Barw Barw Medical Journal 2960-1959 2025 08 28 Carcinoma ex Pleomorphic Adenoma: A Case Series and Literature Review 15 20 10.58742/bmj.vi.202 eng Abdulwahid M. Salih Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. a.salih@smartglobalholding.co.uk Rebaz M. Ali Department of Oncology, Hiwa Cancer Hospital, Shorsh Street, Sulaymaniyah, Iraq. rebaz.ali12@gmail.com Ari M. Abdullah Department of Pathology, Sulaymaniyah Teaching Hospital, Sulaymaniyah, Iraq. ariabdullah1978@gmail.com Aras J. Qaradakhy Department of Radiology, Shorsh Teaching Hospital, Sulaymaniyah, Iraq. aras.qaradakhy@gmail.com Ahmed H. Ahmed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. ahmed.ahmed@gmail.com Imad J. Habibullah Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. Imad.Habibullah@gmail.com Sarwat T. San Ahmed Department of Otolaryngology, Sulaymaniyah Teaching Hospital, Sulaymaniyah, Iraq. sarwat.ahmed@gmail.com Mariwan L. Fatah College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. mariwan.fatah@univsul.edu.iq Abdullah A. Qadir Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. abdullah.qadir@gmail.com Meer M. Abdulkareem Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. meermohammedabdulkarim@gmail.com Shko H. Hassan Zad Organization, Saeed Kaban Street, Judi Tower, Sulaymaniyah, Iraq. shkohamid81@gmail.com Harun Amanj Ahmed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. Harun.amanj@gmail.com 2025 07 18 Introduction Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor that can lead to severe complications and carries a risk of distant metastasis. This study aims to provide a comprehensive overview of CXPA through a case series and a review of the literature. Methods This was a single-center retrospective case series. The patients were included from November 2018 to December 2024. All confirmed cases of CXPA that were diagnosed and managed with complete clinical data were included in this study. Cases with incomplete data were excluded. Results Six patients were included, with ages ranging from 45 to 88 years (mean ± SD: 64 ± 15.36; median: 62). Most were male (66.7%), with an even distribution of occupations. All presented with preauricular swelling lasting 2 to 10 years, and three had left-sided tumors. Fine needle aspiration identified 33.3% as benign and 16.7% as malignant. Ultrasound examination showed solid tumors in four cases, three of which were well-defined. Three (50%) underwent total parotidectomy, and three (50%) underwent superficial parotidectomy. Histopathological examination revealed adenocarcinoma ex pleomorphic adenoma in 50% and squamous cell carcinoma ex pleomorphic adenoma in 16.7%. Tumor sizes ranged from 3.5 to 6 cm (mean: 4.73 ± 1.24 cm). Capsular invasion was present in all cases, with lymph node involvement in 33.3%, lympho-vascular invasion in 16.7%, and perineural invasion in 50%. Adjuvant therapy included radiotherapy or chemoradiotherapy. Conclusion Although CXPA is very rare, it is a serious condition; surgical approach with or without adjuvant therapy may result in preferable outcomes.