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Carcinoma ex pleomorphic adenoma: diagnostic difficulty and outcome
Peter Zbären1, Sibylle Zbären, Marco D Caversaccio
1Department of Otorhinolaryngology, Head, and Neck Surgery, University Hospital, Berne, Switzerland. peter.zbaeren@insel.ch
Objective:
To analyze a series of carcinoma ex pleomorphic adenoma (CXPA) and to assess the diagnostic difficulties.
Study Design:
The clinical presentation of 24 CXPAs was compared with 300 pleomorphic adenomas (PAs). Furthermore, pathohistological findings and follow-up results of CXPAs were evaluated.
Results:
Eight of 24 (33%) CXPAs versus 41 of 300 (14%) PAs were localized in the deep lobe (P < 0.05). Forty-two percent of CXPAs versus 6 percent of PAs, respectively, were greater than 4 cm (P < 0.05). The sensitivity in detecting CXPA by fine-needle aspiration cytology (FNAC) was 47 percent. The tumor was known to be malignant preoperatively in 10 (42%) patients. Six of 24 (25%) patients with CXPA developed a tumor recurrence. The overall 5-year survival rate of CXPA was 76 percent.
Conclusion:
CXPAs are difficult to identify preoperatively. FNAC has a low accuracy and sensitivity. CXPAs versus PAs are significantly more frequently localized in the deep lobe and are significantly greater in size.