Ultrastructural and immunohistochemical aspects of carcinoma in mixed tumors

Four cases of malignant mixed tumor (carcinoma in pleomorphic adenomas) were studied for ultrastructural appearance and for the presence of cytokeratins and vimentin. Ultrastructurally, both squamous and glandular epithelial differentiation were found not only in the same tumor but also within the same cell. One tumor showed mainly mesenchymal differentiation with fibroblast-like cells. The intermediate filament expression of benign mixed tumors (i.e., both cytokeratin and vimentin content) were found in two of the three malignant tumors investigated. In the third tumor, only cytokeratins were found. Thus, the filament content of mixed tumors may change when the tumor becomes malignant. This change does not always parallel a change in morphology. Although one tumor was clearly epithelial ultrastructurally and another mostly mesenchymal, both did contain both cytokeratins and vimentin.