True malignant mixed tumor (carcinosarcoma) of the parotid gland: Report of a case with immunohistochemical study

doi:10.1016/S1079-2104(96)80023-0

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 81, Issue 4, April 1996, Pages 454-458

https://doi.org/10.1016/S1079-2104(96)80023-0 Get rights and content

We present a rare case of parotid gland carcinosarcoma that occurred in an 86-year-old woman. Clinical and histologic data revealed it had developed from a preexisting pleomorphic adenoma. Microscopic examination showed a neoplasm comprised of sarcomatous elements, mainly fibrosarcoma, intermingled with salivary duct-type carcinoma. Sarcomatous cells, excluding those that show chondrosarcomatous differentiation, reacted positively with antibodies directed against vimentin. Carcinomatous cells were positive for epithelial membrane antigen and keratin and negative for myoepithelial markers, which suggest an origin from salivary duct cells. This tumor seemed to consist of two histogenetically different populations of cells without evidence of a common origin from the myoepithelial cell. We also review the literature and discuss the histogenetic origin of true carcinosarcoma of salivary gland.

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Citation Excerpt :
Carcinosarcoma is a rare salivary gland neoplasm typically associated with benign mixed tumor, although de novo cases have been reported.19-22 It is characterized by a carcinoma component, usually adenocarcinoma, squamous cell carcinoma, or undifferentiated carcinoma, and a sarcoma component, such as fibrosarcoma, chondrosarcoma, osteosarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, or leiomyosarcoma.20, 21,23-27 Cytokeratin and vimentin stain the malignant epithelial and mesenchymal components of carcinosarcoma, respectively.
Four poorly differentiated malignant lesions occurred in a 60-year-old Chinese male in the nasal cavity, submandibular gland, a lymph node in the neck, and the mandible. These malignant lesions developed within an 8-year period and each showed distinctive histological features. Among these malignant lesions, the neoplasm in the submandibular gland presented variegated histological and immunohistochemical (IHC) features and posed a diagnostic challenge in interpretation. Based on microscopic and IHC findings, we believe the diagnosis of teratocarcinosarcoma is justified for the submandibular neoplasm and the metastasis in the lymph node. The pathological features and diagnoses of these malignant lesions are discussed.
Immunoprofile of a carcinosarcoma of the submandibular gland
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Some transitional epithelial cells disposed in the periphery of the nests were positive for both vimentin and cytokeratins, suggesting that both elements are derived from a common precursor cell, as in pleomorphic adenoma, in accordance with some authors9,14,15 and support from molecular biological findings. The cells were negative for cytokeratins 7 and 8, and there was no duct formation, which excluded a diagnosis of an adenocarcinoma or a ductal carcinoma.7,9,15 The mesenchymal malignant component is usually represented by chondrosarcoma,4,8,9,16 but in the current case a cartilaginous component was not observed.
Carcinosarcomas are a very rare group of true malignant tumors of the salivary gland. As the name indicates, the tumor is composed of an epithelial and a mesenchymal component, both malignant. We report a case of carcinosarcoma of the submandibular gland in an 86-year-old woman. The epithelial component showed a squamous carcinoma phenotype, whereas the mesenchymal component was morphologically similar to a fibrosarcoma. The epithelial component was strongly positive for CK13, CK14, and AE1/AE, and groups of positive cells were seen for CK19 and vimentin. The whole mesenchymal component was positive for vimentin, negative for cytokeratins, and focal cells were positive for smooth- muscle actin. Both components were strongly positive for P53 and Cyclin D1, and focally positive for MDM2. Rare multinucleated giant cells showed expression of CD68, and focal dendritical cells on carcinomatous nests were positive for S-100. The CK7, CK8, Factor XIIIa, c-erbB-2, P16, CDK-4, Rb1, and E2F-1 were not detected in these 2 groups of malignant cell populations.
Carcinosarcoma arising from a preexisting pleomorphic adenoma - True malignant mixed tumor of the parotid gland
2007, Otolaryngologia Polska
Carcinosarcoma (true malignant mixed tumor) is rare in salivary gland neoplasms. Even rarer is a carcinosarcoma arising from a preexisting pleomorphic adenoma. Case: a 49 year old woman was admitted with left neck pain. Computed tomography and USG – examination revealed a mass originating from left parotid gland. The patient undergone total parotidectomy with facial nerve preservation and then irradiation and chemioteraphy. Clinical and histologic date revealed it had developed from a preexisting pleomorphic adenoma. Conclusion: microscopic examination showed and neoplasm comprised of sarcomatous and carcinomatous cells. This tumor seemed to consist of two histogenetically different populations of cells. We also review the literature and dicuss the histogenetic origin of the carcinosarcoma of salivary gland.

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View full text

True malignant mixed tumor (carcinosarcoma) of the parotid gland: Report of a case with immunohistochemical study

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Malignant mixed tumors of the salivary gland: a review

Pathol Ann

Parotid tumors: histopathology, clinical behaviour, and end results

Surg Gynecol Obstet

Salivary gland tumors: general considerations

Carcinosarcoma of the submandibular salivary gland

Cancer

Carcinosarcoma of the parotid gland: immunohistochemical study of a case

Histopathology

Ultrastructural and immunohistochemical observations of a true malignant tumor (carcinosarcoma) of the tongue

J Oral Pathol Med

Speichelgangcarcinom: Ein den Milchgangcarcinomen der Brustdruse analoge Gruppe von Speicheldrusentumoren

Arch Otorhinolaryngol