Primary intraosseous (central) salivary gland neoplasms in jaw bones: report of a mucoepidermoid carcinoma of the mandible diagnosed by fine-needle aspiration cytology

An unusual case of intraosseous mucoepidermoid carcinoma of the mandible: A case report and literature review

RATIONALE

Mucoepidermoid carcinoma (MEC) is the most common primary salivary gland malignancy. Ectopic MEC can occur in any part of the body, however, only 2% to 4% of MEC could be detected in the jaw, which is named intraosseous mucoepidermoid carcinoma (IMC). IMC is usually a low-grade carcinoma. Uni- or multilocular radiographic lesions should be differential diagnosed with ameloblastoma, odontogenic cysts, and glandular odontogenic cyst (GOC). Radical surgery may prefer for a favorable prognosis. Whereas IMC can recur long after the operation, a long-term follow-up system should be implemented. Owing to its rarity and controversial issues, we report a case report and review the literature to discuss its clinical features, treatments, radiological, and histological characteristics.

PATIENT CONCERNS

The patient presented with a 2-month history of mild pain in the lower left posterior jaw without history of surgery or trauma to the mandible.

DIAGNOSES

Routine postoperative pathology showed that the mass was consistent with a mandibular mucoepidermoid carcinoma.

INTERVENTION

Radical surgery and digital mandibular reconstruction were performed.

OUTCOME

Postoperative imaging showed that the height of the mandible and the symmetry of the mandible were satisfactory. The patient was also satisfied with her appearance. Follow-up has been established.

LESSONS

Effective surgical treatment allows patients to have a favorable prognosis. A long-term follow-up system should be practiced, because local recurrences and regional metastasis could happen even after decades.

Intraosseous mucoepidermoid carcinoma: Outcome review

OBJECTIVE

Identify the effect of patient characteristics, disease traits, and treatment modality on patient outcomes in the rare disease process of intraosseous mucoepidermoid carcinoma.

STUDY DESIGN

Retrospective review of institutional case records and literature.

METHODS

This study includes one case report, a literature review of the MEDLINE database from 1950 through June 2017 using keywords "intraosseous" and "mucoepidermoid," and a query of the University of California, Los Angeles, Department of Pathology database for all documented cases of intraosseous mucoepidermoid carcinoma of the head and neck.

RESULTS

Indicators of poorer prognosis were male gender (P = 0.0071) and higher histological grade (P = 0.0095). Lesion site, size, association with odontogenic cyst, and treatment type did not have a statistically significant correlation with patient outcomes. There also was no statistically significant correlation observed between treatment modality and recurrent or progressive disease when stratified by histological grade of the cancer.

CONCLUSION

This study identified male gender and high histological tumor grade as poor prognostic indicators; however, it did not reveal a statistically significant relationship between treatment modality and patient outcomes. Data regarding patient outcomes following treatment was limited due to loss to follow-up, suggesting that further investigation is required. Based on this review, decisions regarding treatment should be clinically guided and individually tailored to the patient's baseline health, disease severity, and the patient's treatment goals. A multi-disciplinary conference, as was utilized in the presented case report, may be the best approach to treatment planning for these patients at this time.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:1083-1092, 2018.

Ghrelin immunohistochemistry of gastric adenocarcinoma and mucoepidermoid carcinoma of salivary gland

Ghrelin (G-HH) synthesized in several tissues including salivary and stomach glands stimulates appetite in humans by modulating neuropeptide Y neurons in the hypothalamic arcuate nucleus. Loss of appetite is one of the most important symptoms of stomach cancer. We conducted a study using immunohistochemistry to determine whether salivary glands and stomach cancer tissues produce ghrelin. We determined that negative ghrelin immunohistochemistry discriminates tumors from normal tissues and may therefore further our understanding of the clinically important problem of reduced food intake and anorexia in cancer patients. Radioimmunoassay analyses confirmed that cancer cells do not produce a G-HH peptide, whereas normal cells yield this peptide.

Imaging characteristics of neoplasms and other lesions of the jawbones

Obtaining an accurate diagnosis of odontogenic tumor-mimickers (nonodontogenic lesions masquerading as odontogenic lesions) and tumor-like lesions of the jawbones can be difficult and requires a multidisciplinary approach. Lack of familiarity with these disease processes may lead to uncertainty and errors in diagnosis, which increase the possibility of errors in treatment. Radiologists should be aware of the imaging appearances of lesions affecting the jawbones in order to provide a complete differential diagnosis and to guide clinicians in proper patient treatment. The morphologic characteristics of tumors and tumor-like lesions of the jawbones may provide key diagnostic information regarding the aggressive or nonaggressive biologic behavior of such lesions. In addition to imaging findings, thorough physical examination and, often, histologic analysis of biopsy specimens are required.