{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:38:04Z","timestamp":1756384684600},"reference-count":12,"publisher":"Scientific Scholar","content-domain":{"domain":["cytojournal.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>Carcinoma ex pleomorphic adenoma (CXPA) is a rare epithelial malignancy that arises from a primary or recurrent pleomorphic adenoma (PA). It may be noninvasive (NI) or invasive. NI CXPA is extremely rare. Preoperative diagnosis on fine needle aspiration (FNA) of CXPA may be difficult and poses a diagnostic challenge to clinicians and pathologists. Herein, we describe the FNA findings of a case of NI-CXPA. A 69-year-old woman presented with rapid enlargement of a stable parotid mass of 25 years. Cytologically, malignant cells were focally associated with metachromatic fibromyxoid matrix that was homogeneous and dense with a vague fibrillary quality. There were cell groups, papillary-like clusters and single malignant cells. The nuclei were pleomorphic with irregularly dispersed chromatin, and the cytoplasm was ill-defined and granular. Nucleoli were small to inconspicuous. Mitoses and necrosis were not seen. Cytological features were not specific for any type of salivary gland carcinoma. The FNA diagnosis was primary high-grade adenocarcinoma of the parotid gland, not otherwise specified. Facial nerve-sparing total parotidectomy was performed, which histologically showed PA interspersed with ducts and nests composed of pleomorphic atypical nuclei surrounded by extensive hyalinization. Single cells were also noted. No capsular infiltration was seen in the entirely sampled tumor. Immunohistochemistry for Ki-67 showed a higher proliferation rate in the malignant ducts and p63 positive cells focally surrounded some of the malignant ducts. Histological diagnosis was NI-CXPA. Accurate diagnosis is important for proper surgical management; however, the preoperative diagnosis of NI-CXPA is difficult to make on FNA.<\/jats:p>","DOI":"10.4103\/1742-6413.156080","type":"journal-article","created":{"date-parts":[[2015,4,29]],"date-time":"2015-04-29T07:36:35Z","timestamp":1430292995000},"page":"7","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Noninvasive carcinoma ex pleomorphic adenoma of the parotid gland: A difficult diagnosis on fine needle aspiration"],"prefix":"10.25259","volume":"12","author":[{"given":"Theresa","family":"Scognamiglio","sequence":"first","affiliation":[{"name":"Address: Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohan","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, New York-Presbyterian Hospital, New York, NY 10065, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William I.","family":"Kuhel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, New York-Presbyterian Hospital, New York, NY 10065, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sana O.","family":"Tabbara","sequence":"additional","affiliation":[{"name":"Department of Pathology, The George Washington University, Washington, DC 20037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Katayoon","family":"Rezaei","sequence":"additional","affiliation":[{"name":"Department of Pathology, The George Washington University, Washington, DC 20037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rana S.","family":"Hoda","sequence":"additional","affiliation":[{"name":"Address: Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2015,4,29]]},"reference":[{"key":"10.4103\/1742-6413.156080\/ref-1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12105-011-0281-z","article-title":"Carcinoma ex pleomorphic adenoma: A comprehensive review of clinical, pathological and molecular data","volume":"6","author":"Antony","year":"2012","journal-title":"Head Neck Pathol"},{"key":"10.4103\/1742-6413.156080\/ref-2","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1053\/hupa.2001.25000","article-title":"Carcinoma ex pleomorphic adenoma: Pathologic analysis of 73 cases","volume":"32","author":"Lewis","year":"2001","journal-title":"Hum Pathol"},{"key":"10.4103\/1742-6413.156080\/ref-3","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1002\/(SICI)1097-0339(199909)21:3<163::AID-DC3>3.0.CO;2-2","article-title":"Fine-needle sampling findings in 26 carcinoma ex pleomorphic adenomas: Diagnostic pitfalls and clinical considerations","volume":"21","author":"Klijanienko","year":"1999","journal-title":"Diagn Cytopathol"},{"key":"10.4103\/1742-6413.156080\/ref-4","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.otohns.2008.01.013","article-title":"Carcinoma ex pleomorphic adenoma: Diagnostic difficulty and outcome","volume":"138","author":"Zb\u00e4ren","year":"2008","journal-title":"Otolaryngol Head Neck Surg"},{"key":"10.4103\/1742-6413.156080\/ref-5","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.humpath.2009.12.011","article-title":"Prognostic factors of recurrence in salivary carcinoma ex pleomorphic adenoma, with emphasis on the carcinoma histologic subtype: A clinicopathologic study of 43 cases","volume":"41","author":"Katabi","year":"2010","journal-title":"Hum Pathol"},{"key":"10.4103\/1742-6413.156080\/ref-6","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1097\/00005537-200111000-00023","article-title":"Value of fine-needle aspiration cytology of parotid gland masses","volume":"111","author":"Zb\u00e4ren","year":"2001","journal-title":"Laryngoscope"},{"key":"10.4103\/1742-6413.156080\/ref-7","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/j.joms.2013.01.017","article-title":"Fine needle aspiration of parotid tumors: Diagnostic utility from a clinical perspective","volume":"71","author":"Jeong","year":"2013","journal-title":"J Oral Maxillofac Surg"},{"key":"10.4103\/1742-6413.156080\/ref-8","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/(SICI)1097-0339(20000301)22:3<139::AID-DC2>3.0.CO;2-A","article-title":"Fine-needle aspiration cytology of salivary gland: A review of 341 cases","volume":"22","author":"Stewart","year":"2000","journal-title":"Diagn Cytopathol"},{"key":"10.4103\/1742-6413.156080\/ref-9","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1097\/01.prs.0000181654.68120.0f","article-title":"Carcinoma ex benign pleomorphic adenoma of the parotid gland","volume":"116","author":"Nouraei","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"10.4103\/1742-6413.156080\/ref-10","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/1471-2407-9-247","article-title":"Establishment and characterization of pleomorphic adenoma cell systems: An in-vitro demonstration of carcinomas arising secondarily from adenomas in the salivary gland","volume":"9","author":"Maruyama","year":"2009","journal-title":"BMC Cancer"},{"key":"10.4103\/1742-6413.156080\/ref-11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/1742-6413.70406","article-title":"Pleomorphic adenoma: A diagnostic pitfall in the diagnosis of salivary gland lesions on FNAC: Case reports with review of the literature","volume":"7","author":"Gahine","year":"2010","journal-title":"Cytojournal"},{"key":"10.4103\/1742-6413.156080\/ref-12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1159\/000325676","article-title":"Cytologic diagnostic accuracy in pleomorphic adenoma of the salivary glands during 2 periods. 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