J Korean Ophthalmol Soc.  2015 Apr;56(4):598-601. 10.3341/jkos.2015.56.4.598.

A Case of Carcinoma Ex Pleomorphic Adenoma at 1st Operation

• Jeon SJ
• Kim SA
• Paik JS
• Yang SW

• KMID: 2215712
• DOI: http://doi.org/10.3341/jkos.2015.56.4.598

Abstract

PURPOSE
To report a case of carcinoma ex pleomorphic adenoma observed during the patient's first operation.
CASE SUMMARY
A 63-year-old female presented with proptosis and ptosis that was aggravated 1 year prior. On preoperative CT image, a 32 x 20 x 21 mm-sized well demarcated mass (suspected as pleomorphic adenoma) was observed and was removed entirely by anterolateral orbitotomy. The excised mass surface was uneven but the capsule appeared intact on gross examination. Hard, yellow-colored and soft, dark-colored materials were found concurrently on cross section. The histological examination showed malignant cells as part of the soft material and was diagnosed as carcinoma ex pleomorphic adenoma.
CONCLUSIONS
We report a case of carcinoma ex pleomorphic adenoma of the lacrimal gland that presented with malignant change during the patient's first operation. Supposedly, during the process of mass growth, minimal rupture occurred causing malignant transformation. Clinically, although a mass is believed benign based on imaging, the possibility of malignant transformation of a tumor increasing rapidly or enlargement causing development of rapid proptosis should be considered.

Keyword

Carcinoma ex pleomorphic adenoma; Lacrimal gland tumor; Malignant mixed tumor; Pleomorphic adenoma

MeSH Terms

Adenoma, Pleomorphic*
Exophthalmos
Female
Humans
Lacrimal Apparatus
Middle Aged
Mixed Tumor, Malignant
Rupture

Figure

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  Figure 1. The patient shows ptosis of right eye at primary position in preoperative frontal view.

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  Figure 2. On CT image, 32 × 20 × 21 mm sized well dermacated mass is seen (A: coronal view; B: axial view).

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  Figure 3. On cross sectional photo of excised mass (A), the pathologic finding of upper- nodular, translucent lesion has benign characteristics (white arrow), and lower- tan-yellow, firm mass with ill-defined lesion has malignant characterisctics (black arrow). The malignant component is distinguished by its collagenous stromal hyalinization. On microscopic examination (B), morphologic diver-sity with both epithelioid and connective tissue components is seen, which is consistent with pleomorphic adenoma (white arrow). This component is partially replaced by the malignant component (black arrow) – duct formation with nucleus containing chromatin condensation and prominent nucleoli is seen on high power, which is consistent with adenocarcinoma.

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  Figure 4. After operation, ptosis is improved in frontal view.

Reference

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