Mucoepidermoid Carcinoma Associated with Osteosarcoma in a True Malignant Mixed Tumor of the Submandibular Region

Carcinosarcoma of the parotid gland: a case report and review of the literature

BACKGROUND

Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic carcinoma with chondrosarcoma to the best of our knowledge. They consist of distinct carcinomatous and sarcomatous components and may arise de novo or from a preexisting pleomorphic adenoma.

CASE PRESENTATION

Herein we present a case of an 80-year-old white female who presented with progressively increasing left facial swelling over 6 weeks. Magnetic Resonance Imagining revealed a mass (3.4 cm) in the parotid gland with a predominant cystic/necrotic component. The cytology was atypical (Milan3) and a total parotidectomy and selective lymph node dissection was done. The resection showed extensive necrosis with high grade sarcomatous (chondrosarcoma) areas. The epithelial component was adenoid cystic carcinoma with perineural invasion. The patient is currently undergoing radiotherapy of the tumor bed and skull base due to propensity of perineural invasion of the adenoid cystic component. The most common carcinomas in carcinosarcomas of salivary glands are adenocarcinoma and squamous cell carcinoma.

CONCLUSION

Carcinosarcoma is a high-grade aggressive lesion with a poor prognosis and should be treated aggressively. More studies are needed to understand the origin of these tumors.

Carcinosarcoma of the deep lobe of the parotid gland in the parapharyngeal region: A case report

BACKGROUND

Salivary carcinosarcoma is an extremely rare tumor containing both malignant epithelial and mesenchymal constituents. This article reports a rare case of carcinosarcoma with salivary duct carcinoma and osteosarcoma as the tumor components. The clinicopathological characteristics, treatment, and prognosis are discussed in conjunction with the literature.

CASE SUMMARY

A 48-year-old man presented with a complaint of a mass in the right parotid region. Osteosarcoma was first considered for assessment by fine-needle aspiration cytology. Physical examination revealed a mass measuring approximately 4 cm × 3.5 cm × 3 cm. The mass, the whole lobe of the right parotid gland, and the right mandible were completely removed during surgery. Postoperative histopathology confirmed carcinosarcoma of the salivary gland.

CONCLUSION

A definite diagnosis of salivary gland carcinosarcoma can only be obtained after complete surgical resection.

Carcinosarcoma of the parotid gland with mucoepidermoid carcinoma component

Carcinosarcoma is a biphasic malignant tumor composed of both carcinomatous and sarcomatous components. First cited in 1951 [1], there have been few cases of this malignant mixed tumor described in the literature. The typical patient presentation is that of an enlarging facial mass in the area of the parotid gland. Systemic symptoms are often absent. Time to initial presentation ranges from months to years. Physical examination findings include swelling and enlargement in the area of the parotid gland, facial nerve deficits, and possible cervical lymphadenopathy. Routine laboratory values (eg, blood counts and electrolytes) usually remain normal, however, nonspecific inflammatory markers (eg, erythrocyte sedimentation rate) may be elevated. Often times the first step in diagnostic evaluation is computed tomography scan with intravenous contrast. Computed tomography of the head/neck can identify malignant features such as poorly defined margins and calcifications. Magnetic resonance imaging is often performed to better evaluate for soft tissue and perineural invasion. It is important to note that these tumors can be mistaken for abscesses on imaging [2]. Ultimately pathological evaluation with immunohistochemical analysis is required to confirm the diagnosis. We present a case of a 70-year-old male who initially presented with a painless neck mass. To the best of our knowledge, this is the first case of mucoepidermoid carcinoma associated with carcinosarcoma reported in the parotid gland.

Fine-Needle Aspiration Cytology of Carcinosarcoma in the Salivary Gland: An Extremely Rare Case Report

Carcinosarcoma of the salivary gland is an extremely rare tumor that is composed of both malignant epithelial and mesenchymal components. Diagnosing carcinosarcoma with fine-needle aspiration cytology is challenging because of its overlapping cytomorphologic characteristics with other high-grade malignant salivary gland tumors. Among the many features, including pleomorphic oncocytoid epithelial components, necrotic background, and mitoses, recognizing the singly scattered atypical spindle cells is most essential in carcinosarcoma. We present a case of a 66-year-old male patient with characteristic features of carcinosarcoma, who was successfully treated by wide local excision and subsequent radiation therapy.