Intracapsular (in situ) carcinoma ex pleomorphic adenoma with unusual clinical and histological features

Carcinoma ex pleomorphic adenoma poses a challenge to diagnosis and treatment. Herein we describe an extremely unusual case, which presented initially as an intracapsular carcinoma ex pleomorphic adenoma in the right parotid gland. The first recurrence, after an interval of 8 years, showed only recurrence of the benign component. Five years later, a myoepithelial carcinoma arose from the same site. No ductal carcinoma as seen in the initial intracapsular carcinoma ex pleomorphic adenoma was identified. This case report elucidates the atypical clinical behaviour and interesting histological features encountered within this group of salivary neoplasm.     

Carcinoma ex pleomorphic adenoma of the sublingual gland: a case report

We report a case of carcinoma ex pleomorphic adenoma of a sublingual gland in a 70-year-old man.Under a clinical diagnosis of benign salivary gland tumor,excision of the mass with the sublingual salivary gland in an en bloc fashion via an intraoral approach was performed.Histopathologically,there was a rupture of the fibrous capsule and diffuse cell-rich sheets composed of myoepithelial cells with round nuclei were also seen.Immunohistochemically,the cells that composed of cell rich sheets were positive to smooth muscle actin.Final diagnosis of myoepithelial carcinoma ex pleomorphic adenoma was made.     

Adenocarcinoma ex pleomorphic adenoma of the head and neck: Report of five cases

OBJECTIVE: Adenocarcinoma ex pleomorphic adenoma is a rare tumor, and thus the management of the tumor has not been established. METHODS: The retrospective review of the clinical records at Okayama University was performed. RESULTS: We present five cases of adenocarcinoma ex pleomorphic adenoma of the head and neck, including a rare case with nasopharyngeal adenocarcinoma ex pleomorphic adenoma. There was no response to chemotherapy with nedaplatin and 5-FU, but the nasopharyngeal adenocarcinoma ex pleomorphic adenoma showed a remarkable regression after the administration of docetaxel. CONCLUSION: The combination therapy that includes docetaxel may be a promising treatment for adenocarcinoma ex pleomorphic adenoma of the head and neck.     

Malignant mixed tumor of the nasal cavity

Parotid gland is the most common location of malignant mixed tumors. Three different subtypes of these tumors exist: carcinoma ex pleomorphic adenoma, carcinosarcoma, and metastasizing mixed tumor. Carcinoma ex-pleomorphic adenoma is by far the most common subtype. Although unusual sites of these tumors have been published, we report an extremely rare case of a malignant mixed tumor located in the nasal cavity.     

Clear cell carcinoma arising in pleomorphic adenoma of the minor salivary gland

Malignant change arising in pleomorphic adenoma of the salivary glands is uncommon, with a reported incidence of 2-10 per cent. Only one case where a pleomorphic adenoma became a clear cell carcinoma appears to have been published in the English literature. An additional case of clear cell carcinoma arising in pleomorphic adenoma of a minor salivary gland is reported and the relevant literature discussed.     

A case report of metastasizing myoepithelial carcinoma of the parotid gland arising in a recurrent pleomorphic adenoma

Myoepithelial carcinoma, arising in a recurrent or in a pre-existing pleomorphic adenoma of the parotid gland is an extremely rare cancer. We herein report the case of myoepithelial carcinoma occurring in a recurrent pleomorphic adenoma, which showed a high metastatic potential. A 53-year-old male, who had undergone a superficial parotidectomy of the pleomorphic adenoma 2 years previously, presented with recurrent parotid swelling and with multiple coin lesions in the lung. A total parotidectomy and a thoracoscopic biopsy of the lung lesion revealed both lesions to be myoepithelial carcinoma. The patient died about 12 months later despite undergoing intensive chemotherapy.     

Mucoepidermoid carcinoma of the hard palate

A case of mucoepidermoid carcinoma originating in the hard palate was presented. Histological diagnosis of the removed mass at the first operation was pleomorphic adenoma. Tumor recurred at the same site three years later. Subtotal maxillectomy was performed and recurrent tumor was histologically diagnosed as low grade malignant mucoepidermoid carcinoma. A two-year follow-up showed no evidence of recurrence. The low grade malignant mucoepidermoid carcinoma strongly resembles pleomorphic adenoma. The differential diagnosis is important for the better treatment and prognosis.     

Superficial parotidectomy under local anaesthesia

We report a case of superficial parotidectomy performed under local anaesthesia. The patient presented with a parotid lump in which aspiration cytology showed cells consistent with mucoepidermoid carcinoma or adenocarcinoma ex pleomorphic adenoma. Despite counselling the patient refused general anaesthesia but accepted the need for removal of the pathology. We have been unable to find a single case report in the English literature since 1966 outlying this procedure being undertaken solely under local anaesthesia.     

Mucoepidermoid carcinoma expleomorphic adenoma of the submandibular gland

We described a rare case of carcinoma expleomorphic adenoma in which mucoepidermoid carcinoma arise from a previous incompletely excised pleomorphic adenoma of the submandibular gland. The tumor was surgically resected along with a modified radical neck dissection and postoperative radiotherapy. The patient remained disease free 3 years after the last operation. The pathology showed concurrent presence of Warthin's tumor in the specimen. The concurrent presence of mucoepidermoid carcinoma, pleomorphic adenoma, and synchronous Warthin's tumor make this case unique, and such a combination associated with the submandibular gland has not been documented in the literature before.     

Nasopharyngeal pleomorphic adenoma presenting as otitis media with effusion: Case report and literature review

Most tumors arising in the nasopharynx are malignant and frequently develop otitis media with effusion (OME). On the contrary, benign nasopharyngeal tumors are very rare, and pleomorphic adenoma, which is a benign mixed tumor of the nasopharynx, is also rarely encountered. We herein report a case of nasopharyngeal pleomorphic adenoma which initially presented as OME. This tumor completely blocked the orifice of the Eustachian tube but was removed by a combination of transnasal and transoral endoscopic resection. A defect in the mucous membrane was covered with polyglycolic acid sheet and fibrin glue. Mucous membrane completely covered the exposed tubal cartilage without adhesion near the tubal orifice. OME and hearing loss completely subsided 3 months after the surgery. She was disease-free 2 years after the surgery. Use of polyglycolic acid sheet could be a feasible mesh for closure of surgical defect without scarring, and it also led to healing of OME.     

Endoscopic resection of pleomorphic adenoma arising in the nasopharynx

Pleomorphic adenoma is the commonest benign tumor of the salivary glands. It has rarely been reported arising in the nasopharynx. A pleomorphic adenoma originating from the left lateral wall of the nasopharynx was found in a 61-year-old female who presented with nasal obstruction and intermittent epistaxis. It was successfully removed by combined transnasal and transoral surgery under endoscopic visualization. Endoscope-guided surgery may be helpful for the complete resection of benign nasopharyngeal tumors whilst minimizing injury to the Eustachian tube openings or velopharynx.     

Carcinosarcoma of the submandibular gland: an autopsy case

Malignant mixed tumors of salivary glands are classified as three types: carcinoma arising in a pleomorphic adenoma, the most common; benign metastasizing pleomorphic adenoma; and carcinosarcoma (true malignant mixed tumor), which is very rare [Ann. Otol. Rhinol. Laryngol. (1982) 91 342]. In carcinoma, both epithelial and soft tissue elements are malignant. In the context of previous reports, we discuss a case of carcinosarcoma of the submandibular gland including the results of postmortem examination.     

The case of giant pleomorphic adenoma of the parotid gland with the malignancy features

The aim of the study was showed the case of patient aged 41 years, treated in the Otolaryngology Department of Military Medical Academy because of giant pleomorphic adenoma of the parotid gland with the malignancy features. After performed of the BAC of tumour, the CT of neck and the scintigraphy of salivary glands the patient qualified for operation. The tumour resected with capsule and the superficial lobe of the left parotid gland, conservating of function of the facial nerve. The histopathologic examination proved the mucoepidermoid carcinoma in the pleomorphic adenoma didn't infiltrate of capsule. After oncologic consultation the patient had not of complementary radiotherapy, because the operation was radical and the carcinoma had a low radiosensitivity. The above mentioned case confirms of the reports, that the pleomorphic adenoma can undergo of malignancy changes, however the gigantic tumour doesn't write off possibility of operating success.     

Myoepithelial carcinoma ex-pleomorphic adenoma of the parotid gland

INTRODUCTION: Myoepithelial carcinoma accounts for less than 1% of salivary gland malignant tumors. It may develop de novo or, in approximately 50% of the cases, from a pleomorphic adenoma. OBSERVATION: A 57-year-old man with a history of a pleomorphic adenoma of the parotid treated surgically 6 years earlier, presented with a 2 cm tumor mass, palpable in the scar region. The histological examination and immunohistochemical study revealed a low-grade myoepithelial carcinoma. The patient had no complementary treatment. He presented 5 years later with a 2 cm parapharyngeal recurrence which was resected. There was no evidence of recurrent tumor or of distant metastasis at 4 year follow-up. DISCUSSION: Although myoepithelial cells are often predominant in pleomorphic adenomas, carcinomas developing in pleomorphic adenomas show in most cases a glandular differentiation and myoepithelial carcinomas are rare. Currently the diagnostic criteria, the prognosis, and the management of myoepithelial carcinomas are not well documented. Invasive carcinomas developing in pleomorphic adenoma are known to be highly aggressive neoplasms and myoepithelial carcinomas ex-pleomorphic adenoma seem to have a better prognosis. Our reported case was characterized by the weak aggressiveness of the lesion.     

Extra-major salivary gland pleomorphic adenoma of the head and neck: a 10-year experience and review of the literature

Pleomorphic adenomas, or benign mixed tumors, make up 65% of all salivary gland tumors. They also can be found as solid tumors in other parts of the head and neck region, such as the auditory canal, the eyelids, and the orbital area. In this study, we investigated extra-major salivary gland pleomorphic adenomas of the head and neck region retrospectively at a tertiary care center. Between March 1998 and June 2009, 37 patients underwent primary surgery for extra-major salivary gland pleomorphic adenoma of the head and neck. The duration of symptoms, radiographic findings, operative procedures, and pathologic findings were documented. Of the 37 patients enrolled, 22 were male and 15 were female, with a median age of 57?years. Tumors were found in the soft palate, hard palate, nasopharynx, orbital area, trachea, buccal mucosa, cheek, nasal septum, upper lip, lower eyelid, and external auditory canal. Cellular variant of the pleomorphic adenoma was found in four patients, while the remaining patients presented with the classic variant. No myxoid subgroup was noted in our study. Carcinoma ex pleomorphic adenoma was observed only in one patient for whom radical surgery was performed. Twenty-eight patients (76%) had long-term follow-ups, with the average follow-up period being 4.5?years. Local recurrence was observed in three patients, and they underwent revision surgery during the follow-up period. Our results indicate that extra-major salivary gland pleomorphic adenomas are most commonly found in the soft palate. Wide excision was the treatment of choice, although its efficacy might be compromised with cosmetics and functional structures of the head and neck. Therefore, long-term follow-up of patients is necessary.     

Hidradenomata of the external auditory meatus. (Review of the literature and report of a pleomorphic adenoma).

A case of hidradenoma of the external auditory meatus ('ceruminoma') is presented, with a review of the literature. The tumour has the appearances of a pleomorphic adenoma and is devoid of a capsule. It is suggested that the term hidradenoma be used for tumours of the ceruminous glands and that they be classified histologically as (1) adenoma, (2) pleomorphic adenoma, (3) adenoid cystic carcinoma and (4) adenocarcinoma. This classification aids treatment and prognosis. Attention is drawn to the high incidence of malignancy in hidradenomata of the external auditory meatus. The treatment of choice for pleomorphic adenomata is wide surgical excision with an adequate margin of normal skin. If there is doubt regarding complete removal, or a recurrence develops, a wider surgical excision is necessitated.     

Squamous liver metastases from a carcinoma arising within a pleomorphic adenoma of the parotid gland

A case of liver metastases from a squamous carcinoma arising within a pleomorphic adenoma is presented. The literature is reviewed and the clinical features, pathology and treatment of these tumours are discussed briefly.     

Malignant myoepithelioma arising from recurrent pleomorphic adenoma of the soft palate

Malignant myoepithelioma is a rare salivary gland neoplasm that can arise either de novo or within a pre-existing pleomorphic adenoma. We report a case of malignant myoepithelioma arising from a pleomorphic adenoma of the soft palate. A 70-year-old woman presented in our department with a very large tumor of the soft palate. The patient had a history of a pleomorphic adenoma at the same location that was surgically removed 2 years ago. A second operation, with intraoral excision of the tumor was performed. Histological examination of the recurrence revealed a malignant spindle cell neoplasm with an infiltrative growth pattern and a high mitotic rate. Immunohistochemical investigation confirmed the diagnosis of a low-grade carcinoma of myoepithelial origin with free surgical margins. The patient remains free of disease for more than twelve months after the end of treatment.     

Endoscopic surgery for Warthin's tumor of the nasopharynx

Warthin's tumor almost exclusively occurs in the parotid gland. It is the second most common tumor after the pleomorphic adenoma. The extraparotid or ectopic Warthin's tumor is rare and is normally situated in the submandibular gland, cervical lymph node, lip, cheek, tongue, hard palate, lacrimal gland and larynx. In this paper we present a case of the Warthin's tumor with ectopic localization in the nasopharynx with asymptomatic outcome. A 56-year-old man has been diagnosed for 10-year history of headache. He had no past history of any otolaryngologic disease. The axial and coronal NMR scans showed a round-shaped, cyst-like tumor of approximately 12 mm in diameter. The tumor was in the middle line of the nasopharynx without compression of the Eustachian tubes. The histopathologic diagnosis was consisted with Warthin's tumor. The patient underwent tumor removal using an endoscopic transnasal approach. The Warthin's tumor is a benign lesion with extremely rare occurrence in the nasopharynx. The symptoms are varied and sometimes it could be recognized accidentally. In a very rare cases it may transform to malignant neoplasm. The optional approach to the nasopharynx must be selected after careful consideration of the individual case. An endoscopic power instrumentation surgery are recommended for small lesions.     

鼻腔混合瘤的临床分析

目的探讨鼻腔混合瘤的临床表现、病理特点及治疗方法,以提高对此病的诊疗水平。方法回顾性分析6例鼻腔混合瘤患者的临床资料,根据术前鼻内镜和鼻窦CT等术前评估选择手术径路;其中2例行鼻侧切开术,4例行鼻内镜下肿瘤切除术。结果鼻腔混合瘤原发于鼻中隔者5例、鼻咽顶后壁1例;术后随访3年,5例痊愈,1例复发。结论鼻腔混合瘤虽属良性肿瘤,但术后易复发,首次彻底切除是预防复发的关键,术后需定期随访。