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Open Access Case Report

Invasive salivary duct carcinoma ex pleomorphic adenoma of the parotid gland: a teaching case giving rise to the genuine diagnostic difficulty on an inadequate cytology specimen

Sohsuke Yamada13*, Atsunori Nabeshima1, Takahisa Tabata2, Xin Guo1, Takashi Tasaki1, Ke-Yong Wang1, Shohei Shimajiri1 and Yasuyuki Sasaguri1

Author Affiliations

1 Departments of Pathology and Cell Biology School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

2 Departments of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

3 Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan

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Diagnostic Pathology 2012, 7:61  doi:10.1186/1746-1596-7-61

Published: 30 May 2012

Abstract

A history of a recent rapid increase in long-standing swelling mass was presented in the right parotid gland of an 85-year-old male. The inadequate cytologic specimens contained few small clusters of three-dimensional malignant epithelial cells having hyperchromatic pleomorphic nuclei and prominent nucleoli, adjacent to a cluster of benign monomorphic myoepithelial cells. We first interpreted it merely as an adenocarcinoma, not otherwise specified. A radical parotidectomy was performed, and gross examination revealed an encapsulated and firm tumor lesion, looking grayish-blue to yellowish-white, focally associated with extracapsular invasion. On microscopic examination, the tumor was predominantly composed of a proliferation of highly atypical epithelial cells having abundant eosinophilic cytoplasm, often arranged in a Roman-bridge appearance with foci of comedo necrosis, alternating with extensive infiltration to adjacent stroma in a trabecular or alveolar fashion with severe vessel permeation. Within the background of pleomorphic adenoma, the carcinoma cells sometimes replaced ductal luminal cells while retaining an intact-like myoepithelial layer. Therefore, we finally made a diagnosis of invasive salivary duct carcinoma ex pleomorphic adenoma. We should be aware that owing to its characteristic features, cytopathologists might be able to determine correct diagnosis, based on multiple and adequate samplings.

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2126158270695815

Keywords:
Salivary duct carcinoma; Carcinoma ex pleomorphic adenoma; Salivary gland; Cytology