Mucoepidermoid carcinoma of minor salivary glands: a clinical study of 16 cases and review of the literature

Abstract

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of salivary glands with a widely diverse biologic behavior that is correlated with the histological grade of the tumor. The purpose of this study was to evaluate the clinical outcomes of MEC of minor salivary glands in a group of 16 patients, who were treated in our clinic, and to discuss the management of this carcinoma. Between 1985 and 2000, 16 patients with MEC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the 'G. Papanikolaou' General Hospital, in Thessaloniki. The age range was 16-65 years. The distribution of the primary sites was: hard plate (one), soft palate (two), hard and soft palate (three), hard and soft palate with spread in paranasal sinus and nasal cavity (one), buccal mucosa (three), hard palate, alveolar process and buccal mucosa (two), and retromolar triangle (our). The tumors were clinically staged according to the tumor nodes metastase (TNM) system (Seifert, 1991). All patients were treated radically with surgery. The surgery was combined with radiotherapy in nine patients. Radiotherapy was delivered using Co-60. Doses ranged from 50 to 60 Gy and the duration of the therapy ranged from 25 to 35 days. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. The mean follow-up range was 4-14 years. From the 16 patients with MECs 10 (62.5%) were alive and five (35.6%) had died from the disease. Four patients were free of the disease for more than 5 years (range 8-14), five patients were free of the disease for 5 years and one patient was free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence developed in one patient 10 years after the initial treatment. Lymph node metastases occurred in one patient within the first year after the initial surgical treatment. Distant metastases (two in bones and one in lungs) occurred in three patients within 2 years after completing the treatment. The Pearson chi-square statistical analysis was used for comparing the Ki-67 values in correlation with histological grade of the tumors. The Ki-67 expression was only 1% in low-grade MECs, while in intermediate-grade tumors it was estimated between 3 and 4%. The high-grade tumors had increased expression (10%) of tumor cells. Complete surgical excision is the treatment of choice for MECs. Adequate excision is important in all grades of tumors. Prognosis of MECs is a function of the histological grade, adequacy of excision and clinical staging. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.