Clinical Image
A 50 year old female presented to our institute with complaints of foreign body sensation in oral cavity, the patient was evaluated by ENT department and there was a mass in oropharynx and right tonsillar region, the growth was biopsied and reported as carcinoma ex pleomorphic adenoma. The patient was offered surgical treatment but refused and started on paclitaxel based chemotherapy but the mass continued to grow and it lead to such a point that it was causing occlusion in the nasal cavity as well as oral cavity leading to feeding and breathing difficulty as seen in Figure 1A. The patient was referred to Gastroenterology Department for Ryle’s tube insertion but due to insufficient mouth opening, Ryle’s tube could not be inserted, and patient was subjected to feeding jejunostomy. The patient had a drastic and rapid growth of tumor and with no response to chemotherapy, Figure 1B shows image of the patient just 1 year back.
Carcinoma ex pleomorphic adenoma (Ca ex PA) is defined as a carcinoma arising from a primary (de novo) or recurrent benign pleomorphic adenoma (PA) [1] Carcinoma ex pleomorphic adenoma predominantly affects the major salivary glands with a majority of cases noted in the parotid and submandibular glands. Cancer has been known to manifest in the minor salivary glands in the oral cavity [2].
Figure 1. (A) Patient image showing tumor mass protruding out of right nasal cavity causing significant nasal as well as oral cavity occlusion. (B) Patient image 1 year before, showing the significant change in the facial features after the progression of carcinoma ex pleomorphic adenoma.
References
2. Damm DD, Fantasia JE. Large palatal mass. Carcinoma ex-pleomorphic adenoma. Gen Dent. 2001 Nov-Dec;49(6):574, 658.