A 67-year-old man with metastatic carcinoma ex pleomorphic adenoma of the parotid gland: case report and review of the literature.

Carcinoma ex pleomorphic adenoma (Ca ex PA) is an uncommon but highly aggressive malignancy arising from long-standing pleomorphic adenoma. Malignant transformation typically presents with rapid enlargement, pain, and facial nerve involvement. Metastatic spread is exceptionally rare. We describe a 67-year-old man with a decades-long right parotid mass that underwent malignant change after prior surgical excision confirmed Ca ex PA. After being lost to follow-up, he re-presented with neck stiffness, hearing loss, and facial nerve palsy. Imaging demonstrated a recurrent parotid mass infiltrating adjacent space, accompanied by cervical lymphadenopathy and bilateral pulmonary nodules suggestive of metastases. This case highlights the severe consequences of untreated or inadequately followed salivary gland neoplasms and underscores the necessity of early excision, thorough histopathologic assessment, and consistent long-term surveillance to prevent advanced Ca ex PA.