DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.003

Pages: 2408-2413

Schwannoma-like pleomorphic adenoma (SLPA) is an uncommon variant of pleomorphic adenoma (PA) in which modified myoepithelial cells grow as spindle cell sheets with nuclear palisading, closely resembling the Antoni A areas of a schwannoma. The pattern can mislead the pathologist on cytology, on small biopsies, and sometimes on resection specimens. To gather the published cases, appraise the diagnostic criteria used to separate SLPA from true schwannoma and other spindle cell lesions of the salivary region, and propose a pragmatic diagnostic approach. Narrative review with structured case extraction. We identified reports through targeted searches and citation tracking, and included cases in which a PA showed extensive schwannoma-like areas. Schwannomas with glandular elements were treated as a differential diagnosis, not as cases. We identified eight reports describing 11 cases (1977-2025). Individual data were extractable for 10 cases: median age 54 years (range 39-90), eight women, eight parotid tumors, one submandibular and one hard palate lesion; the size, when reported, was 1.5-3.5 cm. All cases showed palisaded spindle cell areas; the ductal epithelial component could be as small as about 5% of the tumor. Cytokeratin and S-100 protein were consistently expressed. In the four recent reports that documented p63, spindle cells were positive, but the extent varied from focal to diffuse. S-100 protein, SOX10, and CD10 did not discriminate SLPA from schwannoma. We found no reports of recurrence or malignant transformation, although follow-up was inconsistently documented. SLPA is probably under-recognised. A panel including cytokeratin, p63, and a neural marker, supported by generous sampling for ductal or myxochondroid foci, resolves most cases. The role of PLAG1 remains to be tested in this specific setting. Standardised reporting criteria and molecular data are needed.