J Korean Assoc Oral Maxillofac Surg.  2010 Feb;36(1):53-56. 10.5125/jkaoms.2010.36.1.53.

Carcinoma ex pleomorphic adenoma of the parotid gland: Case report

• Jung JH
• Lee SC
• Kim DW
• Park DS
• Lee SK
• Park CH
• Yeom HR
• Kim HM
• Song MS

• KMID: 1457819
• DOI: http://doi.org/10.5125/jkaoms.2010.36.1.53

Abstract

Carcinoma ex pleomorphic adenoma is transformed at the incidence of 1-20% in pleomorphic adenoma and frequently recurred. It accounts for 10% of all malignant salivary tumors and its average age of occurrence is 60s. It will present in a large, long-standing pleomorphic adenoma or in one that was previously treated but has recurred. According to cell composition in malignant cell carcinoma, and clear cell adenocarcinoma. Most (75%) occur in parotid gland, while about 20% occur in the minor gland of the oral mucosa. The metastasis rate to regional lymph node is about 25%, and to distant organs about 33% and the 5-year survival rates are 40%. Though the treatment of the carcinoma ex pleomorphic adenoma is not established, it is treated ideally with and extensive resection, neck dissection, postoperative radiotherapy, and chemotherapy. When occurred in parotid gland, facial paralysis is reported. With a review of literatures, we report a case of carcinoma ex pleomorphic adenoma which operated with total parotidectomy and supraomohyoid neck dissection.

Keyword

Carcinoma ex pleomorphic adenoma; Supraomohyoid neck dissection

MeSH Terms

Adenocarcinoma, Clear Cell
Adenoma, Pleomorphic
Incidence
Lymph Nodes
Mouth Mucosa
Neck Dissection
Neoplasm Metastasis
Parotid Gland
Survival Rate

Figure

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  Fig. 1. About 4 cm sized lobulating well-defined mass with hyperintense on T2WI enhancement on right parotid.

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  Fig. 2. Photographs showing the appearance of well capsulated mass.

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  Fig. 3. Photographs showing confinement within tumor capsule, no lymphatic and vascular tumor emboli, and clear resection margin. By immunohistochemistry, the carcinoma component is positive for p53 and shows high Ki-67 index (up to 30%).

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  Fig. 4. Intraoperative photographs. A. Supraomohyoid neck dissection was performed and facial nerve was preserved. B. Facial nerve was covered with rotating sternocleidmas-toid muscle flap.

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  Fig. 5. There was non-specific problem of function and esthetics (post op 5 months).

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  Fig. 6. No definite evidence of local recurrence and significant lymph node in bilateral neck (post op 36 months).

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  Fig. 7. Photograph showing extraoral appearance.

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  Fig. 8. 7×7 cm sized well defined mass with heterogeneous attenuation on left parotid.

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  Fig. 9. photograph showing the removal of mass and facial nerve preservation.

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  Fig. 10. Postoperative photograph showing improved facial contour.

Reference

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