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Metastatic Carcinoma Ex Pleomorphic Adenoma of Parotid Gland



Pleomorphic adenoma is a mixed tumour   commonly involving major salivary glands. 25 of pleomorphic adenomas can undergo malignant transformation if untreated, even though they are benign tumors. There are three distinct entities in the spectrum of malignancy in pleomorphic    adenomas which include Carcinoma ex pleomorphic    adenoma, carcinosarcoma and benign metastasising  pleomorphic adenoma. CXPA is defined as the   carcinomatous transformation within a benign mixed tumour in which the initial benign elements are still identifiable .They develop from epithelial components of pleomorphic adenoma which display aggressive behaviour. Distant metastases have been reported to occur in as many as 44 of patients with CXPA which include the lungs (the most common site), pleura, pharynx, kidney, ocular choroid, liver, bone, brain, and spinal cord. None of the published literature has reported synchronous brain and lung metastasis at presentation.We report an interesting case of CXPA with upfront multiple brain and lung metastasis and review the literature of this   aggressive tumor.


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Seethala RR. An update on grading of salivary gland carcinomas.Head Neck Pathol. 2009;3:69- 77.

Qureshi A, Barakzat A, Nazim U et al Spectrum of malignancy in mixed tumours of salivary gland: a morphological and immunohistochemical review of 23 cases. Indian J PatholMicrobiol.2009;52:150- 54.

Kato H, Kanematsu M, Mizuta K, Ito et al. Carcinoma ex pleomorphic adenoma of the parotid gland: Radiologic-Pathologic correlation with MR Imaging including diffusion weighted imaging. Am J Neuroradiol.2008;29:865-67.

Lewis JE, Olsen KD, Sebo TJ. Carcinoma ex pleomorphic adenoma: pathologic analysis of 73 cases. Hum Pathol 2001, 32:596–604.

LiVolsi VA, Perzin KH. Malignant mixed tumors arising in salivary glands. I.Carcinomas arising in benign mixed tumors: a clinicopathologic study.Cancer 1977, 39: 2209–2230.

Brandwein M, Huvos AG, Dardick I et al.Noninvasive and minimally invasive carcinoma ex mixed tumor: a clinicopathologicand ploidy study of 12 patients with major salivary tumors of low (or no?) malignant potential. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 1996, 81:655–664.

.Olsen KD, Lewis JE. Carcinoma ex pleomorphic adenoma: aclinicopathologic review. Head Neck 2001, 23:705–712.

.Tortoledo ME, Luna MA, Batsakis JG. Carcinomas ex pleomorphic adenoma and malignant mixed tumors. Histomorphologic indexes. Arch Otolaryngol 1984, 110:172–176.

.Thompson L. World Health Organization classification of tumours:pathology and genetics of head and neck tumours. Ear Nose Throat J 2006, 85:74.

Akan H, Yildiz L, Unal R. Carcinoma ex pleomorphic adenoma of the minor salivary gland with pulmonary metastasis. DiagnIntervRadiol. 2008;14:3-5.

Gnepp DR. Malignant mixed tumors of the salivary glands: a review.PatholAnnu 1993, 28(Pt 1):279–328.

Sheedy SP, Walker KM, DeLone DR et al. CNS metastasis of carcinoma ex pleomorphic adenoma of the parotid gland. Am J Neuroradiol.2006;27:1483-85.

. Hellin-Meseguer D, Melgarejo-Moreno P, Hostalet E et al. Carcinoma ex adenoma of the submandibular gland with distant metastases. B-ENT 2007, 3(1):27–29.

. Ilhan HD, Oner FH, Sarioglu S et al. Bilateral choroidal metastasis from carcinoma ex pleomorphic adenoma of the parotidgland. Clin Experiment Ophthalmol 2005, 33(1):70–72.

. Vivian MA, Sahni VA, Lowe AC et al. Benign metastasizing adenoma presenting as a solitary kidney mass: imaging features. Urology 2012, 80(2):17–18.

Chen HH, Lee LY, Chin SC et al. Carcinoma ex pleomorphic adenoma of soft palate with cavernous sinus invasion. World J SurgOncol.2010;8:24.

Elad Sharon1, Ronan J Kelly1 and Eva Szabo. Sustained response of carcinoma ex pleomorphic adenoma treated with trastuzumab and capecitabine. Head & Neck Oncology 2010, 2:12


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