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.     

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.     

Simultaneous primary pleomorphic adenoma in parotid gland and minor salivary gland in the parapharyngeal space

The majority of salivary gland tumours present as a single mass in one gland. Sometimes multiple primary neoplasms can be seen in more than one salivary gland. The most common tumour is Warthin's tumour. Multiple primary pleomorphic adenomas are extremely rare. Most of them are in the major salivary glands. The author reports the first case of simultaneous pleomorphic adenomas in the parotid gland and minor salivary gland at the parapharyngeal space.     

Giant pleomorphic adenoma in accessory salivary gland

Giant pleomorphic adenoma is the most common neoplasm of salivary glands, specially of parotitis. Less frequently derives from minor salivary glands and, in the case, its size is small. We report one case of pleomorphic adenoma of great mass seated in a palatine salivary gland and avail the opportunity to review these sort of tumors.     

Carcinoma ex pleomorphic adenoma of the palatal minor salivary gland with extension into the nasopharynx

Carcinoma ex pleomorphic adenoma presenting in the nasopharynx is extremely rare. We present a case of carcinoma ex pleomorphic adenoma occupying the nasopharynx and the soft palate in a 51-year-old woman. To the best of our knowledge, this is the first reported case of carcinoma ex pleomorphic adenoma in the nasopharynx.     

颈部罕见巨大涎腺多形性腺瘤1例

涎腺多形性腺瘤（pleomorphic adenoma）又称涎腺混合瘤（mixedtumor）,是最常见的涎腺上皮肿瘤,其中80％～90％发生于腮腺,其次为下颌下腺和舌下腺。虽然绝大多数为良性,但仍有恶变倾向,其恶变率为2％～9％啦’。可发生于任何年龄段,以30～50岁最多见,女性多于男性。现报告1例巨大涎腺多形性腺瘤如下。     

喉小涎腺癌15例临床分析

目的 探讨喉小涎腺癌的临床特点、治疗及预后.方法 回顾性分析中国医学科学院肿瘤医院头颈外科1959至2005年收治的15例喉小涎腺癌患者的临床资料.11例(73.3%)病变位于声门上区,4例(26.7%)病变位于声门下区.其中腺样囊性癌10例,腺癌2例,黏液表皮样癌、恶性混合瘤、基底细胞腺癌各1例.单独手术7例;手术+放疗7例,其中6例患者行术后放疗,1例行术前放疗;1例行放疗+化疗.治疗后4例局部复发患者行手术挽救,其中l例肺转移后行转移灶切除;1例治疗后颈转移患者行放疗.结果 随访时间2～16年,中位数为8年.治疗后局部复发4例次,颈淋巴转移1例次,远处转移5例次,其中局部复发伴远处转移3例.7例患者存活3～16年,其中5例为无瘤生存,1例行单纯手术治疗,4例行手术+放疗;4例远处转移于治疗2～10年后死亡;其余4例随访2～16年后失访.结论 喉小涎腺癌很少见,其易发生局部复发和远处转移,远处转移是最主要的死亡原因.外科手术是喉小涎腺癌的主要治疗方法 ,手术结合放疗可望提高肿瘤局部控制率.     

Malignant minor salivary gland tumors of the larynx

OBJECTIVE: To report our experience in treating patients with malignant minor salivary gland tumors of the larynx. DESIGN: Thirty-three-year retrospective study. SETTING: Tertiary referral center specializing in head and neck surgery. PATIENTS: Twelve patients with malignant minor salivary gland tumors of the larynx were identified from a search of the institutional databases and pathology records at Memorial Sloan-Kettering Cancer Center, New York, NY, between the years 1970 and 2003. All slides were independently reviewed by 2 pathologists (R.G. and D.C.). Details on patient and tumor characteristics, as well as treatment and surgical outcome, were recorded. RESULTS: Ten patients (83%) had adenoid cystic carcinoma and 2 (17%) had myoepithelial carcinoma. Five (42%) were located in the supraglottis and 7 (58%) in the subglottis. Ten (83%) had surgery (6 with adjuvant radiotherapy) and 2 (17%) were treated with radiotherapy alone. Of the 10 patients who had surgery, total laryngectomy was required in 6 (60%), supraglottic horizontal laryngectomy in 2 (20%), and cricotracheal resection in 2 (20%). With a median follow-up of 55 months (range, 1-194 months), 10 patients are alive, 6 of whom have no evidence of disease. Seven patients (58%) developed recurrent disease, 2 of whom had local recurrence alone, 1 had regional recurrence alone, 3 had distant recurrence alone, and 1 had local and distant recurrence. CONCLUSIONS: Up to 60% of patients with malignant minor salivary gland tumors of the larynx will develop recurrent disease locally, regionally, or at distant sites. In adenoid cystic carcinoma, regional recurrence is rare, but distant recurrence is common and may occur up to 10 years after the index therapy. For both adenoid cystic and myoepithelial carcinoma, partial surgery is possible in selected cases, but because of the high propensity for submucosal spread and perineural and lymphovascular invasion, total laryngectomy is usually recommended.     

Metastasizing pleomorphic salivary adenoma

OBJECTIVE: To address questions about the etiology, behavior, optimal treatment, and prognosis of metastasizing pleomorphic adenoma (MPA), we undertook a review of the literature (1953-2005) and constructed a virtual series of all identified cases of MPA, metastatic lesions that are very occasionally identified in patients with a history of pleomorphic salivary adenoma and, on detailed pathological evaluation, found to exhibit all the histological hallmarks of the preceding benign lesions. DATA SOURCES: A review of the English-language literature between 1953 and 2005 using MEDLINE, secondary references identified from bibliographies of pertinent articles, and a further case from one of our institutions. DATA SYNTHESIS: A virtual case series was constructed and quantitatively analyzed. Forty-two patients with an average age of 33 years were identified. There were 20 male and 22 female patients. There was an overwhelming history of incomplete surgery for pleomorphic salivary adenoma. Most patients had locoregional recurrences before metastasis, and the mean presentation-to-metastasis latency was 16 years. Bone was the most common site for metastases (45%), followed by the head and neck (43%) and lung (36%). There was significant morbidity and mortality from distant disease, with 5-year disease-specific and disease-free survival of 58% and 50%, respectively. Developing distant lesions within 10 years of the primary tumor and presence of metastases in multiple sites were independent predictors of survival on Cox regression analysis. Metastasectomy conferred significant survival advantage over nonoperative treatment (log-rank analysis, P<.02). Chemotherapy and radiotherapy were of limited value. CONCLUSIONS: Meticulous surgery is crucial in preventing MPA. Metastatic disease carries significant morbidity and mortality and should be treated surgically when feasible.     

Carcinoma arising in monomorphic adenoma of the salivary gland

A case of carcinoma arising in a membranous type of monomorphic adenoma of the parotid gland is reported, and the literature is reviewed. This may represent the first unequivocal case of carcinoma arising in a nonadenolymphomatous and nonsebaceous monomorphic adenoma of the salivary gland.     

Metastatic salivary pleomorphic adenoma

Pleomorphic adenomas of the salivary gland are usually regarded as benign tumours. We report a case in which a solitary pulmonary metastasis arose from a pleomorphic adenoma of the right parotid gland. The mechanism of metastasis is discussed.     

Heterotopic salivary pleomorphic adenoma

The occurrence of heterotopic salivary tissue in the head and neck is briefly reviewed, and an additional case of heterotopic cervical pleomorphic adenoma added to the literature.     

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.     

Surgical treatment of recurrent pleomorphic adenoma of the parotid gland

Recurrent pleomorphic adenomas of the parotid gland warrant consideration because of the potential for facial nerve injury occurring with surgical treatment and the risk of malignant conversion. Forty-eight cases of recurrent pleomorphic adenoma treated at the University of Michigan, Ann Arbor, between 1935 and 1975 were retrospectively analyzed. The results of surgical procedures for recurrence were determined with respect to tumor control and resultant facial nerve function. Malignant conversion developed in three (6%) of 48 cases. The results of this study underscore the importance of adequate surgical excision of initial recurrences as well as primary tumors to prevent tumor recidivism. Tumor control rates and facial nerve preservation are enhanced with formal parotidectomy for recurrent tumor when feasible. In cases in which facial nerve identification and dissection is not possible, en bloc total parotidectomy offers effective, though not absolute, control of extensive recurrence.     

Unusual chordoma of the neck region simulating salivary gland pleomorphic adenoma

We report a 34-year-old woman with a cervical chordoma consisting of an intraspinal and extraspinal portion. The extraspinal component of the tumor invaded the deeper structures of the left side of the neck, and was subjected to repeated partial removal. It was misinterpreted as pleomorphic adenoma of salivary gland origin, whereas the intraspinal portion was a neurilemmoma with unusual mucous degeneration.     

Unusual cervical cyst. Adenocarcinoma ex-pleomorphic adenoma of a minor salivary gland

Cysts with an origin in a malignant tumour of the cervical region are rare. It is even more uncommon that the malignant tumour has its origin in a minor salivary gland as it is the malignant transformation of a pleomorphic adenoma. Some considerations are made regarding its localization, histopathology, diagnosis and therapeuthic attitude, as well as some advices to take into account in order to arrive to the diagnosis and correct treatment in similar cases to the one shown.     

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.