Mucoepidermoid Carcinoma Ex-Pleormorphic Adenoma of Parotid Gland: A Rare Variant with Cytodiagnostic Handicap

  • Steuphen Roy Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
  • Norhafiza Mat Lazim Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
  • Zubaidah Saizul Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
  • Hasnan Jaafar Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
  • Aniza Binti Hassan Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
  • Nurul Syuhada Abdul Hamid Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
Keywords: Carcinoma ex pleomorphic adenoma, mucoepidermoid carcinoma ex pleormorphic adenoma, fine needle aspiration cytology

Abstract

Carcinoma ex pleomorphic adenoma is a rare malignant tumor predominantly arising from salivary glands. Mucoepidermoid carcinoma ex pleormorphic adenoma (MECxPA) is a rare subtype with only ten cases reported in literature. This is a case report of a 53- year-old female with three years history of parotid swelling mimicking clinical features of a benign tumor and even eluding fine needle cytology as pleormorphic adenoma. Histopathological examination reported malignancy of MECxPA variant following superficial parotidectomy. This cytodiagnostic pitfall has been widely reported in literature hence warranting a high index of suspicion and aggressive management in addressing parotid tumors to ensure prompt and adequate treatment.

Author Biographies

Steuphen Roy, Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
Dr.Steuphen Roy MD, MRCSEd(ENT) Otolaryngology, Head & Neck Surgery Postgraduate Medical Officer
Norhafiza Mat Lazim, Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
Dr. Norhafiza Mat Lazim MD, MMed(ORL-HNS) Consultant Otolaryngology, Head & Neck Surgeon Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
Zubaidah Saizul, Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
Dr. Zubaidah Saizul MD Pathology Postgraduate Medical Officer Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
Hasnan Jaafar, Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
Prof Dr Hasnan Jaafar MD, M.Path Consultant Pathologist Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
Aniza Binti Hassan, Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
Dr Aniza Binti Hassan MBBS, M.Path Consultant Pathologist Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
Nurul Syuhada Abdul Hamid, Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia
Dr Nurul Syuhada Abdul Hamid MD Pathology Postgraduate Medical Officer Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia

References

M Sherif Said. (2015 Nov 22). Pathology of Carcinoma Ex Pleomorphic Adenoma. Medscape.

Pollack AZ, Paul BC, Sheu MC, Har-El G. High-Grade mucoepidermoid carcinoma ex-pleomorphic adenoma of the parotid gland: Case report and review of literature. International Journal of Otolaryngology and Head & Neck Surgery. 2014;9;3(01):9.

Klijanienko J, El‐Naggar AK, Servois V, Rodriguez J, Validire P, Vielh P. Mucoepidermoid carcinoma ex pleomorphic adenoma: nonspecific preoperative cytologic findings in six cases. Cancer Cytopathology: Interdisciplinary International Journal of the American Cancer Society. 1998;84(4):231-4.

Lau RP, Yee-Chang M, Rapkiewicz A. Educational Case: Head and Neck Neoplasia: Salivary Gland Tumors. Academic Pathology. 2018;5:2374289518770655.

Olsen KD, Lewis JE. Carcinoma ex pleomorphic adenoma: a clinicopathologic review. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck. 2001;23(9):705-12.

BEAHRS OH, WOOLNER LB, KIRKLIN JW, Devlne KD. Carcinomatous Transformation of Mixed Tumors of the Parotid Gland. Plastic and Reconstructive Surgery and the Transplantation Bulletin. 1958;21(2):156-7.

Verma K, Kapila K. Role of fine needle aspiration cytology in diagnosis of pleomorphic adenomas. Cytopathology. 2002;13(2):121-7.

Batrani M, Kaushal M, Sen AK, Yadav R, Chaturvedi NK. Pleomorphic adenoma with squamous and appendageal metaplasia mimicking mucoepidermoid carcinoma on cytology. Cytojournal. 2009;6.

Altin F, Alimoglu Y, Acikalin RM, Yasar H. Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy. Brazilian Journal of Otorhinolaryngology. 2018 Jun 11.

Eppsteiner RW, Fowlkes JW, Anderson CM, Robinson RA, Pagedar NA. Aggressive salivary malignancies at early stage: outcomes and implications for treatment. Annals of Otology, Rhinology & Laryngology. 2017;126(7):525-9.

Morse E, Fujiwara RJ, Judson B, Prasad ML, Mehra S. Positive surgical margins in parotid malignancies: Institutional variation and survival association. The Laryngoscope. 2018 Sep 7.

Published
2019-06-21