Skip to main content
Log in

Small Cell Carcinoma ex-Pleomorphic Adenoma of the Parotid Gland

  • Case Report
  • Published:
Head and Neck Pathology Aims and scope Submit manuscript

Abstract

Small cell carcinoma (SCC) is a high-grade malignancy usually encountered in the lungs but also seen in almost any site including the salivary glands. SCC is important to recognize because it often metastasizes widely and is treated with systemic chemotherapy. Carcinoma ex pleomorphic adenoma is a malignant epithelial neoplasm arising in a pre-existing benign mixed tumor (i.e., pleomorphic adenoma, PA). While virtually any salivary carcinoma can arise from a PA, to our knowledge SCC ex-PA has not been described. We report a case of a woman presenting with fullness of the right neck and a parotid gland mass. The tumor was resected and evaluated grossly, by light microscopy, and by immunohistochemistry. Grossly, a 1.6 cm well-circumscribed nodule was identified within the parotid. Microscopic examination revealed foci of SCC associated with high-grade adenocarcinoma, in the background of a PA. The SCC was immunoreactive for cytokeratin in a dot-like pattern and neuroendocrine markers synaptophysin and CD56. Despite the focal nature of the SCC in the parotid, a pure SCC metastasis was present in one neck level II lymph node. The patient was free of disease with 8 months of follow-up. Our case illustrates that: (1) although rare, in the salivary glands SCC may arise from lower grade neoplasms including PAs; (2) SCC ex PA may metastasize as pure SCC even if the primary SCC component was focal; (3) adequate sampling of PAs is crucial to prevent missing a rare SCC that must be treated with chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Gnepp DR, Brandwein-Gensler M, El-Naggar AK, et al. Carcinoma ex pleomorphic adenoma. In: Barnes L, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology and genetics of head and neck tumours. Lyon: IARC Press; 2005. p. 242–243.

  2. Lewis JE, Olsen KD, Sebo TJ. Carcinoma ex pleomorphic adenoma: pathologic analysis of 73 cases. Hum Pathol. 2001;32:596–604.

    Article  PubMed  CAS  Google Scholar 

  3. Ellis GL, Auclair PL. Carcinoma ex pleomorphic adenoma. In: AFIP atlas of tumor pathology: tumors of the salivary glands. Vol 9, 4th ed. Washington: ARP Press; 2008.

  4. Levenson RM Jr, Ihde DC, Matthews MJ, et al. Small cell carcinoma presenting as an extrapulmonary neoplasm: sites of origin and response to chemotherapy. J Natl Cancer Inst. 1981;67:607–12.

    PubMed  Google Scholar 

  5. Remick SC, Ruckdeschel JC. Extrapulmonary and pulmonary small-cell carcinoma: tumor biology, therapy, and outcome. Med Pediatr Oncol. 1992;20:89–99.

    Article  PubMed  CAS  Google Scholar 

  6. Weng CT, Chu PY, Liu MT, et al. Small cell carcinoma of the head and neck: a single institution’s experience and review of the literature. J Otolaryngol Head Neck Surg. 2008;37:788–93.

    PubMed  Google Scholar 

  7. Hatoum GF, Patton B, Takita C, et al. Small cell carcinoma of the head and neck: the university of Miami experience. Int J Radiat Oncol Biol Phys. 2009;74:477–81.

    Article  PubMed  Google Scholar 

  8. Renner G. Small cell carcinoma of the head and neck: a review. Semin Oncol. 2007;34:3–14.

    Article  PubMed  CAS  Google Scholar 

  9. Gnepp DR, Corio RL, Brannon RB. Small cell carcinoma of the major salivary glands. Cancer. 1986;58:705–14.

    Article  PubMed  CAS  Google Scholar 

  10. Rekhtman N. Neuroendocrine tumors of the lung: an update. Arch Pathol Lab Med. 2010;134:1628–38.

    PubMed  Google Scholar 

  11. Hisa Y, Tatemoto K. Bilateral parotid gland metastases as the initial manifestation of a small cell carcinoma of the lung. Am J Otolaryngol. 1998;19:140–3.

    Article  PubMed  CAS  Google Scholar 

  12. Ulubas B, Ozcan C, Polat A. Small cell lung cancer diagnosed with metastasis in parotid gland. J Craniofac Surg. 2010;21:781–3.

    Article  PubMed  Google Scholar 

  13. Nagao T, Gaffey TA, Olsen KD, et al. Small cell carcinoma of the major salivary glands: clinicopathologic study with emphasis on cytokeratin 20 immunoreactivity and clinical outcome. Am J Surg Pathol. 2004;28:762–70.

    Article  PubMed  Google Scholar 

  14. Gnepp DR, Wick MR. Small cell carcinoma of the major salivary glands: an immunohistochemical study. Cancer. 1990;66:185–92.

    Article  PubMed  CAS  Google Scholar 

  15. Chander S, Ergün EL, Westphal S, et al. Small cell carcinoma of the parotid gland: evaluation with FDG PET imaging. Clin Nucl Med. 2004;29:502–3.

    Article  PubMed  Google Scholar 

  16. Vural C, Dogan O, Yavuz E, et al. Small cell neuroendocrine carcinoma of the parotid gland. Otolaryngol Head Neck Surg. 2000;122:151–2.

    Article  PubMed  CAS  Google Scholar 

  17. Witt RL. Primary small cell carcinoma of the parotid gland. Otolaryngol Head Neck Surg. 1996;114:826–9.

    Article  PubMed  CAS  Google Scholar 

  18. Olsen KD, Lewis JE. Carcinoma ex pleomorphic adenoma: a clinicopathologic review. Head Neck. 2001;23:705–12.

    Article  PubMed  CAS  Google Scholar 

  19. Ellis GL, Auclair PL. Small cell carcinoma. In: AFIP atlas of tumor pathology: tumors of the salivary glands. Vol 9, 4th ed. Washington: ARP Press; 2008. pp 332–341.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ashley Cimino-Mathews.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cimino-Mathews, A., Lin, B.M., Chang, S.S. et al. Small Cell Carcinoma ex-Pleomorphic Adenoma of the Parotid Gland. Head and Neck Pathol 6, 502–506 (2012). https://doi.org/10.1007/s12105-012-0376-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12105-012-0376-1

Keywords

Navigation