Our patient, a 46yearold female, presented with a left parotid mass of 20year duration. Safety and efficacy of pembrolizumab for sgc expressing programmed death ligand 1 pdl1 were explored. Outcomes of postoperative concurrent chemoradiotherapy for. Histological examination of the second recurrence showed a malignant spindle cell neoplasm with.
Mec can also involve a variety of other sites that have minor mucoserous glands. Epithelialmyoepithelial carcinoma of the parotid gland. Mucoepidermoid carcinoma mec is the most common primary epithelial salivary gland malignancy, constituting about half of all malignant salivary gland tumors found in children 1,2. Epidermal growth factor receptor egfr signaling pathway gene mutations are important in predicting a patients prognosis, selecting molecularly targeted drugs, and estimating the efficacy of a molecular therapy. Sclerosing mucoepidermoid carcinoma with eosinophilia is a rare thyroid neoplasm of uncertain pathogenesis that resembles salivary gland mucoepidermoid carcinoma. The findings of the present case suggest that this rare type of salivary gland carcinoma may be associated with a chronic inflammatory condition such as igg4. This biopsy result shows low grade mucoepidermoid carcinoma of the right parotid gland and the ent has suggested to completely remove the right parotid gland. Histologic grade is a significant predictor of outcome in salivary gland carcinomas.
Cancer in the salivary gland is called salivary gland cancer. This is a patient with surgical stage t1, clinical n0, lowgrade parotid mucoepidermoid carcinoma. Minor salivary gland tumours are comparatively rare, and comprise about 10% of all salivary tumours. Mucoepidermoid carcinoma arising in warthins tumor of the. Mucoepidermoid carcinoma of the parotid gland request pdf. Journal of clinical medicine article intracystic in situ mucoepidermoid carcinoma. A myoepithelial carcinoma, a rare malignant salivary gland neoplasm, arose in a pleomorphic adenoma of the parotid gland. The mass was resected and shown to be a mucoepidermoid carcinoma final diagnosis. With prompt diagnosis and adequate treatment, the prognosis of emc of salivary gland is generally improved. Fnac is an easily accesible, cost and time effective method for diagnosis. Maml2 rearrangements are detectable in 80% to 85% of. Read hpvp16 overexpression in mucoepidermoid carcinoma of the parotid gland, international journal of radiation oncology biology physics on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Mucoepidermoid carcinoma is more frequent in females, occurs in the fifth decade of life and is usually found in the parotid gland. Pathology outlines epithelial myoepithelial carcinoma.
Our patient was treated successfully with widelocal resection and remained free of disease for 6 months. Treatment options for patients with unresectable or metastatic salivary gland carcinoma sgc are limited. Prognosis and survival for salivary gland cancer canadian. Mucoepidermoid carcinoma genetic and rare diseases. Since the publication of the series by conley and arena, 7 there have been many articles on the subject of metastatic disease to the parotid gland. Comparative histogenesis and morphogenesis of mucoepidermoid carcinoma and pleomorphic adenoma. Primary scc originating in the parotid is a rare and aggressive tumor. A, fluorine18 fluorodeoxyglucose positron emission tomographic scan demonstrating mediastinal and abdominal lymph node metastases at 3 months after completion of adjuvant concurrent chemoradiation.
Among the 309 cases of surgically resected wts in chinese. Salivary gland tumours are rare and have very wide histological. Prognostic factors for metastatic cutaneous squamous cell. Dec 01, 2005 mucoepidermoid carcinoma mec is the most common primary salivary gland malignancy, accounting for approximately 25% of all malignancies. To explore the prognostic significance of patient and disease characteristics on the survival of patients with metastatic cutaneous squamous cell carcinoma of the parotid gland at a tertiary care center in halifax, nova scotia, canada. Mucoepidermoid carcinoma mec, one of the most common malignant salivary gland neoplasms, is divided into low, intermediate, and highgrade types according to the histologic features. We present an adenocarcinoma tumor of the parotid gland that was dedifferentiated from a lowgrade epithelialmyoepithelial carcinoma and was followed up for 3 years. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment.
It is a rapidly advancing lesion which, if not recognised and treated early, results in high morbidity and. Salivary gland cancers are rare and represent approximately 5% of all head and neck cancers and only 0. Jun 18, 20 mucoepidermoid carcinoma is a type of cancer of the salivary glands salivary gland cancer is diagnosed in 23 individuals per 100,000 people each year, and 3035% of these are mucoepidermoid carcinomas. It has a slight female predilection and usually presents as a painless, rubberlike or soft mass, which may be fixed or mobile. Prognostic factors for parotid mucoepidermoid carcinoma mec usually include disease grade, tumor stage, node stage, perineural invasion, and lymphovascular invasion. Clinical stage and histological grade of mucoepidermoid carcinoma are the main prognostic factors. However, the sheer variety of tumor type and the rarity of these tumors pose challenges to devising highly predictive grading schemes. As our knowledge base has evolved, it is clear that carcinoma ex pleomorphic adenoma is not automatically a high grade tumor as is traditionally. Epithelialmyoepithelial carcinoma of salivary gland. Role of 18ffdg petct in management of highgrade salivary gland malignancies hansin jeong1, man ki chung1, youngik son1, joon young choi2, hyung jin kim3, young hyeh ko4, and chunghwan baek1 1department of otorhinolaryngologyhead and neck surgery, samsung medical center, sungkyunkwan university school of medicine.
Epithelial myoepithelial carcinoma emc is a rare biphasic tumor of salivary glands with low malignant potential. Mucoepidermoid carcinoma mec of the salivary gland is believed to arise from pluripotent reserve cells of the excretory ducts that are capable of differentiating into squamous, columnar, and mucous cells. More than half of these cases involve the major salivary glands, primarily the parotid glands. Epithelial myoepithelial carcinoma of parotid gland. Radiotherapy if a salivary gland tumour is cancerous, radiation therapy may be necessary. The parotid gland is the most common location of benign neoplasms affecting major salivary glands. Nomogram to predict the prognosis of parotid gland.
Mucoepidermoid carcinoma in warthin tumor of the parotid gland article pdf available in archives of medical science 1. Histopathologic grading of salivary gland neoplasms. Treatment and survival outcomes based on histologic. The tumor is composed of epidermoid and mucin producing cells, which take origin from the duct epithelial lining. Garrett griffin of midwest ear nose and throat and midwest facial plastic surgery, respectively, have joined forces to improve outcomes for patients with benign and malignant tumors of the parotid gland. Mucoepidermoid carcinoma in warthin tumor of the parotid gland. Hybrid tumors are very rare tumor entities which are composed of two different tumor types, each of which conforms to an exactly defined tumor category.
Clinicopathological significance of egfr pathway gene. We report a case of mec arising in wt of the parotid gland, describing clinical and pathological aspects. Histologically, mec is comprised of a mixture of cell types including mucous, epidermoid, and intermediate cells that can be. In the face of small, lowgrade cancers, the risk of lymph. Mucoepidermoid carcinoma can also be found in other organs, such as bronchi, lacrimal sac, and thyroid gland. However elective treatment of the n0 neck region remains a controversial topic.
Mucoepidermoid carcinoma mec is the most common primary salivary gland malignancy, accounting for approximately 25% of all malignancies. Synchronous multiple unilateral parotid gland tumors of. Compared with pulmonary adenocarcinoma with mucoepidermoid carcinoma like or adenoid cystic carcinoma like structure and pulmonary adenosquamous carcinoma, primary salivary gland type lung carcinomas have special characteristics in median age, sex, location, tumor size, ln involvement and pleura invasion, with negative ttf1 and napsin a. Mcqs on diseases of salivary glands oral pathology part 2. Mucoepidermoid carcinoma is the most common type of minor salivary gland malignancy in adults. A clinicopathological study of 14 cases saverio capodiferro 1,y, giuseppe ingravallo 2,y, luisa limongelli 1, mauro giuseppe mastropasqua 2, angela tempesta 1, gianfranco favia 1 and eugenio maiorano 2 1 department of interdisciplinary medicine section of odontostomatology, university of bari aldo moro. Postoperative radiation therapy for parotid mucoepidermoid. The diagnosis of mec can be quite challenging due to the degree of histologic overlap with other glandular, clear cell, or oncocytic salivary gland tumors. Being exposed to certain types of radiation may increase the risk of salivary cancer. Mucoepidermoid carcinoma is a rare primary thyroid tumor with indolent biologic potential. A rare case of mucoepidermoid carcinoma of parotid with.
Adjuvant treatment for parotid mucoepidermoid carcinoma. Muc4 and erbb2 expression in major and minor salivary gland mucoepidermoid carcinoma. The majority of these tumors are benign, and therefore, timely and accurate diagnosis of salivary gland malignancy in children is challenging. Mucoepidermoid carcinoma can also be found in other organs, such as bronchi, lacrimal sac, and thyroid gland mucicarmine staining is one stain used by pathologist for detection. A 21 year old female presented in our hospital with a painless swelling in the left parotid region simulating a parotid gland tumor. On a deeper plane, the parotid is related to the styloid process and the muscles connected to it. 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 cancer is a rare disease in which malignant cancer cells form in the tissues of the salivary glands. The initial tumour was a pleomorphic adenoma with epithelial and myoepithelial elements.
Parotid squamous cell carcinoma scc is e ither primary, when another primary site of origin is unknown or when it is not present in parotidean lymph nodes, or metastatic. The etiology of salivary gland tumors sgts remains mostly unknown. Mucoepidermoid carcinoma mec is one of the most common salivary gland carcinomas. The second most common minor salivary gland tumour 1240% globally is mucoepidermoid carcinoma. Mucoepidermoid carcinoma mec is the most common primary salivary gland malignancy in both adults and children. The most common type of such a lesion is warthin tumor 612% of all adenolymphomas. The aim of this study is to identify independent prognostic factors and establish a nomogram model for parotid gland mucoepidermoid carcinoma pmec patients using the national cancer institutes. Adotrastuzumab emtansine tdm1 after progression on trastuzumab. Poorly differentiated adenocarcinoma extending to the specimen margins. Mucoepidermoid carcinoma of parotid gland salman alkhalifa, frcs, dlo1 noor yousif abdulkarim, md, msc ucl2 fatima n abulfateh, md1 1king hamad university hospital, 2bdf hospital abstract objective. Role of intraparotid node metastasis in mucoepidermoid. Myoepithelial carcinoma malignant myoepithelioma of the. Mucoepidermoid carcinoma of parotid gland salman a. The majority 75% of salivary gland tumors occur in the parotid gland, and while benign lesions are more common, mucoepidermoid carcinoma mec makes up 4050% of malignant parotid gland tumors.
Pilomatrixoma of parotid region mimicking the mucoepidermoid. Primary squamous cell carcinoma of the parotid gland is a rare aggressive malignancy. Mucoepidermoid carcinoma is the most common malignant tumor of salivary gland. Sclerosing mucoepidermoid carcinoma with eosinophilia of. Hpvp16 overexpression in mucoepidermoid carcinoma of the. Pdf mucoepidermoid carcinoma in warthin tumor of the. An understanding of the combined cytological and immunocytological features of this tumor is valuable in differentiating it from other primary. Although most common in the parotid gland, mucoepidermoid carcinoma is frequently encountered in the oral cavity in the palate, cheeks, lips, tongue and retromolar region. Objective to determine clinical and histopathologic features of mucoepidermoid carcinoma of the parotid gland, specifically, the relation of tumor stage and grade and treatment type with clinical outcome. The marginal part of the solid mass included warthin tumor cells. But the role of intraparotid nodes ipns remains unclear, therefore, the study aimed to analyze the significance of ipns in predicting recurrence in parotid mec.
In part 2, we discuss neoplasms and tumorlike lesions of the salivary glands with a key emphasis on. Clinical course of a patient with highgrade mucoepidermoid carcinoma of the parotid gland. The salivary glands include paired major glands pa. Mucoepidermoid carcinoma of the major salivary glands. Only 23 cases of sclerosing mucoepidermoid carcinoma with or without eosinophilic infiltratie have been reported to date in such an anatomical location. The parotid gland is the largest salivary gland, located in front of the ear. The diagnosis is made after excluding metastasis from other sites in the head and neck or other primary malignancies of the parotid. Advanced stage and highgrade tumors are significant predictors of decreased survival.
We present a case of pilomatrixoma in the parotid region mimicking mucoepidermoid carcinoma on aspiration cytology. Role of ffdg petct in management of highgrade salivary. Mar 25, 2006 this biopsy result shows low grade mucoepidermoid carcinoma of the right parotid gland and the ent has suggested to completely remove the right parotid gland. Jun 19, 2015 carcinomatous components can be represented by squamous cell carcinoma the most common 1820, oncocytic carcinoma, adenocarcinoma, undifferentiated carcinoma and mucoepidermoid carcinoma mec 2125. Dedifferentiation is defined as highgrade malignant tumor development out of a lowgrade malignant tumor. Background mucoepidermoid carcinoma mec is a common cancer in the oral salivary gland malignancy, which mainly occurs in the parotid gland.
Subsequently the tumour recurred twice and was characterised by invasion of the mandible. The tumor entities of a hybrid tumor are not separated but have an identical origin within the same topographical area. Current classifications of salivary gland tumors separate mucoepidermoid carcinoma from other neoplasms on the basis of a number of histological features. Pembrolizumab for the treatment of advanced salivary gland. People with salivary gland cancer may have questions about their prognosis and survival. Primary squamous cell carcinoma of the parotid is an uncommon, aggressive malignancy with a poor prognosis. Primary squamous cell carcinoma of the parotid gland. In this chapter, we are going to discuss about salivary glands cancers, their clinical manifestations and. Signs of salivary gland cancer include a lump or trouble swallowing. Among the major salivary glands, the parotid gland is most commonly involved. Because of rarity of emc a standard treatment guideline is not yet known. Mucoepidermoid carcinoma of the head and neck in children. Synchronous multiple unilateral parotid gland tumors of benign and. Surgery complete surgical resection, with adequate free margins, is currently the mainstay treatment for salivary gland tumours.
Secondline treatment of her2positive salivary gland tumor. Sep 10, 2018 the treatment for epithelialmyoepithelial carcinoma of salivary gland involves a combination of surgery, chemotherapy, and radiation therapy, in most cases. However, mucoepidermoid carcinoma is not inherited from a parent or passed down through a family. Major salivary glands were involved in 46 cases 44 parotid, two submandibular, and intraoral minor glands in 23. However, their significance in mec have been poorly clarified. The most common malignant major and minor salivary gland tumor is the mucoepidermoid carcinoma, which comprises about 10% of all salivary gland neoplasms and approximately 35% of malignant salivary gland neoplasms. Objectives to describe a case of mucoepidermoid carcinoma of the parotid gland that caused obstruction of a salivary gland duct and manifested as a parotid retention cyst.
Two types of tumors have been described under this category. Who gets epithelialmyoepithelial carcinoma of salivary gland. Mucoepidermoid carcinoma 30% and 35% of the parotid and minor salivary glands malignancies respectively, and 20% of those involving the submandibular gland. A case of excised parotid mucoepidermoid carcinoma was presented. Mucoepidermoid carcinoma, or cancer of the salivary gland, is a genetic disease in the sense that it occurs due to changes mutations in genes that regulate how cells in the body divide. Most of these tumors are benign not cancer, but the parotid glands still are where most malignant cancerous salivary gland tumors start. Mar 05, 2016 posteriorly, the gland dips in the space between the mandible and the mastoid, with the adjoining external auditory meatus intimately surrounded by the gland in its free borders, that is, anteriorly and inferiorly. Mucoepidermoid carcinoma the salivary glands are those glands whose primary function is to produce saliva. Squamous cell carcinoma of the parotid gland request pdf. Minor salivary gland tumours account for 1015% of all salivary gland neoplasms and are usually malignant. Clinical and radiological findings often mimic a benign tumor. Although known to occur in submandibular gland and minor salivary glands, its most common location is parotid. Keywords acinic cell carcinoma 4 pathology 4 salivary glands 4 therapy 4. Objectives to describe a case of mucoepidermoid carcinoma of the parotid gland that caused obstruction of a salivary gland duct and manifested as a parotid.
Sixtynine cases of mucoepidermoid carcinoma with a minimum of five years followup are presented. Only a doctor familiar with a persons medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis. Although mucoepidermoid carcinoma of the parotid gland is the most common parotid gland malignancy, it is still a rare tumor with a lack of large populationbased studies. Majority of the salivary gland tumors arise in parotid gland with maximum being of benign nature. The aim of this report is to present a case of mucoepidermoid carcinoma of the left parotid gland, which has been removed surgically. Review of the major and minor salivary glands, part 2. Parotid gland as initial metastatic site of nasopharyngeal. Mucoepidermoid carcinoma mec is the most common malignancy of the major and minor salivary glands, comprising 34% of salivary gland malignancies. Parotid gland as initial metastatic site of nasopharyngeal carcinoma. Jul 15, 2016 mucoepidermoid carcinoma mec, an extremely rare tumor, arises from the epithelial component of preexisting parotid warthin tumors wt.
The submandibalar salivary gland shows patchy chronic inflammation but is free of tumour. Although mucoepidermoid carcinomas mecs are considered as the second most common malignant salivary gland neoplasm, only 0. Case study of a parotid gland adenocarcinoma dedifferentiated. Cords, sheets and clusters of mucous, squamous, intermediate and clear cells. Dedifferentiation in lowgrade mucoepidermoid carcinoma of. Current state of knowledge on salivary gland cancers ncbi. Most common salivary gland malignancy in childhood mean of. A clinicopathological study of 14 cases saverio capodiferro 1,y, giuseppe ingravallo 2,y, luisa limongelli 1, mauro giuseppe mastropasqua 2, angela tempesta 1, gianfranco favia 1 and eugenio maiorano 2 1 department of interdisciplinary medicine section of. Mucoepidermoid carcinoma mec is the most common malignant salivary gland neoplasm, representing over 30% of all malignant salivary gland tumors. Lowgrade mucoepidermoid carcinoma of salivary gland. The salivary glands are small structures in the head and neck, but can give rise to a wide. Mucoepidermoid carcinoma is a type of cancer of the salivary glands salivary gland cancer is diagnosed in 23 individuals per 100,000 people each year, and 3035% of these are mucoepidermoid carcinomas. Jul 14, 2015 mucoepidermoid carcinoma is the most frequently diagnosed malignancy of the salivary gland.
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