Carcinosarcoma expleomorphic adenoma of the parotid gland with no history of long-standing or recurrent pleomorphic adenoma &ndash; a case report

Francia Victoria  A. De Los Reyes,; Socorro  Cruz-Yañez,; Maria Josefa  D. Mesina,

Carcinosarcoma expleomorphic adenoma of the parotid gland with no history of long-standing or recurrent pleomorphic adenoma – a case report

Francia Victoria A. De Los Reyes | Socorro Cruz-Yañez | Maria Josefa DL. Mesina

Abstract:

Carcinosarcoma ex pleomorphic adenoma of the salivary gland is an extremely rare tumor of the major and minor salivary glands that is composed of a mixture of both carcinomatous and sarcomatous elements with an identifiable benign epithelial and mesenchymal tumor counterpart. This report describes a rare case of carcinosarcoma ex pleomorphic adenoma involving the left parotid gland in a 61-year-old female with no history of a long-standing pleomorphic adenoma, nor a recurrent pleomorphic adenoma, and describes its morphology and important immunohistochemistry findings. Carcinosarcoma ex pleomorphic adenoma contains features of the two tumors under malignant mixed tumors, which are carcinosarcoma and carcinoma ex pleomorphic adenoma. Immunohistochemistry studies were done to document the epithelial and mesenchymal areas from both the malignant and benign sections of the tumor and to classify the carcinoma and sarcoma component, consisting of adenocarcinoma, not otherwise specified for the carcinoma component, and myxoid chondrosarcoma and mesenchymal chondrosarcoma for the sarcoma component. The paucity of documented cases of carcinosarcoma ex pleomorphic adenoma in prior scientific publications requires reporting cases such as this. Furthermore, the report provides an insight into the more complex molecular and structural changes that manifest as cancer behavior in the tumors of the salivary gland. The case contributes to the fund of knowledge for diagnosis and improvement of quality of care.

References:

Barnes L, Eveson J, Reichart P. Pathology and genetics of head and neck tumours. Lyon: Oxford University Press; 2005; 18: 242–4.
Alvarez-Cañas C, Rodilla IG. True malignant mixed tumor (carcinosarcoma) of the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod [Internet]. 1996; 81(4): 454–8. doi: 10.1016/s1079-2104(96)80023-0
T Tang Eng Soon V, Wee Y, Rom L, Azura Bte Mohamed Mukari S. Carcinosarcoma of the parotid: Parapharyngeal extension with facial nerve palsy and airway obstruction. Int J Head Neck Surg [Inter net]. 2007; 2(1). doi: 10.5580/12cb
Norhafiza Mat Lazim GR. A rare presentation of carcinosarcoma in a long standing parotid mass. J Otol Rhinol [Internet]. 2015; 04(02). doi: 10.4172/2324-8785.1000221
Kim YS, Lim S, Lee MJ. A case of carcinosarcoma expleomorphic adenoma. Med J Chosun Univ 2013; 38(2): 103–6.
Chao T, Rassekh C, Loevner L, Cannady S, et al. Giant parotid carcinosarcoma (true malignant mixed tumor) arising in a pleomorphic adenoma: Preservation of the facial nerve by retrograde dissection and free flap reconstruction. J Neurol Surg B: Skull Base [Inter-net]. 2015; 76(S 01). doi: 10.1055/s-0035-1546680
Ishikura N, Kawada T, Mori M, Maegawa H, Ohta M, Imamura Y. Cytological features of carcinosarcoma ex pleomorphic adenoma of the parotid gland: A case report. Acta Cytol [Internet]. 2014; 58(4): 419–26. doi: 10.1159/000365272
Mok Y, Min En N, Chwee Ming L, Petersson F. Minimally invasive carcinosarcoma ex pleomorphic adenoma: A case report and literature review with cytohistological correlation. Head Neck [Internet]. 2016; 38(9): E2483–E2489. doi: 10.1002/hed.24462
Petersson F, Loh KS. Carcinosarcoma ex non-recurrent pleomorphic adenoma composed of TTF-1 positive large cell neuroendocrine carcinoma and myofibrosarcoma: Apropos a rare case. Head Neck Pathol [Internet]. 2012; 7(2): 163–70. doi:10.1007/s12105-012-0385-0.
Tanahashi J, Daa T, Kashima K, et al. Carcinosarcoma ex recurrent pleomorphic adenoma of the submandibular gland. APMIS [Internet]. 2007; 115(6): 789–94. doi: 10.1111/j.1600-0463.2007.apm_647.x
Antony J, Gopalan V, Smith RA, Lam AKY. Carcinoma ex pleomorphic adenoma: A comprehensive review of clinical, pathological and molecular data. Head Neck Pathol [Internet]. 2011; 6(1): 1–9. doi: 10.1007/s12105-011-0281-z
Andreadis D, Poulopoulos A, Epivatianos A, Nomikos A, Christidis K, Barbatis C. Carcinosarcoma of the parotid gland: Immunohistochemical analysis with emphasis in cell cycle mitotic activity and cell adhesion molecules expression. Oral Oncol Extra [Internet]. 2006; 42(4): 140–3. doi: 10.1016/j.ooe.2005.10.004
Bishop P. Immunohistochemistry vade mecum [Internet]. [Accessed 2016 Jan 31] Available from: http://www.e-immunohistochemistry.info.
Cavalcante RB, Lopes FF, Ferreira AS, Freitas R de A, Souza LB de. Immunohistochemical expression of vimentin, calponin and HHF-35 in salivary gland tumors. Braz Dent J [Internet]. 2007; 18(3): 192–7. doi: 10.1590/s0103-64402007000300003
Nagao T, Sato E, Inoue R, et al. Immunohistochemical analysis of salivary gland tumors: Application for surgical pathology practice. Acta Histochem Cytochem [Internet].2012; 45(5): 269–82. doi: 10.1267/ahc.12019
Ueda T, Aozasa K, Tsujimoto M, et al. Prognostic s i g n i f i c a n c e o f K i - 6 7 r e a c t iv i t y i n s o f t t i s s u e sarcomas. Cancer [Internet]. 1989; 63(8): 1607–11. doi: 10.1002/1097-0142(19890415)63:8<1607::aid-cncr2820630827>3.0.co;2-1