Cytomorphologic spectrum of carcinoma ex pleomorphic adenoma.
OBJECTIVE
To delineate the cytomorphologic features of carcinoma ex pleomorphic adenoma (CPA) and identify the diagnostic pitfalls.


METHODS
Smears of 14 cases suspected as CPA on fine needle aspiration over a period of 15 years were reviewed. Cytohistologic correlation was done in 10 cases.


RESULTS
All cases had a salivary gland mass of 1-16 years' duration, with a rapid increase in size in 10 cases. Epithelial cells predominated over stroma in 11 of 14 cases. Group I showed unequivocal malignant cells admixed with benign epithelial and stromal components of pleomorphic adenoma (PA), which were considered diagnostic of CPA on review. The cytologic differential diagnosis in these cases included mucoepidermoid carcinoma, carcinosarcoma and metastatic adenocarcinoma. Group II comprised 7 cases suspected to be cellular PA with atypia or CPA. These showed mild to moderate degrees of pleomorphism, absence of unequivocal malignant cells, and a variable proportion of benign epithelial and stromal components. Four of them were histologically confirmed as CPA.


CONCLUSIONS
Sampling error is an important cause of diagnostic pitfalls. Correlation with clinical data is essential in diagnosis of CPA on cytology. In a proper clinical setting, extensive fine needle aspiration sampling should be done initially. Any degree of nuclear atypia in PA should be documented, alerting the clinician and histopathologist to the possibility of CPA.
Nigam
Sonu
S
Cytopathology Division, Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. batrar@bol.net.in
Kumar
Neeta
N
Jain
Shyama
S
D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary; D008949:Adenoma, Pleomorphic / Q000175:diagnosis* / Q000473:pathology*; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology*; D018277:Carcinoma, Mucoepidermoid / Q000175:diagnosis; D002296:Carcinosarcoma / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology