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Kuo YC, Lee JJ, Wee SJ. Free Fibular Osteocutaneous Flap Combined With Simultaneous Tendon Reconstruction for Midfoot Restoration After Myoepithelial Carcinoma Resection. Ann Plast Surg 2024; 93:339-342. [PMID: 39016285 DOI: 10.1097/sap.0000000000004028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
ABSTRACT Myoepithelial carcinomas of soft tissue are rare, and most are malignant. The optimal treatment is surgical excision. The arches of the foot are a composite structure responsible for weight bearing and pressure distribution, so it is a vast challenge in reconstruction. We report a case of reconstruction of the midfoot with a free fibular bone flap and tendon graft. We review the literature to compare various options in foot reconstructions and sort out the outcomes of different bone flaps. The free fibula osteocutaneous flap is the superior choice for midfoot reconstruction owing to its sufficient length, strength, flexible skin paddles, easy-to-withstand osteotomy, and simultaneous tendon graft harvesting.
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Affiliation(s)
- Yu-Chen Kuo
- From the Department of Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Jian-Jr Lee
- Department of Plastic and Reconstruction Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Shyun-Jing Wee
- Department of Plastic and Reconstruction Surgery, China Medical University Hospital, Taichung City, Taiwan
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Gui L, He X, Zhu Y, Zhang Y, Tang L, Yao J. Effect of Primary Site and Treatment Modality of Patients With Head and Neck Myoepithelial Carcinoma on Survival. Clin Oncol (R Coll Radiol) 2024; 36:e171-e181. [PMID: 38664176 DOI: 10.1016/j.clon.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 06/03/2024]
Abstract
AIM Epidemiological evidence on myoepithelial carcinoma is rare. This study aimed to investigate the effect of tumor primary site and treatment modality on survival in patients with head and neck myoepithelial carcinoma. MATERIALS AND METHODS Data on adult patients diagnosed with head and neck myoepithelial carcinoma between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Uni- and multivariable Cox proportional hazard models were utilized to evaluate the effects of different tumor primary sites and treatment modalities on overall survival (OS) and cancer-specific survival (CSS), and expressed as hazard ratio (HR) and 95% confidence interval (CI). RESULTS A total of 415 patients were enrolled. No significant differences in OS and CSS were found between different tumor primary sites (P > 0.05). Compared with partial excision, patients with total excision (HR = 1.65, 95%CI: 1.12-2.42) (partial or total removal of the organ in which the tumor is located and complete removal of the tumor) or no surgery (HR = 3.52, 95%CI: 2.05-6.03) had worse OS. Compared with surgery only, patients with radiotherapy only had poorer OS (HR = 4.69, 95%CI: 2.32-9.46) and CSS (HR = 6.72, 95%CI: 2.59-17.46), while no significant differences in OS (P = 0.120) and CSS (P = 0.847) were found among patients who received surgery combined with radiotherapy. In patients with AJCC III/IV, patients with radiotherapy only (HR = 4.51, 95%CI: 1.61-12.62) had poorer OS compared to those with surgery only, whereas patients who received surgery combined with radiotherapy had better OS (HR = 0.50, 95%CI: 0.29-0.89). CONCLUSION The tumor primary site may not affect the prognosis of patients with myoepithelial carcinoma, while the effect of treatment modality on prognosis is related to the primary site and stage of the tumor.
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Affiliation(s)
- L Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
| | - X He
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Y Zhu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Y Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - L Tang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - J Yao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Wu Y, Xu W, Lu H, Liu L, Liu S, Yang W. Clinicopathological features and prognostic factors of salivary gland myoepithelial carcinoma: institutional experience of 42 cases. Int J Oral Maxillofac Surg 2024; 53:268-274. [PMID: 37591716 DOI: 10.1016/j.ijom.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
Myoepithelial carcinoma (MECA) is a rare type of carcinoma for which the clinicopathological features and prognostic factors have not yet been fully clarified. A retrospective study of 42 patients diagnosed with salivary gland MECA was performed, focusing on the clinicopathological features and prognostic factors. Of the 42 patients, 20 died of cancer, 20 lived without tumour, one lived with distant metastasis, and one was lost to follow-up. Overall, 69.0% had tumour recurrence, 16.7% had cervical nodal metastasis, and 21.4% had distant metastasis. The 5-year overall survival rate was 70.2%. Kaplan-Meier analysis revealed that patients with pathological positive lymph nodes (pN+), multiple recurrences of tumour, and higher histological grade had worse overall survival. Multivariate Cox analysis indicated pN+ and higher histological grade to be independent predictors of decreased survival. The 5-year overall survival rate in the pN0 group was 87.5%, while that in the pN+ group was 28.6%. In conclusion, myoepithelial carcinoma can be defined as a tumour with a high incidence of recurrence and poor prognosis, especially in pN+ patients. Pathological positive lymph nodes and histological grade may serve as predictors of survival.
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Affiliation(s)
- Y Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China.
| | - W Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China.
| | - H Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China.
| | - L Liu
- Department of Oral Pathology,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - S Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China.
| | - W Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China.
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4
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Tay WJ, Tan GZL, Wu B, Petersson F. Oncocytic low-grade myoepithelial carcinoma ex pleomorphic adenoma - A rare case illustrating key learning points. Ann Diagn Pathol 2022; 60:152011. [PMID: 35905533 DOI: 10.1016/j.anndiagpath.2022.152011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oncocytic myoepithelial carcinoma ex pleomorphic adenoma neoplastic is a rare neoplastic event and may not display overt malignant radiological features. METHODS Using routine histopathology and immunohistochemistry, we characterize a case of low-grade oncocytic carcinoma ex pleomorphic adenoma. RESULTS The tumor arose in the left parotid gland in a 59 year old female. Computed tomography (CT) imaging demonstrated a well-defined, lobulated, enhancing lesion with relative central stellate hypoenhancement. Histologically, the tumor displayed a multi-nodular, non-destructive, invasive pattern, low mitotic activity (one mitotic figure per 10 high power fields) and a small remnant focus of pleomorphic adenoma. The neoplastic cells showed significant expression of cytokeratin 5/6, S-100 protein, smooth muscle actin and p63. CONCLUSION Low-grade oncocytic carcinoma ex pleomorphic adenoma is a challenging histopathological diagnosis which can be established with use of immunohistochemistry, generous tumor sampling and recognition of the multi-nodular, non-destructive, pattern of invasion. In the absence of clear-cut tumor encroachment into external structures, its malignant nature may not be easily identified on pre-operative imaging.
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Affiliation(s)
- Wan Jing Tay
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Gideon Ze Lin Tan
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Fredrik Petersson
- Department of Pathology, National University Health System, Singapore, Singapore.
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Wang JQ, Deng RX, Liu H, Luo Y, Lu MM, Yang ZC. Malignant Myoepithelioma of the Head and Neck: Demographics, Clinicopathological Characteristics, Treatment, and Prognosis. Front Oncol 2022; 12:754967. [PMID: 35847870 PMCID: PMC9279609 DOI: 10.3389/fonc.2022.754967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 05/20/2022] [Indexed: 11/26/2022] Open
Abstract
Malignant myoepithelioma of the head and neck (HNMM) is a rare malignancy, and its characteristics and survival rates have not been well-defined. This study aimed to define the epidemiology of HNMM and identify the prognostic factors associated with the disease. Data on all patients diagnosed with HNMM between 1991 and 2016 were gathered from the Surveillance Epidemiology and End Results (SEER) database. The demographics, clinicopathological characteristics, treatment, and prognoses of the patients were described. Cox regression analysis was used to identify the prognostic factors, and the prognostic nomograms for overall survival (OS) and disease-specific survival (DSS) were constructed. A total of 333 cases of HNMM were identified. The average age at diagnosis was 60.6 years, and 50.1% of the patients were men. After diagnosis, 46.2% of patients underwent surgery alone, 43.5% of patients underwent surgery and radiotherapy, and 3.6% of patients received only radiotherapy. Survival analysis showed that the 5-year OS and DSS for all HNMM patients were 69.7 and 82.1%, respectively. In the multivariate analysis model, the undifferentiated pathological grade (P <0.05) and M1 in the M category (P <0.01) were independent prognostic factors for poor OS and DSS, whereas the use of surgical resection was an independent favorable prognostic factor for both OS and DSS (P <0.05). The prognostic nomograms for OS and DSS prediction were constructed; the C-index values for OS and DSS prediction were 0.78 (95% CI 0.70–0.86) and 0.79 (95% CI 0.67–0.90), respectively. In conclusion, this SEER data-based study demonstrated that HNMM patients often had a favorable prognosis, and distant metastasis, pathological grade, and the use of surgery contributed to their survival. Furthermore, we developed a prognostic nomogram to predict OS and DSS for HNMM patients to aid physicians in the clinical management of this rare disease.
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Affiliation(s)
- Jia-Qi Wang
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Rong-Xin Deng
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Hui Liu
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yuan Luo
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Meng-Meng Lu
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Zhi-Cheng Yang
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- *Correspondence: Zhi-Cheng Yang,
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Myoepithelial carcinoma of major salivary glands: Analysis of population-based clinicopathologic and prognostic features. Transl Oncol 2022; 20:101410. [PMID: 35417814 PMCID: PMC9018141 DOI: 10.1016/j.tranon.2022.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 11/20/2022] Open
Abstract
The demographic features of major salivary glands myoepithelial carcinoma has been analyzed using propensity score-matching. The correlation between tumor stage and prognostic for patients with myoepithelial carcinoma is conformed. The radiotherapy is a favorable factor for overall survival in patients with myoepithelial carcinoma.
Background This study aimed to investigate the effect of demographic characteristics and disease stage on the survival outcomes of patients with myoepithelial carcinoma (MECA) of the salivary glands, and to assess the role of radiotherapy in these patients. Methods The Epidemiology, Surveillance and End Results database was queried from 2000 to 2018 to identify patients with MECA. Data pertaining to the tumor stage, size, histological grade, and demographic characteristics were analyzed. The relationship between clinicopathological features and overall survival (OS) was assessed using statistical analyses. Results In total, 290 patients (137 men and 153 women) were identified. The parotid gland was the most common tumor location (76.6% patients). Approximately half of the patients had locally advanced tumors, and 14.5 and 6.6% had lymph node and distant organ involvement, respectively. The median OS was 142 months, while the survival rates at 120 months and 180 months were 53% and 39%, respectively. In the cohort, 160 patients (55.2%) underwent surgery alone, while 130 patients (44.8%) underwent surgery combined with radiotherapy. Multivariate Cox analysis revealed that histopathological grade, stage, T3 stage (hazard ratio [HR]: 2.47, P = 0.039), T4 stage (HR: 3.33, P = 0.011), N2 stage (HR: 6.59, P = 0.002), and M1 stage (HR: 2.72, 95%confidence interval [CI]: 1.03–7.19; P = 0.044) were associated with poor prognosis. Radiotherapy (HR: 0.58, P = 0.042) was a favorable factor for OS, and it reduced the mortality risk by 42%. Conclusions Histological grade, stage, and radiotherapy are independent risk factors for OS. The decision to administer chemotherapy for MECA should be made with caution. Adjuvant radiotherapy is recommended in high-risk patients.
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Liu Y, Mi Y, Zhang L, Gong Q, Jiang T. Prognostic analysis and establishment of a nomogram in patients with myoepithelial carcinoma of the salivary gland: A population-based study. Laryngoscope Investig Otolaryngol 2022; 7:125-134. [PMID: 35155790 PMCID: PMC8823152 DOI: 10.1002/lio2.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/26/2021] [Accepted: 12/11/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Currently, the clinicopathological characteristics and prognosis of myoepithelial carcinoma of salivary gland (MC-SG) have not been defined well. The present study aimed to describe the clinicopathological characteristics and prognosis of MC-SG patients. METHODS The Surveillance, Epidemiology, and End Results database was searched for all patients diagnosed with MC-SG between 1991 and 2016. The Kaplan-Meier method and log-rank tests were used to evaluate the survival. Univariate and multivariate Cox regression analysis were used to identify prognostic biomarkers for overall survival (OS) and disease-specific survival (DSS). Furthermore, a prognostic nomogram was established, and its predictive accuracy and discriminative ability were determined using the concordance index (C-index). RESULTS In total, 245 patients diagnosed with MC-SG were identified. The median OS was 152.0 months, with 3-, 5-, and 10-year survival rates of 79.8%, 69.2%, and 50.3%. The 3-, 5-, and 10-year DSS rates were 82.5%, 77.1%, and 61.9%, respectively. Regarding the treatment regimen, most patients (92.2%) underwent surgery, and 103 patients (42.4%) received postoperative radiotherapy. Surgery could significantly prolong OS and DSS (p < .05), but postoperative radiotherapy did not significantly prolong OS and DSS when compared with individuals receiving surgery alone (p > .05). Multivariate Cox analysis revealed that T category (T4), lymph node metastasis (N2), distant metastasis (M1), and poor differentiation were independent unfavorable prognostic factors for OS and DSS. Older age (>62 years) was also independently associated with OS. In addition, the C-index for the established OS- and DSS-specific nomogram was 0.80 (95% CI: 0.72-0.88) and 0.82 (95% CI: 0.73-0.90). CONCLUSION Age, tumor invasion, metastases, and pathological grade were independently associated with prognosis of MC-SG patients, and the prognostic nomogram of this rare disease was established.
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Affiliation(s)
- Ying Liu
- Center for Esthetic DentistryJinan Stomatological HospitalJinanChina
| | - Yong Mi
- Dental LaboratoryJinan Stomatological HospitalJinanChina
| | - Li Zhang
- Center for Esthetic DentistryJinan Stomatological HospitalJinanChina
| | - Qi Gong
- Center for Esthetic DentistryJinan Stomatological HospitalJinanChina
| | - Tao Jiang
- Center for Esthetic DentistryJinan Stomatological HospitalJinanChina
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Prognostic analysis and nomogram establishment in patients with head and neck myoepithelial carcinoma. Eur Arch Otorhinolaryngol 2022; 279:4093-4102. [DOI: 10.1007/s00405-022-07269-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
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Bravo Thompson H, Lim Law M, Vergara Vasquez R, Castillo Fernandez O. Parotid Myoepithelial Carcinoma in a Pediatric Patient with Multiple Recurrences: Case Report. Case Rep Oncol 2021; 14:989-997. [PMID: 34326733 PMCID: PMC8299374 DOI: 10.1159/000515783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Myoepithelial carcinoma of the salivary glands is a rare entity, with scarce amount of case reports in the literature. Due to its infrequency, its diagnosis is usually difficult and uncertain. Although there are reports of locoregional recurrences and distant metastases, its low incidence and varied biological behavior limits the clinical evidence that can be used to predict the prognosis and determine the course of treatment. We present a 23-year-old female patient without past medical history with an initial 1-year history of volume increase in the right parotid region of tumor aspect and painful on palpation. As a malignancy was suspected, a total parotidectomy was performed, reporting in the deep lobe a parotid myoepithelial carcinoma with vascular and neural invasion, negative borders, and 3–9 negative regional nodes. During her 16-year clinical evolution, she presented approximately every 2 years and a total of 9 locoregional recurrences and hepatic metastases, including cervical lymphoid nodules, temporal bone, frontal bone, and temporal fossa. Those recurrences have been treated with coordinated efforts between repeated external radiotherapy, chemotherapy, and multiple surgical resections. Myoepithelial tumors represent only 1.0–1.5% of all salivary gland tumors. The literature reports suggest a high incidence of locoregional recurrences and distant metastases in de novo myoepithelial carcinomas. Due to its rarity, treatment continues to be based on the experience of medical staff.
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Affiliation(s)
| | - Maria Lim Law
- Clinical Oncology, National Cancer Institute, Panama City, Panama
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Dekhou A, Rehman R, Parzen JS, Quinn TJ, Zhang PL, Rontal M, Noujaim S, Tapia M, Deraniyagala R. Primary Parotid Tumor Thrombosis: Immunohistologic Features and Awareness of Metastatic Potential. Cureus 2021; 13:e16174. [PMID: 34367782 PMCID: PMC8336355 DOI: 10.7759/cureus.16174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 12/03/2022] Open
Abstract
Tumor thrombosis is a poor prognostic feature and an exceptionally rare occurrence in salivary gland malignancies. We present a case of primary parotid myoepithelial carcinoma (MC) with tumor thrombosis in the external jugular vein (EJV). An 82-year-old man presented with a right-sided facial mass. MRI with and without gadolinium demonstrated a mass of the right parotid gland with a filling defect of the right EJV. The patient underwent right parotidectomy and selective neck dissection. Tumor thrombosis was found intraoperatively within the EJV. Final pathology demonstrated a poorly differentiated MC. Adjuvant radiation therapy without concurrent systemic therapy was administered. Three months later, restaging positron emission tomography (PET) with CT revealed numerous bilateral pulmonary nodules with biopsy, demonstrating poorly differentiated MC without locoregional relapse. Given that primary parotid tumor thrombosis is associated with a poor prognosis, the use of early systemic therapy should be investigated.
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Affiliation(s)
- Antonio Dekhou
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Rafey Rehman
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Jacob S Parzen
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
| | - Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
| | - Ping L Zhang
- Department of Pathology, Beaumont Health, Royal Oak, USA
| | - Matthew Rontal
- Department of Otolaryngology, Beaumont Health, Royal Oak, USA
| | - Samir Noujaim
- Department of Radiology, Beaumont Health, Royal Oak, USA
| | - Martin Tapia
- Department of Hematology Oncology, Beaumont Health, Royal Oak, USA
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Tenner E, Menke-Lechner E, Edlinger S, Kitzwoegerer M, Sprinzl G. [Myoepithelial carcinoma of the parotid gland: a rare tumor with diagnostic challenges]. Wien Med Wochenschr 2021; 172:35-39. [PMID: 33512620 DOI: 10.1007/s10354-020-00811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
We report on the occurrence of a myoepithelial carcinoma (MC) of the parotid gland in a 58-year-old female patient, 6 years after total parotidectomy of a locoregional myoepithelioma. Due to the rapid growth in the former resection area, panendoscopy and tumor extirpation of the right parotid region were performed. From a histomorphological and cytomorphological point of view, a hyalinized clear cell carcinoma of the salivary gland was originally diagnosed. After further immunohistochemical investigations and preparation of deeper section levels the morphological picture and immunohistochemical expression pattern corresponded to a myoepithelial carcinoma of the salivary gland, with focal lateral excision margins. Based on the radiological impression of suspicious lymph nodes during the staging examinations and the perineural invasion in the histological findings, modified radical neck dissection of the ipsilateral levels I-V was performed. All lymph nodes were histologically negative. An adjuvant radiotherapy was then initiated. The patient is tumor-free 7 months after surgery and after completing the adjuvant radiation treatment. Clinical assessment of the facial nerve showed House-Brackmann grade 5 facial palsy. The aim of this case report is to describe the difficulties in the diagnostics and treatment of this rare entity.
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Affiliation(s)
- Elias Tenner
- Klinische Abteilung für Hals‑, Nasen‑, Ohrenkrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich
| | - Edda Menke-Lechner
- Klinische Abteilung für Hals‑, Nasen‑, Ohrenkrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich
| | - Stefan Edlinger
- Klinische Abteilung für Hals‑, Nasen‑, Ohrenkrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich
| | - Melitta Kitzwoegerer
- Institut für klinische Pathologie und Molekularpathologie, Karl Landsteiner Privatuniversität, Dunant-Platz 1, 3100, St. Pölten, Österreich
| | - Georg Sprinzl
- Klinische Abteilung für Hals‑, Nasen‑, Ohrenkrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich
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12
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Wei X, Lin P, Zhang S, Li L, Wang W. Two cases of rare thyroid malignancy-case report. Gland Surg 2021; 10:386-394. [PMID: 33633996 DOI: 10.21037/gs-20-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report 2 cases of rare thyroid malignancy: angiosarcoma and myoepithelial carcinoma (MC). Thyroid angiosarcomas (TAS) is extremely rare and comprises less than 1% of primary thyroid cancer worldwide. MC usually presents as a slow-growing painless mass arising in the salivary glands. It has not been reported in the thyroid gland. The first case describes a 59-year-old patient who was admitted to hospital with the discovery of thyroid nodule for 1 month. The tumor thrombus was found in the left internal jugular vein and superior thyroid artery during the operation. Diagnosis of angiosarcoma of the thyroid was based on positive endothelial markers such as thrombomodulin and CD31 after total thyroidectomy. The left internal jugular vein, left recurrent laryngeal nerve and anterior cervical banding muscle were invaded by thyroid tumor. No lymph node metastasis was observed. The patient died after 4 years. The second case describes a 55-year-old woman who presented with the discovery of thyroid nodule for 1 month. Right thyroid lobectomy and right neck lymph node functional dissection were carried out. The results from postoperative pathology revealed that papillary carcinoma in right lobe of thyroid and MC next to thyroid were found. Besides, the metastasis of MC was observed at right II-IV level and right VI level. Five years later, the patient was re-admitted to hospital, primarily due to the discovery of anterior cervical tumor for one year. Then, she underwent left thyroid lobectomy and right tumor resection. Postoperative routine pathology showed recurrent MC in the right thyroid. After surgery and radiotherapy, the patient was followed up for 2 years. Angiosarcoma and myoepithelioma should be kept in mind in diagnosis of thyroid malignant tumor.
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Affiliation(s)
- Xianfeng Wei
- Department of Otolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China.,Tianjin Institute of Otolaryngology, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Key Clinical Discipline of Tianjin Otolaryngology, Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Peng Lin
- Department of Otolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China.,Tianjin Institute of Otolaryngology, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Key Clinical Discipline of Tianjin Otolaryngology, Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Shengchi Zhang
- Department of Otolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China.,Tianjin Institute of Otolaryngology, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Key Clinical Discipline of Tianjin Otolaryngology, Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Li Li
- Department of Otolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China.,Tianjin Institute of Otolaryngology, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Key Clinical Discipline of Tianjin Otolaryngology, Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Wei Wang
- Department of Otolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China.,Tianjin Institute of Otolaryngology, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Key Clinical Discipline of Tianjin Otolaryngology, Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
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13
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Myoepithelial Tumors of Salivary Gland: A Clinicopathologic and Immunohistochemical Study of 15 Patients with MIB-1 Correlation. Head Neck Pathol 2020; 15:479-490. [PMID: 32959208 PMCID: PMC8134606 DOI: 10.1007/s12105-020-01225-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
Myoepithelial neoplasms are rare tumors of the salivary glands with predominant myoepithelial differentiation and a broad histologic spectrum. Their histological features, immunohistochemical profile and biological behavior are not well characterized and pose a diagnostic challenge. A total of 15 myoepithelial tumors, diagnosed during 2012 and 2019 were subcategorized and correlated with MIB-1 labeling index (LI) and various histological parameters. Immunohistochemical stains for MIB-1 and other antibodies were performed. Statistical analysis was done by chi-square test, Fisher's exact test and Kaplan Meier curve. Nine patients were male and six were female with the median age of 44 years (range 21-83 years). Of the 15 patients, 6 cases were classified as myoepithelioma (ME) and 9 cases as myoepithelial carcinoma (MECA). Parotid gland was the most common site (46.7%) followed by the palate. MEs showed well circumscribed tumor borders whereas MECAs exhibited focal capsular to extensive invasion into adjacent tissues. Epithelioid cell morphology was most common followed by mixed cell morphology. MIB-1 LI was significantly associated with invasive tumor borders, necrosis and high mitosis. Increased frequency of recurrence was noted with high MIB-1 LI, though it was not statistically significant. MIB-1 LI was high in nearly all MECAs with focal capsular to extensive invasion while low in MEs. Myoepithelial tumor with multinodular growth pattern and focal capsular invasion may have an indolent behavior if mitotic activity and MIB-1 LI is low. Early diagnosis and treatment of MECAs significantly improves the patient's survival and prognosis.
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Bisceglia M, Panniello G, Nirchio V, Sanguedolce F, Centola M, Ben-Dor DJ. Metastatic Cutaneous Basal Cell Carcinoma: Report of 2 Cases Preceding the Hedgehog Pathway Antagonists Era. Adv Anat Pathol 2020; 27:98-111. [PMID: 31895095 DOI: 10.1097/pap.0000000000000259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. However, metastatic BCC is a very rare event with weakly effective therapeutic options and a poor prognosis, until a few years ago. In 2012, small-molecule therapies, capable of inactivating the hedgehog signaling pathway and thus reducing tumor growth and progression, were introduced into clinical practice for the treatment of patients with advanced BCC. We present retrospectively 2 personal cases of metastatic BCC of the skin, from the premolecular therapy era, from primary tumors that arose years before in the head and neck area. The former case occurred in a 45-year-old woman with a history of recurrent BCC of the retroauricular skin who eventually died due to diffuse metastatic spread. The latter case concerned a 70-year-old man also with a history of recurrent BCC of the nasal-perinasal skin who developed multiple subcutaneous and lymph node metastases in the neck. In both cases, the diagnoses were based on biopsies of the metastatic sites. The first patient died 5 months after the diagnosis of metastatic disease, while the second was alive and disease-free 2 years after neck lymph node dissection and external radiation therapy, and then lost to follow-up. We extensively discuss several tumor entities with basal or basaloid features that may enter the differential diagnosis with BCC in metastatic sites. In addition, we briefly summarize the advances in clinical therapeutics using small molecules, which are now an integral part of the treatment of such advanced BCC cases.
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15
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Roos ME, Claassen J, Booysen G, van den Heever J, Seedat RY. 3D printed titanium prosthesis reconstruction following subtotal maxillectomy for myoepithelial carcinoma - a case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:175-178. [PMID: 30922711 DOI: 10.1016/j.jormas.2019.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 03/18/2019] [Indexed: 01/28/2023]
Abstract
We present the case of a 43 year old male with a myoepithelial carcinoma of the hard palate who underwent a subtotal maxillectomy, resulting in a significant midfacial defect. The defect was successfully reconstructed with a titanium prosthesis using Additive Manufacturing (AM), better known as 3D printing; the process used to manufacture the prosthesis being Direct Metal Laser Sintering (DMLS). A maxillary denture was fitted onto the titanium DMLS frame post-operatively. This method of reconstruction of a large midfacial defect proved to be successful both functionally and cosmetically, and resulted in a good quality of life 3 years post-operatively.
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Affiliation(s)
- M E Roos
- Department of Otorhinolaryngology, University of the Free State and Universitas Academic Hospital, Bloemfontein, South Africa.
| | - J Claassen
- Department of Otorhinolaryngology, University of the Free State and Universitas Academic Hospital, Bloemfontein, South Africa
| | - G Booysen
- Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Bloemfontein, South Africa
| | - J van den Heever
- Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Bloemfontein, South Africa
| | - R Y Seedat
- Department of Otorhinolaryngology, University of the Free State and Universitas Academic Hospital, Bloemfontein, South Africa
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16
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Lubin D, Song S, Zafar HM, Baloch Z. The key radiologic and cytomorphologic features of oncocytic and oncocytoid lesions of the salivary gland. Diagn Cytopathol 2019; 47:617-636. [PMID: 30912629 DOI: 10.1002/dc.24175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/18/2022]
Abstract
Oncocytic and oncocytoid lesions represent a distinct subset of salivary gland lesions. True oncocytic lesions of the salivary gland are entirely composed of oncocytes. These are characterized by the presence of abundant eosinophilic granules due to the presence of abundant cytoplasmic mitochondria. Oncocytic lesions of the salivary gland include oncocytosis, oncocytoma, and oncocytic carcinoma. In addition to the true oncocytic lesion, there exists another group of salivary gland lesions, which demonstrate cells with abundant and occasionally granular cytoplasm. These are often termed as "oncocytoid" lesions. The recently proposed Milan System for reporting salivary gland cytology clearly states that fine-needle aspiration specimens representing oncocytic/oncocytoid lesions of salivary gland cannot effectively distinguish between a nonneoplastic lesion, benign and malignant neoplasms. Therefore, most lesions lacking classic cytomorphologic features will be classified under the umbrella diagnostic term of "Salivary Gland Neoplasm of Uncertain Malignant Potential" (SUMP). In this review, we discuss and illustrate key clinicopathologic and radiologic features that can help the practicing cytopathologist narrow down the differential and provide the best management based diagnosis.
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Affiliation(s)
- Daniel Lubin
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sharon Song
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Hanna M Zafar
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Zubair Baloch
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Wakasaki T, Kubota M, Nakashima Y, Tomonobe E, Mihara T, Fukushima J. Invasive myoepithelial carcinoma ex pleomorphic adenoma of the major salivary gland: two case reports. BMC Cancer 2016; 16:827. [PMID: 27793123 PMCID: PMC5084397 DOI: 10.1186/s12885-016-2871-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/21/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Myoepithelial carcinoma (MEC) is a rare salivary gland tumor. Its long-term prognosis remains unknown because of the paucity of reported cases with long-term follow-up. Although some case series exist, the clinical features of MEC vary considerably depending on the site of origin. Therefore, accumulation of these rare cases is important. CASE PRESENTATION Case 1: An 89-year-old man presented with a 10-year history of a mass originating from the right parotid gland and involving the neck. The mass grew rapidly for 3 months, reaching approximately 8 cm. There was no facial paralysis. MEC ex pleomorphic adenoma (PA) was suspected. Superficial parotid gland resection was performed in 2013; the tumor grade was pT3N0M0, and the resection margins were free of carcinoma. Because of several high-risk factors for metastasis (i.e., invasive carcinoma ex PA, high MIB1 index, and mutant p53 protein positivity), radiotherapy and chemotherapy were recommended as adjuvant therapy. Although the patient refused adjuvant therapy, he was recurrence-free at 36 months after surgery. Case 2: A 54-year-old woman presented with a >10-year history of a right submandibular mass, which grew rapidly for 1 year, reaching approximately 6 cm. Preoperative diagnosis was PA of the right submandibular gland. Submandibular gland resection was performed in 2013. Pathological analysis revealed invasive MEC ex PA, pT3N0M0; in addition, the carcinoma portion had an extra capsule and had invaded the platysma muscle close to the margin. An MIB1 index of 40 % and mutant p53 protein positivity indicated a high risk for metastasis. Additional resection and right neck dissection revealed no residual carcinoma. The patient refused adjuvant chemotherapy. One year after surgery, metastasis to the right pulmonary hilar node and both lungs were detected. Chemotherapy prevented recurrent growth of the lesion and extended survival. The patient was alive with cancer 30 months after the first surgery. CONCLUSIONS High expression of the Ki67 labeling index might reflect prognosis of these cases. Chemotherapy for distant metastasis was effective, as expected. Further accumulation of cases and long follow-up data are needed to elucidate the pathophysiology and prognosis of MEC ex PA.
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Affiliation(s)
- Takahiro Wakasaki
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan. .,Department of Head and Neck Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Miniami-ku, Fukuoka, 811-1395, Japan.
| | - Marie Kubota
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Yutaka Nakashima
- Department of Pathology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Eri Tomonobe
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Takenao Mihara
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Junichi Fukushima
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
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Yokose C, Asai J, Kan S, Nomiyama T, Takenaka H, Konishi E, Goto K, Ansai SI, Katoh N. Myoepithelial carcinoma on the right shoulder: Case report with published work review. J Dermatol 2016; 43:1083-7. [DOI: 10.1111/1346-8138.13358] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/07/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Chiharu Yokose
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Jun Asai
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Saori Kan
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Tomoko Nomiyama
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Hideya Takenaka
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Eiichi Konishi
- Department of Surgical Pathology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Keisuke Goto
- Department of Diagnostic Pathology; Kainan Hospital; Kyoto Japan
| | - Shin-ichi Ansai
- Division of Dermatology; Musashi Kosugi-Hospital; Nippon Medical School; Kyoto Japan
| | - Norito Katoh
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
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