Polymorphous Adenocarcinoma: High-Grade Transformation With Immunohistochemical Workup

Intraoral tumours associated with mucosa are commonly oral squamous cell carcinomas followed by minor salivary gland carcinomas, the commonest being mucoepidermoid carcinoma, adenoid cystic carcinoma, and polymorphous adenocarcinoma (PAC). PAC is the second most common malignant tumour that is found in the minor salivary glands of the oral cavity and rarely exhibits high-grade transformation (HGT). We report a case of a 50-year-old woman with a tumour on her buccal mucosa for six months. Histopathologically, the tumour showed more than 15 histopathological patterns with areas of HGT. The high-grade transformed areas predominantly showed solid patterns, increased mitosis, necrosis, vascular invasion, and perineural invasion. An immunohistochemical (IHC) panel inclusive of p63, SOX-10, S-100, calponin, vimentin, and Ki-67 was done to evaluate the tumour and grade PAC. The Ki-67 index was around 25%-30%, confirming the diagnosis of PAC-HGT. This might be the first case of primary PAC-HGT seen on the buccal mucosa on initial clinical presentation.