Prognostic factors of carcinoma ex pleomorphic adenoma of the salivary glands, with emphasis on the widely invasive carcinoma: a clinicopathologic analysis of 361 cases in a Chinese population

2016 ◽  
Vol 122 (5) ◽  
pp. 598-608 ◽  
Author(s):  
Yu-Hua Hu ◽  
Chun-Ye Zhang ◽  
Rong-Hui Xia ◽  
Zhen Tian ◽  
Li-Zhen Wang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Salivary Glands ◽  
Pleomorphic Adenoma ◽  
Chinese Population ◽  
Invasive Carcinoma ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Widely Invasive

scholarly journals Intracapsular Carcinoma ex Pleomorphic Adenoma

2019 ◽  
Vol 34 (1) ◽  
pp. 68-69
Author(s):  
Jose M. Carnate ◽  
Marvin C. Masalunga
Keyword(s):  
Pleomorphic Adenoma ◽  
Invasive Carcinoma ◽  
Growth Patterns ◽  
Surrounding Tissue ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Duct Carcinoma ◽  
Non Invasive ◽  
Minor Salivary Gland Tumors ◽  
History Of ◽  
Widely Invasive

This is the case of a 37-year-old female patient presenting with a 10-year history of a gradually enlarging right infra-auricular mass. A parotidectomy was performed. The surgical pathology specimen consisted of an 18 cm diameter encapsulated nodular mass with a homogenous, cream-tan solid surface. Microscopic section showed an encapsulated neoplasm with abundant chondromyxoid stroma and tubular epithelial elements characteristic of a pleomorphic adenoma. (Figure 1) Randomly scattered within the tumor were foci of haphazard and complex glands. (Figure 2) These glands exhibited nuclear pleomorphism, luminal necrosis, and mitoses compatible with an adenocarcinomatous proliferation. (Figure 3) Based on these features, the case was signed out as an intracapsular carcinoma ex pleomorphic adenoma.   Carcinoma ex pleomorphic adenoma is a carcinoma arising from a pre-existing pleomorphic adenoma. The antecedent benign tumor may either be a long-standing one, often with a history measured in decades, or characterized by a protracted history of excisions and multiple recurrences.1,2 The carcinoma on the other hand is either epithelial or myoepithelial in derivation. By morphologic sub-type, the most commonly reported carcinoma arising in a pleomorphic adenoma is a salivary duct carcinoma or an adenocarcinoma that is not otherwise specified (NOS).1,3 Residual pleomorphic adenoma tissue is identifiable either in its typical morphology, a chondromyxoid stroma, or a hyalinized sclerotic nodule.1   Aside from the type of carcinoma arising from the pleomorphic adenoma, another parameter that has to be reported is the extent of involvement by the carcinomatous component. A carcinoma that is entirely limited to within the parent tumor that is still enclosed by a complete capsule is termed an “intracapsular” or “non-invasive” carcinoma ex pleomorphic adenoma.1,2 Once the carcinoma breaches the capsule and infiltrates the surrounding tissue, then it is considered invasive. If the invasion is less than 4 – 6 mm beyond the capsular border, the tumor is termed “minimally invasive”. Carcinomatous elements that extend beyond this threshold is termed “widely invasive”.1 This threshold is greater than the previous threshold of 1.5 mm recommended in an earlier edition of the WHO classification although the present edition does state that this threshold is preliminary and requires further validation.1,2,4 It has to be pointed out though that quantifying invasion may not always be possible in tumors that have positive margins, those that are intrinsically unencapsulated such as minor salivary gland tumors, and those with complex multinodular growth patterns such as in recurrent pleomorphic adenoma.1 This difficulty has to be stated in the report and what conditions preclude quantifying the degree of invasion.   Non-invasive carcinoma ex pleomorphic adenoma has quite a good outcome with very low reported rates of recurrence or regional metastasis. In a review of thirty cases and a report of an additional three cases, only one case showed recurrence or metastasis.3 This favorable outcome certainly contrasts with that of the widely invasive type where metastasis is reported to occur in up to 70% of cases.1 Another review of ten cases showed one case developing metastasis, and recommended that non-invasive cases should thus still be followed up closely after primary treatment because regional or distant metastasis can occur.2   To the best of our knowledge, there are no published local data on the incidence of early malignant transformation of pleomorphic adenomas in the Filipino population. Hence, we take this opportunity to report this case. Awareness of the entity and prudent liberal sampling of these tumors may help address this gap.

Extracapsular invasion: A potential prognostic marker for Carcinoma ex‐pleomorphic adenoma of the salivary glands? A Systematic Review

2019 ◽  
Vol 48 (6) ◽  
pp. 433-440 ◽  
Author(s):  
Everton Freitas Morais ◽  
Juliana Campos Pinheiro ◽  
Dáurea Adília Cóbe Sena ◽  
Hébel Cavalcanti Galvão ◽  
Lélia Batista Souza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Salivary Glands ◽  
Pleomorphic Adenoma ◽  
Prognostic Marker ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Extracapsular Invasion

Invasive carcinoma ex pleomorphic adenoma of submandibular gland: A case report

2011 ◽  
Vol 23 (4) ◽  
pp. 207-209
Author(s):  
Doh Jeing Yong ◽  
Mahadzir Mazlinda ◽  
Alias Zanariah ◽  
Balwant S. Gendeh
Keyword(s):  
Case Report ◽  
Submandibular Gland ◽  
Pleomorphic Adenoma ◽  
Invasive Carcinoma ◽  
Carcinoma Ex Pleomorphic Adenoma

Malignant transformation of the salivary gland pleomorphic adenoma in myoepithelial carcinoma – the report of two cases

2019 ◽  
Vol 8 (1) ◽  
pp. 52-55
Author(s):  
Paulina Szabelska ◽  
Anna Rzepakowska ◽  
Benedykt Szczepankiewicz ◽  
Elżbieta Niemczyk ◽  
Ewa Osuch-Wójcikiewicz ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Surgical Treatment ◽  
Salivary Glands ◽  
Pleomorphic Adenoma ◽  
Malignant Transformation ◽  
Benign Tumor ◽  
Complete Recovery ◽  
Surrounding Tissue ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Myoepithelial Carcinoma

A multiform adenoma is the most commonly diagnosed benign tumor of the salivary glands. In the majority of patients, surgical resection of the tumor with the adequate surrounding tissue of salivary gland allows for complete recovery. A small percentage of the cases is a recurring pleomorphic adenoma. Even more rarely the diagnosis of carcinoma ex pleomorphic adenoma is made. The study presents two clinical cases of the malignant transformation of pleomorphic adenoma into the myoepithelial carcinoma. The surgical treatment and additional radiotherapy were performed in both cases.

Carcinoma ex pleomorphic adenoma of minor salivary glands with major epithelial-myoepithelial component: clinicopathologic and immunohistochemical study of 3 cases

2015 ◽  
Vol 19 (3) ◽  
pp. 164-168 ◽  
Author(s):  
Bruno Tavares Sedassari ◽  
Harim Tavares dos Santos ◽  
Fernanda Viviane Mariano ◽  
Nelise Alexandre da Silva Lascane ◽  
Albina Altemani ◽  
...  
Keyword(s):  
Salivary Glands ◽  
Pleomorphic Adenoma ◽  
Immunohistochemical Study ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Minor Salivary Glands

Carcinoma ex pleomorphic adenoma of major salivary glands: CT and MR imaging findings

2021 ◽  
pp. 20200485
Author(s):  
Can Wang ◽  
Qiang Yu ◽  
Siyi Li ◽  
Jingjing Sun ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Salivary Glands ◽  
Invasive Carcinoma ◽  
Cervical Lymph Node Metastasis ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Type I ◽  
Adc Value ◽  
Type Iii ◽  
Major Salivary Glands ◽  
Sensitivity Specificity

Objectives: To describe the CT and MR imaging characteristics of primary carcinoma ex pleomorphic adenoma (Ca-ex-PA) in major salivary glands and present more information for recognizing this malignancy. Methods: 212 patients with primary Ca-ex-PA in major salivary glands (169 in the parotid gland, 36 in the submandibular gland, 7 in the sublingual gland) underwent CT and MR imaging (plain and contrast-enhanced scans) prior to surgical management and histopathological examination. The CT and MR imaging findings of this condition were retrospectively reviewed and correlated with their pathological types: non-invasive carcinoma (Type I, 37 cases), minimally invasive carcinoma (Type II, 18 cases), and widely invasive carcinoma (TypeIII, 157 cases). The binary logistic regression analysis was used to analyze the independent influencing factors of morphology and boundary for differentiating between Type I/II and Type III of Ca-ex-PA, and the sensitivity, specificity and positive predictive value were calculated. Differences in apparent diffusion coefficient (ADC) values between Type I/II and Type III of Ca-ex-PA were calculated by independent sample t-tests. Results: On CT and MR imaging, there were 190/212 cases (89.6%) identified as lobular, 203/212 cases (95.8%) with enhancement, and 173/212 cases (81.6%) with inhomogeneous after contrast administration.Calcification within the mass was shown in 76 of 192 cases (39.6%) on plain CT examination. Of 55 neoplasms with Type I and II, 38 (69.1%) were presented as round or oval and 42 (76.4%) as well-defined margins. Of 157 neoplasms with Type III, 103 (65.6%) were presented as irregular form and 110 (70.1%) as uneven margins or with partial uneven margins.The sensitivity, specificity and positive predictive value for distinguishing Type I/II and Type III tumors according to the morphology and boundary were 78.34%, 63.64% and 86.01%, respectively. The mean ADC value of Ca-ex-PA (22 cases) in major salivary glands was about 0.93 × 10−3 mm2 s−1, and there was no significant difference in mean ADC value between Type I/II and Type III of this neoplasm. Cervical lymph node metastasis and distance metastasis were found in 67 patients (31.6%, Type III) and 32 patients (15.1%, Type I in 1; Type II in 1; and Type III in 30), respectively. Conclusions: Most Ca-ex-PA is characterized by an irregular, lobular, and inhomogeneous enhanced neoplasm with uneven margin or partial uneven margin on CT and MR imaging, which is frequently corresponding with Type III. And a round or oval mass with well-defined margin usually correlates with Type I and II. Morphology and boundary are important basis for distinguishing Type I/II and Type III tumors. Calcification within the neoplasm shown on CT may be regarded as a specific sign for indicating this malignancy. Low ADC value is an important manifestation of this neoplasm.Ca-ex-PA with Type III is more likely to have cervical lymph node metastasis and distant metastasis.

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