The schwannoma-like pleomorphic adenoma is a rare histopathological variant of the pleomorphic adenoma. Five previous reports with seven cases exist in English language literature. These tumors present in the parotid gland most commonly. Intraparotid schwannomas of the facial nerve and schwannomas with glandular differentiation have also been reported. A 60-year-old male presented with an asymptomatic swelling over the left angle of the mandible. The swelling had been present for about 12 years with a recent increase in size. CT imaging showed a hyperdense circumscribed mass of the superficial lobe of the parotid. The working diagnosis was that of a benign tumor of salivary gland or soft tissue origin. The mass was excised with careful preservation of the facial nerve. The 3.5 cm mass was submitted for histopathological examination. The well-circumscribed, encapsulated mass showed a predominant sheet-like proliferation of Antoni type A-like tissue, Foci of glandular differentiation with duct-like structures were also seen. Cytological atypia or mitotic activity were not seen. Nuclei of lesional cells diffusely and strongly expressed reactivity to p63. The final diagnosis was a schwannoma-like pleomorphic adenoma. No recurrence has been reported in the 15 months since the removal. Facial nerve function is unimpaired with a House Brackmann facial nerve function score of one. The potential for misdiagnosis in fine needle aspirate and incisional biopsies is real in cases of schwannoma-like pleomorphic adenoma. The diagnostic pitfalls include the schwannoma and leiomyoma. Schwannomas with glandular differentiation have also been reported and therefore a misdiagnosis may potentially occur in excised specimens. Careful application of immunohistochemistry may help in the differentiation of these lesions.

The controversies on 5-fluorouracil (5-FU) appear to be gradually culminating in two divergent groups of workers. One group uses low doses of the drug administered weekly and the other group prefers high doses, the so-called standard loading dose system or its modification. The present study reports impressions with a modified repeated protracted high dose schedule of 5-FU in 325 patients with far-advanced solid malignancies treated in Bangladesh with 20% objective and 40% subjective responses. The morbidity rate was high but the protraction and the vigilance perhaps have kept the mortality rate at 1.5%. About 14% of 120 patients with gastrointestinal metastatic cancers have survived more than 1 year and 8% beyond 2 years. Review of the literature on 5-FU reveal a tendency towards better response rates with higher drug concentrations particularly in the tumor-bearing area. It is noted that some prolonged survivors are always recorded by workers using high dose schedules but not yet by those using weekly schedules. It is imperative to wait for both short- and long-term results of the controlled trials before valid conclusions can be made.

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