Florid keratin pearls in pleomorphic adenoma - A mimicker to malignancy

The presence of numerous keratin pearls on microscopic study is a feature commonly seen in well-differentiated squamous cell carcinoma. Pleomorphic adenoma (PA) can show the presence of squamous metaplasia with keratin pearls as a rare finding. Here, we present a case of a male patient in the 5th decade presenting with a mass on the buccal mucosa who smokes tobacco. On microscopic study, the mass showed tumor cells presenting with extensive keratin pearl formation. In this paper, we want to highlight the rare findings of extensive keratin in PA of minor salivary glands, the significance of special stains in diagnosis and differential diagnosis of this uncommon presentation.