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Hasan H, Duong DQ, Coblens O, Qiu S, Clement CG. MAML2-rearrranged sclerosing mucoepidermoid carcinoma of submandibular gland: an incidental finding in a patient with history of recurrent sialadenitis and Sjögren's syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00159-7. [PMID: 39138066 DOI: 10.1016/j.oooo.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 08/15/2024]
Abstract
The Sclerosing subtype of mucoepidermoid carcinoma is rare, with only 39 cases reported in literature. We present a new case of sclerosing mucoepidermoid carcinoma (SMEC) with MAML2 rearrangements. A 49-year-old woman with Sjögren's syndrome experienced recurrent submandibular sialadenitis and sialolithiasis, leading to the removal of her right gland. Postoperative imaging revealed a calcified mass in her left gland which was subsequently resected. The pathologic examination revealed a well-defined tumor with extensive fibrous stroma, predominantly epidermoid cells, and occasional mucinous components. There was a dense lymphocytic and plasma cell infiltrate at the tumor's periphery. Immunohistochemistry was positive for p40 and CK7, few IgG4+ plasma cells. No eosinophils were identified. Fluorescence in situ hybridization (FISH) revealed rearrangement of the MAML2 (11q21) region. Adjuvant radiation was not recommended because of the patient's history of autoimmune diseases and the fact that the tumor was small, localized, and had negative resection margins. The patient was advised to undergo a repeat CT scan of the neck, scheduled for 3 months later. This case highlights the importance of considering SMEC in the differential diagnosis of patients with sialolithiasis or Sjögren's syndrome.
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Affiliation(s)
- Hasanain Hasan
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Dinh Quoc Duong
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Orly Coblens
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Suimin Qiu
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Cecilia G Clement
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
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Shi W, Law T, Brumund KT, Chang J, Patel C, Lin G, Hu J. Low-grade mucoepidermoid carcinoma mimicking benign cystic lesions in the salivary gland: A diagnostic dilemma. Rare Tumors 2024; 16:20363613241242397. [PMID: 38525087 PMCID: PMC10960343 DOI: 10.1177/20363613241242397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Mucoepidermoid carcinoma (MEC) is a common malignancy arising in the parotid gland. The diagnosis of MEC is typically based on its morphological features alone, characteristically containing mucocytes, intermediate cells and epidermoid cells. However, when cystic degeneration is diffuse, it is challenging to distinguish MEC from other benign cystic tumors. This is a case report of a 58-year-old Caucasian man who presented with a parotid mass. H&E sections of the mass reveal multiloculated cysts lined by bland-looking epithelium with only rare papillary architectures. The papillary proliferation contains mucocytes, and epidermoid cells highlighted by the p63 immunohistochemistry study. The diagnosis was confirmed by FISH result of positive MAML2 (11q21) rearrangement. Patient underwent parotidectomy and is disease-free 6 months post-surgery. MEC with cystic degeneration is a common diagnostic pitfall which can mimic many benign lesions in the salivary gland. We present a rare case with MEC with extensive cystic change, its molecular and pathologic findings and review the diagnostic features of MEC, its benign mimickers and useful tools for distinguishing these entities.
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Affiliation(s)
- Wangpan Shi
- Department of Pathology, University of California, San Diego, CA, USA
| | - Timothy Law
- Department of Pathology, California Northstate University, College of Medicine, La Jolla, CA, USA
| | | | - Jennifer Chang
- Department of Radiology, University of California, San Diego, CA, USA
| | - Charmi Patel
- Department of Pathology, University of California, San Diego, CA, USA
| | - Grace Lin
- Department of Pathology, University of California, San Diego, CA, USA
| | - Jingjing Hu
- Department of Pathology, University of California, San Diego, CA, USA
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3
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Nakano S, Okumura Y, Murase T, Nagao T, Kusafuka K, Urano M, Yamamoto H, Kano S, Tsukahara K, Okami K, Kawakita D, Nagao T, Hanai N, Iwai H, Kawata R, Tada Y, Nibu KI, Inagaki H. Salivary mucoepidermoid carcinoma: Histological variants, grading systems, CRTC1/3-MAML2 fusions, and clinicopathological features. Histopathology 2021; 80:729-735. [PMID: 34657306 DOI: 10.1111/his.14586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/25/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the histological diversity of salivary mucoepidermoid carcinoma (MEC), its clinicopathological features, and its associations with CRTC1/3-MAML2 fusions. METHODS Salivary MEC cases (n=177) were examined for CRTC1/3-MAML2, histological variants were classified, and tumors were graded according to four different grading systems. Adverse histological features considered unusual in MEC were also investigated. RESULTS Of the 177 MEC cases, 110 were positive for CRTC1/3-MAML2. The classical variant was most frequent in the fusion-positive, fusion-negative, and all case groups. Clear/oncocytic variant was the second most frequent in the fusion-positive and total case groups. Oncocytic, Warthin-like, and spindle variants were recognized in the fusion-positive group only. Clear cell, sclerosing, mucinous, and central variants were recorded in both fusion-positive and fusion-negative groups. No case was classified as a ciliated variant, as a mucoacinar variant, or as a high-grade transformation. Compared with the classical variant, non-classical variants were characterized by frequent CRTC1/3-MAML2 fusions and a lower clinical stage in all cases. Of four histological features considered unusual in MEC, marked nuclear atypia, frequent mitoses (>10/10HPFs), and extensive necrosis were found independently of the fusion status, and accounted for 3-5% of all cases. However, none of the cases showed overt keratinization. On comparison, the AFIP and modified Healey grading systems downgraded tumors, the Brandwein system upgraded tumors, and the Memorial Sloan Kettering system provided a moderate means of assessment. CONCLUSION Recognition of the histological diversity of MEC, its clinicopathological features, and its associations with CRTC1/3-MAML2 fusions is helpful for an accurate diagnosis of this carcinoma.
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Affiliation(s)
- Satsuki Nakano
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yoshihide Okumura
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.,Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
| | - Takayuki Murase
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | | | - Makoto Urano
- Department of Diagnostic Pathology, Fujita Health University, School of Medicine, Bantane Hospital, Nagoya, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate of School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Okami
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Toru Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroshi Iwai
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Inagaki
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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Harada H, Toyozumi Y, Sasaguri T, Kuyama K, Nakatsuka SI, Kurose A. Sclerosing mucoepidermoid carcinoma of the salivary glands: report of three cases with special concern to the counterpart accompanied by eosinophilia. Med Mol Morphol 2021; 54:265-274. [PMID: 33796950 DOI: 10.1007/s00795-021-00285-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
Sclerosing mucoepidermoid carcinoma (SMC) is described as a "sclerosing variant" of mucoepidermoid carcinoma, and it is characterized by dense fibrosis and sclerosis of the stroma. SMC with eosinophilia (SMCE) is another and more rare subtype characterized by eosinophilia in addition to the sclerotic stroma common to SMC. However, unlike SMC, SMCE is not listed in the current 4th edition of WHO classification. Here, we describe three cases: one SMC in the parotid gland, one SMCE in the submandibular gland and one SMCE in the minor salivary gland of the oral cavity. The patients included a 71-year-old Japanese male, a 74-year-old Japanese female, and an 81-year-old Japanese female. They each complained of mass formation and underwent surgical resection. Histologically, the tumors mainly consisted of squamous cells with scarce keratinization that formed irregular large and small nests along with cystic structures containing mucous cells against the background of sclerotic stroma. One oral SMCE showed fine nesting and trabecular invasion. The two SMCEs included dense aggregates of eosinophils as well as more prominent lymphoid infiltration. Fluorescence in situ hybridization for MAML2 confirmed split signals in SMC, but not in SMCE.
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Affiliation(s)
- Hiroshi Harada
- Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, 5 Zaifu, Hirosaki, 036-8562, Japan.
| | - Yasuo Toyozumi
- Department of Diagnostic Pathology, Kumamoto City Hospital, Kumamoto, Japan
| | - Takakazu Sasaguri
- Department of Diagnostic Pathology, Kitakyushu General Hospital, Kitakyushu, Japan
| | - Kayo Kuyama
- Department of Pathology, Nihon University School of Dentistry at Matsudo, Matsudo, Japan
| | | | - Akira Kurose
- Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, 5 Zaifu, Hirosaki, 036-8562, Japan
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Rasul U, Bradish T, Bashir MT, Shakeel M. Sclerosing variant of mucoepidermoid carcinoma: a diagnostic challenge. BMJ Case Rep 2020; 13:13/10/e236509. [PMID: 33040037 DOI: 10.1136/bcr-2020-236509] [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: 11/03/2022] Open
Abstract
The sclerosing variant of mucoepidermoid salivary gland carcinoma is extremely rare. It is nearly impossible to diagnose this condition preoperatively. We present a case of a 23-year-old woman with a 1-year history of left parotid enlargement with inconclusive fine-needle aspiration cytology results. MRI showed an irregular parotid mass, and subsequent partial parotidectomy confirmed the diagnosis. We discuss the diagnostic pitfalls of this condition and provide a review of the literature surrounding its pathogenesis and management.
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Affiliation(s)
- Usman Rasul
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Tom Bradish
- Department of Otolaryngology, Head and Neck surgery, NHS Grampian, Aberdeen, UK
| | | | - Muhammad Shakeel
- Department of Otolaryngology, Head and Neck surgery, Aberdeen Royal Infirmary, Aberdeen, UK
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