Clear cell myoepithelial carcinoma in the base of the tongue: Case report and review of the literature

Clinicopathological features and prognostic factors of salivary gland myoepithelial carcinoma: institutional experience of 42 cases

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.

Histopathological Analysis of Metastatic Tumours of the Oral Cavity with Example of Metastatic Renal Cell Carcinoma to Tongue

Background/Aim: Metastatic tumours make up only 1-3% of all malignant tumours of the oral region; however, in 25% of the total number of cases, they are the first sign of the disease. Usually, metastases in the oral region are followed by poor prognosis. Metastases are more common in the mandible than in the maxilla; in soft tissues, they most commonly occur in the attached gingiva and tongue. Malignant tumours of the lung, breast, kidney, liver, bone, prostate, thyroid gland, skin, colon and female genital organs most commonly give metastases in this region, usually in patients aged 40 to 70 years.

Case Report: We present a patient aged 79 years with a tumour change in the body of the tongue. After histopathological and immunohistochemical analysis (Cytokeratin, Vimentin, CD 10 positive tumour cells, Cytokeratin 7, Cytokeratin 20 negative tumour cells), there was a suspicion of metastasis of clear cell renal carcinoma (CCRC). Due to renal cancer, the patient had left kidney operated seven years before the diagnosis of tongue tumour.

Conclusions: Diagnosis of metastatic tumours of the oral region is a great challenge, both for clinicians and for histopathologists. Since it is a heterogeneous group of neoplasms, standard histopathological tissue processing, is not always sufficient to determine the histological type of tumour and its primary origin. In the analysis of metastatic tumours of the oral region, team work is important and careful clinical and histopathological assessment lead to definitive and accurate diagnosis.

Clear cell myoepithelial carcinoma involving vestibule and alveolus: A rare case report with review of literature

Myoepithelial carcinomas (MCs) are difficult to distinguish from their benign counterpart due to diverse morphology. This neoplasm was introduced by Stromeyer et al. in 1975. They comprise of <2% of all salivary gland carcinomas involving most commonly major salivary glands and are characterized by differentiation of tumor cells into myoepithelial cells. The cells may present as epithelioid, plasmacytoid, spindle, clear, stellate and mixed type predominantly. Literature search revealed very few cases reported as clear cell variant of MC. Here, we report a case of clear cell MC involving buccal vestibule extending up to alveolus. The diagnosis was confirmed, and the patient was surgically treated.

Glycogen-Rich Clear Cell Squamous Cell Carcinoma Originating in the Oral Cavity

Clear cell squamous cell carcinoma (CCSCC) is a rare histological subtype of squamous cell carcinoma (SCC) that was originally described in the skin. Here, we report a case of a 66-year-old female patient who presented with a fungating ulcerative mass of the left lateral tongue extending anteriorly to the floor of the mouth, and posteriorly to the left retromolar fossa and the oropharynx. The patient had a history of SCC of the left posterior tongue that was treated with partial glossectomy and adjuvant radiotherapy. Representative biopsies were obtained from the floor of the mouth, tongue and retromolar fossa. The examined biopsies showed various degrees of dysplastic surface epithelium with transition into infiltrating epithelial tumor nests and cords with clear cytoplasm and malignant cellular features. Pancytokeratin, CK5/6, and p63 were all diffusely positive. S-100, Calponin, and smooth muscle actin (SMA) were negative. PAS stain was diffusely positive and diastase labile in the tumor clear cells. Sparse areas of mucicarmine positivity were noted. Based on these findings a final diagnosis of a glycogen-rich CCSCC was given. This case represents a very rare histological variant of oral SCC, which is significant for the histological differential diagnosis of clear cell tumors of the oral cavity.

Myoepithelial carcinoma of the salivary gland: pathologic and CT imaging characteristics (report of 10 cases and literature review)

OBJECTIVE

To summarize the pathologic and computed tomography (CT) imaging characteristics of myoepithelial carcinoma in the salivary gland.

STUDY DESIGN

Ten patients with myoepithelial carcinoma of the salivary gland underwent enhanced CT scanning, and the pathologic and CT imaging features were evaluated, including the pathologic type, size, margin morphology, and enhancement pattern of the lesions.

RESULTS

Myoepithelial carcinoma had a multinodular or lobulated outline. The cut surfaces were gray-brown with no or incomplete capsules, and visible bleeding was observed in some cases. The pathologic cell type of the tumor was spindle-shaped, clear, plasmacytoid, or epithelioid cells or a mixture of cell types. Nonenhanced CT imaging showed an irregular lobulated or multinodular lesion with ill-defined margins and inhomogeneous attenuation and punctate calcification in a minority of the lesions. The enhanced CT imaging results revealed moderate and intense inhomogeneous enhancement, including cystic and slit-like regions with no enhancement, intense nodular enhancement, and small tortuous vessels in the arterial phase.

CONCLUSION

The pathologic features and CT imaging findings of myoepithelial carcinoma were characteristic, and familiarity with these imaging findings might aid in the diagnosis of this entity.

Salivary gland myoepithelial carcinoma

Salivary gland myoepithelial carcinoma (MC) or malignant myoepithelioma is a rare entity. MC usually presents as a slow-growing painless mass arising in the parotid gland, but may involve other salivary glands. This tumour may be particularly locally aggressive, but its clinical and biological features are not yet fully understood. MC may arise from pre-existing benign lesions, such as pleomorphic adenomas or benign myoepitheliomas, or may arise de novo. It usually affects patients over 50 years old, with no gender preference. Because it is often asymptomatic, the presentation and diagnosis can be delayed by months, even years. The current WHO classification considers MC to be an intermediate- to high-grade malignancy. Other published data suggest it is likely to be a high-grade neoplasm, consistent with its aggressive behaviour. Its epidemiology, histopathological features, immunohistochemical profile, clinical behaviour and optimal management are not well understood. Following review of the current literature we aim to address these.

Myoepithelial Carcinoma of the Salivary Glands: A Clinicopathologic Study of 29 Patients

PURPOSE

Myoepithelial carcinomas (MECs) of the salivary glands are relatively rare. The clinicopathologic features, immunohistochemical profile, and biologic behavior have not been well-defined.

MATERIALS AND METHODS

A total of 29 patients with MEC diagnosed during a 10-year period were included in the present study focusing on the biologic behavior, and the pathologic samples of 28 patients were collected for additional investigation of the histologic characteristics. Thirteen samples with detailed immunohistochemical results were included for illustrating immunohistochemical profiles.

RESULTS

The parotid gland (n = 7) was the most common site involved, followed by the palate (n = 6) and the submandibular gland (n = 6). A multinodular growth pattern (n = 14) and sheet-like arrangement of tumor cells (n = 14) were observed. Of the 28 MEC samples, 14 (50%) were epithelioid, 5 (18%) were clear cell, 5 (18%) were plasmacytoid, 3 (11%) were mixed cell type, and 1 (3%) was spindle. The tumor-associated matrix was more prevalently hyalinized than myxoid. Of the 28 cases, 12 (43%) were classified as high grade and 16 (57%) as low grade. Immunohistochemical analysis revealed pan-cytokeratin (92.3%), smooth muscle actin (36%), S-100 protein (54.5%), and p63 (91.7%) positivity and carcinoembryonic antigen (100%) negativity. Ki-67 was immunoreactive in 62% of the MECs, with the Ki-67 labeling index ranging from less than 5 to 20%. Eleven patients developed recurrence (median disease-free survival 43 months) and 11 (44%) developed metastases. Two patients (8%) died of disease after a mean period of 18 months. Fourteen patients (61%) were without any evidence of disease after a mean of 32.5 months (range 3 to 86). The mitotic rate correlated weakly (P = .042) with a poor outcome, but none of the other factors showed a significant correlation with the prognosis.

CONCLUSION

MECs of the salivary glands have a relatively high recurrence rate and metastasis rate and a long period of survival with tumor. A combination of pathologic features and various immunohistochemical indexes are crucial for the accurate diagnosis of MECs. Extensive excision is the favorable choice for treating MECs, and suprahyoid lymph node dissection is recommended when the submandibular gland is involved.

Salivary adenoid cystic carcinoma with an early phase of high-grade transformation: case report with an immunohistochemical analysis

BACKGROUND

The early phase of salivary gland carcinomas with high-grade transformation (HGT) is extremely rare. We reported one case of adenoid cystic carcinoma (AdCC) with early HGT, herein.

CASE PRESENTATION

The patient was a 27-year-old Japanese woman who suffered from swelling of the left parotid region. Most of this tumor consisted of typical AdCC histology, whereas the central area of this tumor was composed of solid growth component by atypical cells with clear cytoplasm and marked nuclear atypia. Immunohistochemically, this area was strongly and diffusely positive for epithelial membrane antigen, p53, p16, Her-2, cyclin A and cyclin B1. The Ki-67 labeling index of this area was high, entirely different from that of AdCC area.

CONCLUSION

Overall, this area was an early phase of AdCC-HGT. This case is the second case of early AdCC-HGT. We discuss the development of salivary gland carcinoma with HGT.

VIRTUAL SLIDES

http://www.diagnosticpatology.diagnomx.eu/vx/1598278104895730.