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Myoepithelioma, also known as malignant myoepithelioma, is a rare malignant tumor originating from myoepithelial cell. This article reports a patient with a huge tumor in the neck and left elbow who underwent fine needle aspiration under local anesthesia. The pathological diagnosis was a myoepithelioma. Under general anesthesia, giant tumors in the lower neck, posterior cranial fossa, neck, and left elbow were removed, and postoperative pathology showed that they were all myoepithelial tumors. Immunohistochemistry showed AE1/AE3 (+), P63 (+), CK7 (+), CK5 (+), and CD138 (+). The clinical characteristics and diagnosis and treatment process of this case are reported and relevant literature is reviewed.
Subject(s)
Humans , Myoepithelioma/pathology , Immunohistochemistry , Epithelial Cells , Neck/pathology , CarcinomaABSTRACT
Objective@#To describe the clinicopathologic features and outcome of a patient with epithelial-myoepithelial carcinoma of the lacrimal gland who underwent modified lateral orbitotomy with en toto removal of the lesion and adjuvant radiotherapy.@*Methods@#This is a case report.@*Results@#A 31-year-old Filipino male seafarer presented with a 2-month history of an enlarging left superotemporal orbital mass and inferonasal displacement of the globe. Magnetic resonance imaging revealed a superotemporal extraconal mass within the lacrimal sac fossa with evidence of osseous infiltration of the superolateral orbital rim. Modified lateral orbitotomy was performed with en toto removal of the lesion and the clinically infiltrated adjacent lateral bony margin. Histopathologic diagnosis of epithelial-myoepithelial carcinoma of the lacrimal gland was made based on the classic and distinct biphasic morphology and was confirmed with immunohistochemistry studies (cytokeratin-7, S-100, and p63). Systemic surveillance using positron emission tomography and computed tomography scan with contrast revealed no evidence of regional or distant metastasis. Adjuvant radiotherapy of the orbital area was performed for increased local control. Twelve months postoperatively, the patient showed no evidence of tumor recurrence.@*Conclusion@#Epithelial-myoepithelial carcinoma of the lacrimal gland is a rare condition, and this is the first documented case from the Philippines. Accurate diagnosis is necessary for appropriate treatment. It should be included in the differential diagnosis of infiltrative lesions in the lacrimal gland fossa.
Subject(s)
Lacrimal ApparatusABSTRACT
RESUMEN: El carcinoma mioepitelial es una rara neoplasia maligna de las glándulas salivales; puede originarse de novo o desarrollarse en un adenoma pleomórfico preexistente o un mioepitelioma. Las características histológicas e inmunohistoquímicas de un caso de carcinoma mioepitelial de glándula parótida originado por la transformación maligna de un adenoma pleomórfico primario previo se investigaron en este trabajo. Se demostró la presencia de mitosis, pleomorfismo nuclear, áreas necróticas, mioepiteliocitos con una marcación con p63 superior al 75 % y un índice proliferativo de 15 %, características que pueden desencadenar un desenlace adverso. Resulta clave el examen periódico de la paciente que dará una probabilidad superior de curación y sobrevida y de investigar eventuales recurrencias o metástasis.
ABSTRACT: Myoepithelial carcinoma is a rare malignant neoplasm of the salivary glands; it may originate de novo or develop into a pre-existing pleomorphic adenoma or myoepithelioma. The histological and immunohistochemical characteristics of a case of myoepithelial carcinoma of the parotid gland originated by the malignant transformation of a previous primary pleomorphic adenoma were investigated in this work. The presence of mitosis, nuclear pleomorphism, necrotic areas, myoepitheliocytes with a p63 labeling greater than 75 % and a proliferative index of 15 % were demonstrated, characteristics that can trigger an adverse outcome. The periodic examination of the patient is essential, which will give a higher probability of cure and survival and to investigate eventual recurrences or metastases.
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BACKGROUND@#Pulmonary epithelial-myoepithelial carcinoma is a very rare type of salivary gland lung tumor. No standard treatment plan yet. This article intends to analyze the clinical characteristics of pulmonary epithelial-myoepithelial carcinoma and discuss the diagnosis and treatment of pulmonary epithelial-myoepithelial carcinoma.@*METHODS@#The clinical data of a patient with pulmonary epithelial-myoepithelial carcinoma were analyzed and other relevant clinical literatures were reviewed.@*RESULTS@#Epithelial cells immunohistochemically expressed cytokeratin and myoepithelial cells immunohistochemically expressed SMA and S-100. The next-generation sequencing was mainly HRAS gene mutation and the express of PD-L1 protein was negative.@*CONCLUSIONS@#Most of the patients with Pulmonary epithelial-myoepithelial carcinoma have a good prognosis. Diagnosis mainly depends on microscopic examination and immunohistochemistry. The treatment of pulmonary epithelial-myoepithelial carcinoma is mainly surgical resection. The effect of radiotherapy and chemotherapy is not clear.
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Subject(s)
Female , Humans , Middle Aged , Nasal Cavity , Nasal Obstruction , Parotid Gland , Pathology , Salivary Glands , TurbinatesABSTRACT
Epithelial–myoepithelial carcinomas (EMCs) account for <1% of all salivary gland malignancies. Till now, 23 cases of dedifferentiated EMC have been reported to the best of our knowledge. However, dedifferentiation of oncocytic EMC to mucoepidermoid carcinoma is extremely rare. A 38-year-old female presented with right post aural swelling 4 cm × 2 cm in size for 6 months. Surgical excision was carried out, and we received partly skin-covered tissue 5 cm × 2 cm in size. Sections examined showed features of oncocytic EMC dedifferentiating into mucoepidermoid carcinoma. Myoepithelial component showed oncocytic change which was highlighted by p63.
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Chromosomal instability, leading to aneuploidy, is one of the hallmarks of human cancers. USP44 (ubiquitin specific peptidase 44) is an important molecule that plays a regulatory role in the mitotic checkpoint and USP44 loss causes chromosome mis-segregation, aneuploidy and tumorigenesis in vivo. In this study, it was investigated the immunoexpression of USP44 in 28 malignant salivary gland neoplasms and associated the results with DNA ploidy status assessed by image cytometry. USP44 protein was widely expressed in most of the tumor samples and no clear association could be established between its expression and DNA ploidy status or tumor size. On this basis, it may be concluded that the aneuploidy of the salivary gland cancers included in this study was not driven by loss of USP44 protein expression.
Resumo Instabilidade cromossômica acarretando aneuploidia é um dos fatores marcantes de neoplasias malignas humanas. USP44 (peptidase específica de ubiquitina 44) é uma importante molécula que exerce um papel regulador no ciclo celular e sua perda pode acarretar em segregação cromossômica deficiente, aneuploidia e desenvolvimento de tumores in vivo. Neste estudo, investigou-se a expressão imuno-histoquímica da proteína USP44 em 28 neoplasias malignas de glândulas salivares, associando-se os resultados com o estado de ploidia do DNA avaliado por citometria de fluxo. A proteína USP44 apresentou ampla expressão na maioria das amostras avaliadas e não foi observada associação entre a expressão protéica e o estado de ploidia do DNA ou extensão do tumor. Baseando-se nos resultados, concluiu-se que a aneuploidia das neoplasias malignas de glândulas de salivares incluídas neste estudo não foi influenciada pela perda de expressão da proteína USP44.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Aneuploidy , DNA/genetics , Salivary Gland Neoplasms/genetics , Ubiquitin-Specific Proteases/metabolismABSTRACT
Myoepithelial carcinoma is a rare malignant tumor. The primary site of this tumor is the salivary glands. With the rapid ad-vancement in immunohistochemical examination and pathological examination, the number of clinical cases of the most common type of myoepithelial carcinoma of the salivary glands, as well as rare primary sites of myoepithelial carcinoma, reported in the litera-ture has increased. Based on related cases reported in the literature, various studies worldwide, and our personal practical experience, this article summarized advancements in the research on myoepithelial carcinoma, including etiology, pathology, clinical characteris-tics, diagnosis, and treatments, as well as myoepithelial carcinoma features of various rare primary sites. This article aims to provide useful evidence for oncologists in diagnosing and treating myoepithelial carcinoma.
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Purpose To study the clinical features,pathological manifestation and immunohistochemical phenotype and improve the diagnosis and treatment of myoepithelial carcinoma in salivary glands.Methods Histomorphology and immunohistochemical phenotype were analyzed after the sections were stained with routine HE and immunohistochemical methods,and the relevant literatures were reviewed.Results The tumours were predominantly composed of pale-stained clear cells.In some cases,plasma-like cells,epithelioid cells and spindle cells were also seen.The cells were arranged in nest,solid or cords.Mitosis was easily seen,cytological atypia was obvious and necrosis existed in 4 cases.The results of immunohistochemical staining showed that CK was expressed in all cases.EMA was expressed in 8 cases.p63 and CK5/6 were expressed in 11 cases.S-100 was expressed in 10 cases.vimentin was expressed in 4 cases.Calponin was expressed in 2 cases.SMA was expressed in one case.The proliferation index of Ki-67 was 5％ to 40％.Conclusion The histological changes of myoepithelial carcinoma cells are diverse,and pathological and immunohistochemical methods are helpful for improving the rate of right diagnosis.Sugery is the main treatment for myoepithelial carcinoma.
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Objective To evaluate the risk of locoregional recurrence (LRR) and the influencing factors for long-term survival in patients with epithelial-myoepithelial carcinoma (EMCa).Methods A retrospective analysis was performed for 18 EMCa patients, who received initial therapy or initial adjuvant therapy in our hospital from 1999 to 2015, to investigate their survival.Among these patients, 8(44%) underwent surgery alone, 9(50%) received adjuvant radiotherapy, and 1(6%) received radical concurrent chemoradiotherapy.Locoregional recurrence-free survival (LRFS) and overall survival (OS) rates were compared between these groups.The Kaplan-Meier mtthod was used to calculated survival rates and log-rank test was used to compare the LRFS.Results With a median follow-up time of 46 months, 5 patients developed LRR, and the 5-year LRFS and OS rates were 69% and 93%, respectively.The patients treated with radiotherapy had a significantly higher 5-year LRRFS rate than those not treated with radiotherapy (71% vs.57%, P=0.569).Conclusions LRR is the main failure mode of EMCa treatment, and further improving local control is the key to improved survival.
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OBJECTIVE Epithelial-myoepithelial carcinoma (EMC) is a rare malignant neoplasm of the salivary glands. The aim of the study was to investigate the diagnosis, treatment and prognosis of EMC of the parotid gland.METHODSThe clinical data of 23 cases of EMC of the parotid gland from 1999 to 2013 were analyzed retrospectively. Of all the patients, 13 cases received radical surgery only, 9 cases received postoperative radiotherapy, and one case received postoperative chemotherapy. Kaplan-Meier survival curve was used to analyze the clinical data. RESULTSThe overall survival rate at 5-year was 81.0% and the overall no recurrence survival rate at 5-year was 67.3%. The recurrence rate was 39.1% (9/23). The 5-year no recurrence survival rate of radical surgery group was 55.6%, compared with 80.0% in the combined modality therapy group, there was no significant deference (χ2=2.232, P=0.135).CONCLUSIONThe postoperative recurrence rate of EMC is high. Radical surgery could be the main treatment of EMC, when the surgical margin couldn't be achieved, adjuvant radiotherapy or chemotherapy might be helpful.
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We present what is believed to be the first report of heterogeneous carcinoma arising from breast ductal adenoma. A 57-year-old woman presented with a nodule in her right breast. Histological examination of a vacuum-assisted biopsy specimen revealed epithelial tubular proliferation and papillary apocrine epithelium. The myoepithelial cells lining the tubules were confirmed by immunohistochemistry. The nodule had increased in size 18 months later and tumorectomy was performed. The surgical specimen revealed proliferating apocrine epithelium with sheet-like and cribriform architecture within a mammary duct. Some myoepithelial cells showed irregular proliferation around the tubular epithelium. All three components, including apocrine, myoepithelial and glandular cells, showed prominent nuclear atypia and significant mitotic activity. The patient was diagnosed with malignant transformation of ductal adenoma. The malignant potential of ductal adenoma has not previously been discussed, but this heterogeneous carcinoma could represent a serious pitfall in the diagnosis of ductal adenomas.
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Myoepithelial carcinoma (MC) is a rare neoplasm of the salivary gland generally occurring in the parotid gland and rarely in the minor salivary glands. It poses a diagnostic challenge on fine-needle aspiration (FNA) cytology because it can show different cell types and lack clear features of malignancy. This can lead to a range of differential diagnosis on cytology. The diagnostic difficulty can be compounded if the lesion is present at an unusual site. A 41-year-old male presented with a recurrent swelling on the check since 2 years with a prior history of pleomorphic adenoma (PA) at the same site 8 years back. FNA was performed and a diagnosis of recurrent PA or myoepithelial cell neoplasm was given. Final diagnosis was made on histology and immunohistochemistry studies and reported as MC of minor salivary gland originating within PA. Pathologist should be aware of the occurrence of MC at the sites of the minor salivary glands in the oral cavity and its wide morphologic spectrum to make a confident diagnosis of MC preoperatively.
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Pleomorphic adenoma is the most common epithelial neoplasm of lacrimal gland. A clear cell myoepithelial carcinoma arising in the background of pleomorphic adenoma is common in the salivary glands but very rare in the lacrimal glands. We report the case of a 27 year old man whose lacrimal gland pleomorphic adenoma recurred several times over a period of four years and ultimately evolved into a clear cell myoepithelial carcinoma ex pleomorphic adenoma.
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Myoepithelial carcinoma is an uncommon malignant salivary gland neoplasm with a predilection for parotid gland. However, its occurrence in minor salivary glands is considerably less with only 28 cases being reported in the literature. We report a case of myoepithelial carcinoma of palate in a 50-year-old woman. Computed tomography and magnetic resonance imaging revealed an extensive lesion in the palate. Microscopically, the tumor exhibited a wide spectrum of cytomorphologic features that overlap with other salivary gland tumors. Immunohistochemistry served as an adjunct in the diagnosis of the lesion. Clinical, radiographic, and histopathologic correlation along with immunohistochemical profi le enabled to arrive at a diagnosis of myoepithelial carcinoma.
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Epithelial-myoepithelial carcinoma (EMC) is a rare, often low grade malignant neoplasm that occurs most commonly in the parotid gland. However, EMC originating from a minor salivary gland is extremely rare. A 38-year-old female patient was referred to our department for dysarthria and a huge mass at the base of tongue. Transoral resection of the mass was performed using a midline glossotomy approach. The pathological examination revealed epithelial-myoepithelial carcinoma of a minor salivary gland. Sequential adjuvant chemoradiotherapy was performed. After clinical follow-up of 26 months, she has remained free of disease. We report on this rare condition in order to share our experience.
Subject(s)
Adult , Female , Humans , Chemoradiotherapy, Adjuvant , Dysarthria , Follow-Up Studies , Parotid Gland , Salivary Glands, Minor , TongueABSTRACT
A 45-year-old female patient visited the clinic due to ear fullness. A 8 mm sized mass was found in the external auditory canal. It was surgically removed and the pathology exam confirmed epithelial-myoepithelial carcinoma (EMC). EMC is glandular epithelial neoplasm of the salivary gland. EMC originating from the external auditory canal is very rare, and only 1 case has been reported so far in the literature. The difference between our case and the one previously published was that the tumor was previously proven as a benign tumor (i.e. pleomorphic adenoma) 5 years ago. Therefore, this is the first case in the literature showing the evolvement of pleomorphic adenoma of the external auditory canal into EMC.
Subject(s)
Female , Humans , Adenoma, Pleomorphic , Ear , Ear Canal , Neoplasms, Glandular and Epithelial , Salivary GlandsABSTRACT
A 45-year-old female patient visited the clinic due to ear fullness. A 8 mm sized mass was found in the external auditory canal. It was surgically removed and the pathology exam confirmed epithelial-myoepithelial carcinoma (EMC). EMC is glandular epithelial neoplasm of the salivary gland. EMC originating from the external auditory canal is very rare, and only 1 case has been reported so far in the literature. The difference between our case and the one previously published was that the tumor was previously proven as a benign tumor (i.e. pleomorphic adenoma) 5 years ago. Therefore, this is the first case in the literature showing the evolvement of pleomorphic adenoma of the external auditory canal into EMC.
Subject(s)
Female , Humans , Adenoma, Pleomorphic , Ear , Ear Canal , Neoplasms, Glandular and Epithelial , Salivary GlandsABSTRACT
PURPOSE: Epithelial-myoepithelial carcinoma (EMC) represents about the 1% of the malignant neoplasms in the salivary glands and clinically most commonly found localized, well defined and sometimes presents orofacial pain. Treatment of choice is surgical excision. Postoperative radiotherapy can be used when surgical margins are doubtful. We report our experience of EMC of the parotid gland. METHODS: A 78-year-old man presented with a three-year history of a localized, painless, 7 x 6 cm sized recurred tumor in his right preauricular area. He was diagnosed as EMC of the right parotid gland. So a total parotidectomy was performed. In his old medical history, he had a mass in the same area 5 years ago. The diagnosis of pleomorphic adenoma was made and the mass excision was performed at the local clinic without further evaluation. RESULTS: It was unable to visually discriminate between the tumor and the normal tissue. So a total parotidectomy was performed. The patient was got post-operative radiotherapy and was followed up for 9 months. There was no specific evidence of recurrence. CONCLUSION: We present a case of EMC of the parotid gland in right preauricular area, which is uncommon. So we report a uncommon case of EMC to discuss about our experience with relevant journal discussion.
Subject(s)
Aged , Humans , Adenoma, Pleomorphic , Facial Pain , Parotid Gland , Salivary GlandsABSTRACT
Epithelial-myoepithelial carcinoma (EMC) is a low-grade malignant salivary gland neoplasm that was first described in 1972. EMC occurs in the older age group, there is a female predilection and mainly involves the parotid gland. Most authors recommend superficial parotidectomy as a treatment for low-grade malignant tumor in the superficial lobe of parotid gland. The treatment of epithelial-myoepithelial tumors typically includes surgical excision aimed at achieving a R0 resection. This paper reports a case of EMC of the parotid gland treated only by a conservational surgical excision. The lesion was exposed by the retromandibular approach and detached. After the parotid gland envelop was exposed, the mass was observed and was easy to remove due to capsulation. The preoperative diagnosis was a pleomorphic adenoma on the left parotid gland. The tumor was removed surgically with a conservative extracapsular dissection. The postoperative diagnosis was EMC, so superficial parotidectomy or radiation therapy was considered. Nevertheless, the patient was observed and no additional treatment was attempted because the patient was old and a successfully excision of the tumor had been achieved.