Low-grade Mucoepidermoid Carcinoma Research Articles

Deeper wedge resection and parenchymal-sparing bronchoplasty of the secondary carina: an alternative surgical technique for removal of tumor located at the orifice of upper lobar bronchus

BackgroundSleeve resection and reconstruction of the bronchial corner between the upper lobar bronchus and the intermediate bronchus is technique demanding.Case presentationA 33-year-old Chinese man suffered from recurrence of low-grade malignant mucoepidermoid carcinoma located at the orifice of upper lobar bronchus with invasion to the main bronchus nearly 1 year after he had undergone an incomplete bronchoscopic resection. With detailed preoperative and intraoperative evaluation by computed tomography and bronchoscopy, a deeper wedge resection and bronchoplasty of the secondary carina was performed. The freedom from tumor cells at the cut-edges was guaranteed by frozen examination. The postoperative course was uneventful and the patient was free from recurrence for 18 months after the surgery.ConclusionsWith an R0 resection, the procedure described in the present case report was feasible and relatively easy, thus an alternative to sleeve lobectomy or sleeve bronchial resection for small-size low-grade malignancy located at the orifice of upper lobar bronchus.

Pediatric salivary gland tumors and tumor-like lesions

Salivary gland tumors and tumor-like lesions in the pediatric population are uncommon. They comprise aheterogeneous group of infectious/inflammatory and neoplastic conditions. Pediatric salivary neoplasms include benign tumors of mesenchymal or epithelial origin as well as malignancies of epithelial (carcinomas), mesenchymal (sarcoma) or hematolymphoid (lymphoma) derivation. Infectious/inflammatory conditions and hematolymphoid malignancies may represent either genuine parenchymal pathology or conditions involving intraglandular lymph nodes of the parotid glands (intraglandular lymphadenopathy and intraglandular nodal lymphomas). Pediatric sialadenitis may be of diverse etiologies including viral (mumps, CMV, HIV, etc.), bacterial, autoimmune (juvenile Sjögren syndrome) or idiopathic (chronic recurrent juvenile sialectatic sialadenitis). Angiomatous lesions (juvenile capillary hemangioma, lymphangioma and vascular malformation) and pleomorphic adenomas represent the most common pediatric benign mesenchymal and benign epithelial tumors, respectively. The vast majority of salivary gland carcinomas in children and adolescents represent low-grade mucoepidermoid carcinomas followed by acinic cell and adenoid cystic carcinomas (together >80% of carcinomas). Other malignant neoplasms include (rhabdomyo-) sarcomas, malignant lymphomas and very rarely sialoblastomas. This long differential diagnosis list of etiologically and biologically highly heterogeneous entities, their shared clinical presentation as "salivary gland enlargement" and the significant differences in their therapeutic strategies and prognosis underline the need for careful assessment to identify the correct diagnosis. Diagnosis is mainly based on aset of typical clinical and imaging features, serological/microbiological findings and, in selected cases, histomorphological characteristics in biopsy specimens.

Whole-Exome Sequencing of Salivary Gland Mucoepidermoid Carcinoma.

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. To explore the genetic origins of MEC, we performed systematic genomic analyses of these tumors. Whole-exome sequencing and gene copy-number analyses were performed for 18 primary cancers with matched normal tissue. FISH was used to determine the presence or absence of the MECT1-MAML2 translocation in 17 tumors. TP53 was the most commonly mutated gene in MEC (28%), and mutations were found only in intermediate- and high-grade tumors. Tumors with TP53 mutations had more mutations overall than tumors without TP53 mutations (P = 0.006). POU6F2 was the second most frequently mutated gene, found in three low-grade MECs with the same in-frame deletion. Somatic alterations in IRAK1, MAP3K9, ITGAL, ERBB4, OTOGL, KMT2C, and OBSCN were identified in at least two of the 18 tumors sequenced. FISH analysis confirmed the presence of the MECT1-MAML2 translocation in 15 of 17 tumors (88%). Through these integrated genomic analyses, MECT1-MAML2 translocation and somatic TP53 and POU6F2 mutations appear to be the main drivers of MEC. Clin Cancer Res; 23(1); 283-8. ©2016 AACR.

Mucoepidermoid Carcinoma of Salivary Gland: Limitations and Pitfalls on FNA.

Mucoepidermoid Carcinoma (MEC) is the most common malignant neoplasm of salivary gland origin. However, its morphologic heterogeneity poses difficulty in interpretation. In the present series we discuss the morphologic features of MEC, limitations and pitfalls in its diagnosis on Fine Needle Aspiration Cytology (FNAC). Fourteen cases of suspected MEC were evaluated cytologically followed by histopathological examination for confirmation. A definite cytological diagnosis was rendered in nine cases; three of the remaining five were underdiagnosed as abscess, pleomorphic adenoma and mucus cyst. Of the remaining two cases, one case each of sebaceous carcinoma and sialadenitis was mislabeled as MEC on cytology. A satisfactory aspirate composed of intermediate cells, mucin secreting cells and squamous cells in a mucinous background may not be obtained in all cases of low grade MEC. High grade MEC can be classified as squamous cell carcinoma. Hence, awareness of confounding factors with clinicopathologic correlation and judicious use of frozen section can help in minimizing errors.

Bronchial Mucoepidermoid Carcinoma.

A 12-year-old boy with chronic respiratory complaints, including cough, exercise intolerance, and persistent wheezing, was referred to our hospital because of persistent symptoms under extensive asthma therapy. A standard radiograph of the chest detected very slight hyperinflation of the left lung with increased lung translucency (Figure 1). Computed tomography revealed a polypoid mass distally in the left main bronchus with a density around 55 HU and very slightly decreased attenuation of the left lung, probably due to secondary air trapping (Figure 2). Bronchoscopy confirmed this finding, and biopsy revealed the mass to be a low-grade mucoepidermoid carcinoma (Figure 3). A curative bronchial sleeve resection was performed with partial mediastinal lymphadenectomy. All lymph nodes were normal, and there is no recurrence to this date (one year). Adjuvant chemotherapy was not indicated.

Intra bronchial mucoepidermoid carcinoma in an 8 year old girl: A case report of rare tumor with review of literature

Abstract Intra bronchial and intra tracheal tumors are very rare in pediatric age group. Most of the literature clubs primary pulmonary tumors with these; hence actual incidences are not well defined. Amongst this mucoepidermoid carcinoma (MEC), whether low or high-grade account for only 0.1–0.5% of lung carcinomas. We report such a rare case of an eight year old girl presenting with history of recurrent lower respiratory tract infections with respiratory distress. CT scan of chest was suggestive of a mediastinal mass. She underwent rigid bronchoscopic biopsy, histopathology showed it to be mucus gland adenoma. She underwent right thoracotomy with complete excision of mass along with right lower lobectomy. Histopathology reported it to be a low-grade MEC with clear margins. She did not require any chemotherapy or radiotherapy and has no recurrence at 1-year follow up.

Abstract 4280: Paralleled workflow for expansion of limited patient material using CRC for in vitro/PDX/biological/genetic studies of a low-grade mucoepidermoid carcinoma

Abstract Acquiring live cancer cells preserving original characteristics is a critical step for precision medicine. Here we illustrate a paralleled workflow using a low-grade sublingual salivary mucoepidermoid carcinoma (MEC) as an example. Methods: Working under IRB approval, tissue from two distinct regions of a MEC were obtained and primary epithelial cell cultures established using CRC (F medium with Rho Kinase (ROCK) inhibitor Y-27632 with irradiated Swiss 3T3-J2 mouse fibroblast feeder cells). Epithelial cells were separated from feeders to test under non-CRC conditions including 2D (MammoCult™), colony formation in Matrigel (F medium, Y-27632), patient derived xenograft (PDX) formation (10*6 cells/50:50 matrigel/PBS/mammary fatpad), and RNA and DNA extracted for RNAseq, exome sequencing and PCR/RT-PCR for a CRTC1-MAML2 fusion gene (reported in MEC). Sequences were analyzed for relative transcript abundance, differentially expressed genes (DEGs), and single nucleotide polymorphisms (SNPs) (TopHat/CuffLinks, SAMTOOLS, variant database: dbSNP & 1000G, UCSC hg19) between the two MEC regions and fusion genes (FusionCatcher). Potentially pathophysiological SNPs were identified (OMIM and SNPedia). Gene ontology was performed on transcriptome data (PARTEK Genomic Suite, Pathway Studio). Immunohistochemistry (IHC) was used to compare protein expression of selected DEG and downstream effectors in original cancer and surrounding normal tissue, cell pellets, Matrigel colonies and PDX (confirmed as human using MAB1273). Results: CRC cultures established from both sites grew similarly under all in vitro and in vivo conditions. PDX showed well-differentiated histology comparable to original cancer. One of the 11 DEG was amphiregulin but protein expression was equivalent in the two cell cultures. Amphiregulin, EGFR, p-EGFR, p-AKT, and mTOR were expressed in vitro (CRC and non-CRC), in vivo (PDX) and in original cancer, where they were up-regulated as compared to surrounding normal tissue. Five potentially pathophysiologically significant SNPs were detected (BRCA2 (rs144848), TP53 (rs1042522), AURKA (rs2273535), DBYD (rs1801265), and (SOD2 rs4880)) but no CRCTC1-MAML2 fusion gene. FusionCatcher detected a possible novel fusion product currently under investigation. Conclusion: The paralleled approach provided sufficient material to identify amphiregulin as an upregulated growth factor pathway in a CRTC1-MAML2 fusion gene negative MEC. Previously, amphiregulin upregulation was pathophysiologically linked to the CRTC1-MAML2 fusion gene. Results from the two MEC sites were biologically concordant and genetically similar. In summary, CRC can be used to expand limited patient derived material for more extensive studies under non-CRC conditions. Support: R56DE023259 (PAF) Citation Format: Ahmad M. Alamri, Xuefeng Liu, Weisheng Wang, Xiaogang Zhong, Bhaskar Kallakury, Bruce Davidson, Priscilla A. Furth. Paralleled workflow for expansion of limited patient material using CRC for in vitro/PDX/biological/genetic studies of a low-grade mucoepidermoid carcinoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4280.

Expression of Membrane-Bound Mucins and p63 in Distinguishing Mucoepidermoid Carcinoma from Papillary Cystadenoma.

The aim of this study was to compare the immunoexpression of epithelial mucins (MUCs) in salivary duct cysts, papillary cystadenomas, and mucoepidermoid carcinomas and to evaluate if any of these markers could be useful for differentiating between mucoepidermoid carcinoma and papillary cystadenoma. We also sought to validate the p63 expression pattern found to differentiate between mucoepidermoid carcinoma and papillary cystadenoma. Immunoexpression of MUC1, MUC2, MUC4, MUC7, and p63 was studied and quantified in 22 mucoepidermoid carcinomas, 12 papillary cystadenomas, and 3 salivary duct cysts. The immunohistochemical evaluation was collectively performed by 3 oral pathologists. Scores and trends in proportions were assessed using the nonparametric Wilcoxon-Mann-Whitney rank sum test. Mucoepidermoid carcinomas, papillary cystadenomas, and salivary duct cysts demonstrated variable MUC expression patterns. All tumors were positive for p63 immunoexpression with p63 labeling in salivary duct cysts and papillary cystadenomas (15/15) limited to the basal layers of the cystic spaces, whereas in mucoepidermoid carcinomas (22/22) the p63 labeling extended throughout the suprabasal layers (p<0.001). This study adds more confirmatory data to validate that the reactivity pattern of p63 protein can be used in distinguishing between papillary cystadenoma and low-grade mucoepidermoid carcinoma. Although positive reactivity in a tumor with MUC1 and MUC4 was inconclusive, negative reactivity suggests the diagnosis of a benign PC or SDC.

Mucoepidermoid Carcinoma of Hard Palate in a Pediatric Case

Salivary gland neoplasms are rare in childhood. Only 1 to5.5% of minor salivary gland tumours occur in children and adolescents. The most common malignant minor salivary gland tumours are mucoepidermoid carcinomas (MECs). Herein, we present a rare case of mucoepidermoid carcinoma occuring in the hard palate. Presentation of Case: A 12-year-old boy visited our hospital with a swelling and ulceration of the right hard palate. Clinical examination revealed a localized mucosal nodule of the right posterior hard palate, measuring 1*1 cm. Biopsy was performed. The tumour was diagnosed as a low grade MEC. Wide excision was performed. The patient didn’t need another therapy. During 15-month follow-up, the patient showed no evidence of local tumour recurrence or metastasis. Discussion: Mucoepidermoid carcinoma occurring in the oral cavity is extremly rare. These tumours are usually presenting as a painless, reddish-purple nodule. Biopsy is necessery for definitive diagnosis. Histologically, MECs are divided into low, intermediate and high grade subtypes. Differantial diagnosis of palatal tumours in children include pleomorphic adenoma, benign or malignant mesenchymal tumours, and less commonly giant cell granuloma. A wide local excision with safe free margins is the operative procedure for low-grade MECs.

Ki-67 Index in Salivary Gland Neoplasms

Abstract Assessment of proliferation is a means of predicting local recurrence and metastatic potential of malignancies. A mitotic count is not an ideal marker for proliferation in certain situations, such as salivary gland neoplasms. Ki-67 expression as a proliferation marker has been investigated in many human tumors. In the present study, Mitotic index (MI) and Ki-67 index were studied in pleomorphic adenoma, basal cell adenoma, mucoepidermoid carcinoma, adenoid cystic carcinoma epithelial myoepithelial carcinoma, carcinoma ex Pleomorphic adenoma and adenocarcinoma of salivary glands. The results were compared. The MI was similar in benign neoplasms, mucoepidermoid carcinoma and epithelial myoepithelial carcinoma, whereas it was high in carcinoma ex pleomorphic adenoma, adenocarcinoma and adenoid cystic carcinoma. The Ki-67 index was different in basal cell adenoma and pleomorphic adenoma. It was helpful in differentiating high grade and low grade mucoepidermoid carcinoma. It highlighted the malignant behavior of epithelial myoepithelial carcinoma. It was concluded that Ki-67 in benign neoplasms is 5% or less and in malignant ones more than 23% with a few exceptions. In mucoepidermoid carcinoma and epithelial myoepithelial carcinoma, Ki-67 index was found to be a better indicator for aggressiveness. These findings will be presented in this paper, with review of literature. How to cite this article Kaza S, Rao TJM, Mikkilineni A, Ratnam GV, Rao DR. Ki-67 Index in Salivary Gland Neoplasms. Int J Phonosurg Laryngol 2016;6(1):1-7.

Treatment of Low grade Mucoepidermoid carcinoma of hard palate: A conservative approach

Mucoepidermoid carcinoma of the minor salivary glands though malignant, often displays clinical characteristics similar to benign tumors. Although it is the most common of all malignancies of salivary glands, and the palate is reported to be a frequently affected site, the incidence of palatal mucoepidermoid carcinoma is still quite rare. Proper guidelines regarding treatment of such low grade tumors have not been defined. The aim of this article is to present a case of low grade mucoepidermoid carcinoma of the palate and discuss the possibility of conservative approach for treatment.

Glandular Odontogenic Cyst Mimicker: A Novel Entity

ABSTRACTGlandular odontogenic cyst (GOC) is an uncommon developmental odontogenic cyst of jaws with a frequency of approximately 0.2%. Because of its aggressive biological behavior including its malignant transformation potential, recently collaborative efforts by few researchers have laid down certain histopathological criteria segregating it from its mimickers which include dentigerous cyst, lateral periodontal cyst (LPC), or botryoid cyst, radicular cyst, and central low-grade mucoepidermoid carcinoma. Therefore, cautious histopathological evaluation is necessary of GOC mimickers in order to prevent its overdiagnosis. Here, we present a case of GOC mimicker in a 12-year-old male patient in left maxillary region.How to cite this articleAzmi KE, Patel S, Pathak J, Swain N. Glandular Odontogenic Cyst Mimicker: A Novel Entity. J Contemp Dent 2016;6(2):145-148.

Bronchial Foreign Body Alerting of a Bronchial Tumor: The Need of a Follow-Up Radiography.

Lung tumors are extremely rare in the pediatric population, comprising only 0.2% of all malignancies in children. Among them, mucoepidermoid carcinoma (MEC) is even rarer with a reported frequency of 0.1% to 0.2%. MEC is defined by the World Health Organization as a tumor characterized by a combination of mucus-secreting, squamous, and intermediate cell types. We describe the case of a 4-year-old girl who presented with a history of intermittent fever and nonproductive cough of 1-month duration after foreign body aspiration. The chest X-ray showed complete collapse of the left lung. After removal of the foreign body, the lung expanded well after. However, the control chest X-ray done after 5 days showed again complete collapse of the left lung. The biopsy specimen taken during bronchoscopy confirmed the diagnosis of low-grade MEC. Fluorescence in situ hybridization (FISH) confirmed the presence of MAML2 rearrangement. Complete surgical resection with preservation of lung parenchyma was performed. No adjuvant therapy was needed. Repeat bronchoscopy was performed 2 months after surgery and showed no recurrence of the tumor. In conclusion, a remote chest X-ray after removal of a foreign body is necessary to avoid missing a rare serious underlying disease such as MEC. According to the size and the location of the tumor, complete surgical removal is sufficient without additional treatment in case of low-grade tumor. The presence of MAML2 rearrangement confers a favorable outcome and may have long-term implications for the clinical management.

Low-Grade and High-Grade Mucoepidermoid Carcinoma of the Lung: CT Findings and Clinical Features of 17 Cases.

The objective of our study was to characterize the CT features and clinical findings of low-grade and high-grade mucoepidermoid carcinoma (MEC) of the lung. The CT findings and clinical information of 17 consecutive patients with primary low-grade (n = 11) or high-grade (n = 6) MEC were analyzed retrospectively. We assessed tumor location, size, contour, margin, density, calcification, obstructive changes, presence of metastasis, and enhancement. In patients with low-grade MEC, tumor location was central in 10 and peripheral in one. In contrast, one and five tumors in patients with high-grade MEC were central and peripheral, respectively. There was a significant difference between central and peripheral locations among tumor grades (p = 0.005). In low-grade MECs, tumor contour was smoothly oval (n = 3) or spheric (n = 4); four were lobular. In five patients with low-grade MEC, tumors had well-defined margins; margins in the other six were poorly defined. Tumor density was homogeneous and heterogeneous in eight and three low-grade tumors, respectively. All six high-grade tumors had heterogeneous density, lobular contours, and poorly defined margins. Enhancement in both low-grade and high-grade tumors was greater than that of chest wall muscles, and low-grade tumors showed greater enhancement (46.90 ± 20.44 HU) than did high-grade tumors (22.50 ± 8.38 HU) (p = 0.015). A markedly enhanced homogeneous central bronchial nodule or mass may suggest low-grade MEC. High-grade MEC tends to be peripheral, to have poorly defined margins, and to be lobular, heterogeneous nodules or masses with less enhancement.

Intraexcretory duct low-grade mucoepidermoid carcinoma in situ: a case report and literature review

Intraexcretory duct low-grade mucoepidermoid carcinoma in situ: a case report and literature review

Warthin-like Mucoepidermoid Carcinoma: A Combined Study of Fluorescence In Situ Hybridization and Whole-slide Imaging.

There has been some debate as to whether a subset of metaplastic Warthin tumors (mWTs) harbor the mucoepidermoid carcinoma (MEC)-associated CRTC1-MAML2 fusion. We analyzed 15 tumors originally diagnosed as mWT (mWT-like tumors), 2 of which had concurrent MECs. We looked for the CRTC1/3-MAML2 fusion transcripts and performed immunohistochemistry for p63 and fluorescence in situ hybridization (FISH) for the MAML2 split. To localize MAML2 split-positive cells at the cellular level, whole tumor tissue sections were digitalized (whole-slide imaging [WSI]). The CRTC1-MAML2, but not CRTC3-MAML2 was detected in 5/15 mWT-like tumors. FISH-WSI results showed that all epithelial cells harbored the MAML2 split in fusion-positive mWT-like tumors and were totally negative in fusion-negative mWT-like tumors. A review of the hematoxylin and eosin-stained slides showed that morphology of the "metaplastic" epithelium was virtually indistinguishable between fusion-positive and fusion-negative tumors. However, oncocytic bilayered tumor epithelium, characteristic to typical WT, was always found somewhere in the fusion-negative tumors but not in the fusion-positive tumors. This distinguishing histologic finding enabled 5 pathologists to easily differentiate the 2 tumor groups with 100% accuracy. The age and sex distribution of fusion-positive mWT-like tumor cases was similar to that of fusion-positive MEC cases and significantly different from those of fusion-negative mWT-like tumor and typical WT cases. In addition, only fusion-positive mWT-like tumors possessed concurrent low-grade MECs. In conclusion, a subset of mWT-like tumors were positive for the CRTC1-MAML2 fusion and had many features that are more in accord with MEC than with WT. The term Warthin-like MEC should be considered for fusion-positive mWT-like tumors.

Application of bronchoscope in diagnosis and treatment of bronchial mucoepidermoid carcinoma in children

Objective To explore the application of bronchoscope in diagnosis and treatment of bronchial mucoepidermoid carcinoma in children. Methods The clinical data of 4 cases of bronchial mucoepidermoid carcinoma treated in Department of Interventional Pulmonology, Beijing Children's Hospital Affiliated to Capital Medical University from April 2013 to June 2015, were retrospectively analyzed, and their clinical manifestations, chest computed tomography(CT), bronchoscopic manifestations were analyzed. Results Among the 4 cases of bronchial mucoepidermoid carcinoma, 3 cases were low-grade bronchial mucoepidermoid carcinoma, and 1 case was intermediate grade malignant. Onset of clinical manifestations occurred from the ages of 4 years and 11 months old to 10 years and 9 months old.All patients had no characteristic clinical manifestations, only 2 cases had hemoptysis, while the main symptoms were cough, wheezing, and exercise tolerance decreased in 4 the patients, and they were initially misdiagnosed as pneumonia, asthma or bronchial foreign body.Chest CT prompted that there was circular mass in respiratory tract, the lesions located in left main bronchus in 2 patients, in right bronchus intermedius in 1 patient, and in right middle bronchus in 1 case, and atelectases or emphysema occurred in bronchus.The biopsy by bronchoscope under general anesthesia was performed for more enough specimen in all the 4 patients.The lesions were completely removed in 3 patients by interventional bronchoscopy, and 1 patient by lobectomy. Conclusions The children with bronchial mucoepidermoid carcinoma were presented with cough and wheezing without specific manifestations. Biopsy by bronchoscope is a good choice for the diagnosis of bronchial mucoepidermoid carcinoma. Bronchoscopic intervention was effective in the treatment of non-operative carcinoma. Key words: Mucoepidermoid carcinoma; Bronchus; Child; Bronchoscope

Mucoepidermoid Carcinoma in a Young Patient: A Case Report

Mucoepidermoid carcinoma is the most common malignant tumor of the major and minor salivary glands, especially in the fourth decade of life. Genetic disorders, exposure to ionizing radiation, and smoking are reported as major risk factors. A 15-year-old female was referred to a head and neck outpatient clinic, presenting with a swelling of the parotid gland in the right preauricular region, causing lifting of the earlobe. A biopsy was performed with the hypothesis of pleomorphic adenoma. On gross examination, it was observed a tumor-like mass partially covered by a capsule, measuring approximately 5 cm. Microscopic examination revealed malignant neoplasm of the salivary gland, composed predominantly of cystic spaces lined with mucous cells and sometimes showing papillary proliferations. Solid arrangements of squamous cells groups were also seen in few areas of the lesion. The final diagnosis was low-grade mucoepidermoid carcinoma. The patient was referred to an oncology center.

P63 Positive Mucoepidermoid Tumor of the Lacrimal Sac with Associated Papilloma

ABSTRACTWe report a case of a 44-year-old man who presented with a left medial canthal mass and epiphora. Imaging was suggestive of a mass continuous with the nasolacrimal sac. Subsequent surgical exploration revealed a mass adherent to bone with invasion of the lacrimal system. Histological examination revealed a squamous/transitional cell papilloma overlying a low-grade mucoepidermoid carcinoma (MEC). Complete surgical resection was completed and pathology confirmed the diagnosis. This is the first case in which a MEC has been reported concurrently with an overlying papilloma, providing support for the hypothesis that MECs arise from papillomas in the lacrimal sac. Additionally, the tissue stained positive for p63, which is congruent with MEC immunoreactivity in the salivary gland. The description of these unique histopathological findings may assist in definitive diagnosis and improve our understanding of the pathophysiology underlying lacrimal sac MEC tumors.

FNAC induced histological changes in Warthin tumor mimicking as cancer

Warthin tumor is the second most common salivary gland tumor affecting male in 6th to 7th decade of life. It can grow in peri- parotid or cervical lymph nodes too. Preoperative FNAC procedure can induce partial to near total infarction and metaplastic changes in tumor masquerading with malignancy, mainly squamous cell carcinoma or low grade mucoepidermoid carcinoma.Here, I present a case in which FNAC procedure was performed. Later on histopathology, metaplastic changes in epithelium of Warthin tumor and extensive infarction were noted. Such lesion could have been mistaken as Squamous cell carcinoma or low grade mucoepidermoid carcinoma. Thus acquaintance with morphological alteration caused by FNAC procedure is very important to avoid misdiagnosis.Journal of Pathology of Nepal (2015) Vol. 5, 778-780