Carcinoma ex pleomorphic adenoma

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Invasive salivary duct carcinoma ex pleomorphic adenoma of the parotid gland: a teaching case giving rise to the genuine diagnostic difficulty on an inadequate cytology specimen

Invasive salivary duct carcinoma ex pleomorphic adenoma of the parotid gland: a teaching case giving rise to the genuine diagnostic difficulty on an inadequate cytology specimen

dimensional malignant epithelial cells having hyperchromatic pleomorphic nuclei and prominent nucleoli, adjacent to a cluster of benign monomorphic myoepithelial cells. We first interpreted it merely as an adenocarcinoma, not otherwise specified. A radical parotidectomy was performed, and gross examination revealed an encapsulated and firm tumor lesion, looking grayish-blue to yellowish-white, focally associated with extracapsular invasion. On microscopic examination, the tumor was predominantly composed of a proliferation of highly atypical epithelial cells having abundant eosinophilic cytoplasm, often arranged in a Roman-bridge appearance with foci of comedo necrosis, alternating with extensive infiltration to adjacent stroma in a trabecular or alveolar fashion with severe vessel permeation. Within the background of pleomorphic adenoma, the carcinoma cells sometimes replaced ductal luminal cells while retaining an intact-like myoepithelial layer. Therefore, we finally made a diagnosis of invasive salivary duct carcinoma ex pleomorphic adenoma. We should be aware that owing to its characteristic features, cytopathologists might be able to determine correct diagnosis, based on multiple and adequate samplings.
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<p>Sinonasal/nasopharyngeal pleomorphic adenoma and carcinoma ex pleomorphic adenoma: a report of 17 surgical cases combined with a literature review</p>

<p>Sinonasal/nasopharyngeal pleomorphic adenoma and carcinoma ex pleomorphic adenoma: a report of 17 surgical cases combined with a literature review</p>

A carcinoma ex-pleomorphic adenoma (CXPA) is a malignant epithelial neoplasm arising from a primary or recurrent benign PA. Tumors of this variety account for approximately 3.6 – 4% of all salivary gland neoplasms, which in turn account for 12% of all salivary gland malignancies. 6 CXPA is extremely rare in the sinonasal and nasopharyngeal regions, and only a few cases have been reported in the literature (Table 1). 5–14 CXPA is divided into noninvasive, minimally invasive, and invasive categories according to the degree of invasion of carcinoma beyond PA. This distinction is important for determining prognosis and guiding appropriate treatment. Noninvasive and mini- mally invasive CXPA rarely occur in a malignant fashion, and invasive CXPA has a 5-year survival rate of approxi- mately 30%. 15
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High Grade Mucoepidermoid Carcinoma  Ex Pleomorphic Adenoma of the Parotid Gland:  Case Report and Review of Literature

High Grade Mucoepidermoid Carcinoma Ex Pleomorphic Adenoma of the Parotid Gland: Case Report and Review of Literature

Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological di- agnosis. Methods: We present a case of a 71-year-old male with an enlarging left neck mass over several months. CT showed both a parapharyngeal space mass and a separate level II neck mass. Results: The patient underwent resection of the left parapharyngeal mass and ipsilateral selective level II - IV lymphadenectomy. The final pathologic diagnosis was metastatic high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma. Conclu- sions: We describe a novel presentation of high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma as a metastatic parapharyngeal mass.
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An unusual case of spleen metastasis from carcinoma ex pleomorphic adenoma of the parotid gland

An unusual case of spleen metastasis from carcinoma ex pleomorphic adenoma of the parotid gland

Pleomorphic adenoma (PA) is the most common tumor of the salivary glands (it includes about 65% of all salivary gland tumors). PA originates more commonly in parotid glands (65% to 75%), 8% in submandibular glands, and only 6% to 7% in minor salivary glands. Generally, it is considered a benign and slow-growing tumor, but about 1.6% to 7.5% of PA shows malignant changes during its natural history, including three different types: carcinoma ex pleomorphic adenoma (CXPA), also called malignant mixed tumor, carcinosarcoma, and metastasizing PA (MPA); the latter two are exceedingly rare [1,2].
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Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland

Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland

The malignant form of pleomorphic adenoma (PA) (or carcinoma ex pleomorphic adenoma (CXPA)), also called malignant mixed tumor, carcinosarcoma or metastasizing PA, is defined as a carcinoma arising from a primary or re- current benign PA. Carcinosarcomas are composed of ma- lignant epithelial and mesenchymal components, and are therefore often called ‘true malignant mixed tumors’ , whereas metastasizing PAs are characterized by the pres- ence of one or more foci of metastatic, histologically be- nign PAs, but these two entities are exceedingly rare [1]. This present study focused on CXPA.
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Quantitative promoter methylation differentiates carcinoma ex pleomorphic adenoma from pleomorphic salivary adenoma

Quantitative promoter methylation differentiates carcinoma ex pleomorphic adenoma from pleomorphic salivary adenoma

The archives of the oral pathology laboratories of the Liverpool and Manchester University Hospital Dental Schools were searched using SNOMED code (M89413). Electronic databases were searched from 1993-2007. Diagnosis was confirmed through review of all potential H&E stained slides and cases with a demonstrable pre-existing PSA or its “ghost” were included in the study (n=24). Additional cases (n=7) were also included where the clinical presentation indicated Ca ex PSA: history of a long-standing stable swelling with recent rapid alteration in size and with histological confirmation of a malignant tumour, usually high grade and often showing multiple patterns of differentiation. Presence of multiple patterns of malignant salivary gland type tumours or diverse differentiation alone was not accepted as definite evidence of Ca ex PSA. All cases were reviewed independently by two pathologists (GH, JAW). Cases of PSA were identified by database searching (SNOMED code M89400) (n=28).
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Human epithelial growth factor receptor 2 in human salivary carcinoma ex pleomorphic adenoma: a potential therapeutic target

Human epithelial growth factor receptor 2 in human salivary carcinoma ex pleomorphic adenoma: a potential therapeutic target

4,5 Previous studies have shown that HER2 is overexpressed in salivary malignant pleomorphic adenoma and is involved in multiple cellular pathways, including cell proliferation, adhesi[r]

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<p>Anlotinib is effective in the treatment of advanced carcinoma ex pleomorphic adenoma of the submandibular gland</p>

<p>Anlotinib is effective in the treatment of advanced carcinoma ex pleomorphic adenoma of the submandibular gland</p>

CXPA typically presents as a fi rm mass in the parotid or submandibular gland. It is very dif fi cult to diagnose preo- peratively. About a quarter of patients had a previously trea- ted salivary pleomorphic adenoma. 6,7 Treatment for CXPA remains challenging because conducting large randomized clinical trials is not realistic due to the entity ’ s low incidence. The major approach is surgical resection and radiotherapy. The value of chemotherapy is inclusive in advanced disease. There is very scant literature on chemotherapy in the treat- ment of CXPA. Several agents alone or in combination (vinorelbine, paclitaxel, cyclophosphamide, doxorubicin,
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Juvenile pleomorphic adenoma of the cheek: a case report and review of literature

Juvenile pleomorphic adenoma of the cheek: a case report and review of literature

The differential diagnosis of the juvenile pleomorphic adenoma of the cheek (Table 1) includes buccal space abscess, dermoid cyst, foreign body reaction, fibroma, lipoma, neurofibroma, rhabdomyosarcoma, mucoepider- moid carcinoma, adenoid cystic carcinoma, polymor- phous low-grade adenocarcinoma and carcinoma ex pleomorphic adenoma [16,18]. The possibility of buccal space abscess was ruled out due to absence of sign of inflammation. The solid nature of the lesion coupled with the lack of tissue representing the three germ layers rule out the possibility of mature cystic teratoma (dermoid cyst). The lack of ulceration of the buccal mucosa, pain, paresthesia or invasion of the surrounding tissue rules out the possibility of malignant transformation. Carcinoma ex pleomorphic adenoma is characterized by the presence of malignant epithelium (salivary duct carcinoma, undif- ferentiated carcinoma, adenocarcinoma not otherwise specified, terminal duct carcinoma or myoepithelial carci- noma) with benign stroma. Carcinoma ex pleomorphic adenoma is extensively infiltrative malignancy with necrosis, perineurial invasion, frequent mitotic figures, marked nuclear atypia. Adenoid cystic carcinoma usually shows cribriform, solid or tubular pattern similar to cylin- dromas of skin. It is composed of small bland myoepithe- lial cells with scant cytoplasm and dark compact angular nuclei that surround pseudoglandular spaces with PAS+ excess basement membrane material and mucin. Periph- eral perineurial invasion and small true glandular lumina are sometimes seen but no squamous differentiation; or extensive necrosis are usually absent. Adenoid cystic carci- noma has high proliferative index, high p53 immunoreac- tivity, intense staining for BCL-2 but negative reactivity for glial fibrillary acidic protein. In contrast, pleomorphic adenoma is not invasive, show no perineurial invasion; has squamous metaplasia and mesenchyme-like areas. Charactaristically, pleomorphic adenoma has strong glial fibrillary acidic protein in the myxochondromatous areas [19]. The basal cell carcinoma is a low grade malignancy similar to basal cell adenoma. It is an infiltrative tumor with perineurial invasion and vascular invasion; variable cytologic atypia and mitotic activity. It is composed of solid, trabecular, tubular or membranous patterns but there is no myxoid matrix or cartilegenous areas. The basal cell adenoma is composed of basaloid cells sharply delin- The histological features of the juvenile pleomorphic ade-
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Metastasizing Pleomorphic Adenoma: A Fascinating Enigma

Metastasizing Pleomorphic Adenoma: A Fascinating Enigma

Salivary gland tumors represent 1% to 4% of all human neoplasias [1]. Pleomorphic adenoma is the most common tumor that a ff ects the aforementioned glands [1–3]. Rarely PA undergoes malignant transformation into Carcinoma Ex-Pleomorphic Adenoma (CEPA) or carcinosarcoma. It is even more uncommon that PA metastasizes. Among sali- vary gland neoplasms, metastasizing pleomorphic adenoma (MPA) constitutes an extremely rare group of tumors [2, 3]. Although apparently benign, the MPA-associated mortality could be as high as 22% [2]. According to Nouraei and colleagues’ review of case reports, the 5-year disease-specific and disease-free survivals of patients suffering from MPA are 58% and 50%, respectively [3].
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Concurrent pleomorphic adenoma in parapharyngeal space and submandibular gland

Concurrent pleomorphic adenoma in parapharyngeal space and submandibular gland

Malignant transformations in recurrent and large pleo- morphic adenomas are known [22,23]. Malignancy can arise from epithelial (carcinoma ex pleomorphic ade- noma) or mesenchymal (true malignant mixed tumor) components [23]. Metastasizing mixed tumor is the third sub-type of malignant mixed tumor, and develops from an otherwise unremarkable mixed tumor [23]. The diag- nosis of malignant mixed tumor requires the presence of a recognizable mixed tumor (primary or recurrent) in association with a carcinoma and/or sarcoma [23]. The histological features that may consistently predict the development of metastases have not yet been identified [23]. Serial histological sections in our case showed no evidence of malignant epithelial or mesenchymal compo- nents in association with both tumors in our patient. Competing interests
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Pleomorphic adenoma gene 1 mediates the role of karyopherin alpha 2 and has prognostic significance in hepatocellular carcinoma

Pleomorphic adenoma gene 1 mediates the role of karyopherin alpha 2 and has prognostic significance in hepatocellular carcinoma

We applied co-immunoprecipitation using a polyclonal antibody of KPNA2 and proteins acquired from the as- says were used for detection of PLAG1, with ACTB as a negative control. The association of PLAG1 with KPNA2 was confirmed in two HCC cell lines, as PLAG1, but not ACTB, could be detected in the precipitate enriched by KPNA2 antibody (Figure 1a). Next, In vitro models were applied to explore whether the association would be functional for PLAG1 in nucleus shuttling. Firstly, the overexpression of KPNA2 in Huh7 was validated in two different clones by stable transfection with KPNA2 ex- pression vector (Figure 1b, designated as Clone1, Clone2). Then, we established a small-interfering RNA (siRNA)- mediated loss of KPNA2 expression in SMMC7721 cells (Figure 1c, designated as si144 and si467). KPNA2 acts as regulator of nucleus import, the translocation of KPNA2 into nucleus partly represented the biological effect of KPNA2 and was determined in HCC cell lines of in vitro models. Cell fractionation followed by immunoblotting in- dicated that intervention of KPNA2 could modulate the nucleus KPNA2 expression (Figure 1d), suggesting our
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Pleomorphic adenoma of head and neck region: our institutional review

Pleomorphic adenoma of head and neck region: our institutional review

Although, pleomorphic adenoma is benign tumors with good prognosis, the treatment of choice is surgical excision with free margins to prevent recurrence or malignant transformation. Removal of tumor along with superficial lobe of parotid gland is adequate for major cases. In case of deep lobe, total conservative (leaving facial nerve intact), total parotidectomy should be done. 18 Pleomorphic adenomas in parapharyngeal space due to its complex anatomical region are traditionally approached by trans-cervical and parotid approaches as they provide wide intra-operative visibility and minimal functional after-effects. Rarely, trans-oral approach is used. Tumor spillage, capsular tears, dehiscences, female gender is critical for recurrences.
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Original Article Expression of MYB protein and its clinicopathological significance in adenoid cystic carcinoma of salivary gland

Original Article Expression of MYB protein and its clinicopathological significance in adenoid cystic carcinoma of salivary gland

Pathology, Nanjing Stomatological Hospital, Medical School of Nanjing University (China), including 98 cases of ACC and 68 cases of non- ACC neoplasms (20 cases of basal cell adeno- ma, 12 cases of pleomorphic adenoma, 11 cases of myoepithelioma, 10 cases of Warthin tumor, 6 cases of oncocytoma and 9 cases of basal cell carcinoma). All the cases were pri- mary tumors resected for the first time. None of them was treated with radiotherapy, chemo- therapy or immunotherapy pre- or post-opera- tively. The 20 wax blocks of salivary gland tis- sue adjacent to ACC and 5 wax blocks of salivary gland tissue of non-neoplastic lesions (including submandibular gland calculus and inflammation) were selected as controls. According to the 2005 WHO histological classi-
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Pleomorphic Adenoma Of The Hard Palate – A Clinical StudySharma Pramod

Pleomorphic Adenoma Of The Hard Palate – A Clinical StudySharma Pramod

The study comprised of 12 patients with pleomorphic adenoma of the hard palate operated between January 2014 and May 2018. All patients reported with a slow growing mass in the hard palate which was painless. After thorough clinical examination, FNAC was done for all patients. FNAC was sensitive for Pleomorphic adenoma in all cases. Coronal CT scans were done to know the extent of bony involvement and surgical planning. Routine blood investigations were done in all cases. A pre-operative impression was taken with alginate and a dental stone model fabricated. The stone model was used to create a palatal splint to aid in retention of dressing placed after surgical excision. (Figure) All patients underwent wide local excision under general anaesthesia.
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Stroke Secondary to a Parapharyngeal Pleomorphic Adenoma – Case Report

Stroke Secondary to a Parapharyngeal Pleomorphic Adenoma – Case Report

The mass was then excised piecemeal with meticulous blunt dissection of attached soft tissues. Histology of the sample was reported as follows: sections showed benign tumour composed of a mixture of glandular epithelial as well as mucinous, cartilaginous and hyalinised stromal elements. Features were that of pleomorphic adenoma.

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Imaging Characteristics of Recurrent Pleomorphic Adenoma of the Parotid Gland

Imaging Characteristics of Recurrent Pleomorphic Adenoma of the Parotid Gland

P leomorphic adenoma, or benign mixed tumor, is the most common tumor of the parotid gland and represents 70% of all parotid neoplasms. 1 It is a slow-growing benign neo- plasm, most commonly seen as a solitary lesion. Histologi- cally, it is characterized by the presence of cellular pleomor- phism and is composed of an epithelial and connective tissue component within a stroma of mucoid, myxoid, chondroid, and osteoid origin. 2 The tumor is surrounded by a delicate and

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Case Report Multiple bilateral Warthin’s tumors of the parotid glands with pleomorphic adenoma: a case report

Case Report Multiple bilateral Warthin’s tumors of the parotid glands with pleomorphic adenoma: a case report

Such auxiliary examinations as B-ultrasound, computed tomography (CT) and magnetic reso- nance imaging (MRI) are deemed common in diagnosing parotid gland tumors. However, to obtain a more accurate diagnosing result, rich experience and comprehensive understanding of the sufferer’s medical history are necessary. But imaging tests are unreliable when diagnos- ing a co-existence of tumors with different his- tological types. MRI scan is a good choice of diagnosing parotid gland tumors because of its remarkable identifying ability towards soft tis- sue. For instance, pleomorphic adenomas usu- ally reflect round like and are enveloped by a layer of smooth surface [33], with bright signal areas on the T2-weighted images and prompts low-intensity edges where the envelope exists [34]. Ultrasound guided fine needle aspiration cytology (Ultrasound-guided FNAC) is consid- ered as a relatively simple examination of which the accuracy of identifying the benign tumors with the malignant tumors can reach to 85%- 97% [35]. But it’s diagnostic sensitivity towards the parotid disease sensitivity is not high. Pre- operative physical examinations, especially pal- pation is significant in the diagnosis of parotid tumor. The difficulty arises when diagnosing tumors from the deep lobe of parotid gland. Resection stands in the first place when deal- ing with multiple parotid gland tumors. Ethun- andan M [5] believes such benign multiple tumors basically happening in the superficial parotid should be adopted palpation during operation and superficial parotidectomy owing to the difficulty of precisely judging the number of tumors and their pathological types before operation. Whether to adopt the surgical meth- od of parotidectomy of total lobe should be decided by the position and features of the tumor.
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Genomic profiling of rectal adenoma and carcinoma by array-based comparative genomic hybridization

Genomic profiling of rectal adenoma and carcinoma by array-based comparative genomic hybridization

Copy number increase of EFNA1 (1q22), PTGS2 (1q31.1), KDM5B (1q32.1), ESRRG (1q41), KIFC1 (6p21.32), PBX2 (6p21.32) and SOX4 (6p22.3) were only detected in rectal cancer in array CGH. Among them, EFNA1 had increased expression in carcinoma com- pared with adenoma, and KIFC1 had an upward trend but not significant in statistical analysis (Figure 4A). Of these genes KIFC1 and SOX4 were also significantly overexpressed in rectal tumor tissues than paracancer- ous tissues (Figure 4B).

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A Comparative Study of the Expression of Her2/Neu in Invasive Ductal Carcinoma of Breast Associated With and Without Ductal Carcinoma in SITU

A Comparative Study of the Expression of Her2/Neu in Invasive Ductal Carcinoma of Breast Associated With and Without Ductal Carcinoma in SITU

The tumor shows various growth pattern like diffuse sheets, well defined nests, cords, trabeculae and also as individual cells. Glandular differentiation may be well developed to barely detectable. The individual tumor cells are usually large and pleomorphic compared to that of classical invasive lobular carcinoma. The tumor shows prominent nuclei and nucleoli and increased mitotic figures. About 60% of the cases shows areas of necrosis. The amount of stroma varies from scant to abundant desmoplastic stroma. Elastic tissue are present in about 90% of cases. The presence of chalky streaks on gross examination is due to the presence of elastosis involving the vessel and duct walls .About 60% of the cases show calcification. The interphase between the tumor and stroma shows mononuclear cell inflammatory infiltrates. 12
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