Head and Neck Pathology

, Volume 12, Issue 1, pp 82–88 | Cite as

Low Grade Carcinoma Ex-Pleomorphic Adenoma: Diagnosis and Diagnostic Challenges Caused by Fine Needle Aspiration: Report of Three Cases and Review of Literature

  • Michael Covinsky
  • Zhenjian Cai
  • Manju Ambelil
  • Jing Liu
  • Hui Zhu
Original Paper


Low grade carcinoma ex pleomorphic adenoma (LG CXPA) is a rare low grade malignant neoplasm arising from preexisting pleomorphic adenoma (PA). LG CXPA demonstrates no overt cytological atypia, and can be difficult to distinguish from cellular PA. Invasive growth is one of the hallmarks of LG CXPA, e.g., tumor extends beyond the capsule and into adjacent non-neoplastic tissue. However, it is known that capsular and vascular invasion, as well as the presence of stroma-rich PA in soft tissue without a capsule (pseudopodia) can be seen in PA. These histological findings have no prognostic significance and are not diagnostic of malignancy. In addition, recurrent PA typically presents as numerous nodules extending into soft tissue and skeletal muscle, which again are not considered malignant features. Thus, “infiltrative growth” of LG CXPA is difficult to define and diagnosis is challenging to many practicing pathologists. In this study, we report three cases of LG CXPA. We review the diagnostic criteria for LG CXPA, and discuss the diagnostic challenges caused by fine needle aspiration (FNA) changes. FNA is widely used as a cost-effective, quick and accurate method for diagnosing salivary gland lesions. Histological changes post-FNA are usually focal and mild, and are not causes of diagnostic difficulties. According to our knowledge, this is the first report of LG CXPA complicated with FNA changes.


Salivary gland neoplasm Pleomorphic adenoma Low-grade carcinoma ex pleomorphic adenoma Pleomorphic adenoma malignant transformation 


Compliance with Ethical Standards

Conflict of interest

None of the authors have any conflicts of interest to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Department of Pathology and Laboratory MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA

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