Diagnosis Of Mucoepidermoid Carcinoma Research Articles

INTRAOSSEOUS MUCOEPIDERMOID CARCINOMA OF MANDIBLE: A CASE REPORT

Intraosseous mucoepidermoid carcinoma (MEC) is a rare neoplasm of the jaws with uncertain pathogenesis. We present the case of a 48-year-old female patient who underwent evaluation of a bone defect on the left side of the jaw found during a routine imaging exam. The radiological examination revealed a well-defined unilocular radiolucent lesion with irregular margins. An excisional biopsy with an exploratory puncture was performed. Histopathological examination revealed a malignant neoplasm of glandular origin with three distinct cell morphologies: epidermoid, intermediate, and mucous. These cells permeate the stroma forming multiple cystic, sometimes filled with mucus and delimited by mucous and intermediate cells. Strong PAS-positivity demonstrated mucin areas. The diagnosis of MEC was established based on these findings. Although the intraosseous appearance is rare, MEC should be included in the differential diagnosis of bone pathologies. Intraosseous mucoepidermoid carcinoma (MEC) is a rare neoplasm of the jaws with uncertain pathogenesis. We present the case of a 48-year-old female patient who underwent evaluation of a bone defect on the left side of the jaw found during a routine imaging exam. The radiological examination revealed a well-defined unilocular radiolucent lesion with irregular margins. An excisional biopsy with an exploratory puncture was performed. Histopathological examination revealed a malignant neoplasm of glandular origin with three distinct cell morphologies: epidermoid, intermediate, and mucous. These cells permeate the stroma forming multiple cystic, sometimes filled with mucus and delimited by mucous and intermediate cells. Strong PAS-positivity demonstrated mucin areas. The diagnosis of MEC was established based on these findings. Although the intraosseous appearance is rare, MEC should be included in the differential diagnosis of bone pathologies.

MUCOEPIDERMOID CARCINOMA ON THE FLOOR OF THE MOUTH: A CASE REPORT

A 60-year-old man sought out our dental service with a lesion in the oral mucosa. The intraoral examination showed a nodular, painless, normochromic, and non-bleeding lesion with approximately 30 days of evolution, affecting the right region of the mouth floor with a clinical hypothesis of adenoma. The biopsy was performed and the histopathological analysis revealed a malignant neoplastic lesion of the salivary gland characterized by the proliferation of mucous cells, epidermoids, and intermediate cells arranged either in sheets or in islands, forming cystic spaces with eosinophilic content inside, which were often covered by basaloid mucous cells. The diagnosis of mucoepidermoid carcinoma was established, and the patient was referred for treatment at the oncology referral center. A 60-year-old man sought out our dental service with a lesion in the oral mucosa. The intraoral examination showed a nodular, painless, normochromic, and non-bleeding lesion with approximately 30 days of evolution, affecting the right region of the mouth floor with a clinical hypothesis of adenoma. The biopsy was performed and the histopathological analysis revealed a malignant neoplastic lesion of the salivary gland characterized by the proliferation of mucous cells, epidermoids, and intermediate cells arranged either in sheets or in islands, forming cystic spaces with eosinophilic content inside, which were often covered by basaloid mucous cells. The diagnosis of mucoepidermoid carcinoma was established, and the patient was referred for treatment at the oncology referral center.

Mucoepidermoid Carcinoma of Breast Presenting as Abscess-like Pus Discharging Mass; A Rare Tumour With Unusual Presentation

Background: Mucoepidermoid carcinoma (MEC) breast is a very rare triple negative breast cancer with relatively better overall prognosis. They have histomorphological and immunohistochemical features similar to the salivary gland MEC. Literature suggests that they also carry molecular characteristics similar to the salivary gland MEC. Case Presentation: A 73-years-old woman presented with complaints of painful, foul smelling pus discharging mass in right breast. Patient underwent therapeutic incision and drainage along with diagnostic biopsy. On histopathology, diagnosis of MEC, high grade was made. Conclusion: Primary MEC is a very rare triple negative breast cancer (TNBC) usually with much better survival outcome in comparison to other TNBCs. However, the index case had locally advanced disease with unique presentation leading to an alternative initial management.

Mucoepidermoid carcinoma of the palate: a rare case report

<p class="abstract">The salivary glands home of several tumoral pathologies, diversified by their locations and their histological types. Described as a rare malignant tumor of the accessory salivary glands, more so in the palatine bone; the diagnosis of Mucoepidermoid carcinoma (CME) remains difficult to evoke due to the uncommonness of the clinical signs and the insidious evolution. The purpose of this case report is to discuss the clinical manifestation, diagnosis, treatment and the follow-up plan of this case. A 39-year-old patient, with no prior pathological history, presents with a painless swelling on the palate evolving for 4 years causing swallowing difficulties without any other signs, several clinical, radiographic and histopathological investigations were carried out for excision of the lesion. Biopsy of the lesion confirmed the diagnosis as mucoepidermoid carcinoma of the palate, following which wide surgical excision with adjacent free margins was performed, the additional surgical treatment consisted of bilateral functional lymph node dissection of groups I, II and III. The follow-up of the patient shows a good improvement in the local condition in the 18 months, after 36 radiotherapy sessions and without signs of recurrence. On the control CT scan with placement of an obturator palatal prosthesis to improve the quality of life awaiting a palatal flap. This case report highlights the need for diagnosis and of an appropriate treatment plan in cases of malignant tumors, as this can lead to morbidity and mortality.</p>

SURGICAL TREATMENT IN A CASE OF MODERATELY DIFFERENTIATED MUCOEPIDERMOID CARCINOMA AFTER EXCISIONAL BIOPSY: CASE REPORT

Mucoepidermoid carcinoma (MEC) is the most common malignant major and minor salivary gland neoplasm, with a predilection for the parotid gland, followed by the hard palate. A 45-year-old female patient presented to the maxillofacial outpatient clinic with a symptomatic nodular lesion on the hard palate that had first appeared 6 months earlier. The imaging exam showed an expansive growth in the region. The diagnostic hypothesis was hemangioma. Accordingly, an excisional biopsy was performed. Histomorphologic analysis showed lobular infiltration of mucous cells permeated by intermediate and epidermoid cells, in addition to intense vascular proliferation within the affected structures and margins. The diagnosis of MEC (moderately differentiated) was made. The patient was referred to the head and neck surgical service and the surgical margins were expanded. At 12-month follow-up, there was no recurrence. Hence, the case points to the importance of incisional biopsy in suspicious lesions to avoid possible loss of margins in surgical treatment. Mucoepidermoid carcinoma (MEC) is the most common malignant major and minor salivary gland neoplasm, with a predilection for the parotid gland, followed by the hard palate. A 45-year-old female patient presented to the maxillofacial outpatient clinic with a symptomatic nodular lesion on the hard palate that had first appeared 6 months earlier. The imaging exam showed an expansive growth in the region. The diagnostic hypothesis was hemangioma. Accordingly, an excisional biopsy was performed. Histomorphologic analysis showed lobular infiltration of mucous cells permeated by intermediate and epidermoid cells, in addition to intense vascular proliferation within the affected structures and margins. The diagnosis of MEC (moderately differentiated) was made. The patient was referred to the head and neck surgical service and the surgical margins were expanded. At 12-month follow-up, there was no recurrence. Hence, the case points to the importance of incisional biopsy in suspicious lesions to avoid possible loss of margins in surgical treatment.

Uncommon diagnostic pitfalls of mucoepidermoid carcinoma on cytology: A tertiary care center, retrospective descriptive study

Introduction: Diagnosis of mucoepidermoid carcinoma (MEC) on fine-needle aspiration cytology (FNAC) is grim with important diagnostic pitfalls, leading to wrong treatment decisions. This study highlights uncommon mimics of MEC on FNAC smears of major salivary glands and compares the cytologic findings with definitive histopathology diagnosis for identification of potential diagnostic pitfalls. Methods: This is a retrospective descriptive study of MEC cases diagnosed over a duration of 5 years (April 2015–April 2020) at a tertiary care center with available preoperative FNAC and postoperative histopathology resection specimens. Results: Out of a total of 18 MEC cases diagnosed by histopathologic examination, 8 (44%) were wrongly diagnosed on preoperative FNAC as a different benign or malignant entity. Further details of these cases are shared in the text. Discussion: Although FNAC remains an important preoperative diagnostic tool in salivary gland lesions, utmost care is required in the cases of MEC which are notorious for misinterpretation on cytology. A number of uncommon mimics, both benign and malignant, need to be considered and carefully excluded to spare the patient of avoidable miseries of misdiagnosis. Conclusion: MECs of salivary glands can mimic the morphology of a variety of benign as well as malignant lesions on cytology with low cyto-histologic concordance especially in cystic lesions.

Prognostic impact of CRTC1/3-MAML2 fusions in salivary gland mucoepidermoid carcinoma: A multiinstitutional retrospective study.

Mucoepidermoid carcinoma (MEC) is rare, but the most common primary malignancy of the salivary gland and not infrequent in young individuals. CRTC1/3‐MAML2 fusions are frequently detected in MEC and are useful as a diagnostic biomarker. However, there has been debate as to whether the fusions have prognostic significance. In this study, we retrospectively collected 153 salivary gland MEC cases from 11 tertiary hospitals in Japan. As inclusion criteria, the MEC patients in this study had curative surgery as the initial treatment, received no preoperative treatment, and had no distant metastasis at the time of the initial surgery. The MEC diagnosis was validated by a central pathology review by five expert salivary gland pathologists. The CRTC1/3‐MAML2 fusions were detected using FISH and RT‐PCR. In 153 MEC cases, 90 (58.8%) were positive for CRTC1/3‐MAML2 fusions. During the follow‐up period, 28 (18.3%) patients showed tumor recurrence and 12 (7.8%) patients died. The presence of the fusions was associated with favorable tumor features. Of note, none of the fusion‐positive patients died during the follow‐up period. Statistical analysis showed that the presence of the fusions was a prognostic indicator of a better overall survival in the total and advanced‐stage MEC cohorts, but not in the early‐stage MEC cohort. In conclusion, CRTC1/3‐MAML2 fusions are an excellent biomarker for favorable overall survival of patients with salivary gland MEC.

MUCOEPIDERMOID CARCINOMA: AN EVOLUTION OF 21 YEARS

A female patient, 37 years of age, reported volume increase in the right side of the face in 5 months with painful symptoms. An intraoral examination revealed an endophytic palatal and vestibular lesion, extending from the premolar region to the molar region. The radiographic examination showed a radiolucent lesion with radiopaque areas near the maxillary sinus. The patient presented a history of untreated lesion on the palate diagnosed as adenocarcinoma in 1997. In 2018, a new incisional biopsy was performed. The histologic examination showed the malignant neoplasm of salivary gland characterized cystic spaces lined by a single layer of mucous cells and areas with epidermoid cells. Histochemical analysis of the mucous cells and contents of the microcystic spaces were stained positive with the mucicarmine. The final diagnosis of mucoepidermoid carcinoma was issued. The patient was referred for treatment in the Liga norterriograndense contra o câncer and is followed up.

MUCOEPIDERMOID CARCINOMA WITH BONE COMMUNICATION: A CASE REPORT WITH EMPHASIS IN CLINICAL AND HISTOPATHOLOGIC FEATURES

Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor; however, the bone communication in this type of pathology is rare. We describe the case of a 32-year-old female patient with an asymptomatic lesion in anterior mandible incidentally discovered in routine radiographic examinations. A well-defined, unilocular radiolucent lesion in the right posterior mandible was found without dental involvement. The clinical diagnosis was odontogenic keratocyst, and incisional biopsy was performed. Microscopic examination revealed a malignant salivary gland tumor, consisting of mucous cells with broad and clear cytoplasm; epidermoid cells with polygonal shape, eosinophilic cytoplasm, and vesicle nuclei; and intermediate cells with scarce cytoplasm and hyperchromatic nucleus. Clinicopathologic characteristics led to the diagnosis of mucoepidermoid carcinoma. The patient was referred to the reference hospital of Rio Grande do Norte, where he underwent resection of the mandible and currently undergoes radiotherapy.

ONCOCITIC VARIANT OF CENTRAL MUCOEPIDERMOID CARCINOMA: A RARE CASE REPORT

Mucoepidermoid carcinoma (MC) constitutes a heterogeneous lesion and may present histologic variations that make the diagnosis difficult to establish. A 45-year-old women presented to a referral center complaining of a 10-year increase of volume in the left posterior mandible, associated with dental displacement, with no sign of oral mucosal involvement. Computed tomography evidenced a large hypodense area, with well-defined limits, cortical bone thinning, and a discrete area of solution of continuity. Incisional biopsy was performed with diagnostic hypothesis of dentigerous cyst or ameloblastoma. Histopathologic analysis revealed a malignant neoplasia with glandular differentiation, presenting a prominent component of large oncocytoid polygonal cells, such as cells with squamous, basaloid, columnar, and mucous aspects. Multiple cystic and ductiform spaces, sometimes containing basophilic mucoid-like material, were observed. Histochemical and immunohistochemical reactions were also performed, and the diagnosis of oncocytic MC was established. Tumor resection and mandibular reconstruction with microsurgical fibular graft were considered for treatment.

Are demographics associated with mucoepidermoid or acinic cell carcinoma parotid malignancies in children?

ObjectiveTo identify possible associations between patient demographics and parotid cancer histological type in pediatric patients.MethodsPediatric patients (ages: birth-18.0 years) in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of mucoepidermoid carcinoma or acinic cell carcinoma of the parotid gland using the ICD O-3 codes of C07.9 and 8430 or 8550. Patients were classified into the following cohorts: <14 and 14–18 years of age based on the mean age at diagnosis.ResultsThree hundred and three pediatric patients were diagnosed with mucoepidermoid carcinoma or acinic cell carcinoma of the parotid gland within the SEER 18 registries. Female pediatric patients 14–18 years of age were 7.68 times more likely to have an acinic cell carcinoma (adjusted OR: 7.68 [95% CI: 2.01–29.44]). When stratified by histological type, 58.9% of female pediatric patients ≥14 years of age had an acinic cell carcinoma as compared to 37.3% of male pediatric patients ≥14 years of age, 36.5% of female pediatric patients <14 years of age, and 34.0% of male pediatric patients <14 years of age (P = 0.01).ConclusionsBased on this study, pediatric female patients between the ages of 14 and 18 years are the most likely cohort to have acinic cell carcinoma. The results of this study may assist providers during the work up of a pediatric patient with a suspected parotid malignancy.

PIGMENTED MUCOEPIDERMOID CARCINOMA: A CASE REPORT

Objective Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy, but to date, there are few reported cases of the pigmented variant of mucoepidermoid carcinoma. Classically, MEC is a malignant epithelial tumor composed of varying proportions of mucous, epidermoid, intermediate, columnar, clear, and occasionally oncocytic cells. There are two main classification systems that stratify MEC into low-, intermediate-, and high-grade types on the basis of morphologic and cytologic features. Additionally, there are well recognized variants of MEC, including clear cell and oncocytic variants of MEC. This case is selected to highlight the uncommonly encountered pigmented variant of MEC. Clinical Presentation A 32 year-old male with a one year history of cheek pain presented with a 0.9 × 0.5 cm pigmented and painful swelling of the right inferior buccal mucosa, adjacent to tooth #30. Intervention and Outcome An incisional biopsy was taken of the right inferior buccal mucosa and submitted for histopathologic diagnosis. A diagnosis of mucoepidermoid carcinoma, pigmented, low-grade (AFIP Grading Scheme) was rendered. Subsequent CT and PET imaging revealed no evidence of metastasis, and the tumor was fully resected with negative margins under general anesthesia. Immunohistochemical profile demonstrated positive staining for CK5/6 and p63 with focal S100 and mammaglobin positivity. Conclusion Mucoepidermoid carcinoma is a common salivary gland malignancy, but the uncommon pigmented variant of MEC can pose confusion for the surgical pathologist.

Mucoepidermoid carcinoma mimicking a mucocele: a case report highlighting the importance of microscopic analysis of oral lesions

Resumo Objetivo: O objetivo deste trabalho é relatar um caso de carcinoma mucoepidermoide palatino (CME) mimetizando uma mucocele, ressaltar os principais diagnósticos diferenciais e apontar a necessidade de uma biópsia para estabelecer o diagnóstico mesmo na suspeita de benigno. lesões reativas. Relato de caso: uma fêmea foi encaminhada a um estomatologista para avaliação de um inchaço no palato notado cerca de dois meses antes. O exame físico revelou nódulo submucoso translúcido, indolor, com halo eritematoso no palato mole direito. Considerando a aparência clínica, a hipótese diagnóstica incluiu mucocele e adenoma pleomórfico. Uma biópsia incisional foi realizada. A análise histológica do espécime mostrou diagnóstico definitivo de CME de baixo grau. O caso foi gerenciado através de uma incisão cirúrgica completa. Atualmente, ela tem sido acompanhada sem sinais de recorrência. Conclusão: o diagnóstico precoce da CME pode orientar um manejo terapêutico adequado e, consequentemente, promover um prognóstico favorável.

Mucoepidermoid carcinoma at an uncommon location

Mucoepidermoid carcinoma (MEC) usually arises from salivary glands, representing 5–10% of all salivary gland tumors, and rarely arises in the jaws. MEC mainly occurs in the parotid gland; intraorally MEC appears as asymptomatic swellings in minor salivary glands, mostly on the palate, and contributes for 2.8–15% of all salivary gland tumors. Due to its great biological diversity, treatment and prognosis depend on the histological grade, location, and tumor stage. Here, we present a case of MEC in a female patient aged 65 years with emphasis on the importance of early diagnosis and proper management of the disease. Even when its clinical appearance is not suggestive of malignancy, the diagnosis of MEC should be considered in cases of proliferative oral lesions.

Mucoepidermoid Carcinoma of the Hard Palate in a Young Patient.

Carcinomas of salivary glands are rare and can affect major or minor salivary glands. Among them, the mucoepidermoid carcinoma is the most prevalent and its occurrence in the first 2 decades of life is highly unusual. Their common clinical aspect to different diseases is a challenge in diagnosis. The objective of this work is to elucidate the diagnosis of lesion in the hard palate of an adolescent patient, brown-skinned, male, forwarded to the oral surgery department at the State University of Londrina. Initially, he complained about a progressive swelling in the last 60 days. Through computed tomography scan, it was noted intraosseous involvement in the maxilla involving dental apex of the elements 13, 14, 15, right maxillary sinus extending to piriform sinus. Proceeding with clinical examination, followed by biopsy, histology, and immunohistochemical analysis, we established the diagnosis of mucoepidermoid carcinoma. After verification, the patient was sent to the referenced service to start cancer treatment.

English

Mucoepidermoid Carcinoma (MEC) is the most common malignant tumor in salivary glands. About 70% of these tumors are found in the parotid gland, 15 to 20% in the oral cavity, mostly in the palate, and 6 to 10% in the submandibular gland. MEC has female predilection and the mean age at onset is in the 5th decade of life. The treatment decision depends on the histopathology (Low-grade, Intermediate-grade, High-grade). A 12 year-old male with a right palatal tumor, having no association with vital teeth arrived at our service centre. The excisional biopsy reported was: MEC Intermediate-grade. Because few cases of MEC in Paediatric patients have been reported, a review of the literature, with range of age 0-17 years, was made, 24 patients with diagnosis of MEC in Palate, included our case, were found, the average age was 14 (29%), the predilection in genre was female with 19 cases (79%), and 5 cases in Male (21%). MEC has a female predilection and is uncommon in the first decade of life but should be considered even in paediatric patients. The prognosis depends on the clinical stage, grade of the tumor, location, and adequacy of treatment. The presence of nodal disease and distant metastases implies a poor prognosis. Key words: Mucoepidermoid carcinoma, palate, childhood.

Mucoepidermoid Carcinoma of the Salivary Glands: Survival and Prognostic Factors.

The aim of this study was to establish global survival rates and potential prognostic factors for mucoepidermoid carcinoma (MC) of the salivary glands in patients diagnosed at the Dr. Eduardo Cáceres Graziani National Institute for Neoplastic Diseases (INEN), Lima, Peru, between 2002 and 2012. This was an observational, analytical and longitudinal (information reconstructed in time) retrospective cohort study. Data were obtained from clinical records and used to determine the overall survival (OS) rate at 2 and 5years, and the individual percentage survival for each prognostic factor using the actuarial technique. We also performed univariate analysis for each possible prognostic factor using log-rank analysis, and multivariate analysis using Cox's regression model. The study was approved by the institutional review board at Dr. Eduardo Caceres Graziani INEN and conducted in accordance with the 1964 Declaration of Helsinki. For this type of study formal consent was not required. The OS rate of the 51 patients enrolled in the study was 81% at 2years and 78% at 5years. In the multivariate analysis, the equation that best explained the survival result contained the variable, clinical stage (p=0.063). The results revealed the importance of clinical stage regarding the survival of patients with a primary diagnosis of MC of the salivary glands.

Molecular diagnostics in the differential diagnosis of glandular odontogenic cyst and mucoepidermoid carcinoma – case reports

AbstractGlandular odontogenic cyst (sialo‐odontogenic cyst) (GOC) is an uncommon developmental odontogenic cyst. Its clinical significance lies in its tendency to recur, and histopathological features which mimic those of mucoepidermoid carcinoma (MC). Molecular methods such as fluorescence in situ hybridisation (FISH) have the potential to identify genetic abnormalities that are specific to MC and thus avoid this diagnostic pitfall. This report describes three cystic lesions of the jaws with a differential diagnosis of GOC and MC. One occurred in the mandibular premolar area of a 49‐year‐old woman and was diagnosed as GOC. The second developed in the maxilla of a man aged 39 in association with an impacted second premolar tooth. This was initially diagnosed as dentigerous cyst, but after recurrence 6 years later, the diagnosis was revised to GOC. The third occurred in the left retromolar area of a 30‐year‐old woman 5 years after the extraction of the left mandibular third molar; a diagnosis of GOC was favoured after two incisional biopsies, but a third showed unequivocal, invasive MC which had infiltrated nerves and bone. Morphologically, the only distinguishing feature was the so‐called epithelial sphere, whorl or plaque‐like thickening, which was identified in both GOC but not in the MC. FISH confirmed the above diagnoses by demonstrating a MAML2 rearrangement in the MC, but in neither of the GOC. While histopathology may reliably distinguish between GOC and MC, the presence of the specific MAML2 rearrangement in the latter clinches the diagnosis.

Mucoepidermoid carcinoma of the retromolar region: report of a clinical case

Although the number of reported cases is low, mucoepidermoid carcinoma is the most common malignant salivary gland neoplasm in the oral cavity. Its etiology is unknown. Clinically, it is described as a painful or painless swelling most often seen in the palate. Due to its great biological diversity, treatment and prognosis depend on the histological grade, location, and tumor stage. The objective of the present study was to describe a clinical case of mucoepidermoid carcinoma in a Brown female patient aged 45 years. Intraoral physical examination revealed a 1.0 cm diameter, bluish bubble with clear boundaries in the left retromolar region. The bubble had been there for roughly four months. An excisional biopsy was performed to confirm the clinical diagnosis of mucocele. Yellowish mucous leaked during the excision. The anatomical-pathological result was mucoepidermoid carcinoma, after which the patient was referred to a head and neck surgeon. Hence, we emphasize the importance of early diagnosis and proper management of this disease. Even when its clinical appearance is not suggestive of malignancy, mucoepidermoid carcinoma diagnosis should be considered in cases of proliferative oral lesions.

Significance of Fusion Gene Analysis for the Differential Diagnosis of Mucoepidermoid Carcinoma

Significance of Fusion Gene Analysis for the Differential Diagnosis of Mucoepidermoid Carcinoma