Central mucoepidermoid carcinoma arising directly from a glandular odontogenic cyst of the mandible: a case report

BACKGROUND

Central mucoepidermoid carcinoma (MEC) is a rare salivary gland tumor that affects the jawbone. Glandular odontogenic cyst (GOC) is also a rare odontogenic developmental cyst with glandular differentiation. GOC shares some histological features with central MEC, and a pre-existing GOC can develop into central MEC. Here, we present a rare case of central MEC developed directly from a pre-existing GOC of the mandible.

CASE PRESENTATION

A 67-year-old Japanese man presented with a cystic lesion in the right third molar region. Histologically, the biopsy specimen demonstrated both typical findings of a GOC component lined with non-keratinized squamous epithelium and a recognizable component of central MEC consisting of polycystic nests with mucous cells, intermediate cells, and epidermoid cells in the cyst wall. The results from the immunohistochemistry for cytokeratin (CK) profiling demonstrated that, while both central MEC and GOC expressed CKs 7, 14, 18, and 19, CK13 was interestingly exclusively expressed in GOC. Fluorescence in-situ hybridization (FISH) revealed the rearrangement of the Mastermind like (MAML)-2 gene in both the MEC and GOC components.

CONCLUSIONS

Our case suggests that central MEC and GOC may be in the same spectrum of diseases caused by the rearrangement of the MAML-2 gene. However, given that the expression profile of CK13 was completely different between central MEC and GOC, they can be considered as separate tumors. Overall, we demonstrated a rare case in which central MEC may have originated directly from the GOC.

Dentigerous cyst exhibiting prominent mucous cell metaplasia: report of a unique case mimicking central mucoepidermoid carcinoma

A Japanese male aged 61 presented with persistent pain in the left posterior area of the mandible for several weeks. A panoramic X-ray revealed a unilocular lesion showing characteristics of a dentigerous cyst associated with an impacted third molar. A cystectomy was performed and histopathological examination revealed a cystic lesion with a fibrous wall. The lumen was covered with non-keratinizing squamous cells with obvious intercellular bridges, which were intermingled with partially ciliated goblet-cell-type mucous and columnar cells. Such cystic lesions should be carefully examined to distinguish them from the glandular odontogenic cyst and central mucoepidermoid carcinoma of the jawbone.

Central mucoepidermoid carcinoma arising from glandular odontogenic cyst confirmed by analysis of MAML2 rearrangement: A case report

Central mucoepidermoid carcinoma (MEC) poses a diagnostic challenge because of its rarity and histological overlap with glandular odontogenic cyst (GOC). In MEC of both salivary glands and jaws, MAML2 arrangement has been well known as the specific gene alteration. We report a case of central MEC arising from GOC diagnosed by MAML2 fusion gene. A 57-year-old male presented a multilocular cystic lesion in left molar region of the mandible. Histopathologically, multiple cysts lined by thin cuboidal or non-keratinized squamous epithelium with small duct-like structures, mucous cells and ciliated cells were present. It was diagnosed as GOC. The recurrent lesion after nine years showed the proliferation of many cystic and solid nests composed of epidermoid, mucous and intermediated cells. Nested PCR revealed CRTC3-MAML2 fusion gene in the recurrent lesion, but not in the primary one. Similarly, MAML-2 rearrangement by FISH analysis was positive in the recurrent lesion, while negative for the primary one, thus confirming the diagnosis of central MEC arising from GOC. Analysis of MAML2 rearrangement can be used as a supportive evidence to distinguish central MEC from GOC.

Central mucoepidermoid carcinoma: An up-to-date analysis of 147 cases and review of prognostic factors

OBJECTIVE

To integrate the available data published on central mucoepidermoid carcinoma (CMC) into a comprehensive analysis of its clinical aspects, histology, treatment, and prognostic factors.

METHODS

An electronic search was undertaken in July 2017. Eligibility criteria for publications included having clinical, histological, treatment, and time of follow-up data to confirm the diagnosis.

RESULTS

In addition, gender, histological grade, conservative treatment, and lymph node metastasis were significant independent prognostic factors.

CONCLUSION

Male patients with histological grade III CMC of the jaw bone, who used conservative treatment as the main treatment, and presented with lymph node metastasis, were more likely to have a worse prognosis.

Glandular odontogenic cyst: Series of five cases

Introduction:

Glandular odontogenic cyst (GOC) is a clinically rare and histopathologically unusual type of developmental odontogenic cyst with unpredictable and potentially aggressive behaviour.

Materials and Methods:

Archival data of cases histopathologically identified as GOC were analyzed from the Department of Oral Pathology over the past six years. The clinical, radiographic, histopathological features and treatment were evaluated. Special stains such as periodic acid Schiff, mucicarmine along with immunohistochemical staining for cytokeratin 19 were employed to confirm the histopathological diagnosis.

Results:

The study indicated a strong female predilection with slightly more number of cases found in maxilla than mandible. Most cases showed a well defined multilocular radiolucency. The microscopic features which aid in its differentiation from its mimickers such as central mucoepidermoid carcinoma, lateral periodontal cyst, dentigerous cyst and botryoid odontogenic cyst which were observed included presence of variable thickness of the lining epithelium, epithelial plaques and whorls, hobnail cells, ciliated cells, clear cells and goblet cells.

Conclusion:

The present case series aims to throw light on the clinical, radiographic and microscopic features of GOC, which may aid in its definitive diagnosis in problematic cases.

Central mucoepidermoid carcinoma radiographically mimicking an odontogenic tumor: A case report and literature review

Central mucoepidermoid carcinoma (CMC) of the jaw bones is a rare malignant salivary gland tumor of unknown pathogenesis, comprising about 4% of all mucoepidermoid carcinomas (MECs). Most cases are histologically classified as a low-grade tumor and radiographically appear as a well-defined unilocular or multilocular radiolucent lesion. Block resection or wide local excisions are the treatment of choice and patients usually show a good overall prognosis although a long-term follow-up is necessary. This report describes a case of a 28-year-old male with MEC in the posterior region of the mandible and discusses its clinical, radiographic and histopathological findings. Although rare, CMC may be considered a differential diagnosis in cases of proliferative and osteolytic lesions in the oral cavity even when its clinical and/or radiographic findings do not suggest malignancy.