Carcinoma mucoepidermoide bronquial: a propósito de dos casos clínicos / Bronchopulmonary mucoepidermoid carcinoma: apropos of two clinical cases

Resumen El carcinoma mucoepidermoide bronquial es una neoplasia infrecuente, representando el 0,1 a 0,2% de los tumores malignos primarios del pulmón. En general tiene un buen pronóstico, sin embargo, existe un subtipo de alto grado de pronóstico más ominoso. En este artículo se presentan dos casos clínicos de carcinoma mucoepidermoide bronquial de bajo grado, enfocado en su diagnóstico y manejo quirúrgico.

ABSTRACT Bronchopulmonary mucoepidermoid carcinoma is an uncommon neoplasm, accounting for 0.1 to 0.2% of primary malignant tumors of the lung. In general it has a good prognosis, however there is a subtype of high grade of more ominous prognosis. In this paper we present two clinical cases of low grade pulmonary mucoepidermoid carcinoma, focused on their diagnosis and surgical management.

Carcinoma mucoepidermoide bronquial en la infancia: Caso clínico / Bronchial mucoepidermoid carcinoma in childhood: Case report

Los tumores bronquiales son raros en los niños. La mayoría son malignos; el más común es el tumor carcinoide. Con menor frecuencia, se asienta en el árbol traqueobronquial el carcinoma mucoepidermoide. El carcinoma mucoepidermoide representa del 0,1% al 0,2% de los tumores malignos broncopulmonares. Se manifiesta con síntomas de obstrucción de la vía aérea y/o neumonías recurrentes. El diagnóstico precoz y el tratamiento adecuado son de gran importancia en el pronóstico. La broncoscopía con biopsia de la masa endobronquial es el método de elección para confirmar el diagnóstico. El tratamiento consiste en la resección quirúrgica de la lesión. Se presenta a una niña de 11 años con disnea de esfuerzo y tos debidas a un carcinoma mucoepidermoide bronquial de bajo grado de malignidad. Se describen las manifestaciones clínicas, los métodos diagnósticos y el tratamiento de esta rara neoplasia en pediatría.

Bronchial tumors are rare in children. Most of them are malignant, being the carcinoid tumor the most common. Less frequently the mucoepidermoid carcinoma is found in the tracheobronchial tree. Mucoepidermoid carcinoma accounts for 0.1 to 0.2% of all malignant bronchopulmonary tumors. It manifests with symptoms of airway obstruction and/or recurrent pneumonias. Early diagnosis and appropriate treatment are of great importance in the prognosis. Bronchoscopy with biopsy of the endobronchial mass is the method of choice to confirm the diagnosis. Treatment consists of surgical resection of the lesion. We present an 11-year-old girl with dyspnea on exertion and cough due to a low malignant mucoepidermoid carcinoma of the bronchi. We describe the clinical manifestations, the diagnostic methods and the treatment of this rare neoplasia in pediatrics.

Carcinoma Mucoepidermóide do Pulmão ­ estado da arte a propósito de um caso clínico / Mucoepidermoid carcinoma of the lung ­ state of art with regard to a case report

O Carcinoma Mucoepidermóide do Pulmão (CMP) é um tumor com baixo potencial de malignidade; acredita-se que é indolente, mas pouco se sabe sobre as suas características dada a sua baixa incidência (0,2% de todos os tumores pulmonares). Os autores apresentam um caso clínico de um Carcinoma Mucoepidermóide do Pulmão de alto grau, a que se associa, habitualmente, metastização à distância, recorrência do tumor e mau prognóstico. Destaca-se a exuberante metastização (pleural, pericárdica, ganglionar e cerebral), que contrasta com o curso da doença, relativamente indolente, volvidos 12 meses do diagnóstico. Dado não ter indicação cirúrgica, a doente foi tratada com radioterapia e quimioterapia, apesar de ainda não estar definido um tratamento standard para este tipo histológico. A raridade do diagnóstico e os escassos estudos da literatura condicionam a abordagem terapêutica sistémica destes doentes, constituindo um desafio para a comunidade médica. O possível papel da terapêutica dirigida, como os inibidores da tirosina cinase do receptor do fator de crescimento epidérmico (EGFR) ou a terapêutica contra o oncogene de fusão CRTC1-MAML2, tem sido investigado, em doentes com Carcinoma Mucoepidermóide do Pulmão de alto grau.

Mucoepidermoid Carcinoma of the Lung (MECL) is a tumor of low malignant potential; we believe it is indolent, but little is known about its clinical features because of the low incidence rate (incidence of 0.2% of all lung cancers). We present a clinical case of a high degree Mucoepidermoid carcinoma of the lung, which frequently have distant metastasis, tumor recurrence and a bad prognosis. It is highlighted in this case the exuberant metastases (pleural, pericardial, cerebral, lymph nodes), contrasting with the relatively indolent course of the disease since the diagnosis (10 months ago). Our patient was treated with radiotherapy and chemotherapy, although effective treatment measures for high-grade tumors have not been established. The rarity of the diagnosis and the rare studies in the literature affect the systemic approach to these patients, becoming a challenge for the scientific community. The role of targeted therapy directed against the epidermal growth factor receptor (EGFR) and the novel fusion oncogene CRTC1-MAML2, is being investigated in high-grade tumors.

Resección transoral-transnasal de tumores del espacio parafaríngeo / Transoral-transnasal approach to parapharyngeal space tumors

Objetivos: Determinar la tasa de resección quirúrgica completa en tumores seleccionados del Espacio parafaríngeo tratados por vía transoral o transnasal o por ambas. Diseño: descriptivo, retrospectivo. Materiales y métodos: Se incluyeron en este estudio los pacientes que tuvieron neoplasias localizadas en el espacio parafaríngeo y que fueron tratados con cirugía por vía transoral o transnasal. El abordaje transoral consistió en realizar una incisión con cauterio en la zona de mayor protrusión del tumor (pilar amigdalino y paladar), disección de la mucosa y del tumor de los planos profundos, traccionándolo hacia la cavidad oral. Para disecar el límite superior (rinofaringe) y lateral se utilizaron endoscopios que fueron introducidos por la incisión y por la cavidad nasal. El abordaje transnasal consistió en realizar una incisión en la pared lateral de la rinofaringe y disecar el tumor del plano profundo traccionándolo hacia el cavum. Resultados: Fueron tratados 3 pacientes por vía transoral y uno por vía endonasal por padecer tumores del espacio parafaríngeo. Tres tumores se originaron en glándulas salivales menores localizadas una en el espacio. Preestiloideo (1/3), otra en el espacio masticador (1/3) y otra en el sector superior del espacio preestiloideo (1/3). La histología dio como resultado dos adenoma pleomorfo y un carcinoma mucoepidermoide de bajo grado (1/3). (Está bien así? Qué es 1/3?). Una neoplasia se originó en el lóbulo profundo de la parótida y se extendió al espacio preestiloideo, su histología fue carcinoma mucoepidermoide de grado moderado. Conclusiones: La tasa de resección completa en pacientes con tumores del espacio parafaríngeo seleccionados tratados por vía transoral y endonasal fue del 100%. (AU)

Objectives: To determine the rate of complete surgical resection in parapharyngeal space selected tumors treated with transoral and / or transnasal approach. Design: Descriptive, retrospective. Materials and methods: Patients who had tumors localized in parapharyngealspace and who were treated with transoral or transnasal surgery. were included in this study. The transoral approach consisted in performing an incision with cautery in the area of greates tumor protrusion (tonsillar pillar and palate), dissection of the mucosa and tumor of the deep planes, pulling it into the oral cavity. To dissect the upper limit (nasopharynx) and lateral we used endoscopes that were inserted by the incision and the nasal cavity. The transnasal approach consisted in making an incision in the side wall of the nasopharynx and dissect the tumor of the deep plane pulling it towards the cavum. Results: Three patients were treated with transoral and one byendonasalapproacheswho had parapharyngeal space tumors. Three tumors originated in minor salivary glands located in prestyloidspace (1/3), masticator space (1/3) and upper sector of pree-styloid space (1/3). Histology was in two pleomorphic adenoma, and another onelow degree mucoepidermoid carcinoma (1/3). A neoplasm was originated in the deep lobe of the parotid gland and was extended to the prestyloid space, was a moderate degree of mucoepidermoid carcinoma. Conclusions: Complete resection rate in patients with selected parapharyngeal space tumors, treated by transorally and endonasal approach was 100%. (AU)

Mucoepidermoid carcinoma of the salivary glands: a retrospective study of 51 cases and review of the literature / Carcinoma mucoepidermoide de glándulas salivales. estudio retrospectivo de 51 casos y revisión de la literatura

The aim of this study is to present the casuistic of mucoepidermoid carcinoma of salivary glands in patients diagnosed at “Dr. Eduardo Cáceres Graziani” National Institute for Neoplastic Diseases, Lima, Perú. From January 2002 to December 2012, 51 cases were diagnosed as mucoepidermoid carcinoma. The number of female patients was higher, with 28 cases (54.9%), and regarding age distribution, 33.3% of the patients were under 30 years old. Pain was one of the main symptoms, and 74.5% of the mucoepidermoid carcinomas were located in the parotid gland. It is concluded that epidemiology regarding age and gender of the 51 cases analyzed was in the same range as other studies, and that most cases were located in major salivary glands, in agreement with reports on other populations. Other characte ristics showed a homogeneous distribution.

El propósito de este estudio es presentar la casuística del carcinoma mucoepidermoide de glándulas salivales de pacientes diagnosticados en el Instituto Nacional de Enfermedades Neoplásicas “Dr. Eduardo Cáceres Graziani” Lima, Perú, desde el 2002 hasta el 2012. Realizamos un estudio retrospectivo en el cual fueron incluidos sujetos con diagnóstico primario de carcinoma mucoepidermoide en glándulas salivales. Entre enero de 2002 y diciembre de 2012, se registraron 51 casos. El número de pacientes de sexo femenino fue mayor, con 28 casos (54,9%) y con respecto a la distribución por edades, el 33,3% de los pacientes eran menores de 30 años de edad. El dolor fue uno de los síntomas principales. El 74,5% de los carcinomas mucoepidermoides se localizaron en la glándula parótida. De los hallazgos obtenidos se concluye principalmente que en lo que respecta a la distribución epidemiológica de edad y género de los 51 casos analizados estas variaron en el mismo rango de otros estudios. También se distingue que el mayor número de casos estuvieron localizados en glándulas salivales mayores, dato en concordancia con otras poblaciones reporta das. Las demás características presentaron una distribución homogénea.

Mucoepidermoid Carcinoma of Palate: A Case Report.

The most common types of salivary gland tumors are the pleomorphic adenoma and the mucoepidermoid carcinoma (MEC). MEC mainly occurs in the parotid gland; intraorally MEC appears as asymptomatic swellings in minor salivary glands, most commonly occurs on palate. It shows a variety of biological behaviors and variable natural history. Clinical, radiological and histopathological findings of palatal MEC in a young woman presented here. Surgical resection was done. Follow-up of one and half year did not show any recurrence.

Low grade mucoepidermoid carcinoma in a setting of Warthin's tumor.

Warthin's tumor also known as papillary cystadenoma lymphomatosum is a common benign salivary gland neoplasm that occurs exclusively in parotid gland. Rarely, the tumor can undergo carcinomatous or lymphomatous transformation of epithelial or lymphoid component, respectively. Herein, we describe a case of 55-year-old female who had undergone parotidectomy for a rapidly growing tumor in the right parotid gland. The case was diagnosed as mucoepidermoid carcinoma developed in a setting of Warthin's tumor based on the histomorphology, special staining characters, and immunohistochemical findings. The pathogenesis and differential diagnoses of such rare malignancy has been discussed briefly.

Carcinoma mucoepidermoide de las glándulas salivares en Brasil: resultados clinicopatológicos y una breve revisión / Mucoepidermoid carcinoma of the salivary glands in Brazil: clinicopathological outcomes and a brief review

The biological features and the clinical behavior of the mucoepidermoid carcinoma are varied and not known yet. The aim of present paper was to analyze the potential prognostic factors affecting the survival of patients diagnosed with primary mucoepidermoid carcinoma of head and neck. A retrospective study was conducted in 16 patients treated between 1990 and 2008 in the General Hospital of Riberirao Preto, USP Medicine School, Brazil. The following variables were studied: age, sex, anatomical location, tumor size, clinical stage, histological degree, relapse, metastasis, involved surgical edges ant treatment on the clinical-pathological results. The survival curves were designed using the Kaplan-Meier method and the statistic analysis was made using the log-rank test. The 68.7 percent of patients was of male sex, all patients were between 13 and 83 years old. The 75 percent of tumors was located in the great salivary glands, the 56.3 percent in the parotid glands ones, the mucoepidermoid carcinomas of low degree and of II stage were the 37.5 percent. The surgical resection was carried out in all patients. The follow-up period in present study fluctuates between 6 and 217 months. The general rate of 5- y years or 10-years survival was of 85.6 percent whereas the rates of disease-free survival were of 81.8 percent at 5 years and of 68.2 percent at 10 years. The were statistically significant influences of the tumor size (p = 0.05), presence of metastasis (p = 0.04) and of the primary anatomical location (p = 0.04) on the rates of disease-free survival. The results obtained show the significance of the primary anatomical location of the tumor, of its size and of the presence of metastasis in the survival of mucoepidermoid carcinomas(AU)

Las características biológicas y el comportamiento clínico del carcinoma mucoepidermoide son muy variados y aún poco conocidos. El propósito de este estudio fue analizar los factores pronósticos que puedan afectar la supervivencia de los pacientes con diagnóstico de carcinoma mucoepidermoide primario de cabeza y cuello. Se realizó un estudio retrospectivo de 16 pacientes tratados entre 1990 y 2008 en el Hospital General de Ribeirao Preto, Escuela de Medicina USP, Brasil. Se estudiaron las variables: edad, sexo, localización anatómica, tamaño del tumor, estadio clínico, grado histológico, recidiva, metástasis, bordes quirúrgicos comprometidos y tratamiento, sobre los resultados clínico-patológicos. Las curvas de supervivencia fueron construidas utilizando el método de Kaplan-Meier y el análisis estadístico fue realizado mediante la prueba del log-rank. Se constató 68,7 por ciento de pacientes del sexo masculino, todos los pacientes comprendidos en las edades entre 13 y 83 años. El 75 por ciento de los tumores se localizó en las glándulas salivales mayores, 56,3 por ciento en parótida, los carcinomas mucoepidermoides de bajo grado y estadio II con 37,5 por ciento. La resección quirúrgica fue realizada en todos los pacientes. El período de seguimiento en este estudio varió entre 6 y 217 meses. La tasa general de supervivencia, tanto a los 5 como a los 10 años fue de 85,6 por ciento, mientras que las tasas de supervivencia libre de enfermedad fueron de 81,8 por ciento a los 5 años y de 68,2 por ciento a los 10 años. Se demostró la existencia de influencias estadísticamente significativas del tamaño del tumor (p = 0,05), presencia de metástasis (p = 0,04), y de la localización anatómica primaria (p = 0,04) sobre las tasas de supervivencia libre de enfermedad. Los resultados obtenidos demuestran la importancia de la localización anatómica primaria del tumor, de su tamaño y de la presencia de metástasis, en la supervivencia de los carcinomas mucoepidermoides(AU)

Carcinoma mucoepidermoide de glándulas salivales en Brasil: relación clinicopatológica / Mucoepidermoid carcinoma of the salivary glands in Brazil: clinicopathological outcomes

The biological features and clinical behavior of mucoepidermoid carcinomas are widely variable and poorly understood. This study aimed to investigate prognostic factors that may affect survival in patients with a primary diagnosis of head and neck mucoepidermoid carcinomas. The effects of age, gender, anatomic localization, tumor size, clinical stage, histological grade, recurrence, metastasis, compromised surgical margins and treatment on clinicopathological outcomes were investigated. Survival curves were generated using the Kaplan-Meier method and analyses were performed using the log rank test. A total of 16 cases were analyzed over a period of 18 years; males were 68.7 percent, with ages ranging from 13 to 83 years. The 75 percent of the tumors developed in the major salivary glands, 56.3 percent in the parotid gland and they were predominantly classified as stage II 37.5 percent and low-grade lesions 37.5 percent at diagnosis. Surgical resection was performed in all patients. The follow-up period in this study ranged from 6 to 217 months. The 5 and 10-year overall survival rates were both 85.6 percent. Disease-free survival rates were 81.8 percent (5 years) and 68.2 percent (10 years). There were statistically significant effects of tumor size (p= 0.05), metastasis (p= 0.04) and primary anatomic localization (p= 0.04) on disease-free survival rates. Through a long follow-up period in present study we could highlight the relevance of primary anatomical site, tumor size and metastasis as useful prognostic factors that may affect survival in patients with a primary diagnosis of head and neck mucoepidermoid carcinomas(AU)

Las características biológicas y el comportamiento clínico del carcinoma mucoepidermoide son muy variados y aún poco conocidos. El propósito de este estudio fue investigar los factores pronósticos que puedan afectar la supervivencia de los pacientes con diagnóstico primario de carcinoma mucoepidermoide de cabeza y cuello. Se estudiaron la edad, el sexo, la localización anatómica, el tamaño del tumor, el estadio clínico, el grado histológico, la recidiva, la metástasis, los bordes quirúrgicos comprometidos y el tratamiento, sobre los resultados clínico-patológicos. Las curvas de supervivencia fueron construidas con el método de Kaplan-Meier y el análisis estadístico fue realizado mediante la prueba del log-rank. Fueron analizados 16 casos durante un periodo de 18 años. Se constató un 68,7 por ciento de pacientes del sexo masculino y de edades comprendidas entre los 13 y los 83 años. El 75 por ciento de los tumores se localizó en las glándulas salivales mayores, el 56,3 por ciento en parótida y las clasificaciones predominantes en el momento del diagnóstico fueron lesiones de bajo grado y estadio II con un 37,5 por ciento. La resección quirúrgica fue realizada en todos los pacientes. El periodo de seguimiento en este estudio varió entre 6 y 217 meses. La tasa general de supervivencia, tanto a los 5 como a los 10 años fue de 85,6 por ciento, mientras que las tasas de supervivencia libre de enfermedad fueron de 81,8 por ciento a los 5 años y de 68,2 por ciento a los 10 años. Se demostró la influencia estadísticamente significativa del tamaño del tumor (p= 0,05), la presencia de metástasis (p= 0,04) y de la localización anatómica primaria (p= 0,04) sobre las tasas de supervivencia libre de enfermedad. Los resultados obtenidos demostraron la importancia de la localización anatómica primaria del tumor, de su tamaño y de la presencia de metástasis, en la supervivencia de los pacientes con diagnóstico primario de carcinoma mucoepidermoide(AU)

Sinonasal mucoepidermoid carcinoma: a case report and literature review / Carcinoma mucoepidermoide nasosinusal: reporte de caso y revisión de la literatura

We report on a patient who presented at our clinic with a growth of the right palate of twenty years duration. A biopsy of the area was performed and the lesion was diagnosed as low-grade mucoepidermoid carcinoma (MEC). Due to the size of the tumor, it was decided to begin treatment with radiotherapy followed by chemotherapy. Once the initial treatment was completed, the lesion was reevaluated and surgery followed by reconstruction was recommended. The Patient rejected the recommended treatment and opted to enrolled in a pain management, palliative care program.

Reportamos sobre un paciente que se presentó con un crecimiento del paladar derecho de veinte años de evolución. Se realizó una biopsia del área y se diagnosticó la lesión como carcinoma mucoepidermoide (MEC) bajo grado. Debido al tamaño del tumor, se decidió comenzar el tratamiento con radioterapia seguida de quimioterapia. Una vez que el tratamiento inicial se completó, la lesión fue reevaluada y se recomendó la cirugía seguida de reconstrucción. El paciente rechazó el tratamiento recomendado y optó por seguir un tratamiento de manejo del dolor, programa de cuidados paliativos.

Carcinoma mucoepidermoide central mandibular: presentación de dos casos / Mandibular central mucoepidermoid carcinoma: report of two cases

Los carcinomas mucoepidermoides centrales de los maxilares son lesiones raras. Comprenden el 15 por ciento de todos los tumores malignos que se presentan en los maxilares. A la fecha hay sólo alrededor de 200 casos publicados en la bibliografía. Se presentan dos casos de pacientes tratados en 2005-2006. Los carcinomas mucoepidermoides de los maxilares provocan síntomas inespecíficos y deben ser diagnosticados por biopsia incisional. Su tratamiento primario es quirúrgico, permaneciendo aún poco claro el rol de terapéuticas adyuvantes.

Variante oncocítica del carcinoma mucoepidermoide / Oncocyte variant of mucoepidermoid carcinoma

El carcinoma mucoepidermoide es el más común de todos los tumores malignos de glándulas salivales, constituye el 30 por ciento de ellos. Aproximadamente la mitad de los casos (53 por ciento) ocurre en las glándulas salivales mayores. El 45 por ciento predomina en glándula parótida, el 7 por ciento en la submandibular y el 1 por ciento en la glándula sublingual. Este tumor se presenta con más frecuencia en el sexo femenino (3:2) y en la quinta década de la vida. Múltiples variantes, con diferentes rangos de diferenciación han sido descritas, se incluyen: la oncocítica, esclerosante, uniquística, sebácea, de células claras, células globosas de alto grado, células fusocelular y psamomatosa. El carcinoma mucoepidermoide variante oncocítica es un subtipo raro que puede mostrar prominentes cambios oncocíticos. Se reporta un caso de carcinoma mucoepidermoide variante oncocítica de alto grado histológico. El índice de Ki 67 fue del 5 por ciento, el tumor fue negativo para C-erb2 y presentó inmunorreactividad para E-caderina y Syndecan-1(AU)

The mucoepidermoid carcinoma is the commonest of all malignant tumors of salivary glands, accounting for the 30 percent of them. Approximately the half of cases (53 percent) occurs in the major salivary glands. The 45 percent has predominance in parotid gland, the 7 percent in the submandibular one, and the 1 percent in the sublingual gland one. This type of tumor is more frequent in female sex (3-2) and at fifth decade of life. Multiple variants with different ranks have been described including the oncocyte, sclerosant, unicystic, sebaceous, of clear cells, high degree spherical cells, fusocellular and psammomatous. The mucoepidermoid carcinoma, oncocyte variant, is an unusual subtype that may to shows significant oncocyte changes. Authors report a case of histological high degree mucoepidermoid carcinoma. The rate of Ki 67 was of 5 percent, the negative tumor for C-erb2 and had immunoreaction to E-caderine and Syndecan-1(AU)

A Case of Primary Mucoepidermoid Carcinoma Arising from the Common Bile Duct / 대한소화기학회지

Mucoepidermoid carcinoma of the bile duct is an extremely rare tumor. Seventeen cases originating from intrahepatic bile duct and 2 cases from common hepatic duct have been reported in the English literature. Mucoepidermoid carcinoma arising from the common bile duct has not been previously reported. A 68 year-old man was admitted due to obstructive jaundice. Computed tomography showed a malignant tumor of the common bile duct located in the intrapancreatic segment. Filling defects of the distal common bile duct was seen on endoscopic retrograde cholangiogram. Under the impression of bile duct cancer, pylorus-preserving pancreatoduodenectomy was performed. Histologic diagnosis of the resected specimen was mucoepidermoid carcinoma of the common bile duct. After surgery, the patient received concurrent chemoradiotherapy, and planned to receive additional chemotherapy. We herein report on a first case of primary mucoepidermoid carcinoma of the common bile duct, and review the literature.

Central mucoepidermoid carcinoma of the mandible.

Central mucoepidermoid carcinoma are extremely rare tumors, representing about 2 to 4% of all mucoepidermoid carcinomas. They are histologically low-grade cancers, usually affecting the mandible as uni- or multilocular radiographic lesions. Effective surgical treatment involving wide local excision or en bloc resection, allows patients to have a favorable prognosis after a long-term follow up. We report a case of central mucoepidermoid carcinoma affecting the mandible and discuss its clinical, radiographic, and histological findings, with a review of the literature.

Composite Follicular Variant of Papillary Carcinoma and Mucoepidermoid Carcinoma of Thyroid Gland: A Case Report

A 50-yr-old male presented a thyroid mass with dysphasia and hoarseness. He underwent total thyroidectomy and neck node dissection. Pathologically, the tumor had two distinct tumor components with intermingled areas: follicular variant of papillary carcinoma and mucoepidermoid carcinoma. Mucoepidermoid carcinoma composed of columnar cells, mucocytes, and squamoid cells showing solid and cystic lesion. Several small cysts lined by benign ciliated columnar epithelia suggesting that this tumor had originated from solid cell nest were seen around the tumor. By immunohistochemistry, columnar cells and squamoid cells in mucoepidermoid carcinoma were positive for cytokeratin but negative for thyroglobulin, TTF-1 and calcitonin. Positivity of p63 was seen in squamoid cells and basal cells of cysts. Some mucocytes are CEA positive. Tumor cells of papillary carcinoma are positive for TTF-1, thyroglobulin but negative for CEA, calcitonin and p63.

Parotid neoplasms: analysis of 600 patients attended at a single institution / Neoplasias de parótida: análise de 600 pacientes atendidos em uma única instituição

Salivary gland tumors are rare, generally benign and affect mainly the parotid gland. AIM: The purpose of this study was to retrospectively analyze all cases of parotid tumors treated at our institution from 1953 to 2003. METHODS: All patients with primary parotid tumors were selected; clinical and histopathological data were analyzed and described. RESULTS: 600 cases of parotid tumors were selected; 369 were benign and 231 were malignant. Pleomorphic adenoma was the most frequent benign tumor. The most common malignant tumor was the mucoepidermoid carcinoma. Therapy in most cases consisted of parotidectomy. Adjuvant therapy - mainly radiotherapy - was used in some cases with malignant tumors. The incidences of local, regional and distant recurrences of malignant tumors were 10 percent, 8 percent and 9 percent. CONCLUSION: Patients with parotid tumors treated at our institution were mainly adults, with marginally more female patients. Benign tumors were mostly the pleomorphic adenoma, which were more frequent than malignancies. Most of the patients were treated by partial or total parotidectomy. Adjuvant therapy, mainly radiotherapy, was used in selected malignant cases.

Os tumores de glândula salivar são raros e acometem principalmente a parótida, sendo a maioria de natureza benigna. OBJETIVOS: Avaliar todos os casos de tumor de parótida atendidos na nossa instituição, durante o período de 1953 a 2003. Estudo Retrospectivo. CASUÍSTICA E MÉTODOS: Todos os pacientes com tumores primários de parótida foram selecionados e os dados clínicos e histopatológicos foram analisados e descritos. RESULTADOS: Foram selecionados 600 casos, sendo 369 benignos e 231 malignos. Dentre os tumores benignos, o adenoma pleomorfo foi o mais comum, e dentre os malignos, o carcinoma mucoepidermoide. A principal modalidade de tratamento foi a parotidectomia e em alguns casos malignos, terapias adjuvantes, principalmente a radioterapia, foram aplicadas. Os índices de recorrência local, regional e à distância dos tumores malignos foram de 10 por cento, 8 por cento e 9 por cento, respectivamente. CONCLUSÕES: O perfil dos pacientes com tumor de parótida foi formado predominantemente por adultos e discreta predileção pelo gênero feminino. Os tumores benignos foram os mais frequentes. A maioria dos pacientes foram tratados por parotidectomia parcial ou total. O uso de terapias adjuvantes, principalmente a radioterapia, foi reservada para casos específicos de tumores malignos.

Carcinoma mucoepidermoide da traqueia mimetizando asma brônquica / Mucoepidermoid carcinoma of the trachea mimicking asthma

Em casos de asma de início recente em que o controle clínico com tratamento habitual (corticosteroide e broncodilatador) é insatisfatório, é importante considerar outros diagnósticos, tais como insuficiência cardíaca congestiva, refluxo gastroesofágico ou outras formas de obstrução das vias aéreas. Relatamos o caso de uma paciente do sexo feminino com carcinoma mucoepidermoide da traqueia mimetizando um quadro de asma brônquica. A paciente apresentava tosse e sibilância, bem como espirometria anormal com padrão obstrutivo responsivo a broncodilatador. Após um ano, apresentou deterioração clínica e espirométrica. Nenhuma anormalidade foi encontrada no radiograma de tórax. A TC revelou lesão vegetativa, a 1 cm da carina, reduzindo a luz traqueal. A fibrobroncoscopia mostrou imagem semelhante a tumor carcinoide brônquico. O diagnóstico anatomopatológico após a ressecção cirúrgica foi carcinoma mucoepidermoide de baixo grau, sem envolvimento linfonodal. Embora a curva fluxovolume não fosse sugestiva de obstrução de vias aéreas superiores, a espirometria realizada após a cirurgia mostrou redução significativa do grau de obstrução e maior reversibilidade com broncodilatador. Não houve evidência de recidiva da doença ou retorno dos sintomas após dois anos de seguimento.

In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.

Mucoepidermoid carcinoma of lung: a case report.

Mucoepidermoid lung tumours are uncommon neoplasms comprising of 0.2% of all the lung tumours and historically included under the term bronchial adenomas. This is a case report of a bronchial tumour in the hilar region present since 3 years. The neoplasm could be easily classified as a mucoepidermoid tumour of low malignant potential, as it resembled the histologically identical lesion in the main salivary glands. The case is reported for its rarity and for the histological evaluation of the malignant potential in an apparently clinically benign neoplasm.

Oncocytic variant of mucoepidermoid carcinoma of submandibular gland: an unusual clinical and morphological entity.

In this case report we describe a rare tumor--Oncocytic variant of Mucoepidermoid carcinoma of the submandibular salivary gland with a review of the literature. Oncocytic metaplasia in salivary glands is a benign change that is associated with increasing age and also seen in a few salivary gland neoplasms', which include oncocytoma, Warthin's tumor, and the rare, oncocytic carcinoma. Oncocytic differentiation in mucoepidermoid carcinoma (MEC) is uncommon. Only twelve well-documented cases of oncocytic MEC have been reported previously all of which occurred in the parotid gland. To the best of our knowledge this is the first case of oncocytic mucoepidermoid carcinoma involving the submandibular salivary gland. The recognition of this entity is important, since most of the other primary oncocytic lesions of the salivary gland are benign.

Mucoepidermoid carcinoma arising in Warthin's tumor: a case report.

Malignant transformation of the epithelial component of Warthin's tumor is extremely rare. We describe our experience of mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland in a 35 year old female. The tumor removed from the parotid region was well encapsulated and histologically comprised ofmucoepidermoid carcinoma along with areas of Warthin's tumor. The pathogenesis and differential diagnosis of this rare occurrence have been discussed.