Mucoepidermoid Carcinoma Of Parotid Gland Research Articles

Identification of facial nerve displaced vertically in locally invasive mucoepidermoid carcinoma of parotid gland: A rare case discussion

One of the most technically challenging surgeries in the head and neck domain is superficial parotidectomy with its definitive step being facial nerve identification. There are certain anatomical landmarks to guide the surgeon in the identification process. However displacement or obliteration of local anatomy can complicate the identification of facial nerve and render the surgery cumbersome. Displacement of the intracranial portion of the facial nerve has been adequately described in literature however there is a stark lacunae in literature regarding displacement of facial nerve in parotid surgeries and associated challenges. We present a case of a displaced facial nerve in a locally invasive mucoepidermoid carcinoma of the parotid gland invading the sternocleidomastoid muscle and retromandibular vein in which a superficial parotidectomy was undertaken.

GCT-01. Pediatric intracranial germ cell tumors and primary polyuria-polydipsia syndrome: a 13-year single institutional experience

Abstract Intracranial germ cell tumors (IGCTs) represent about 4% of all childhood brain tumors. They are common in both the pineal and pituitary regions and sometimes they can be bifocal. Suprasellar and bifocal IGCTs usually present stereotypical symptoms, including primary polyuria-polydipsia syndrome (PPS). Consolidated IGCTs’ therapy is based on the International Society of Pediatric Oncologic (SIOP) CNS GCT II protocol consisting of primary pre-radiation chemotherapy combining etoposide, carboplatin and/or cisplatin and ifosfamide. PPS management in these patients requires monitoring of electrolytes and fluids during chemotherapy, especially for cisplatin and/or ifosfamide-based cycles, for which hyperhydratation is required. We report the results of our single-center cohort of patients with IGCTs treated between 2008 and 2021, focusing on the clinical presentation, treatment and long-term follow-up. Thirty-one patients were analyzed (median age=13 years, 87% male). Twelve children (39%) presented a PPS and needed desmopressin treatment, maintained at long-term follow-up data update in all. Over these PPS patients, 6 had bifocal germinomas, 4 suprasellar germinomas, 1 metastatic germinoma and 1 non-germinomatous IGCT. Eleven PPS children (92%) received cisplatin and/or ifosfamide-based chemotherapy: all of them had optimal biochemical urine and blood investigations before, during and after chemotherapy. None of them presented serious complications during treatment. After a median follow-up of 5 years, two patients (6.5%) died (1 IGCT-related, 1 non-cancer related) and one had a second malignancy (parotid gland mucoepidermoid carcinoma, 6 years after IGCT diagnosis). Childhood IGCTs have an excellent prognosis, but present a significant risk of long-lasting severe endocrine sequelae which may be worsened by the primary oncological strategy, requiring careful management of complications related to fluid and electrolytes disturbances. In order to avoid post-treatment pituitary insufficiency, guidelines for diabetes insipidus management when cisplatin and/or ifosfamide-based protocols are used should be established and all patients should receive meticulous endocrine follow-up.

Establishment of prognostic nomogram for high-grade parotid gland mucoepidermoid carcinoma based on the SEER database.

Purpose: We aim to investigate the clinical factors that affect the prognosis of overall survival (OS) for patients with high-grade parotid gland mucoepidermoid carcinoma (high-grade pMEC) and construct a nomogram for prognosis prediction. Subjects and method: Totally, 519 patients diagnosed as high-grade pMEC from the surveillance, epidemiology, and end results (SEER) database between 2004 and 2015 were reviewed. Independent prognostic factors for OS were identified by univariate and multivariate Cox regression analyses. Nomogram was generated to predict the individual's 3- and 5- year OS rates by using R software. Prediction ability was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) and model calibration was evaluated through calibration plots. Decision curve analysis (DCA) was used to assess the clinical usefulness and net benefit. Results: The results of univariate analysis demonstrated that age, AJCC stage, T stage, N stage, M stage, extraparenchymal lesions, regional lymph nodes status, lymph node dissection status, radiotherapy, chemotherapy, and surgery were significantly correlated with the OS (P < 0.05). Multivariate Cox regression analyses showed that older age at diagnosis, advanced AJCC stage, and positive regional lymph nodes were independent risk factors for OS. In addition, the present study revealed that radiotherapy and surgery were independent protective factors for OS (P < 0.05). The nomograms showed accurate prognostic ability that individually predict 3-years and 5-years overall survival (OS) rates based on age, AJCC stage, regional lymph nodes status, radiotherapy, and surgery. The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram used to predict the 3-year and 5-year overall survival rate were 0.779 and 0.793, indicating that the model had a good predictive power for the overall survival in high-grade pMEC patient. Conclusions: Using the SEER database, we performed univariate and multivariate analyses to determine independent prognostic factors in high-grade pMEC patients. Subsequently, we constructed and validated a prognostic nomogram to predict 3-and 5-year OS rates based on the SEER database and can assist clinicians to intuitively evaluate prognosis of high-grade pMEC patients.

Mucoepidermoid Carcinoma of Parotid Gland Diagnosed as Pleomorphic Adenoma by Fine-Needle Aspiration Biopsy: A Case Report

Mucoepidermoid Carcinoma of Parotid Gland Diagnosed as Pleomorphic Adenoma by Fine-Needle Aspiration Biopsy: A Case Report

Mucoepidermoid carcinoma of the parotid gland: Twenty-year experience in treatment and outcomes.

Parotid gland mucoepidermoid carcinoma (MEC) has published five-year cancer-specific survival (CSS) rates of 77%-97%, with variance related to grade. Patients receiving primary surgery for parotid gland MEC from 1995 to 2014 at a tertiary medical center underwent clinical review, histopathologic review, and cytogenetic analysis. Survival outcomes were evaluated. Among 58 patients, T/N/M classification was as follows: T1 in 35 patients, T2 in 14, T4a in 9, N0 in 53, N1 in 2, N2b in 3. Histologic grade was low in 27, intermediate in 17, and high in 12 patients with 98% MAML2 positivity. All patients underwent parotidectomy, and seven patients received adjuvant radiation therapy. CSS was 100% at 5 years and 94.1% at 10 and 15 years. Two patients experienced locoregional recurrence. Treatment with adequate surgical resection and adjuvant radiation therapy for high-grade or advanced-stage tumors yields excellent survival, independent of clinical stage or pathologic grade.

Mucoepidermoid carcinoma of parotid gland and membranous nephropathy \u2013 differentiation between sclerosing mucoepidermoid carcinoma with eosinophilia and Kimura\u2019s disease

BackgroundWhen we encounter patients who present with both a neck mass and nephrotic syndrome, both malignancy and Kimura’s disease need to be evaluated as the therapeutic strategies differ vastly between them.Case presentationWe present the case of a 27-year-old male patient with neck mass and nephrotic syndrome. The presence of both eosinophilia and elevated immunoglobulin E levels were concerning for Kimura’s disease, which is an allergic syndrome defined by eosinophilic granulomas of neck soft tissue along with peripheral eosinophilia. The eventual final diagnosis, however, was sclerosing mucoepidermoid carcinoma of parotid gland with both eosinophilia and membranous nephropathy. Following the surgical resection of the mass, the nephrotic syndrome completely resolved.ConclusionDetailed histopathological assessments of both the parotid gland and renal tissue were key aspects of the diagnosis and management to exclude Kimura’s disease.

Discordance between fine-needle aspiration cytology and histopathology in patients with mucoepidermoid carcinoma of parotid gland

Fine-needle aspiration cytology (FNAC) is an important diagnostic tool used preoperatively for the diagnosis of parotid lump. Mucoepidermoid carcinoma comprises 5-10% of all salivary gland tumours. It poses a diagnostic challenge on FNAC with high false negative rate. The objective of this study was to evaluate the discordance between cytology/FNAC and histopathology in patients with mucoepidermoid carcinoma. A cross-sectional study was conducted from 1 January 2010 to 31 December 2014. Patients aged 18 years and above with FNAC or histopathology suggestive of mucoepidermoid carcinoma were identified. FNAC when compared with histology (gold standard) was classified into true positive (presence of mucoepidermoid carcinoma correctly diagnosed on FNAC), true negative (absence of mucoepidermoid carcinoma correctly diagnosed on FNAC), false positive (FNAC incorrectly diagnosed mucoepidermoid carcinoma), false negative (FNAC failed to diagnose mucoepidermoid carcinoma). A total of 16 patients fulfilled our eligibility criteria. Seven cytological samples were true positive (ie correctly diagnosed mucoepidermoid carcinoma by FNAC), eight cytological specimens were false negative (ie could not pick up mucoepidermoid carcinoma on FNAC). One case was false positive on cytology (ie diagnosed mucoepidermoid carcinoma on FNAC but was reported to be Warthin's tumour on histopathology) and none were true negative. FNAC is not reliable for diagnosis of mucoepidermoid carcinoma. More than 50% of our patients had discordant results between cytology and histology. We recommend a high index of suspicion for mucoepidermoid carcinoma given the poor yield of cytology.

Prognosis of Pediatric Patients With Mucoepidermoid Carcinoma of the Parotid Gland.

To summarize the prognosis of pediatric patients with mucoepidermoid carcinoma (MEC) of the parotid gland. Pediatric patients with MEC of parotid gland who were surgically treated at the Capital Medical University School of Stomatology from 2000 to 2014 were retrospectively analyzed. Clinical characteristics, pathology reports, and operation records were reviewed and analyzed. In total, 33 patients with an average age of 13.2 years were enrolled. The 5-year overall survival and disease-free survival were 95.8% and 84.4%, respectively. The disease-free survival and overall survival rates were lower in the under-10 age group (75.0 versus 87.7% and 83.3% versus 100%), though no statistically significant difference was found (P = 0.279 and P = 0.075). The patients who underwent complete resection all had a good prognosis without any recurrence or death regardless of whether the cut margin was 1.0 cm, 0.5 cm, or only extracapsular. One patient experienced 3 recurrences within 18 months and eventually died of disease. Good outcomes were achieved in pediatric patients with MEC of the parotid gland. Radical resection ensured a good prognosis regardless of the extent of resection. Frequent recurrence in a short period was associated with a poor prognosis. None.

Synchronous papillary carcinoma of thyroid and mucoepidermoid carcinoma of parotid gland

The presence of multiple malignancies of different histologies occurring synchronously is very rare and is reported in limited numbers across the literature. We hereby report a case presenting with papillary carcinoma of thyroid gland and mucoepidermoid carcinoma of parotid gland accompanied by regional lymph node metastasis of both the aforementioned malignancies. Recognition of such tumors is quintessential as the management and prognosis vary.

Nomogram to predict the prognosis of parotid gland mucoepidermoid carcinoma: a population-based study of 1306 cases.

BackgroundMucoepidermoid carcinoma (MEC) is a common cancer in the oral salivary gland malignancy, which mainly occurs in the parotid gland. The aim of this study is to identify independent prognostic factors and establish a nomogram model for parotid gland mucoepidermoid carcinoma (P-MEC) patients using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database.MethodPatients with P-MEC were selected from between 2004 and 2015. The overall survival (OS) and cancer-specific survival (CSS) rates were estimated using the Kaplan-Meier method with the log-rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors.ResultsA total of 1,306 patients with P-MEC were enrolled. Age, grade, T stage, N stage, M stage, chemotherapy, and surgery type were independent prognostic factors for OS and CSS. A nomogram for OS was formulated based on these independent prognostic factors and validated using an internal bootstrap resampling approach, which showed that the nomogram exhibited a sufficient level of discrimination according to the C-index (0.877, 95% CI [0.855–0.898]).ConclusionSeveral prognostic factors for P-MEC were identified. The nomogram developed in this study accurately predicted the 5- and 10-year OS rates of American patients with P-MEC based on individual characteristics. Risk stratification using the survival nomogram can optimize individual therapies and follow-up.

Largest mucoepidermoid carcinoma of parotid gland in the world

Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the major salivary glands, accounting for 15.5% of all cases benign and malignant.1 It has multiple types of morphological variants and thus poses a significant challenge in diagnosis on Fine needle aspiration cytology (FNAC). The aim of this article is to report a case of MEC in a 70-years-old male patient who presented with a painless firm fluctuant swelling in left preauricular area on left cheek to Karnataka Institute of Medical Sciences, Hubli. Detailed history was noted, and the swelling was examined clinically. Radiological investigations were carried out. Fine-needle aspiration cytology was done for the lesion and report suggested tumor of the parotid gland. Total parotidectomy procedure was done. There were no intra operative complications and post operatively there was grade 4 Housemann Brackmann facial nerve palsy on left side. The weight of the tumor was 1.45 kg. The histologic picture confirmed that the tumor was MEC of parotid gland. Through this article we want to report the management of giant MEC, the largest to be reported in world literature.

A rare case of mucoepidermoid carcinoma of parotid with mandibular metastasis

Mucoepidermoid carcinoma is the most common malignant tumor of salivary gland. Majority of the salivary gland tumors arise in parotid gland with maximum being of benign nature. Although Mucoepidermoid carcinoma accounts for less than 10% of all tumors of the salivary gland, it constitutes approximately 30% of all malignant tumors of the salivary gland. It is characterized by a mixed pattern of the two main cell types: epidermoid and mucus-producing cells. Metastasis from salivary gland malignancy is infrequent and predominantly found in bone, lung, liver and lymph nodes. We are presenting a rare case of metastasis of mucoepidermoid carcinoma of parotid gland to the contralateral mandible.

Perineural spread of mucoepidermoid carcinoma of parotid gland involving V, VI, and VII cranial nerves demonstrated on positron emission tomography/computed tomography

Perineural spread (PNS) in head and neck malignancies has been associated with extremely poor prognosis. Through this interesting case, we demonstrate the PNS of a mucoepidermoid carcinoma of parotid gland with simultaneous involvement of V, VI, and VII cranial nerves identified on positron emission tomography/computed tomography.

Therapeutic effect and prognostic factors for patients with mucoepidermoid carcinoma of parotid gland

Objective To study the therapeutic effect of adjuvant chemotherapy and radiotherapy after operation in patients with mucoepidermoid carcinoma of parotid gland, and to screen the indicators ralated to the prognosis of tumor. Methods Eighty patients with mucoepidermoid carcinoma of parotid gland in First People′ Hospital of Yibin of Sichuan Province from January 2005 to December 2009 were analysed retrospectively in our research. We studied the survival of patients who were treated wtih simple operation(30 cases) or postoperative adjuvant therapy(50 cases). Then we further analyzed the relationships between the prognosis of the patients and some variables (age, gender, smoking, alcohol drinking, lymph node metastasis, distant organ metastasis, treatment method, differentiation degree and T grading). Results Kaplan-Meier survival curves showed that patients with postoperative adjuvant therapy had longer PFS and OS than those without adjuvant therapy (94.4 months vs 69.3 months; 114.9 months vs 96.7 months), with statistical significance (χ2=11.246, P=0.001; χ2=15.803, P=0.001). COX univariate analysis showed that gender (χ2=22.346, P=0.000), smoking (χ2=7.891, P=0.041), lymph node metastasis (χ2=12.371, P=0.005), distant organ metastasis (χ2=9.813, P=0.002), treatment method (χ2=25.261, P=0.000), differentiation degree (χ2=4.361, P=0.006) and T grading (χ2=5.336, P=0.014) were related to the PFS of patients. COX multivariate analysis showed that lymph node metastasis (χ2=11.003, RR=2.827, 95%CI: 1.965-3.851, P=0.011), distant organ metastasis (χ2=7.611, RR=0.472, 95%CI: 0.240-0.775, P=0.016), treatment method (χ2=24.542, RR=5.390, 95%CI: 3.585-9.602, P=0.000), degree of differentiation (χ2=3.221, RR=2.118, 95%CI: 1.845-4.719, P=0.009) and T grading (χ2=4.336, RR=0.804, 95%CI: 0.681-0.916, P=0.024) were related to the PFS of patients. COX univariate analysis showed that smoking (χ2=4.551, P=0.008), alcohol drinking (χ2=11.742, P=0.048), lymph node metastasis (χ2=14.886, P=0.009), distant organ metastasis (χ2=6.713, P=0.005), treatment method (χ2=22.411, P=0.000), degree of differentiation (χ2=8.116, P=0.012) and T grading (χ2=14.443, P=0.035) were related to the OS of patients. COX multivariate analysis showed that lymph node metastasis (χ2=11.711, RR=2.985, 95%CI: 1.521-3.999, P=0.005), distant organ metastasis (χ2=5.390, RR=0.400, 95%CI: 0.201-0.793, P=0.009), treatment method (χ2=19.327, RR=5.086, 95%CI: 3.241-8.006, P=0.000), degree of differentiation (χ2=7.084, RR=2.301, 95%CI: 1.908-4.503, P=0.001) and T grading (χ2=13.229, RR=0.561, 95%CI: 0.348-0.867, P=0.040) were related to the OS of patients. Conclusion Adjuvant radiation and chemotherapy can obviously prolong the PFS and OS for the patients with mucoepidermoid carcinoma of parotid gland. Lymph node metastasis, distant organ metastasis, treatment method, differentiation degree and T grading can greatly influence the prognosis of patients with mucoepidermoid carcinoma of parotid gland, which can be used as independent prognostic indicators for the patients with mucoepidermoid carcinoma of parotid gland. Key words: Mucoepidermoid tumor; Treatment outcome; Prognosis

Mucoepidermoid carcinoma of parotid gland: A case report

Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the major salivary glands, accounting for 15.5% of all cases, benign and malignant. The aim of this article is to report a case of MEC in a 73-years-old male patient who presented with a painless firm fluctuant swelling in left preauricular area. The lesion was thoroughly examined preoperatively, and investigations were carried out. Fine-needle aspiration cytology was done for the lesion and report suggested tumor of the parotid gland. Superficial parotidectomy procedure was done, taking care not to injure the lower division of the facial nerve. Post recovery was uneventful with no defect of facial nerve functions. The histologic picture confirmed that the tumor was MEC of parotid gland. Through the literature reviews of MEC the discussions on prevalence, origin, diagnosis, histological finding, investigation and the modes of treatment are made.

Diagnosis of mucoepidermoid carcinoma of parotid gland by virtual touch tissue quantification

Objective To explore the value of virtual touch tissue quantification(VTQ) in diagnosis of mucoepidermoid carcinoma (MECa) of parotid gland.Methods The sonographic and VTQ findings of 36 patients with MECa of parotid gland proved by pathology were analyzed retrospectively.The patients were divided into 3 groups according to pathology.50 normal subjects were choesn as control group.Results There were significant differences of shear wave velocity (SWV) between MECa groups and control group as well as among MECa groups (all P ＜0.01).Conclusions VTQ provides quantitative information about tissue stiffness which is useful for the diagnosis of MECa of parotid gland. Key words: Ultrasonography; Parotid neoplasms ; Carcinoma, Mucoepidermoid; Virtual touch tissue quantification

Radical Parotidectomy: Reconstruction and Facial Reanimation

Objective: 1) Report a viable reconstructive alternative after parotid gland mucoepidermoid carcinoma resection, rendering a large facial defect and facial nerve paralysis. 2) Demonstrate the combination of temporalis muscle pedicled flap and microvascular fasciocutaneous radial forearm flap, fulfilling 3 purposes: bulk restitution, facial paralysis reanimation, and adequate skin replacement for acceptable aesthetics. Method: Facial defect was left after radical parotidectomy with facial nerve sacrifice, as well as masseter muscle, mandibular periosteum, and skin removal. Reconstruction of the large defect was achieved recurring to temporalis muscle transposition combined with fasciocutaneous radial forearm flap. Facial artery and vein were used for microvascular sutures. Results: The necessity of the head and neck surgeon to make aggressive interventions has enabled the usage of flaps for reconstruction of significant facial defects. Satisfactory results require careful 3-dimensional thought, adequate texture matching as well as functional restoration. The results showed that temporalis muscle transposition was a successful method for bulk restitution and reanimation of permanent facial paralysis in the resting position, including both eyelid and mouth, by tension provided to orbicularis ori and orbicularis oculi muscles. Fasciocutaneous radial forearm flap provided the best possible tissue color and contour restoration of skin due to its thin, pliable tissue. Conclusion: Radial forearm flap and temporalis muscle transposition combined offered a viable reconstructive option after radical parotidectomy resulting in acceptable aesthetic and functional outcomes. Radial forearm flap was a good choice for skin restoration. Temporalis muscle transposition proved to be adequate both for bulk restitution as for reanimation of facial paralysis.

Oncocytic mucoepidermoid carcinoma of the parotid gland with CRTC1-MAML2 fusion transcript: report of a case with review of literature

Oncocytic mucoepidermoid carcinoma is a very rare variant of mucoepidermoid carcinoma, composed predominantly of oncocytic cells. Most previously reported cases described the difficulty in histologic differentiation from other oncocytic tumors. Here we report a case of oncocytic mucoepidermoid carcinoma of parotid gland diagnosed by the detection of CRTC1-MAML2 fusion. A 53-year-old man had a left superficial parotidectomy conducted for 3-cm-sized mass. The resected tumor was composed almost exclusively of oncocytic tumor cells. With detailed histologic evaluation, scarce vacuolated tumor cells, suggestive of mucous cell of mucoepidermoid carcinoma, and one focus of tumor embolism in a vein were found, suggesting the possibility of oncocytic mucoepidermoid carcinoma. Immunohistochemically, oncocytic cells were diffusely positive for p63. Reverse transcriptase polymerase chain reaction and direct sequencing revealed CRTC1-MAML2 translocation of this tumor. To our knowledge, this report describes the first case of oncocytic mucoepidermoid carcinoma confirmed with CRTC1-MAML2 fusion. Identification of this fusion gene may help in distinguishing oncocytic mucoepidermoid carcinoma from its mimics.

Incidence of malignancy in primary Sjogren's syndrome in a Chinese cohort

To evaluate the incidence of malignancies in a cohort of Chinese patients with primary Sjögren's syndrome (pSS) and to identify the risk factors of malignancy in pSS patients. A retrospective analysis was carried out in 1320 pSS patients who were recruited in Peking Union Medical College Hospital from 1990 to 2005 and were followed up for an average of 4.4 years. Among them, 29 patients developed malignancies. Standardized incidence ratios (SIRs) were calculated along with 95% CIs. Clinical characteristics were compared between patients with and without malignancies, as well as patients with haematological and non-haematological tumours. Of the pSS patients, 2.2% developed malignancies during follow-up. Total SIR and SIR for lymphoma were 3.25 and 48.1, respectively. Different types of malignancy were observed including eight lymphomas, two myeloid myelomas and 19 solid tumours, which consisted of invasive thymoma, breast cancer, lung cancer, gastrointestinal adenocarcinoma, hepatoma, squamous cell carcinoma of tongue, uterine cervix cancer, renal carcinoma, thyroid carcinoma and mucoepidermoid carcinoma of parotid gland. Risk factor analysis showed that lymphadenopathy, enlargement of parotid glands, monoclonal immunoglobulin and absence of hypergammaglobulinaemia were correlated with malignancies. The current study confirms the increased incidence of lymphoma in Chinese patients with pSS, with the majority of B-cell non-Hodgkin's lymphoma. Associations between pSS and other malignant tumours such as myeloid myeloma, mouth cancer, breast cancer and thymoma need to be further observed.

Parotid Gland Mucoepidermoid Carcinoma Associated With Myasthenia Gravis

Myasthenia gravis (MG) is an autoimmune neuromuscular disease. Although most MG cases do not have accompanying malignant disease, patients with thymoma may have an increased risk for secondary malignancy. The reason MG patients are prone to developing cancer is not very well known. Salivary gland tumors account for approximately 3% of head and neck tumors, and approximately 80% of these occur in the parotid gland. Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland. MG may be associated with squamous cell carcinoma of the head and neck. We present a patient with MG who developed parotid gland mucoepidermoid carcinoma. MG patients with parotid gland cancer have not been previously reported. We also discuss the possible mechanisms of tumor development in an MG patient.