Carcinoma ex Pleomorphic Adenoma of the Nasal Cavity

Cimino‐Mathews, Ashley; Lin, Brian M.; Chang, Steven S.; Boahene, Kofi; Bishop, Justin A.

doi:10.1007/s12105-011-0262-2

Cited by 37 publications

(22 citation statements)

References 7 publications

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“…ACC is the most common salivary gland type primary adenocarcinoma of the sinonasal tract [1,21]. However, there are only isolated case reports of CEPA in which the carcinoma is ACC [6,7,18,23]. Other carcinomas, such as mucoepidermoid carcinoma [18,24,25], squamous cell carcinoma [18] and adenocarcinoma, not otherwise specified (NOS), [6,23] are also recognized but are equally infrequent.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, the presence of pleomorphic adenoma and ACC as the carcinoma component of a CEPA is exceedingly uncommon (Table 1). [6,7] The varied clinical behavior, treatment alternatives, and long term patient prognosis of ACC CEPA is not well developed or understood. There is no large comprehensive evaluation of primary sinonasal tract ACC CEPA with respect to their clinical features, imaging findings, histomorphology, immunohistochemical reactivity, treatment outcomes, and clinical behavior.…”

Section: Introductionmentioning

confidence: 99%

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Sinonasal Tract Adenoid Cystic Carcinoma Ex-Pleomorphic Adenoma: A Clinicopathologic and Immunophenotypic Study of 9 Cases Combined with a Comprehensive Review of the Literature

Toluie

Thompson

2012

Head and Neck Pathol

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Primary sinonasal tract carcinoma ex-pleomorphic adenoma (CEPA) is very uncommon, with adenoid cystic carcinoma (ACC) CEPA exceptional. These tumors are often misclassified. This is a retrospective study. Nine cases of ACC CEPA included 7 females and 2 males, aged 39-64 years (mean, 51.1 years). Patients presented most frequently with obstructive symptoms (n = 5), epistaxis (n = 3), nerve changes or pain (n = 3), present for a mean of 25 months (men: 9.5 versus women: 29.4 months; p = 0.264). The tumors involved the nasal cavity alone (n = 5), nasopharynx (n = 2), or a combination of locations (n = 2) with a mean size of 2.9 cm (females: 3.3; males: 1.7; p = 0.064). Most patients presented at a low clinical stage (n = 7, stage I), with one patient each in stage II and IV, respectively. Histologically, the tumors showed foci of PA associated with areas of ACC. Tumors showed invasion (lymph-vascular: n = 4; perineural: n = 6; bone: n = 6). The neoplastic cells were arranged in tubules, cribriform and solid patterns, with pegshaped cells arranged around reduplicated basement membrane and glycosaminoglycan material. Mitoses ranged from 0 to 33, with a mean of 8.7 mitoses/10 HPFs. Necrosis (n = 2) and atypical mitotic figures (n = 1) were seen infrequently. Immunohistochemical studies showed positive reactions for cytokeratin, CK5/6, p63, CK7, EMA, SMA, calponin, S100 protein and CD117, several highlighting luminal versus basal cells components. GFAP, CK20 and MSA were non-reactive. p53 and Ki-67 were reactive to a variable degree. Surgery (n = 8), accompanied by radiation therapy (n = 5) was generally employed. Five patients developed a recurrence, all of whom died with disease (mean, 8.4 years), while 4 patients are either alive (n = 2) or had died (n = 2) without evidence of disease (mean, 15.9 years). In summary, ACC CEPA probably arises from the minor mucoserous glands of the upper aerodigestive tract, usually presenting in patients in middle age with obstructive symptoms in a nasal cavity based tumor. Most patients present with low stage disease (stage I and II), although invasive growth is common. Recurrences develop in about a 55 % of patients, who experience a shorter survival (mean, 8.4 years) than patients without recurrences (mean, 15.9 years). The following parameters, when present, suggest an increased incidence of recurrence or dying with disease: bone invasion, lymph-vascular invasion, and perineural invasion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sinonasal Tract Adenoid Cystic Carcinoma Ex-Pleomorphic Adenoma: A Clinicopathologic and Immunophenotypic Study of 9 Cases Combined with a Comprehensive Review of the Literature

Toluie

Thompson

2012

Head and Neck Pathol

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“…Finally, it is important to consider that ACC may be the malignant component of a carcinoma ex-pleomorphic adenoma, as noted in nine of the current cases. However, it is probably more important to thoroughly sample any SNT pleomorphic adenoma to exclude an ACC, than to necessarily try to identify a pleomorphic adenoma in a patient presenting with ACC [23,36,105].…”

Section: Immunohistochemical Studiesmentioning

confidence: 99%

Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases

Thompson

Penner

Ho³

et al. 2013

Head and Neck Pathol

119

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'Primary sinonasal tract and nasopharyngeal adenoid cystic carcinomas (STACC) are uncommon tumors that are frequently misclassified, resulting in inappropriate clinical management. Eighty-six cases of STACC included 45 females and 41 males, aged 12-91 years (mean 54.4 years). Patients presented most frequently with obstructive symptoms (n = 54), followed by epistaxis (n = 23), auditory symptoms (n = 12), nerve symptoms (n = 11), nasal discharge (n = 11), and/or visual symptoms (n = 10), present for a mean of 18.2 months. The tumors involved the nasal cavity alone (n = 25), nasopharynx alone (n = 13), maxillary sinus alone (n = 4), or a combination of the nasal cavity and paranasal sinuses (n = 44), with a mean size of 3.7 cm. Patients presented equally between low and high stage disease: stage I and II (n = 42) or stage III and IV (n = 44) disease. Histologically, the tumors were invasive (bone: n = 66; neural: n = 47; lymphovascular: n = 33), composed of a variety of growth patterns, including cribriform (n = 33), tubular (n = 16), and solid (n = 9), although frequently a combination of these patterns was seen within a single tumor. Pleomorphism was mild with an intermediate N:C ratio in cells containing hyperchromatic nuclei. Reduplicated basement membrane and glycosaminoglycan material was commonly seen. Necrosis (n = 16) and atypical mitotic figures (n = 11) were infrequently present. Pleomorphic adenoma was present in 9 cases; de-differentiation was seen in two patients. Immunohistochemical studies showed positive reactions for pan-cytokeratin, CK7, CK5/6, CAM5.2, and EMA, with myoepithelial reactivity with SMA, p63, calponin, S100 protein and SMMHC. CD117, CEA, GFAP and p16 were variably present. CK20 and HR HPV were negative. STACC needs to be considered in the differential diagnosis of most sinonasal malignancies, particularly poorly differentiated carcinoma, olfactory neuroblastoma and pleomorphic adenoma. Surgery (n = 82), often accompanied by radiation therapy (n = 36), was generally employed. A majority of patients developed a recurrence (n = 52) 2-144 months after initial presentation. Overall mean follow-up was 19.4 years (range 0.4-37.5 years): 46 patients died with disease (mean 6.4 years); 5 were alive with disease (mean 5.4 years), and 35 patients were either alive or had died of unrelated causes (mean 16.3 years). ACC of the SNT is uncommon. Recurrences are common. The following parameters, when present, suggest an increased incidence of either recurrence or dying with disease: mixed site of involvement, high stage disease (stage IV), skull base involvement, tumor 123Head and Neck ) 8:88-109 DOI 10.1007 recurrence, a solid histology, perineural invasion, bone invasion, and lymphovascular invasion.

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“…Así, la transformación maligna de alguno de los componentes tisulares del adenoma pleomorfo se define como un carcinoma ex adenoma pleomorfo. Dicha transformación representa cerca del 4% del total de tumores de glándulas salivales y el 12% de los tumores malignos 6,7 . En general, este tipo de tumores son poco frecuentes, presentando un largo periodo de evolución y en ocasiones como recidivas posteriores al primer tratamiento de un adenoma pleomorfo, siendo en este escenario, el desarrollo de carcinomas de alto grado las formas más comunes de presentación.…”

Section: Discussionunclassified

Carcinoma mioepitelial ex adenoma pleomorfo de parótida: Reporte de un caso y revisión de la literatura

Felipe

et al. 2014

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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Carcinoma ex Pleomorphic Adenoma of the Nasal Cavity

Abstract: Carcinomatous transformation of a PA in the nasal cavity is extremely rare, but does occur. Accordingly, PAs of this site should be thoroughly sampled and closely examined to exclude the possibility of malignant transformation.

Cited by 37 publications

References 7 publications

Sinonasal Tract Adenoid Cystic Carcinoma Ex-Pleomorphic Adenoma: A Clinicopathologic and Immunophenotypic Study of 9 Cases Combined with a Comprehensive Review of the Literature

Sinonasal Tract Adenoid Cystic Carcinoma Ex-Pleomorphic Adenoma: A Clinicopathologic and Immunophenotypic Study of 9 Cases Combined with a Comprehensive Review of the Literature

Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases

Carcinoma mioepitelial ex adenoma pleomorfo de parótida: Reporte de un caso y revisión de la literatura

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