Difference between revisions of "Carcinoma ex pleomorphic adenoma"

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Carcinoma ex pleomorphic adenoma (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Carcinoma ex pleomorphic adenoma -- low mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = Carcinoma ex pleomorphic adenoma. [[H&E stain]].
| Micro      =
| Micro      = epithelial or myoepithelial cells with cytologic features of malignancy, pleomorphic adenoma (required if no history)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[salivary duct carcinoma]], [[mucoepidermoid carcinoma]], [[adenoid cystic carcinoma]], [[pleomorphic adenoma]]
| LMDDx      = [[salivary duct carcinoma]], [[mucoepidermoid carcinoma]], [[adenoid cystic carcinoma]], [[pleomorphic adenoma]]
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| Assdx      =
| Assdx      =
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx = pleomorphic adenoma (required if not present in assoc. with carcinoma)
| Signs      = usu. parotid mass, firm
| Signs      = usu. mass lesion, firm
| Symptoms  =
| Symptoms  =
| Prevalence = uncommon
| Prevalence = uncommon
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| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
| Prognosis  = typically poor
| Prognosis  = dependent on stage, typically poor
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    =
}}
}}
'''Carcinoma ex pleomorphic adenoma''', abbreviated '''ca ex PA''', is a rare malignant [[salivary gland]] tumour that arise from a [[pleomorphic adenoma]].
'''Carcinoma ex pleomorphic adenoma''', abbreviated '''ca ex PA''', is a rare malignant [[salivary gland]] tumour that arises from a [[pleomorphic adenoma]].


==General==
==General==
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Diagnosis (either 1 or 2):  
Diagnosis (either 1 or 2):  
#History of a pleomorphic adenoma at the same site.
#History of a pleomorphic adenoma at the same site (~25% of cases<ref name=pmid21744105/>).
#Features of a pleomorphic adenoma and a carcinoma.
#Features of a pleomorphic adenoma and a carcinoma.


Epidemiology:
Epidemiology:
*Rare.
*Rare.
*Usually a poor prognosis.<ref name=pmid21744105/>
*Prognosis dependent on stage:
**Good for early lesions - like PA.<ref name=pmid23821206/>
**Poor for advanced lesions.<ref name=pmid21744105/>


==Gross==
==Gross==
*Usually mass lesion - partoid gland.<ref name=pmid21744105/>
*Usually mass lesion - typically parotid gland.<ref name=pmid21744105/>


==Microscopic==
==Microscopic==
Features:
Features:
*Cells with cytologic features of malignancy - '''key feature'''.
*Cells (epithelial or myoepithelial) with cytologic features of malignancy - '''key feature'''.
*Architecture (any of the following):  
*Architecture (any of the following):  
**Glands.
**Glands.
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**Single cells (may be subtle).  
**Single cells (may be subtle).  


Architectural patterns:
Subtyping/patterns:
*[[Ductal carcinoma]] NOS (arising from ductal cells) - most common pattern for Ca ex PA.
*Epithelial carcinoma (~75% of cases<ref name=pmid21744105/>):
**[[Ductal carcinoma]] NOS (arising from ductal cells) - most common pattern for ca ex PA.
**"Named carcinoma":
***[[Salivary duct carcinoma]] - second most common pattern for Ca ex PA.
***[[Mucoepidermoid carcinoma]].
***[[Adenoid cystic carcinoma]].
*Myoepithelial carcinoma NOS (arising from myoepithelial cells).
*Myoepithelial carcinoma NOS (arising from myoepithelial cells).
*"Named carcinoma":
**[[Salivary duct carcinoma]] - second most common pattern for Ca ex PA.
**[[Mucoepidermoid carcinoma]].
**[[Adenoid cystic carcinoma]].


Note:
Notes:
*Often adenocarcinoma-like.
*Myoepithelial cells may be clear cells.
*Myoepithelial cells may be clear cells.


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===Images===
===Images===
<gallery>
Image: Carcinoma ex pleomorphic adenoma -- very low mag.jpg | Ca ex PA - very low mag.
Image: Carcinoma ex pleomorphic adenoma -- low mag.jpg | Ca ex PA - low mag.
Image: Carcinoma ex pleomorphic adenoma - a1 -- low mag.jpg | Ca ex PA - low mag.
Image: Carcinoma ex pleomorphic adenoma - a2 -- low mag.jpg | Ca ex PA - low mag.
Image: Carcinoma ex pleomorphic adenoma -- intermed mag.jpg | Ca ex PA - intermed. mag.
Image: Carcinoma ex pleomorphic adenoma - a1 -- intermed mag.jpg | Ca ex PA - intermed. mag.
Image: Carcinoma ex pleomorphic adenoma -- high mag.jpg | Ca ex PA - high mag.
Image: Carcinoma ex pleomorphic adenoma -- very high mag.jpg | Ca ex PA - very high mag.
</gallery>
www:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311945/figure/Fig1/ Ca ex PA - showing ca and PA areas (nih.gov)].<ref name=pmid21744105/>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311945/figure/Fig1/ Ca ex PA - showing ca and PA areas (nih.gov)].<ref name=pmid21744105/>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311945/figure/Fig2/ Ca ex PA - showing capsule invasion (nih.gov)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311945/figure/Fig2/ Ca ex PA - showing capsule invasion (nih.gov)].
==IHC==
Features - ca ex PA versus PA:<ref name=pmid23821206>{{Cite journal  | last1 = Di Palma | first1 = S. | title = Carcinoma ex pleomorphic adenoma, with particular emphasis on early lesions. | journal = Head Neck Pathol | volume = 7 Suppl 1 | issue =  | pages = S68-76 | month = Jul | year = 2013 | doi = 10.1007/s12105-013-0454-z | PMID = 23821206 }}</ref>
*Ki-67 >35% of cells.
*HER2 +ve membrane staining (3+ for high-grade, 2+ or less for low-grade).
*p53 +ve.
*AR +ve.
Others:<ref name=pmid23821206/>
*CK7 +ve.
*AE1/AE3 +ve.
==Sign out==
<pre>
PAROTID GLAND (MASS), LEFT, EXCISION:
- CARCINOMA EX PLEOMORPHIC ADENOMA, LOW-GRADE, INTRACAPSULAR.
-- MARGINS NEGATIVE.
-- SEE TUMOUR SUMMARY AND COMMENTS.
- THREE BENIGN LYMPH NODES.
</pre>
===Micro===
The sections show a lesion with spindled (myoepithelial) cells and an epithelial component,
on a background of a chondromyxoid stroma. The lesion is encapsulated by a thin layer of
fibrous tissue.
Focally, within the lesion, nuclear atypia and mitotic activity are identified, including an atypical mitotic figure.  The atypical region stains with p53. Approximately 45% of the atypical cells stain with Ki-67.  There is no appreciable HER2 staining.
Unremarkable parotid gland and lymph nodes are present.


==See also==
==See also==
Michael
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