Objective: We describe an unusual case of an intracapsular carcinoma ex pleomorphic adenoma of the parotid gland to discuss its pathologic diagnosis and treatment.
Observation: A 22-year-old man presented with a 4 cm mass of the right parotid gland of a 3 years duration, indurated, without facial paralysis, skin infiltration or lymph node swelling. The MRI showed a 4 cm mass of the deep lobe of the parotid gland suggesting a pleomorphic adenoma. The patient underwent total parotidectomy. Frozen sections showed features suggestive of a pleomorphic adenoma. The postoperative course was uneventful. On definitive histological examination, the tumor showed solid areas of atypical polygonal epithelial cells. In the background there are remains of chondromyxoid tissue typical of pleomorphic adenoma. Immunohistochemistry showed an immunoreactivity of cytokeratin 5 and p63. The diagnosis of “Intracapsular carcinoma ex pleomorphic adenoma” of the parotid gland was considered. The patient had no further treatment and the MRI performed 6 months after surgery showed no recurrence. At 9 years of follow-up, the patient is free of disease.
Conclusion: Intracapsular carcinoma ex pleomorphic adenoma in young patients is an extremely rare salivary glands tumor with challenges in both the diagnosis and treatment.
Keywords: Parotid gland; Parotid cancer; Carcinoma ex pleomorphic adenoma; Young adult.