Prognostic factors of palatal mucoepidermoid carcinoma: a retrospective analysis based on a double-center study

Mucoepidermoid carcinoma (MEC) of the palate is a common malignancy of minor salivary glands. This study was designed to identify the prognostic factors for MEC of the palate. The medical records of patients diagnosed with MEC of the palate who visited the Department of Oral and Maxillofacial Surgery at Nanjing Stomatological Hospital and the Department of Stomatology at Central Hospital of Xuzhou were retrospectively studied. The prognostic factors were determined using a Cox proportional hazards model. Furthermore, the expression of cancer stem cell (CSC) markers CD44, CD133, Nanog and Sox2 were detected in neoplastic samples of these patients by immunohistochemistry. As a result, both univariate analysis and multivariate analysis proved a high histological grade and an advanced tumor stage as negative prognostic factors for overall survival. By immunohistochemistry staining and survival analysis, a combination of CD44/CD133/SOX2 was found to have the strongest prognostic value for palatal MEC patients. In conclusion, the proposed nomogram which include histological grade and tumor stage along with cancer stem cell markers provides a more accurate long-term prediction for palatal MEC patients.

Mucoepidermoid carcinoma of the salivary glands. A retrospective study of 51 cases and review of the literature

The aim of this study is to present the casuistic of mucoepidermoid carcinoma of salivary glands in patients diagnosed at "Dr. Eduardo Cáceres Graziani" National Institute for Neoplastic Diseases, Lima, Perú. From January 2002 to December 2012, 51 cases were diagnosed as mucoepidermoid carcinoma. The number of female patients was higher, with 28 cases (54.9%), and regarding age distribution, 33.3% of the patients were under 30 years old. Pain was one of the main symptoms, and 74.5% of the mucoepidermoid carcinomas were located in the parotid gland. It is concluded that epidemiology regarding age and gender of the 51 cases analyzed was in the same range as other studies, and that most cases were located in major salivary glands, in agreement with reports on other populations. Other characte ristics showed a homogeneous distribution.

Primary mucoepidermoid carcinoma at the carina of trachea presenting with wheezing in an asthmatic child mimicking an attack of asthma: A case report

BACKGROUND

Asthma is a very common disease, but primary tracheal tumors are extremely rare in children. Wheezing is not pathognomonic, but is the typical presentation of asthma and could also be found in patients with tracheal tumors.

CLINICAL FINDINGS

This report describes a 12-year-old boy with a previous history of frequent asthma attacks and experienced responses to antiasthma treatment. He was admitted to the hospital due to persistent wheezing and progressive dyspnea. Hyperinflation in the bilateral lungs was detected on chest x-ray, but without other significant findings. Chest computed tomography revealed a mass at the carina. Tracheal mucoepidermoid carcinoma was diagnosed by histopathological assessment.

CONCLUSION

Despite the rarity of tracheal tumors, chest computed tomography scans should be performed in the first place for children presenting persistent wheezing and having poor response to antiasthma treatment to rule out the other alternative diagnosis. Coexistence of other diseases such as tracheal tumor in asthmatic patients should be considered.

[Diagnosis and treatment of the tumors of the parotid region in Pediatrics: cohort]

INTRODUCTION

Parotid tumors are rare in children and usually have multiple differential diagnoses that require different diagnostic and treatment methods.

MATERIAL AND METHODS

Retrospective cohort study of all consecutive pediatric patients with parotid tumors that were treated in Pediatric Surgery Service of Hospital Italiano de Buenos Aires.

RESULTS

Twenty-two patients with parotid tumors were included and 72% (n=16) were female patients. The median age was 10 years (range: prenatal to 19 years). Imaging studies: ultrasound, CT and MRI. Diagnostic methods: needle or open biopsy (14), biopsy of lymph nodes (3), imaging (4), blood test (1). Treatment: surgical resection (12), medical treatment (7), sclerotherapy (2). Diverse histological diagnosis were obtained: pleomorphic adenoma (4), infantile hemangioma (4), PNET (2), low flow vascular malformation (2), Castleman's disease (1), schwannoma (1), neuroblastoma (1), alveolar rhabdomyosarcoma (1), mucoepidermoid carcinoma (1) RICH (Rapidly Involuting Congenital Hemangioma) (1), granulomatous disease (1), reactive adenitis (1), parotid cyst (1), ALL (Acute Lymphoblastic Leukemia) (1). Follow-up (42,5 months): 18 patients are free of disease, 3 are currently under medical treatment and 1 died.

CONCLUSIONS

Our series shows the diversity that parotid tumor can present in pediatric population and is consistent with the literature there the incidence of benign lesions are predominant. However, it is difficult to predict risk of malignancy. An exhaustive diagnosis is important, using complementary methods and biopsy whenever that is necessary.

Central mucoepidermoid carcinoma of the mandible – A case report

INTRODUCTION

Mucoepidermoid carcinoma, compared to other tumors of salivary glands, occurs in 5–10% of cases. Histopathologically, it is divided into a well differentiated tumor that is of low-grade of malignancy, and a medium and poorly differentiated tumor of high grade of malignancy. Central mucoepidermoid carcinoma (CMEC) of the mandible was firstly described by Lepp in 1936, on a 66-year-old female patient. CMEC is characterized by atypical clinical image and radiological manifestation.

CASE OUTLINE

A 55-year-old female patient was examined at the Clinic of Dentistry in Niš, Serbia, with anamnestic data regarding the presence of painless swelling in the right side of the mandible. Considering the histopathological results and presence of enlarged lymph nodes, right hemimandibulectomy and tumour excision from pterygomandibular space followed by supraomohyoid neck dissection was done. In due course, postoperative radiotherapy was applied (60 Gy)

CONCLUSION

CMEC represents a rare tumor, characterized by local tissue destruction and ability to metastasize. Initial biopsy represented the key in preoperative planing. Radical excision with neck lymph node dissection followed by postoperative radiotherapy in our case represent a successful method of treating CMEC of the mandible.

[Expression and significance of discoidin domain receptor 1 in salivary gland mucoepidermoid carcinoma]

PURPOSE

To investigate the expression and significance of discoidin domain receptor 1 (DDR1) in salivary gland mucoepidermoid carcinoma (MEC).

METHODS

Immunohistochemical and Western blot method were used to detect the expression of DDR1 in MEC M3SP2 and MC3 cell lines. Immunohistochemical method was used to detect the expression of DDR1 in 58 MEC and 20 normal salivary gland tissues. SPSS 13.0 software package was used for statistical analysis.

RESULTS

The positive expression rate of DDR1 in salivary gland MEC tissues was 79.3%, significantly higher than 10.0% in normal salivary gland tissues (P<0.01). High expression of DDR1 was not related to clinicopathological parameters of MEC(P>0.05). The expression of DDR1 was positive in MEC M3SP2 and MC3 cell lines.

CONCLUSIONS

DDR1 may play an important role in carcinogenesis and progress of salivary gland MEC.

[New developments in molecular diagnostics of carcinomas of the salivary glands: "translocation carcinomas"]

In recent years the discovery of translocations and the fusion oncogenes that they result in has changed the way diagnoses are made in salivary gland pathology. These genetic aberrations are recurrent; and at the very least serve as powerful diagnostic tools in salivary gland tumors diagnosis and classification. They also show promise as prognostic markers and hopefully as targets of therapy. In this review the 4 carcinomas currently known to harbor translocations will be discussed, namely mucoepidermoid carcinoma, adenoid cystic carcinoma, mammary analogue secretory carcinoma, and hyalinizing clear cell carcinoma. The discovery and implications of each fusion will be highlighted and how they have helped to reshape the current classification of salivary gland tumors.

[Pulmonary Mucoepidermoid Carcinoma--A Case Report]

Mucoepidermoid carcinoma (MEC) of the lungs is a rare type of lung cancer, mainly arising from the submucosal salivary type mucous glands of the large bronchi. MEC is classified into low- and high-grade subtypes based on its cytological and histological features, and this classification correlates well with prognosis. We report the case of a 36-year-old man diagnosed after an initial episode of obstructive pneumonia. CT and bronchoscopy revealed an endobronchial mass in the right S3 bronchus and distal atelectasis. Although biopsy is important for deciding the treatment plan, both pre- and intraoperative biopsy resulted in false negativity in this patient. The tumor was completely resected via right upper lobectomy, and the final pathological diagnosis was low-grade MEC. No evidence of disease was found 2 years after the operation without any adjuvant therapy. At (11; 19) translocation with the associated CRTC1-MAML2 fusion oncogene is often recognized in cases of both salivary and pulmonary MEC. It is speculated that MEC is sensitive to EGFR-TKI therapy, which disrupts CRTC1-MAML2-induced proliferation signals via upregulation of the EGFR ligand amphiregulin.

[A clinical review of 3 cases of children with bronchial tumor]

OBJECTIVE

To investigate the clinical characteristics of bronchial tumors in 3 children to improve the diagnosis of pediatric bronchial tumor.

METHODS

Three cases of children bronchial malignant tumors diagnosed by rigid bronchoscopy were analyzed retrospectively.

RESULTS

The 3 children were males, aged from 6 to 10 years old, and presented with cough, sputum, and fever symptoms for 1 day to 3 months. Chest CT scan and airway remodeling examinations indicated the children's main bronchi were blocked and then the diagnoses of bronchial foreign bodies were made. However bronchial tumors were found in the 3 children by rigid bronchoscopy and were determined as mucoepidermoid carcinoma, large cell lung carcinoma with rhabdoid phenotype, and inflammatory myofibroblastic tumor, respectively.

CONCLUSIONS

Children with bronchial tumor often present with cough, wheezing and other respiratory symptoms that are not specific to bronchial tumor. When a child complaint of repeated cough and wheezing symptoms with unknown cause, not only bronchial foreign body and also bronchial tumor should be considered.

Central mucoepidermoid carcinoma of the anterior region of the mandible: report of an unusual case and review of the literature

INTRODUCTION

Central mucoepidermoid carcinoma is a rare lesion, whose exact pathogenesis is still not fully understood. Generally, it is more frequently encountered in the mandible than in the maxilla and in the posterior than in the anterior aspect of the jaws. Cases of central mucoepidermoid carcinomas are rarely mentioned in the literature, and therefore, additional information concerning this type of lesion is needed.

CASE REPORT

In the present paper, we report an extremely unusual case of a central mucoepidermoid carcinoma in the anterior region of the mandible of a 37-year-old female patient. The diagnosis and the surgical management of the tumor along with the reconstructive techniques utilized to restore the mandible and a 6-year follow-up are discussed.

DISCUSSION

Central mucoepidermoid carcinoma is an unusual tumor of the jaws, especially in the anterior region. It is only locally aggressive and has most frequently a good prognosis if treated with wide surgical excision.

Diagnostic role of DOG1 and p63 immunohistochemistry in salivary gland carcinomas

BACKGROUND

The differential diagnosis of salivary carcinomas is always difficult and challenging. Salivary neoplasms often shows more than one growth pattern and significant morphologic variability may exist within a single tumor and between different tumors. The aim of this study was to examine the role of DOG1 (discovered on gastrointestinal tumor-1) and p63 immunohistochemistry in the diagnosis and differential diagnosis of salivary carcinomas.

METHODS

we examined the expression of DOG1 and p63 immunohistochemistry in 33 mucoepidermoid carcinomas (MEC), 9 acinic cell carcinomas (ACC), 10 adenoid cystic carcinomas (AdCC) and 4 myoepithelial carcinomas.

RESULTS

All ACC showed strong to moderate positivity for DOG1 (P=0.001) and all were totally negative for p63. All MEC expressed strong to moderate positivity for p63 (P=0.001) while only (9.1%) were weak to moderately positive for DOG1. (80%) AdCC were moderately positive for DOG1 in ductal and myoepithelial components and (100%) showed moderate positivity for p63 in myoepithelial cells only (P=0.001). All myoepithelial carcinomas were DOG1 negative, 2 (50%) were weakly positive for p63 while the other 2 were moderately positive (P=0.5).

CONCLUSION

DOG1 is a sensitive marker in the diagnosis of acinic cell carcinoma, p63 is sensitive in the diagnosis of mucoepidermoid carcinoma, the combined use of both markers is helpful and statistically significant in the differential diagnosis of acinic cell carcinoma versus mucoepidermoid carcinoma, both markers can help in the diagnosis of adenoid cystic carcinoma but they have no role in the diagnosis of myoepithelial carcinoma.

[Diagnosis value of TTF-1, Napsin A and Ki-67 index in primary salivary gland-type lung carcinomas]

OBJECTIVE

To study the clinicopathologic characteristics of primary salivary gland-type lung carcinomas, and the immunophenotypic value of TTF-1, Napsin A and Ki-67 in their differential diagnosis.

METHODS

Totally 48 special type lung cancer surgical removal specimens were collected in China-Japan Friendship Hospital during September 2009 to December 2014. A panel of immunohistochemical markers (TTF-1, Napsin A, Ki-67, CK5/6, CK7 and p63) were conducted on these specimens.

RESULTS

The 48 cases of special type lung cancer included 25 cases of primary salivary gland-type lung carcinoma (18 cases of adenoid cystic carcinoma and 7 cases of mucoepidermoid carcinoma), 5 cases pulmonary adenocarcinoma with mucoepidermoid carcinoma-like or adenoid cystic carcinoma-like structure, and 18 cases of pulmonary adenosquamous carcinoma. 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 TTF-1 and Napsin A expression as well as lower Ki-67 index detected by immunohistochemistry. Primary salivary gland-type lung carcinomas usually have an indolent behavior.

CONCLUSIONS

Primary salivary gland-type lung carcinomas are low-aggressive entities. The origins of primary salivary gland-type lung carcinomas were different from that of pulmonary adenocarcinoma with mucoepidermoid carcinoma-like or adenoid cystic carcinoma-like structure and pulmonary adenosquamous carcinoma. Negative TTF-1 and Napsin A expression as well as Ki-67 index lower than 20% have special value for primary salivary gland-type lung carcinomas in their differential diagnosis.

Combined papillary and mucoepidermoid carcinoma of the thyroid gland: a possible collision tumor diagnosed on fine-needle cytology. Report of a case with immunocytochemical and molecular correlations

Fine-needle cytology (FNC) is frequently used to diagnose thyroid nodules discovered by palpation or imaging studies. Molecular tests on FNC material may increase its diagnostic accuracy. We report a case of a classic papillary thyroid carcinoma combined with a mucoepidermoid carcinoma correctly identified on FNC. The papillary component had a classic immunophenotype (CK19+, TTF1+), while the mucoepidermoid one was only focally CK19+. Point mutations (BRAF and RAS) and rearrangements (RET/PTC) of the papillary component have been also investigated on FNC samples, with resulting concurrent rearrangements of RET/PTC1 and RET/PTC3, but no point mutations. The histogenesis of combined papillary and mucoepidermoid carcinoma of the thyroid still remains partly unsettled, and further genomic studies are needed to shed some more light on this peculiar neoplasm.

Mucoepidermoid carcinoma of the palate in adolescence

Although relatively rare, minor salivary gland tumors are more likely to be malignant in pediatric patients than in adults. Mucoepidermoid carcinoma (MEC) represents the most common malignant tumor of the salivary glands. It is critical to differentiate such tumors from common benign salivary gland lesions. The purposes of this report are to present the case of a 15-year-old female with MEC of the palate, and to discuss the importance of a thorough intraoral examination on all patients regardless of age, as well as the need for timely referral for appropriate diagnosis and treatment.

MRI criteria for the diagnosis of pleomorphic adenoma: a validation study

OBJECTIVES

To validate an MRI algorithm characteristic of pleomorphic adenoma (PA).

STUDY DESIGN

Cross-sectional analysis.

SETTING

Academic tertiary-care medical center.

METHODS

A radiologic algorithm for the MRI diagnosis of PA was developed on the basis of five "high probability" criteria that all must be fulfilled for the MRI to qualify as a positive test result: bright T2-signal, sharp margins, heterogeneous nodular enhancement, lobulated contours, T2-dark rim. We then identified MRI images from our institutional database to test the diagnostic accuracy of the proposed algorithm.

RESULTS

A total of 103 parotidectomy cases with adequate MRI studies were identified (pleomorphic adenoma n=41, mucoepidermoid carcinoma n=11, Warthin's tumor n=8, adenoid cystic carcinoma n=6, oncocytoma n=6, acinic cell carcinoma n=5, salivary duct carcinoma n=5, and other n=21). Eighteen of 21 cases that met all five "high probability" MRI criteria were consistent with PA on final histopathology; 3 were consistent with carcinoma. MRI had a specificity of 95.1% [95% confidence interval: 85.6-98.7%] and sensitivity of 43.9% [95% C.I.: 28.8-60.1%] for PA. The positive predictive value was 85.7% [95% C.I.: 70.4-100%] and the negative predictive value was 71.9% [95% C. I.: 62.0-81.9%]. The overall diagnostic accuracy was 74.8% [95% C.I.: 66.2-83.3%].

CONCLUSION

A "high probability" MRI is about 95% specific for pleomorphic adenoma. A subset of patients with MRI imaging that is highly suggestive of PA may reliably avoid further workup. The value of MRI in this setting is especially useful if preoperative fine needle aspiration is not readily available. A significant proportion of PAs, however, have indeterminate imaging features that overlap considerably with other benign and malignant lesions.

Fine-needle aspiration cytology of mammary analog secretory carcinoma masquerading as low-grade mucoepidermoid carcinoma: case report with a review of the literature

BACKGROUND/AIM

The primary role of fine-needle aspiration cytology (FNAC) of salivary gland masses is to determine the underlying process and guide further management. The objective of our study is to provide a comprehensive review of cytologic features and ancillary studies of mammary analog secretory carcinoma (MASC), discuss differential diagnosis and review recent advances in the understanding of its biologic behavior.

CASE

A 23-year-old female underwent ultrasound-guided FNA of a slowly enlarging parotid mass. Smears displayed branching clusters of bland vacuolated polygonal cells in a secretory proteinaceous background. Eosinophilic cells with eccentric nuclei and inconspicuous nucleoli were also noted. Based on positive intracellular mucin staining and the lack of extracellular-matrix material, the cytologic diagnosis rendered was 'suspicious for low grade mucoepidermoid carcinoma'. Superficial parotidectomy revealed an MASC confirmed by fluorescence in situ hybridization (FISH) studies for ETV6 translocation.

CONCLUSION

MASC should be included in the differential diagnosis of mucinous salivary lesions with cystic changes on FNA. Immunohistochemistry for mammaglobin and S-100 helps in excluding morphologic mimics. FISH helps to confirm the diagnosis. Age alone should not be a deterrent in diagnosing a carcinoma.

[Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid gland]

The paper characterizes sclerosing mucoepidermoid carcinoma with eosinophilia, a rare thyroid tumor, including histological and immunohistochemical features. The authors give their observation of a 26-year-old patient. The immunohistochemical findings (positive p63 and TTF-1 tumor cell nuclear staining) show the dual nature of a tumor arising from the cells of the ultimobranchial body and follicular epithelium.

Intraosseous mucoepidermoid carcinoma of jaws: report of 24 cases

OBJECTIVE

Intraosseous mucoepidermoid carcinoma of jaws is rare, and management of the disease remains poorly understood. The aim of this study was to assist the diagnosis and treatment of the tumor.

STUDY DESIGN

The records of clinical data and follow-up information were collected from 1996 to 2010 and retrospectively analyzed for clinical features, surgical intervention, and prognosis.

RESULTS

Of 24 cases, 15 were male, and the average age was 47.33 years. The clinical presentation of this tumor varied. For primary lesions and neck nodes, radical surgery was performed; radiotherapy or chemotherapy was administered after operation. The survival rate of all patients was 66.7%. The average survival period was 53.3 months after surgery.

CONCLUSIONS

Diagnosis should be based on clinical and pathologic manifestations, surgery is the first choice for patient treatment, and radiotherapy may improve prognosis and therefore should be recommended in postoperative period.

Atypical presentation of mucoepidermoid carcinoma after radiation therapy for the treatment of keloids

Radiation therapy to the head and neck for the treatment of benign diseases carries the potential for the late development of carcinoma. Low-dose radiation has been used as an adjunctive treatment for recurrent keloids, especially massive keloids, but the carcinogenic potential of ionizing radiation in this setting remains controversial. We report the case of a 37-year-old black woman with a history of severe earlobe keloids who had been first treated with resection and postoperative radiation at the age of 9 years. When she had reached the age of 36 years, she required reoperation for massive keloid scarring, after which she underwent a second course of postoperative radiation to the right side of her face and neck. Some 20 months after the second administration of radiation therapy, she developed a mucoepidermoid carcinoma in the right parotid gland. The tumor was successfully treated with surgery.

Re-evaluating historic cohort of salivary acinic cell carcinoma with new diagnostic tools

Mammary analogue secretory carcinoma (MASC) was recently identified as a distinct salivary gland neoplasm, morphologically resembling intercalated duct cell predominant acinic cell carcinoma (AciCC). To determine how frequently MASC has mimicked an intercalated duct cell predominant AciCC, we reviewed AciCC diagnosed from 1956 to 1975. Nine AciCC consecutively diagnosed in that period were identified. Based on morphologic examination, one case diagnosed as AciCC in a male patient in 1960 was re-classified as MASC [confirmed by fluorescence in situ hybridization (FISH) showing ETV6 translocation]. Another case diagnosed as AciCC of the palate in a female patient in 1975 was re-classified as mucoepidermoid carcinoma (based on the lack of acinar differentiation, presence of mucous cells, and confirmed by FISH showing MAML2 translocation). In this proof-of-principle study, we show that 1 in 9 cases historically designated as AciCC represents a MASC. "Intercalated duct cell predominant AciCC", especially among male patients, most likely represent examples of MASC. For anatomic sites outside of the parotid glands, broader differential diagnoses should be considered before accepting morphologic variants of AciCC as the final diagnosis.