Carcinoma ex pleomorphic adenoma

Carcinoma ex pleomorphic adenoma is the most common of three malignant mixed tumours of salivary glands, and are thought to arise from pre-existing pleomorphic adenomas (or benign mixed tumours) 1.


These tumours usually occur in older patients (6th to 8th decade), who have had a pleomorphic adenoma in situ for many years (typically 10-15 years) 1.

Clinical presentation

Patients will describe having had a stable parotid mass for many years, before experiencing rapid growth, often associated with painful facial nerve palsy due to tumour infiltration 1.

Radiographic features

As these tumours are aggressive and infiltrating, they present as irregular masses extending into the gland parenchyma and beyond.

  • T1: heterogeneous signal due to haemorrhage, necrosis and calcification 1
  • T2: heterogeneous but generally low signal
  • ADC: low values (compared to pleomorphic adenomas which typically have elevated values)

For staging see malignant salivary tumour staging.

Treatment and prognosis

These tumours have a high rate of metastasis at the time of diagnosis (25-76%) typically to brain, bone, lungs and of course local lymph nodes 2.

Differential diagnosis

The differential is essentially that of other malignant salivary gland tumours including:

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Article Information

rID: 9451
System: Head & Neck
Section: Pathology
Synonyms or Alternate Spellings:
  • Carcinoma arising from pleomorphic adenoma

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