Intracapsular carcinoma ex pleomorphic adenoma. Report of a case with unusual metastatic behaviour

Carcinoma ex pleomorphic adenoma (CXPA): immunoprofile of the cells involved in carcinomatous progression

“…In areas in which the myoepithelium disappeared altogether, the tumour presented morphological and immunohistochemical characteristics similar to those of frankly invasive carcinoma, in spite of remaining within the PA capsule (intracapsular CXPA). This finding shows that tumour situated inside the capsule of CXPA can present areas of intraductal carcinoma and areas of invasive carcinoma which could explain the metastatic behaviour recently reported in a case of intracapsular CXPA 5 . This tumour category (intracapsular CXPA) has also been termed ‘ in situ carcinoma’ and ‘non‐invasive carcinoma’ 20 .…”

“…In contrast, when the carcinomatous component is contained within the PA capsule (intracapsular carcinoma ex pleomorphic adenoma), the tumour has been considered to be non‐invasive and with benign clinical behaviour 1,3 . However, an unusual intracapsular case with metastases has recently been reported 5 …”

Carcinoma ex pleomorphic adenoma of soft palate with cavernous sinus invasion

“…Currently, surgery and post-operative adjuvant radiation therapy is accepted to improve local tumor control and a better tumor control is further associated with increased survival [8,13]. The 5-year survival rate of CXPA ranges from approximately 25% to 65% [14]. In our patient, complete excision of the tumor in CS was infeasible and it was further controlled by post-operative CCRT.…”

“…CXPA also shows the characteristics of frequent recurrence and metastasis [7]. Metastatic lesions most frequently occur in regional lymph nodes, and some of them are seen in lung and bone [14]. Currently, surgery and post-operative adjuvant radiation therapy is accepted to improve local tumor control and a better tumor control is further associated with increased survival [8,13].…”

???Metastasizing pleomorphic salivary adenoma??? should now be considered a low-grade malignancy with a lethal potential

“…Misdiagnosis is common in this disease entity because the residual pleomorphic adenoma tumor may be quite small, and various carcinoma subtypes may also be present [5]. The possible existence of intracapsular carcinoma ex-pleomorphic adenoma has been reported, but less well recognized is the metastatic potential of this disease [6].…”