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Background: Carcinoma ex-pleomorphic adenoma (CXPA) can either arise primarily as a de novo or from the malignant transformation of a benign pleomorphic adenoma (PA). CXPA mostly occurs in adults aged 50 to 70 years; hence, the occurrence of CXPA in younger ages is not common. Case presentation: We report a 27-year-old female who had a history of submandibulectomy for pleomorphic adenoma, and presented with recurrent left submandibular swelling for 4 months. The mass was rapidly increasing in size and was associated with occasional throbbing pain. Examination showed a multilobulated, firm left submandibular swelling with no overlying skin changes. FNAC was performed twice, by conventional and ultrasound-guided techniques, and both concluded as benign salivary gland tumours. CT scan and MRI revealed a well-demarcated tumour with an area of necrosis within, with no obvious invasion into surrounding soft tissue and no significant lymphadenopathy. Having high suspicion of a malignant transformation, the tumour was resected with a concurrent modified radical neck dissection. The histopathological examination confirmed a carcinoma ex-pleomorphic adenoma with the myoepithelial malignant component. The patient subsequently received adjuvant radiotherapy. This case demonstrated that CXPA, although rare, can occur in young adults. Pre-operative FNAC and radiological imaging may mimic a pleomorphic adenoma. Conclusion: The presence of recurrent tumours with rapid growth should alarm the clinician about a possible malignant transformation of a benign parotid tumour. [ABSTRACT FROM AUTHOR]

Parotid lymphoepithelial carcinoma is extremely rare, and makes up only 0.4% of cases among the anaplastic variant of salivary gland carcinoma. We present a 63-year-old man who had progressive enlarging right neck swelling for one year. He sought treatment in another centre and underwent superficial parotidectomy, following an ultrasound assessment of the mass that was suggestive of a benign parotid tumour. There was no fine needle aspiration cytology or other radiological imaging performed prior to the surgery. However, the surgeon encountered difficulty intraoperatively and abandoned the surgery. The incisional biopsy of the tumour was reported as lymphoepithelial carcinoma. He then presented to us with the progression of the residual parotid malignant tumour. CT and MRI showed a locally aggressive parotid tumour that had infiltrated the subcutaneous tissue, external auditory canal, facial nerve, and multiple ipsilateral metastatic cervical lymph nodes. Subsequently, the patient underwent total parotidectomy with facial nerve sacrifice, lateral temporal bone resection and ipsilateral modified radical neck dissection. The surgical site defect was reconstructed with anterolateral thigh myocutaneous free flap. Concurrent static facial reanimation with fascia lata sling was performed. The patient received adjuvant chemoradiation following the surgery. The extent of the local infiltration by the tumour and the resulting surgery could have been reduced if the tumour had been properly assessed and excised at the initial stage. A complete preoperative assessment of a parotid mass is essential to avoid misdiagnosis, unexpected intraoperative finding and delay in definitive treatment. [ABSTRACT FROM AUTHOR]