Cytological Features of Carcinosarcoma ex Pleomorphic Adenoma of the Parotid Gland: A Case Report

Abstract

Background: Carcinosarcoma of the salivary gland is an extremely rare tumor composed of carcinomatous and sarcomatoid components. This report describes the cytological and pathological findings of a case of carcinosarcoma ex pleomorphic adenoma arising in the right parotid gland. Case: A 47-year-old female visited a hospital with swelling of the right parotid region, slight pain and facial palsy. Fine-needle aspiration smears showed both clustered epithelium-like cells and singly scattered cells in a necrotic background. The cells, especially the latter, exhibited significant cellular pleomorphism and had irregularly shaped nuclei. Myxoid stroma-like cell clusters without cellular atypism were also seen. The right parotid gland was resected, and the tumor tissue was histologically diagnosed as carcinosarcoma ex pleomorphic adenoma. Conclusion: The cytological findings of carcinosarcoma ex pleomorphic adenoma have been reported in very few cases. In the present case, various components, including the presence of atypical epithelium-like cell clusters and singly scattered atypical cells with stromal components on cytological specimens, led to consideration of the diagnosis of carcinosarcoma ex pleomorphic adenoma.

Minimally invasive carcinosarcoma ex pleomorphic adenoma: A case report and literature review with cytohistological correlation

“…Significant nuclear pleomorphism, multinucleated tumor giant cells, and a necrotic background were recurring features. In the case of the CSXPA described by Ishikura et al, fragments of metachromatic fibrillary stroma as well as metachromatic hyaline globules were identified, of which the former was present in our case. In the other published case of CSXPA, Kim et al described the presence of occasional benign glandular elements in a predominantly atypical cell population.…”

“…To date, the cytopathological features of salivary gland carcinosarcoma have only been described in 5 case reports, of which a pleomorphic adenoma component was present in 2 . The clinicopathological features of these cases are summarized in Table .…”

A Case of a Coexisting Carcinosarcoma Ex Pleomorphic Adenoma With Langerhans Cell Histiocytosis in the Parotid Gland

“…Carcinosarcoma ex pleomorphic adenoma is usually managed surgically with adjuvant chemotherapy, adjuvant radiotherapy, or adjuvant chemoradiation; however, all treatment modalities yield a dismal prognosis with tumor progression or death from the disease, with rare cases reporting no tumor recurrence. However, these cases report no follow-up period or a minimum follow-up period [ 2 - 4 , 6 - 8 ]. Similarly, our case was surgically removed followed by chemoradiation; however, the lesion progressed and showed metastasis to the lung.…”

“…These stains substantially increased in the transition zone and the frank malignant component. On the contrary, E cadherin is retained in the benign area but lost in the malignant component [ 2 , 4 , 7 , 8 , 12 , 13 ]. One case was reactive with HMGA2 while one peculiar case showed reactivity to HMGA2 and PLAG1 [ 8 , 14 ].…”

“…On the contrary, E cadherin is retained in the benign area but lost in the malignant component [ 2 , 4 , 7 , 8 , 12 , 13 ]. One case was reactive with HMGA2 while one peculiar case showed reactivity to HMGA2 and PLAG1 [ 8 , 14 ]. Management includes surgical resection with neck dissection in cases of lymph node involvement followed by adjuvant radiation.…”