CXPA in the differential diagnosis of minor salivary gland malignancies in the nasal cavity.