Case Of Mucoepidermoid Carcinoma Research Articles

Neck Dissection in cT3/T4 Mucoepidermoid Carcinoma of the Oral Cavity and Oropharynx

Previous research has reported high occult nodal metastases rates for T3/T4 mucoepidermoid carcinoma (MEC) of the oropharynx (OP) and oral cavity (OC). Our study evaluates if there is a benefit of neck dissection (ND) in these patients. The 2004–2016 National Cancer Database was queried for cases of adult MEC of the OC and OP. Patients with clinical T3/T4 disease were included while those with metastatic disease were excluded. Patients were divided into two cohorts: those treated with and without ND. Univariate chi-square, Kaplan-Meier, and multivariable Cox regression analyses were implemented. A total of 243 patients met inclusion criteria, of which 79 (32.5%) underwent ND. The majority of patients were less than 60 years old (60.1%), White (76.2%), and male (53.5%). 92 (37.9%) patients had clinically node-positive (cN+) disease. ND patients had higher rates of cN + disease (53.2% vs. 30.5%, p = 0.002). Of patients undergoing ND, 35 (44.3%) had cN0 disease while 42 (53.2%) had cN + disease. ND patients more commonly had grade III/IV tumors (45.1% vs. 23.4%, p = 0.002). Upon examination of dissected nodes, 20.3% of cN0 patients undergoing ND were found to have occult nodal metastases. There was no significant difference in 5-year overall survival between patients with and without ND (61.8% vs. 53.6%, p = 0.610), even on multivariable Cox analysis (hazard ratio: 1.52, 95% confidence interval: 0.73–3.18, p = 0.269). Our study found patients with cN0 MEC of the OC and OP have a high rate (20.3%) of occult nodal metastasis. In this cohort, patients with ND were not found to have improved survival, possibly due to statistical underpowering. Further research is needed to evaluate the indications and benefit of ND for this rare tumor presentation.

Mucoepidermoid carcinoma: A comparative analysis of histological grading systems

: Salivary gland carcinomas comprise of only 3-5% of all head and neck malignancies. Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor. The morphologic diversity of MEC can pose diagnostic challenges hence, various histological grading systems have been proposed based on the quantitative and qualitative analysis. This proves to be greatly consequential in the management and prognosis of patients with MEC.To compare histologic grading methods in MEC of major & minor salivary glands.20 histopathologically diagnosed cases of MEC (10 each major & minor salivary gland) will be analysed using following methods: Qualitative Method: 1) Modified Healey 2) Memorial Sloan-Kettering Cancer Center method. Quantitative method: 1) Armed force Institute of Pathology (AFIP) 2) Brandwein method Histological findings were evaluated. In our study AFIP grading system, 50% Cases were classified as low grade, 35% as intermediate grade and 15% as high graded. According to Brandwein grading system20% of cases were categorized as low, 35% cases as intermediate, 45% cases as high grade MEC. Modified Healey grading system of MEC showed 50%, 40%, 10% cases as low, intermediate and high grade MEC respectively. MSKCC grading system revealed as 55%, 30% and 15% cases as low, intermediate and high grade MEC respectively. Our finding indicated that MSKCC grading system was the most favourable histological grading system as percentage of agreement found to be 85%.Careful microscopic examination is the most important parameter in the grading of MEC. This meticulous microscopic examination emerges as the cornerstone in grading MEC. Both MSKCC and Modified Healey grading methods exhibits effectiveness in evaluating MEC. Our finding indicated that Memorial Slon Kettering Cancer Center (MSKCC) was the most favourable histological grading system as percentage of agreement found to be 85%. However, further longer studies are imperative to substantiate this finding and for establish of universally accepted grading system for Mucoepidermoid carcinoma.

PD-L1 and PD-L2 Expression in Different Tumor Stages and Types of Malignant Salivary Gland Neoplasms: A Single-center Experience.

There is a limited amount of data on the role of programmed cell death ligand (PD-L) -1 and PD-L2 in salivary gland carcinomas. We aimed to evaluate the prognostic value of PD-L1 and PD-L2 expressions, which are closely related to immune mechanisms, with respect to salivary gland tumor types and stages. Data from patients with salivary gland masses surgically removed between 2006 and 2021, diagnosed with a malignant salivary gland neoplasm, were retrospectively analyzed. Immunoreactivity for PD-L1 and PD-L2 was performed on resection materials. The mean age of 90 patients was 52.1±18.8 and 46.7% were male. Overall, 55.6% of patients were diagnosed with adenoid cystic carcinoma (ACC), 23.3% with mucoepidermoid carcinoma (MEC), 16.7% with acinic cell carcinoma (AciCC), 3.3% with ductal carcinoma (DC), and 1 patient with pleomorphic adenoma ex carcinoma (PA-ex-CA). In all, 52% of ACC, 12% of AciCC, 24% of MEC, and 12% of DC cases were at stage IV. The tumor diameter, frequencies of lymphovascular invasion, metastasis, positive surgical margin, recurrence, and mortality rates of patients at stages III and IV were significantly larger than those at stages I and II ( P <0.05). The percentages of tumor cell score (TCS) and immune cell score (ICS) for PD-L1 were significantly higher among patients with MEC compared with those with other types of tumors ( P =0.0011). However, the percentages of combined score (CS) for PD-L1 and tumor cell score for PD-L2 were comparable among tumor types ( P >0.05). No significant difference was found in these scores for PD-L1 between tumor stages ( P >0.05), but for PD-L2, all patients at stage I had TCS <1% for PD-L2, while all patients at stages II and III, and 92% of patients at stage IV had TCS ≥1% ( P <0.0001). High expression of PD-L1 was mostly observed in MEC cases ( P =0.0016), while all patients with AciCC had a low PD-L1 expression level ( P =0.0206). The mean tumor diameter, rate of lymphovascular invasion, perineural invasion, metastasis, positive surgical margin, recurrence, type of treatment, mortality, and TILs ratio did not differ significantly according to PD-L1 expression level ( P >0.05). The percentage of tumor-infiltrating lymphocytes was comparable among negative and positive PD-L1 scores according to both 1% and 5% threshold values ( P >0.05). High PD-L1 expression is rare in AciCC, while PD-L1 expression is high in MEC. Our findings underline the importance of future screening for PD-L1 and PD-L2 before patients undergoing immunotherapies in all salivary gland tumors.

Nasopharyngeal Mucoepidermoid Carcinoma: A Rare Case Report

Introduction : Mucoepidermoid carcinoma is one of the common malignancies of the salivary glands. Nasopharyngeal mucoepidermoid carcinoma cases are rare. The treatment of these rare cases depends on the stage of the tumor and its invasion into the surrounding tissues. Case: A 63-year-old male patient, who was followed up for thyroid papillary carcinoma in 2006, was referred to our clinic after incidentally detected asymmetrical thickening of the nasopharynx on the left as a result of brain MRI during medical oncology follow-ups. The patient had a complaint of pain in the left neck region for about a month. Excisional biopsy from the lymph node that increased FDG uptake in the left jugulodigastric region in PET/CT and multiple punch biopsy from the nasopharynx were performed. The patient, whose pathology resulted in mucoepidermoid carcinoma, was referred to oncology to receive radiochemotherapy. Discussion: Although rare, it should be kept in mind that in patients presenting with a mass in the nasopharynx, mucoepidermoid carcinoma may be present. Although there is information about treatment options in the studies carried out to date, prospective studies are needed for prognosis and treatment selection.

SALTT study: A retrospective analysis of 111 SAlivary gland tumors of Lung and Tracheobronchial Tree

IntroductionPrimary pulmonary salivary gland-type tumours (PPSGT) are rare lung neoplasms arising from submucosal seromucinous glands in the central airway. Methods and resultsWe retrospectively analysed the clinicopathological features of 111 PPSGTs diagnosed at our institute between 2003 and 2021. The mean age at diagnosis was 43.8 years(range 6–78 years) and a male-to-female ratio of 2:1. On imaging, 92 % of cases had centrally located tumours and 37.3 % were early stage. The histopathological types included 70 cases (63 %) of mucoepidermoid carcinoma (MEC), 31 cases (27.7 %) of adenoid cystic carcinoma (ADCC), two cases of myoepithelial carcinoma, one case each of acinic cell carcinoma (ACC), clear cell carcinoma (CCC), epithelial myoepithelial carcinoma (EMC) and 5 others [including adenocarcinoma of minor salivary gland origin(n = 3), carcinoma with sebaceous differentiation(n = 1) and poorly differentiated carcinoma of salivary gland type(n = 1)]. The size of the tumours found in the resection specimens ranged from 1 cm to 13 cm, with an average size of 4.9 cm. High-risk attributes such as lymphovascular invasion (LVI), perineural invasion (PNI), pleural involvement, positive resection margins, and nodal metastasis were identified in 15.3 %, 15.3 %, 13.6 %,15.2 % and 6.7 % of cases, respectively. These attributes were found to be more frequent in ADCC than in MEC. Surgery was the main treatment modality [68/84 (80 %) cases]. ADCC cases had more recurrence and distant metastasis than MEC cases. The 3- year overall-survival (OS) and recurrence-free survival(RFS) were better in patients with age lesser than 60 years(p-value <0.0001), low pT stage (p-value 0.00038) and lower grade of MEC(p-value-0.0067). ConclusionIt is crucial to have an acquaintance with the morphologic spectrum and immunophenotypic characteristics of PPSGT to recognize them in this unusual location. In tandem, it is crucial to differentiate them from conventional primary non-small cell lung carcinoma, as the management protocols and prognostic implications differ significantly.

Correlation Between Demographic Features and PD-L2 Expression in Mucoepidermoid Carcinoma of Salivary Glands

OBJECTIVE: This study was conducted to determine PD-L2 expression and its association with grading in patients with mucoepidermoid carcinoma METHODOLOGY: : This descriptive study was conducted over a period of 1 year after taking approval from Institutional Ethical Review board. A total of twenty-four cases of MEC were recruited from different tertiary health care hospitals in Lahore and Multan. Data consisting of demographics and clinical features was collected. Histopathological analysis was done according to Seethala's grading system. Immunohistochemistry (IHC) was performed to observe PD-L2 expression. Data was analyzed by using SPSS 25 RESULTS: : The mean age was 30.08±12.8 years and there were 41.7% males and 58.3% females. Most common site of involvement was found to be parotid gland. A total of (54.2%) cases were of low grade. Strong PD-L2 expression was observed in 12(50%) cases while in 5(21%) cases there was week expression. No significant association of PD-L2 expression with grade of tumor was observed. CONCLUSIONS: Among salivary gland tumors, Mucoepidermoid carcinoma is emerging as most frequently diagnosed malignancy. These tumors originate mainly from parotid glands usually during fourth decade of life. As preliminary data generated from current research has highlighted the expression of PD-L2 in malignant MEC. The expression of PD-L2 was observed in all of the tissue specimens in the current study as detected through IHC irrespective of the grade of the tumor KEYWORDS: Programmed cell Death 1 Ligand 2 (PD-L2), Mucoepidermoid Carcinoma (MEC), ImmunohistoChemistry (IHC).

Algorithm for the reconstruction of the parotid region: a single institution experience

ObjectiveThis study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects.Materials and methodsA retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data.ResultsAmong the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received 125I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases.ConclusionImmediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.

Immunohistochemical Expression of XIAP in Mucoepidermoid Carcinoma

Objective: The X-linked inhibitor of apoptosis protein (XIAP) immunohistochemical expression was employed to assess the anti-apoptotic activity of mucoepidermoid carcinoma (MEC) in relation to different clinicopathological variables to understand if XIAP immunoexpression could reflect the histologic grade and the biologic activity and prognosis in MEC patients.&#x0D; Materials and Methods: A retrospective study was accomplished on 16 MEC cases. The worked MEC cases involved the three histologic grades, low, intermediate, and high. Assessement of XIAP immunoexpression was made in relation to different clinicopathological parameters. The analysis of data was done by Pearson`s Chi-square test. Pearson correlation co-efficiency test was used to test the association between the different variables. The P‐value &lt;0.05 was considered to be statistically significant.&#x0D; Results: There were statistically significant differences in XIAP immunoexpression in relation to the following parameters; the TNM clinical stage (P=0.036), and the histologic grade (P=0.008). Conversely, the immunoexpression of XIAP was not significantly correlated with patients’ age (P=0.141), patients` gender (P= 0.471), and the anatomical site of the tumor (P=0.827) in MEC cases.&#x0D; Conclusion: The immunoexpression of XIAP correlates with histologic grading of MEC. Additionally, XIAP immunoexpression reflects the clinical and biological behavior of MEC.

High-grade HER2-positive mucoepidermoid carcinoma of the breast: a case report and review of the literature

BackgroundMucoepidermoid carcinoma of the breast is a rare special type of salivary gland-like tumor of the breast, usually displaying triple-negative phenotype. To date, only 64 cases have been reported in the English literature. Herein, we report the first case of mucoepidermoid carcinoma of the breast with human epidermal growth factor receptor 2 gene amplification.Case presentationA 58-year-old Caucasian woman treated with breast-conserving surgery, radiotherapy, and chemotherapy for an invasive breast carcinoma of no special type, relapsed 20 years later in the ipsilateral left breast. Histological examination of the core needle biopsy of the relapse deferred to the surgical specimen for the definitive diagnosis, because of the broad differential diagnosis. On the resected specimen we observed the presence of a poorly differentiated carcinoma with mucoepidermoid carcinoma of the breast typical features consisting of epidermoid, intermediate and mucinous cells lacking true keratinization, in keeping with the latest World Health Organization diagnostic criteria. The mucoepidermoid carcinoma of the breast was weakly estrogen receptor and androgen receptor positive and progesterone receptor negative, but exceptionally showed human epidermal growth factor receptor 2 gene amplification. Mastermind-like transcriptional coactivator 2 gene translocations were not detected by fluorescent in situ hybridization. The patient received adjuvant chemotherapy with anti-human epidermal growth factor receptor 2 therapy but no endocrine therapy. After 61 months of follow-up, no signs of local or distant recurrence were observed.ConclusionsMucoepidermoid carcinoma of the breast is a very rare entity. Despite being most frequently triple negative, the standard evaluation of receptor status is mandatory, as well as strict application of World Health Organization diagnostic criteria for correct patient management.

Clinical Behavior of the Mucoepidermoid Carcinoma of the Larynx-A Scoping Review.

Mucoepidermoid carcinomas (MEC) of the larynx account for less than 1% of all laryngeal tumors. The unique features and clinical behavior of these rare entities remain unknown. To fill this knowledge gap, we performed a scoping review of every reported case of laryngeal MEC to study the clinical behavior and the treatment modalities in this rare entity. We followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) statement. MedLine, Google Scholar, and Science Direct databases were searched to identify eligible studies. We concluded with 25 studies and overall 66 cases. Our study revealed that the average age of cases was 55.7 years, and the range was from 12 to 81 years, with younger onset in females. Supraglottic (60%) is the most common subsite of laryngeal MEC s followed by glottis (27.3%). Supraglottic carcinomas frequently present with metastatic neck disease at the time of the initial diagnosis and require more extensive surgical approaches. Surgery with negative surgical margins seems to be the cornerstone in the treatment of MEC. Radiation therapy has not been tested widely as monotherapy but is considered a useful adjuvant modality. This study suggests that negative surgical margins seem to be associated to higher disease control rate and that high-grade supraglottic cases likely benefit from addressing neck disease simultaneously. NA Laryngoscope, 134:2578-2584, 2024.

Utility of MUC4 in the diagnosis of secretory carcinoma of salivary glands

Salivary gland tumors are diverse in morphology and both benign and malignant tumors may pose diagnostic challenges especially in small biopsies. Secretory carcinoma (SC) is histologically characterized by microcysts, follicles, solid growth pattern and occasional papillary structures, and absence of zymogen granules. SC is molecularly defined by the presence of novel gene fusion ETV6::NTRK3. Among the positive stains (S100 and mammaglobin), MUC4 is now another promising marker for the diagnosis of SC, that would enable the pathologists to exclude other morphologically close simulators. Aim of this study was to report clinicopathological features and assess utility of MUC4 in the diagnosis of SC. MUC4 was performed on 22 cases of SC. Glass slides were reviewed to record morphological patterns and staining of S100, mammaglobin, DOG1 and MUC4. Age ranged from 9 to 63 years with mean age of 34.41 ± 16.28 years. The male: female ratio was 72.7 %:27.3 %. The majority occurred in major salivary glands. A combination of patterns was seen; microfollicles were the most prevalent (90 %) followed by papillary-cystic and macrofollicles. MUC4 was positive in 19/21 (90 %) cases with almost equal number of 2+ and 3+ staining. MUC4 was negative in all cases of acinic cell carcinoma, polymorphous adenocarcinoma, adenoid cystic carcinoma, salivary duct carcinoma, myopepithelioma and myoeithelial carcinoma, cystadenoma and cribriform adenocarcinoma and all except 3 cases of mucoepidermoid carcinoma tested. Overall sensitivity of MUC4 was 95.4 %, specificity 90 %, p-value being <0.01, positive predictive value 87.5 % and negative predictive value 96.4 %. A characteristic cytoplasmic granular pattern was observed in 76.1 % tumors. S100 and mammaglobin were positive in all the performed cases. DOG1 was positive in 6/11 (28.5 %) tumors. In conclusion, MUC4 is a useful addition to a diagnostic immunohistochemical panel for SC, and to distinguish it from close potential mimickers such as acinic cell carcinoma, especially in practice settings where molecular testing is unavailable.

Clinicopathological characteristics of four major histological types of high-grade parotid carcinoma.

High-grade parotid carcinoma generally has a poor prognosis, and the histological type is mucoepidermoid carcinoma (MEC), salivary duct carcinoma (SDC), carcinoma ex pleomorphic adenoma (CEPA), or adenoid cystic carcinoma (AdCC) in the majority of cases. During the 23-year period from September 1999 to December 2022, 250 patients with parotid carcinoma underwent initial treatment and had the histopathological type of their carcinoma. Retrospective study evaluated 111 MEC, SDC, CEPA, or AdCC cases among 134 patients with high-grade parotid carcinoma. We examined pathological and clinical features and prognosis, evaluated factors associated with recurrence, and performed immunohistological examinations. Pathological and clinical features and factors associated with recurrence were different for each histological type. The 10-year disease-free survival rates were as follows: MEC, 34.9%; SDC, 22.6%; CEPA, 47.1%; and AdCC, 56.3%. Human epidermal growth factor receptor type-2 and androgen receptor were positive in 48% and 56% of patients with SDC, respectively, 38% and 25% of those with CEPA. Each histological type has its own pathological and clinical features, recurrence types, and tumor activities, suggesting that differentiating between high-grade parotid carcinomas according to histological type will improve diagnosis, and thus prognosis.

Survival Outcomes and Factors Affecting Prognosis in Patients with Head and Neck Region Mucoepidermoid Carcinoma Treated with Adjuvant Radiotherapy

Aim: This study aims to ascertain the clinical and pathological factors linked to the outcomes of patients subjected to surgical intervention and postoperative radiotherapy for mucoepidermoid carcinoma (MEC) originating from both major and minor salivary glands in the head and neck region.&#x0D; Material and Method: In this retrospective review, medical records of 42 patients who underwent surgery and subsequent radiotherapy for localized MEC in the major and minor salivary glands of the head and neck were analyzed to identify clinicopathological determinants of overall survival. Secondary endpoints encompassed local-regional control, distant metastasis-free survival, and disease-free survival.&#x0D; Results: The median age of the patient cohort was 56 years, comprising 52.4% males and 47.6% females. The median follow-up period spanned 36 months, with a range of 6 to 88 months. All patients underwent curative surgery, followed by adjuvant radiotherapy. The 2-year and 5-year rates for overall survival (OS), local-regional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were 92% and 72.6%, 92.2% and 85.6%, 84.8% and 73%, 82% and 67.3%, respectively. Notably, only histologic grade emerged as a statistically significant prognostic factor, influencing both OS (p=0.019), DMFS (p=0.014), and DFS (p=0.044).&#x0D; Conclusion: The histologic grade of the tumor is the foremost determinant impacting the outcomes of MEC cases. Adjuvant radiotherapy is recommended for high-grade tumors, while its application for low-grade and intermediate-grade tumors should be individualized based on the anticipated risk of recurrence. This underscores the significance of tailoring treatment approaches according to histologic characteristics.

Identifying potential immuno-oncology targets in salivary gland mucoepidermoid carcinoma based on inflammatory status and treatment response.

Mucoepidermoid carcinoma is a rare salivary gland malignant tumour. This study aimed to investigate inflammatory and immune signatures of mucoepidermoid carcinoma by identifying potential proteo-transcriptomic biomarkers towards the development of precision immuno-oncology treatment strategies. A total of 30 biopsies obtained from patients diagnosed with mucoepidermoid carcinoma between 2013 and 2022 were analysed after H&E staining for scoring of histological inflammatory stroma subtypes and inflammatory hotspots with QuPath. Multiplex immunofluorescence staining and NanoString nCounter PanCancer IO 360™ panel were used to assess stroma and tumour inflammation signatures in high grade mucoepidermoid carcinoma cases in the tumour microenvironment via proteomics and transcriptomics, respectively. Inflammatory cells within the histological inflammatory stroma inflammatory (HIS-INF/hot) tumour neighbourhoods were greater compared to the histological inflammatory stroma-immune desert (HIS-ID/cold) (p = 0.001). A similar trend was observed between treatment non-responders and responders in stroma neighbourhoods (p = 0.0625) and in stroma-to-interface inflammatory hotspots (p = 0.0081), indicating an augmented inflammatory response in hot tumours and non-responders. Furthermore, there were striking differences in the expression of pan-immune leukocyte marker CD45 between responders and non responders particularly in the tumour neighbourhoods (p = 0.0341), but such were not robust for PD-1 and macrophage fractions. Additionally, transcriptomic analysis revealed key differences in leukocyte activation profiles between responders and non-responders. This preliminary report unveils the importance of assessing immune leukocyte cellular fractions and pathways for future prognostic biomarker discoveries in mucoepidermoid carcinoma as per the involvement of CD45-driven inflammatory and immune mediators in high grade mucoepidermoid carcinoma in non-responders to treatment. These findings will potentially contribute to the development of novel personalised immunotherapies.

Zorlayıcı ve Nadir Bir Vaka: Karaciğerin Mukoepidermoid Karsinomu

Mucoepidermoid carcinoma is the most common malignant tumor of the salivary gland. It rarely occurs in other organs. Less than 20 cases of mucoepidermoid carcinoma of liver have been reported in the literature.&#x0D; &#x0D; A 70-year-old woman with a liver mass is reported in this case report. After liver segmentectomy operation, the specimen was examined microscopically, a tumor consisting of epidermoid, mucinous, and intermediate cells was observed. It was interpreted as mucoepidermoid carcinoma. As no other focus was detected from comprehensive scanning of the patient, it was diagnosed as primary mucoepidermoid carcinoma of liver. Due to mimicking other tumors such as adenosquamous carcinoma and squamous cell carcinoma; cautious examination and differential diagnosis are important.

Mucoepidermoid carcinoma showing continuity with the surface mucosa of the oral cavity: a report of 14 cases

We aimed to characterize the histology and the clinicodemographic features of mucoepidermoid carcinoma (MEC), showing continuity with the oral surface mucosa. We reviewed 138 cases of intraoral MEC to identify cases that showed continuity with the surface mucosa and compared their clinicodemographic findings with those of MECs not showing continuity. We compared the sex ratio using the 2-sample Z-test and compared the age distribution using the 2-sample Kolmogorov-Smirnov test. Of the 138 cases examined, 14 showed continuity with the surface mucosa. Their histology showed surface mucosa with an apparent transition to an infiltrating tumor with mucous, intermediate, and epidermoid tumor cells growing in solid and cystic patterns. Their clinical appearance ranged from firm submucosal nodules to erythematous to ulcerated lesions. They showed a strong female predilection (6:1) and sharply bimodal age distribution, with sharp peaks in the fourth and seventh decades. Mucoepidermoid carcinomas that show continuity have a demographic pattern distinct from that of conventional MECs, showing a striking female predilection and bimodal age distribution and suggesting a difference in etiology. Pathologists should remain aware that MEC in the oral cavity can have a histologic appearance of surface origin to reach the correct diagnosis.

Genetic and Immunohistochemical Profiling of Mammary Hidradenoma and Comparison to Mucoepidermoid Carcinoma

Mucoepidermoid carcinoma (MEC) is exceedingly rare in the breast, with <45 cases reported in the literature. Although estrogen receptor/progesterone receptor/human epidermal growth factor 2 triple-negative, MEC is characterized as a special subtype of breast carcinoma with significantly better prognosis than conventional basal-type tumors. Cutaneous hidradenoma (HA) is considered a benign adnexal neoplasm showing histomorphologic overlap with MEC. Rare cases of HA have also been reported in the breast, but these are relatively uncharacterized. In this study, we examined the clinicopathologic, immunohistochemical (IHC), and genetic features of 8 breast HAs, in comparison to 3 mammary MECs. All cases were positive for MAML2 break-apart fluorescence in situ hybridization. Eight cases demonstrated a CRTC1::MAML2 fusion, and one MEC harbored a CRTC3::MAML2 fusion; the latter is a novel finding in the breast. Mutational burden was very low, with only one HA exhibiting a MAP3K1 pathogenic alteration. By IHC, both MEC and HA demonstrated cell type–dependent expression of high- and low-molecular-weight keratins and p63, as well as negative to low-positive estrogen receptor and androgen receptor. Smooth muscle myosin and calponin highlighted an in situ component in the 3 cases of MEC; expression of these myoepithelial markers was negative in HAs. Additional distinguishing characteristics included the growth pattern and tumor architecture, the presence of glandular/luminal cells in HA, and overall higher IHC expression of SOX10, S100 protein, MUC4, and mammaglobin in MEC. Morphologic findings were also compared to a series of 27 cutaneous nonmammary HAs. Mucinous and glandular/luminal cells were identified in significantly more mammary HAs than nonmammary lesions. The findings provide insight into the pathogenesis of MAML2-rearranged neoplasms of the breast, underscore the overlapping genetic features of MEC and HA, and highlight similarities to their extramammary counterparts.

PD-1 and PD-L1 expression in rare lung tumors.

Background: Our knowledge is still limited about the characteristics and treatment of rare lung tumors. The aim of our study was to determine programmed cell death ligand-1 (PD-L1) and programmed cell death-1 (PD-1) expression in rare pulmonary tumors to assess the potential role of immunotherapy. Methods: 66 pathologically confirmed rare lung tumors including 26 mucoepidermoid carcinomas (MECs), 27 adenoid cystic carcinomas (ACCs), and 13 tracheobronchial papillomas (TBPs) were collected retrospectively. Immunohistochemical (IHC) staining was performed on formalin fixed paraffin embedded (FFPE) tumor tissues, and PD-L1 expression on tumor cells (TCs) and immune cells (ICs), and PD-1 expression on ICs were determined. The cut off value for positive immunostaining was set at 1% for all markers. Results: PD-L1 expression on TCs was observed in two cases of MEC (7.7%), one case of ACC (3.7%), and was absent in TBP samples. PD-L1 expression on ICs could be demonstrated in nine cases of MEC (34.6%), four cases of ACC (14.8%), and was absent in TBPs. All PD-L1 TC positive tumors were also PD-L1 IC positive. Higher expression level than 5% of PD-L1 TC and/or IC was observed only in one ACC and in two MEC patients. Among them, strong PD-L1 immunopositivity of >50% on TCs and of >10% on ICs could be demonstrated in one MEC sample. PD-L1 expression of ≥1% on ICs was significantly more common in MEC, than in TBP (p < 0.001). In MEC ≥1% PD-L1 TC or IC expressions were significantly more common in patients aged 55 or older, than in younger patients (p = 0.046, and p = 0.01, respectively). PD-1 expression on ICs was found in five cases of MEC (19.2%), four cases of ACC (14.8%), and in two cases of TBP (15.4%). Only one MEC case showed a higher than 5% expression level of PD-1 on ICs. Conclusion: This retrospective study comprehensively demonstrated the rare expression of PD-L1 and PD-1 in pulmonary MEC, ACC, and TBP. However, we found very strong PD-L1 immunopositivity on both TCs and ICs in one MEC sample, which warrants further investigations in a larger cohort.

Recurrent soft palatal tumour: from pleomorphic adenoma to mucoepidermoid carcinoma

Cases of mucoepidermoid carcinoma (MEC) is common among major salivary gland neoplasms, however infrequent cases are reported for this growth over the palatal region. We presented a case of a 50-year-old gentleman whom presented with tumour over soft palate with 3 different histopathological reports. This gentleman had history of excision of right soft palatal mass on his first presentation which was reported as palatal pleomorphic adenoma, he however had tumour recurrence over the same site after 3 years whereby biopsy was read as squamous cell carcinoma. A wide local excision of the tumour was performed and final report was disclosed as mucoepidermoid carcinoma.

Immunohistochemical Expression Of Human Epidermal Growth Factor Receptor-2 (Her-2) In Common Salivary Gland Carcinomas.

Carcinomas of the salivary gland are known to be aggressive in nature, making them difficult to manage. The therapeutic options offered include excision of the gland (maxillectomy in cases of palatal tumours), with or without lymph node dissection, proceeded with radiotherapy. Chemotherapy has not produced promising outcomes and has a minimal impact as a therapeutic alternative. Targeted therapy against human epidermal growth factor receptor 2 (HER-2), which is a commonly used treatment modality for their mammary analogues, is not being offered to these patients since scant literature is available showing its usefulness and no promising evidence is present regarding their efficacy and efficiency in such cases. The study aimed to evaluate and quantify the immunohistochemical expression of HER-2 in cases of adenoid cystic carcinoma (AdCC), mucoepidermoid carcinoma (MEC) and salivary duct carcinoma (SDC), which are analogues of similar tumours arising in breast tissue. A retrospective, cross-sectional study was carried out in the department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, duration of which was six months. A total of 45 cases (15 of each tumour) were taken, and sampled using non-probability convenience technique. The immunohistochemical marker, monoclonal HER-2 antibody (Leica microsystem Germany) was applied on appropriate blocks of all included cases. The staining pattern and intensity were recorded after visualizing the slides under a light microscope. Seven cases of salivary duct carcinoma and a single case of mucoepidermoid carcinoma expressed positivity for HER-2, while no expression could be seen in the case of adenoid cystic carcinoma. A statistically significant difference was seen when HER-2 expression was compared among the aforementioned tumours. The use of targeted therapy against HER-2 is limited to patients of salivary duct carcinoma and a fraction of patients suffering from mucoepidermoid carcinoma.