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Fig. 5.32 Carcinoma ex pleomorphic adenoma. A Invasive type. Pleomorphic adenoma and carcinoma components are seen in the left and right, respectively. Carcinoma component is reminiscent of salivary duct carcinoma in this case. B Non-invasive type. Carcinoma cells replacing the inner ductal layer leaving outer benign myoepithelial layer.

HB'tM

Fig. 5.33 Carcinoma ex pleomorphic adenoma. A Detail of adenocarcinoma with back-to-back glands composed of pleomorphic tumour cells with focal necrosis. B Many tumour cells are positive for MIB-1 in the carcinoma component (right), whereas only a few positive cells are observed in the pleomorphic adenoma component (left).

with multifocal areas containing carcinoma, which frequently overgrows and replaces many of the benign elements. The earliest changes typically consist of tumour cells replacing the normal inner duct epithelial layer leaving the normal peripherally located myoepithelial layer intact.

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