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Mishra SS, Nanda S, Ahirwar MK, Rath SM, Singh V, Chowhan A. Epithelial-Myoepithelial Carcinoma of Nasal Cavity at an Unusual Age: A Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:3305-3311. [PMID: 37974714 PMCID: PMC10645983 DOI: 10.1007/s12070-023-03974-0] [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: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 11/19/2023] Open
Abstract
Introduction Epithelial-myoepithelial carcinoma (EMC) was recognised as a distinct pathologic entity in World Health Organisation classification. It is an extremely rare low grade carcinoma of salivary gland, with characteristic biphasic tubular structures. It predominantly occurs in Parotid gland but can also be seen in nasopharynx, lacrimal gland, paranasal sinuses, larynx, lung. Nasal EMC (excluding the paranasal sinuses as primary tumour site) are very rare with only 13 cases reported till date. In this case report, we described a case of nasal EMC extending into nasopharynx, its clinical features and management. We have also done a literature review of all the relevant cases of nasal EMC. Material and Methods We searched the PubMed database for articles between January 1950 and December 2022 for nasal EMC for this review. Results We found 13 relevant case reports of nasal EMC and median age was 58 years with female preponderance. We found that our patient was the youngest to be reported till date. Two cases, including the current study, showed epicentre of the tumour in posterior nasal cavity, extending to choana and nasopharynx. Most common presentation was epistaxis, followed by nasal obstruction. Only 4 out of 14 cases had information on surgical margin status, out of which only one has positive surgical margin. Five patients (including the patient in the current study) received adjuvant radiotherapy; however 6 patients (42.8%) did not receive any adjuvant radiotherapy.
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Affiliation(s)
- Shiv Shankar Mishra
- Department of Radiotherapy, All India Institute of Medical Sciences, Raipur, Chhattisgarh India
| | - Siddhartha Nanda
- Department of Radiotherapy, All India Institute of Medical Sciences, Raipur, Chhattisgarh India
| | - Manish Kumar Ahirwar
- Department of Radiotherapy, All India Institute of Medical Sciences, Raipur, Chhattisgarh India
| | - Swaroopa Madhuri Rath
- Department of Radiotherapy, All India Institute of Medical Sciences, Raipur, Chhattisgarh India
| | - Vandita Singh
- Department of Pathology, All India Institute of Medical Sciences, Rajkot, Gujarat India
| | - Amit Chowhan
- Department of Pathology, All India Institute of Medical Sciences, Raipur, Chhattisgarh India
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Waitzman J, Waitzman A, Powers J, Deraniyagala R. Epithelial-Myoepithelial Carcinoma of the Nasal Cavity: A Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231189962. [PMID: 37522369 DOI: 10.1177/01455613231189962] [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: 08/01/2023] Open
Abstract
Epithelial-myoepithelial carcinoma is an extremely rare tumor of the nasal cavity. We present a case involving a 67-year-old female with symptoms of nasal obstruction and recurrent epistaxis. An investigation with endoscopy and CT was performed. The patient underwent endoscopic surgical resection. Microscopic positive margins were present after extensive resection. The patient underwent radiotherapy utilizing proton therapy and has been disease free for 6 months at follow-up.
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Affiliation(s)
- Jacob Waitzman
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ariel Waitzman
- Department of Otolaryngology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Otolaryngology, Corewell Health, Dearborn, MI, USA
| | - Jeremy Powers
- Department of Pathology, Corewell Health, Dearborn, MI, USA
| | - Rohan Deraniyagala
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
- Department of Radiation Oncology, Corewell Health, Dearborn, MI, USA
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Wockner RS, Seethala RR, Emeto TI, McCaul JA, Subramaniam SS. Epithelial-myoepithelial carcinoma of the maxillofacial and sinonasal region: a systematic review of presenting characteristics, treatment modalities, and associated outcomes. Int J Oral Maxillofac Surg 2023; 52:1-12. [PMID: 35667947 PMCID: PMC11227655 DOI: 10.1016/j.ijom.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland malignancy. Controversy exists in the literature regarding the effectiveness of treatment modalities employed in the management of EMC. This systematic review was undertaken to understand the presenting characteristics of EMC and identify the most common treatment modalities and their associated outcomes, in order to help guide an evidenced-based approach to the algorithm of care. The MEDLINE (PubMed) and Embase databases were searched (up to February 23, 2022), and the review was performed in accordance with the PRISMA statement. Fifty-seven studies (51 case reports and six case series) describing 91 cases of EMC were included in this review. In the included studies, a slow-growing painless mass was the most common presenting clinical feature. EMC was most frequently treated with surgery alone (65%). Local disease recurrence occurred in 24% of the cases and metastatic disease in 11%. A positive surgical margin was found to be associated with a higher risk of recurrence (P < 0.001), while adjuvant radiotherapy was associated with a decreased risk of local disease recurrence (P = 0.034). Metastatic disease and multimodal therapy were found to be associated with decreased disease-free and overall survival (all P < 0.05). The current literature supports surgery with clear margins as the mainstay of treatment for EMC of the salivary and seromucous glands of the head and neck. In certain situations, radiotherapy may improve disease-free survival.
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Affiliation(s)
- R S Wockner
- University of Otago, School of Medicine, Wellington, New Zealand.
| | - R R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - T I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - J A McCaul
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - S S Subramaniam
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Victoria, Australia; Department of Oral and Maxillofacial Surgery, Townsville University Hospital, Queensland, Australia
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Eide JG, Kshirsagar RS, Brant JA, Palmer JN, Adappa ND. A National Cancer Database Analysis of Sinonasal Malignant Myoepithelial Carcinoma Outcomes. Am J Rhinol Allergy 2022; 37:7-12. [PMID: 35971225 DOI: 10.1177/19458924221121419] [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: 11/15/2022]
Abstract
OBJECTIVES Myoepithelial carcinoma (MECA) is a rare salivary gland tumor that can occur in the sinonasal cavity with poor outcomes. There are limited data on sinonasal outcomes to guide management. We sought to use the National Cancer Database (NCDB) to better define treatment outcomes in MECA. METHODS We conducted a retrospective analysis of the NCDB from 2004 to 2016 for patients with MECA of the sinonasal cavity. Patient demographic, treatment, and survival information were extracted from the database. Unadjusted Kaplan-Meier estimates, log-rank tests, and a multivariable Cox proportional hazard model were used to assess overall survival (OS). RESULTS A total of 38 patients were included. The average age was 60.7 ± 18.2 years and male patients represented 47.4% of the cohort. Most patients were White (n = 26, 68.4%) and the majority of patients had either private insurance (n = 20, 52.6%) or Medicare (n = 15, 39.5%). The primary site of most tumors was nasal cavity (n = 19, 50%), followed by maxillary sinus (n = 16, 42.1%). Most tumors were >4 cm (n = 17, 44.7%). The 1-, 5-, and 10-year OS was 89.7% (95% confidence interval [CI]: 80.7%-99.8%), 63.6% (95% CI: 49.4%-82%), and 46.4% (95% CI: 31%-69.5%), respectively. The median survival for the overall cohort was 85.8 months. Medicare insurance was associated with a decreased OS (hazard ratio [HR]: 8.2; 95% CI: 2.88-23.4, P < .001). Patients who underwent surgery had a significant survival benefit (HR: 0.04, 95% CI: 0.01-0.21, P < .001). DISCUSSION MECA of the sinonasal cavity is a rare tumor with poorly understood behavior. Data from the NCDB suggests that it is a relatively aggressive tumor with surgical management associated with better outcomes. This analysis is limited by the small sample size and further research into optimal treatment regimens is needed.
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Affiliation(s)
- Jacob G Eide
- Department of Otorhinolaryngology - Head and Neck Surgery, 6572University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Rijul S Kshirsagar
- Department of Otorhinolaryngology - Head and Neck Surgery, 6572University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason A Brant
- Department of Otorhinolaryngology - Head and Neck Surgery, 6572University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - James N Palmer
- Department of Otorhinolaryngology - Head and Neck Surgery, 6572University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology - Head and Neck Surgery, 6572University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Dzuko Kamga J, Leclere JC, Uguen A, Amrane K, Abgral R. Case Report: Nasal Cavity Epithelial-Myoepithelial Carcinoma With High Fluoro-D-Glucose Uptake on Positron Emission Tomography/Computed Tomography. Front Med (Lausanne) 2021; 8:664520. [PMID: 34993207 PMCID: PMC8724132 DOI: 10.3389/fmed.2021.664520] [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: 02/05/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare malignant neoplasm arising most frequently in the salivary glands and exceptionally in the nasal cavity. EMC accounts for ~1–2% of salivary gland tumors. Even if the nodal and distant metastasis rates are low, tumor staging remains indicated. Here, the authors present the 2-deoxy-2-[18F]fluoro-D-glucose PET-CT (18F-FDG-PET/CT) study of a very rare case of biopsy-proven EMC of the left nasal cavity. This 18F-FDG-PET/CT was performed to stage this tumor and guide the therapeutic strategy due to an atypical high-grade presentation in immunohistochemistry. To our knowledge, this is the first case reporting such high 18F-FDG avidity of EMC of the nasal cavity in PET/CT.
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Affiliation(s)
| | | | - Arnaud Uguen
- Department of Pathology, University Hospital of Brest, Brest, France
| | - Karim Amrane
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
- EA 3878 GETBO, IFR 148, Bretagne Loire University, Brest, France
- *Correspondence: Ronan Abgral
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Sharma D, Neiweem A, Davis K, Prendes M, Chundury R, Illing E. Epithelial-Myoepithelial Carcinoma of the Lacrimal Sac and Literature Review of the Lacrimal System. ALLERGY & RHINOLOGY 2020; 11:2152656720920600. [PMID: 32341837 PMCID: PMC7175067 DOI: 10.1177/2152656720920600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Epithelial-myoepithelial carcinomas make up less than 0.1% of head and neck malignancies and are regarded as rare, low-grade malignant neoplasms of the salivary gland. They are thought to arise from intercalated ducts with histopathology showing a classic biphasic morphology of an outer layer of myoepithelial cells and inner layer of epithelial cells. These tumors most commonly occur in the parotid gland; however, rare cases have also been described in the nasal cavity, nasopharynx, subglottis, base of tongue, and the lacrimal gland. Objective To describe the clinical presentation, surgical management, and histopathology of the first reported case of lacrimal sac epithelial-myoepithelial carcinoma. To conduct a literature review of this malignancy, which is present in the lacrimal system. Methods Case report (n = 1) and literature review. Results We report a case of a 72-year-old man presenting with epiphora and a lacrimal sac mass with intranasal extension on imaging and nasal endoscopy. A combined endoscopic endonasal and open approach provided successful definitive treatment for final pathologic diagnosis of epithelial-myoepithelial carcinoma of the lacrimal sac, with orbital reconstruction and lacrimal stenting providing good cosmetic and functional results. Conclusions After PubMed database search for any case series or reports of lacrimal system epithelial-myoepithelial carcinomas, we believe this is the first documented case originating from the lacrimal sac. Although the histopathology of this tumor is distinct, unusual location and clinical presentation may pose significant diagnostic difficulties.
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Affiliation(s)
- Dhruv Sharma
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Ashley Neiweem
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kyle Davis
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark Prendes
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rao Chundury
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elisa Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
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Lee YS, Ha SM, Paik SW, Yang HJ, Jeon HJ, Park DJ, Hwang CS. Epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum: A case report and literature review. Medicine (Baltimore) 2020; 99:e19072. [PMID: 32000457 PMCID: PMC7004653 DOI: 10.1097/md.0000000000019072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Epithelial-myoepithelial carcinoma is an extremely rare, malignant neoplasm that occurs most frequently in the major salivary glands and accounts for approximately 1% of all salivary gland neoplasms. Few reports have described the presence of epithelial-myoepithelial carcinoma in the sinonasal region; hence, the treatment guideline and prognosis remain unclear. PATIENT CONCERNS We reported a case of a 75-year-old woman with complaint of nasal obstruction and frequent epistaxis for 3 years. During the nasal endoscopic examination, a mass in the left nasal cavity originating from the left nasal septum that caused bleeding on touch was observed. DIAGNOSES A diagnosis of epithelial-myoepithelial carcinoma was made based on the features of histopathology and immunohistochemistry of the surgical specimens. The patient was treated by surgical removal of the septal mass using the endonasal endoscopic approach. OUTCOMES In the serial follow-up paranasal sinus imaging and endoscopic inspection, evidence of recurrence was absent for 18 months after surgery. LESSONS This report highlights a case of epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum, one of the most unusual locations. Diagnosis of epithelial-myoepithelial carcinoma should be made based on the findings of immunohistochemistry of the operative specimen. Clinicians should consider complete surgical resection as the effective treatment of choice.
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Affiliation(s)
- Young Sub Lee
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine
| | - Sun Mok Ha
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine
- Department of Biomedical Laboratory Science, Yonsei University Wonju College of Health Science, Wonju, South Korea
| | - Seung Won Paik
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine
| | - Hui Joon Yang
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine
| | - Hyun Jong Jeon
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine
| | - Dong-Joon Park
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine
| | - Chi Sang Hwang
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine
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Lee E, Lee S, Jung MJ, Choi JH. Epithelial-Myoepithelial Carcinoma of the Inferior Turbinate: A Case Report. JOURNAL OF RHINOLOGY 2019. [DOI: 10.18787/jr.2019.26.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Eunsang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Seungjae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Min Jung Jung
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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