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Naso JR, Roden AC. Recent developments in the pathology of primary pulmonary salivary gland-type tumours. Histopathology 2024; 84:102-123. [PMID: 37694812 DOI: 10.1111/his.15039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
Primary pulmonary salivary gland-type tumours are rare neoplasms that are thought to arise from seromucinous glands that are located in the submucosa of large airways. These neoplasms have clinical and pathologic features that are distinct from other pulmonary neoplasms. The majority of primary pulmonary salivary gland-type tumours are malignant, with the most common entities being mucoepidermoid carcinoma, adenoid cystic carcinoma, and epithelial-myoepithelial carcinoma. Less commonly seen are myoepithelial carcinoma, hyalinizing clear cell carcinoma, acinic cell carcinoma, secretory carcinoma, salivary duct carcinoma, intraductal carcinoma, and polymorphous adenocarcinoma. Benign salivary gland-type tumours of the lung include pleomorphic adenoma and sialadenoma papilliferum. Morphologic, immunophenotypic, and molecular features of these neoplasms are largely similar to salivary gland tumours elsewhere, and therefore the exclusion of metastatic disease requires clinical and radiologic correlation. However, the differential diagnostic considerations are different in the lung. The distinction of salivary gland-type tumours from their histologic mimics is important for both prognostication and treatment decisions. Overall, salivary gland type-tumours tend to have a more favourable outcome than other pulmonary carcinomas, although high-grade variants exist for many of these tumour types. Recent advances in our understanding of the spectrum of salivary gland-type tumours reported in the lung and their diversity of molecular and immunohistochemical features have helped to refine the classification of these tumours and have highlighted a few differences between salivary gland-type tumours of the lung and those primary to other sites.
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Affiliation(s)
- Julia R Naso
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
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2
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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 J 2023:1455613231189962. [PMID: 37522369 DOI: 10.1177/01455613231189962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Riaz A, Abbas T, Raza SM, Hurrairah A, Jamshed A. Long-Term Disease Control of Locally Invasive Epithelial-Myoepithelial Carcinoma of Parapharyngeal Salivary Glands With Definitive Radiotherapy. Cureus 2023; 15:e42669. [PMID: 37649950 PMCID: PMC10462795 DOI: 10.7759/cureus.42669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/01/2023] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare clinical entity that affects glandular tissues, most commonly salivary glands. EMC of parapharyngeal space is exceedingly rare. Surgery is the mainstay of treatment with or without chemotherapy, radiotherapy, or both. Due to the rarity of the disease, select cases where surgery is not possible present a management conundrum. We present a case of locally advanced, stage IVa EMC of parapharyngeal space that was treated with upfront definitive radiotherapy. Radiotherapy treatment alone led to long-term disease control in both clinical and radiological follow-ups. The patient was followed for more than eight years posttreatment with no disease recurrence, enjoying the normal activities of life with no late toxicities including xerostomia. This case report highlights the role of radiotherapy in the management of such patients, and more studies are required in this context for surgical candidates with positive disease margins.
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Affiliation(s)
- Adeel Riaz
- General Surgery, The Brooklyn Hospital Center, Brooklyn, USA
- Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Taskheer Abbas
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Syed Mohsin Raza
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Abu Hurrairah
- Radiology, Aziz Fatimah Medical and Dental College, Faisalabad, PAK
| | - Arif Jamshed
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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4
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Shome S, Sil S, Bhaumik A. Epithelial-myoepithelial carcinoma of retro-molar trigone: Unveiling the mystery of rare diagnosis. J Cancer Res Ther 2023; 19:S422-S425. [PMID: 37148010 DOI: 10.4103/jcrt.jcrt_1494_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Epithelial-myoepithelial carcinoma (EMC), a low-grade malignant neoplasm of glandular origin, most commonly involves major and occasionally minor salivary glands. It is rare in minor salivary glands such as hard and soft palate, buccal mucosa, tongue, and so on, frequently affecting geriatric females. EMC comprises diverse histo-pathologic features of an epithelial, myoepithelial de-lineating biphasic pattern along with clear cells, sometimes oncocytic differentiation. Aberrant histo-pathologic features in EMC need judicious discrimination from alike entities, which facilitates appropriate surgical management. Here, we present an unusual case report of EMC in the left retro-molar trigone region in a 60-year-old male patient, the complete diagnosis of which was based on clinical, radiological, histo-pathological, and immuno-histo-chemical features.
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Affiliation(s)
- Sayani Shome
- Department of Oral and Maxillofacial Pathology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
| | - Shiladitya Sil
- Department of Dentistry, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Aritra Bhaumik
- Consultant Oral and Maxillofacial Pathologist, Agartala, Tripura, India
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5
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Jameel Z, Kiluk J, Rosa M. Malignant Adenomyoepithelioma of the Breast and Associated Epithelial-Myoepithelial Carcinoma; A Rare Case Report. Int J Surg Pathol 2022; 30:569-573. [PMID: 35138180 DOI: 10.1177/10668969211070164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adenomyoepithelioma comprises a spectrum of lesions with variable morphology and clinical behavior, presenting at a wide age range. The most common presenting symptom is palpable abnormality. Mammographic abnormalities include focal asymmetries, masses and microcalcifications. Adenomyoepithelioma is a biphasic neoplasm characterized by proliferation of epithelial and myoepithelial cells. Adenomyoepitheliomas can be benign, atypical and malignant (adenomyoepithelioma with carcinoma). Malignant transformation occurs in either one or both cellular components leading to the development of invasive carcinoma. Invasive carcinoma types include invasive breast carcinoma of no special type, invasive lobular carcinoma, invasive carcinoma of special types, myoepithelial carcinoma, metaplastic carcinoma and biphasic carcinoma such as epithelial-myoepithelial carcinoma. While the majority of classic adenomyoepitheliomas have a benign clinical course and can be treated by local excision, local recurrence and distant metastasis have been reported. In malignant cases, treatment is determined by the associated carcinoma to include radiotherapy after breast conserving surgery and sentinel lymph node biopsy or axillary lymph node dissection, as indicated. Herein we report a case of a 62 year old woman who was found to have focal asymmetry on screening mammogram. She underwent a core biopsy of the lesion which showed atypical epithelial-myoepithelial neoplasm and excision was recommended. Upon excision, a diagnosis of malignant adenomyoepithelioma with associated epithelial-myoepithelial carcinoma was rendered with negative margins. The patient declined additional surgery for sentinel lymph node biopsy and declined adjuvant therapy. Six months after surgery, the patient is doing well with no complains. A follow-up mammogram and ultrasound of the axilla showed no abnormalities.
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Affiliation(s)
- Zena Jameel
- 25301Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | - John Kiluk
- 25301Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Marilin Rosa
- 25301Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
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6
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Nandini DB, Singh WT, Aparnadevi P, Ningombam DS. Epithelial-myoepithelial carcinoma ex pleomorphic adenoma of the parotid gland with unique histologic differentiation: A rare case report. J Oral Maxillofac Pathol 2022; 26:S34-S39. [PMID: 35450241 PMCID: PMC9017850 DOI: 10.4103/jomfp.jomfp_400_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/04/2022] Open
Abstract
Epithelial myoepithelial carcinoma (EMC) is an uncommon low-to-intermediate grade salivary gland malignancy that accounts for 1% of all tumors arising in salivary glands. About 80% of these tumors affect the parotid gland. These lesions either arise de novo or from existing pleomorphic adenoma (PA). Histologically, these tumors reveal a biphasic cell population with inner ductal epithelial cells and peripheral myoepithelial cells. There are many histologic variants of EMC, but sebaceous, verocay-like differentiation and high-grade transformation is very rarely reported. This article describes a 48-year-old female patient diagnosed with EMC ex PA with unique histologic differentiation.
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Affiliation(s)
| | - Wahengbam Tulsidas Singh
- Oral & Maxillofacial Surgery, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Potsangbam Aparnadevi
- Department of Oral Pathology & Microbiology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Deepak Singh Ningombam
- Oral Medicine and Radiology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
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7
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Charles R, Murray S, Gray E, Hu J. Pulmonary epithelial-myoepithelial carcinoma (P-EMC) with focal high grade transformation: Molecular and cytologic findings. Diagn Cytopathol 2022; 50:E156-E162. [PMID: 35100487 DOI: 10.1002/dc.24936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pulmonary epithelial-myoepithelial carcinoma (P-EMC) is a rare type of salivary gland tumor of the lung. Diagnosis from preoperative biopsies or fine needle aspiration (FNA) cytology specimens is difficult given the rarity of the tumor and overlapping cytomorphology with other entities. These tumors generally have a good prognosis, however prior reports of recurrence and metastasis to lymph nodes have been reported. Further, little is known about the malignant potential of high grade transformation. The molecular characteristics of this entity are unknown, with only a few case reports commenting on molecular findings. Here, we report a case of P-EMC with focal high grade transformation. We present its diagnostic pitfalls on cytology specimens, surgical pathology, immunohistochemistry, and molecular findings. CASE PRESENTATION A 72 year old female presented with an incidentally detected lung mass. A chest computed tomography (CT) demonstrated a left hilar mass measuring 4.1 cm with endobronchial extension into the left upper lobe. On the initial endobronchial core needle biopsy and cytology FNA, the tumor was misinterpreted as squamous cell carcinoma. The patient subsequently underwent a left pneumonectomy along with mediastinal lymph node dissection. Final surgical pathology of the resection specimen indicated a P-EMC with focal high grade transformation. The patient is disease-free 1 year post-surgery. CONCLUSIONS Due to the rarity of P-EMC, insufficient sampling and histologic heterogeneity, diagnosis of P-EMC on preoperative core needle biopsy or FNA specimen is difficult. Herein, we present a rare case of P-EMC, with a pre-operative FNA cytology specimen that consisted of tumor cells with dense cytoplasm and moderate cytologic atypia, strong positive staining pattern of p40, that was misdiagnosed as squamous cell carcinoma. Follow up surgical resection showed P-EMC with focal high grade transformation. Salivary gland EMCs with high grade transformation have previously been reported to have a worse prognosis, however, little is known about the malignant potential in the lung. Next generation sequencing (NGS) using a 397-gene solid tumor panel identified variants in DNMT3A, APC, STAT3 in both low and high grade components, while KDM5C was present only in the high grade transformation.
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Affiliation(s)
- River Charles
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Sarah Murray
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Eric Gray
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Jingjing Hu
- Department of Pathology, University of California San Diego, San Diego, California, USA
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Okuyama K, Michi Y, Kashima Y, Tomioka H, Hirai H, Yokokawa M, Yamagata Y, Kuroshima T, Sato Y, Tsuchiya M, Kayamori K, Ikeda T, Harada H. Epithelial-Myoepithelial Carcinoma of the Minor Salivary Glands: Case Series with Comprehensive Review. Diagnostics (Basel) 2021; 11:diagnostics11112124. [PMID: 34829471 PMCID: PMC8619087 DOI: 10.3390/diagnostics11112124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 12/21/2022] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor that is histologically characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells, which is especially uncommon in the minor salivary glands (MSG). Because of its histologic variety, complexity, and heterogeneity, it is sometimes challenging to make the accurate diagnosis. Here, we report a literature review of EMC of the MSGs with our experience of two cases. Incisional biopsy was suggestive of pleomorphic adenoma in Case 1 and pleomorphic adenoma or a low-grade salivary gland carcinoma in Case 2. Both cases were performed intraoral tumor resection, and they have good postoperative courses and are alive with no evidence of local recurrence or metastasis at 31 and 16 months, respectively. Considering that the anatomy, structure, and size of salivary glands are quite different from MSGs, it might be difficult to predict EMCs of the MSG similarly to EMCs of the major salivary glands. This comprehensive review also reports the features of EMC of the MSG cases and the trends of diagnosis and discusses treatment strategy.
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Affiliation(s)
- Kohei Okuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
- Correspondence:
| | - Yasuyuki Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Yoshihisa Kashima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Misaki Yokokawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Yuko Yamagata
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Takeshi Kuroshima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Yuriko Sato
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
| | - Maiko Tsuchiya
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.T.); (K.K.); (T.I.)
- Department of Pathology, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Kou Kayamori
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.T.); (K.K.); (T.I.)
| | - Tohru Ikeda
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.T.); (K.K.); (T.I.)
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (Y.K.); (H.T.); (H.H.); (M.Y.); (Y.Y.); (T.K.); (Y.S.); (H.H.)
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Nakaguro M, Tanigawa M, Hirai H, Yamamoto Y, Urano M, Takahashi RH, Sukeda A, Okumura Y, Honda S, Tasaki K, Shimizu A, Tsukahara K, Tada Y, Matsubayashi J, Faquin WC, Sadow PM, Nagao T. The Diagnostic Utility of RAS Q61R Mutation-specific Immunohistochemistry in Epithelial-Myoepithelial Carcinoma. Am J Surg Pathol 2021; 45:885-894. [PMID: 33481388 PMCID: PMC8192334 DOI: 10.1097/pas.0000000000001673] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland cancer characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells. Because of its histologic variety and overlap of histologic features with other salivary gland tumors, there are broad differential diagnoses. The HRAS Q61R mutation has been reported to be frequent in and specific to EMC. We evaluated the usefulness of RAS Q61R mutant-specific immunohistochemical (IHC) staining for detecting this genetic alteration in EMC. We investigated 83 EMC cases and 66 cases of salivary gland tumors with an EMC-like component, including pleomorphic adenoma, adenoid cystic carcinoma, basal cell adenoma/adenocarcinoma, and myoepithelial carcinoma. Sanger sequencing was performed for HRAS, KRAS, and NRAS. The diffuse and membranous/cytoplasmic RAS Q61R IHC expression was observed in 65% of EMC cases, in which all cases harbored the HRAS Q61R mutation. IHC-positive cases were present only in de novo EMCs (54/76 cases, 71%) but not in EMCs ex pleomorphic adenoma. The immunoreactivity was almost always restricted to the myoepithelial cells. Conversely, all EMC cases lacking the HRAS Q61R mutation were negative on IHC. In addition, only 3% of EMC-like tumors showed the abovementioned immunopositivity. None of the cases examined carried KRAS or NRAS mutations. IHC for RAS Q61R is highly sensitive and specific for detecting the HRAS Q61R mutation in EMC. Since significant immunopositivity was almost exclusively identified in nearly two thirds of EMCs but seldom in the histologic mimics, the IHC of RAS Q61R is a useful tool for diagnosing EMC in general pathology laboratories.
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Affiliation(s)
- Masato Nakaguro
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Hirai
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Yoshinari Yamamoto
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Makoto Urano
- Department of Diagnostic Pathology, Fujita Health University, School of Medicine, Toyoake, Japan
| | | | - Aoi Sukeda
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Yuki Okumura
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shogo Honda
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Koichiro Tasaki
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Akira Shimizu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - William C. Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare malignant salivary gland tumor that occurs mostly in the parotid gland. We report a case of EMC of the submandibular gland in a young man. The patient was aware of a slow-growing mass in the right submandibular gland for 1 year. Clinical examination and ultrasound confirmed a right submandibular mass, 2.5 × 3 cm2 in size. Ultrasound-guided fine-needle aspiration indicated a diagnosis of pleomorphic adenoma, which was also suggested by magnetic resonance imaging. The submandibular gland tumor was excised. Immunohistochemical analysis showed carcinoma ex pleomorphic adenoma with a major epithelial-myoepithelial component. The patient was not treated with radiotherapy after surgery. No recurrence was observed during 24 months of follow-up. Because the morphology of EMC is similar to that of a benign tumor, it is frequently initially misdiagnosed. Surgery is always the most effective diagnostic and therapeutic measure for salivary gland tumors, especially those that grow slowly. Resection with negative margins is the treatment of choice for EMC; use of adjuvant radiotherapy is controversial.
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Affiliation(s)
- Jingwen Sun
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University
| | - Xiaojing Cai
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University
| | - Wentao Zou
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University
| | - Jiaxiong Zhang
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University
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11
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Gupta P, Rajwanshi A, Kakkar N. Metastatic Epithelial-Myoepithelial Carcinoma in a Female Presenting with Neck Mass and Lytic Lesion in Acetabulum: A Diagnostic Challenge on Cytology. Turk Patoloji Derg 2021; 37:84-88. [PMID: 32779157 PMCID: PMC10508920 DOI: 10.5146/tjpath.2020.01501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare, low-grade, malignant salivary neoplasm. Establishing an accurate cytological diagnosis is often challenging owing to its rarity, bland cytologic appearance and variable representation of cell populations in the smears. The diagnostic struggle is more so when the aspiration is from a metastatic site with an unknown primary, as in such cases the list of differential diagnoses expands further. A 58-year-old female presented with a low-back pain from last one month. On examination, she also had a level III, right cervical swelling for the last 20 years. Radiology revealed a lytic lesion in the left acetabulum. She had undergone surgery 35 years ago for a right-sided upper neck swelling, the medical records of which were not available. Fine needle aspiration (FNA) from the cervical swelling was performed. The smears were cellular and showed predominantly dispersed, round to polygonal tumor cells with mild pleomorphism, eccentric nuclei, coarse chromatin, occasional nucleoli and moderate cytoplasm with some showing vacuolations. The cell-block section revealed tumor cells arranged in the form of tubules lined by dual layer of tumor cells without any chondromyxoid stroma. On immunocytochemistry, the luminal cells showed positivity for CK7 (epithelial marker) and the abluminal cells showed positivity for p63 (myoepithelial marker). Based on these features, a final diagnosis of metastatic epithelial-myoepithelial carcinoma was rendered. The present report highlights the characteristic cytomorphological and immunocytochemical features of EMC and reiterates the diagnostic accuracy of FNAC for diagnosis of such challenging cases.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ngo MH, Krishnan V, Piché J, Berdugo J. Sebaceous Epithelial-Myoepithelial Carcinoma With Aggressive Behavior and Evidence of Preexisting Pleomorphic Adenoma. Int J Surg Pathol 2020; 29:524-528. [PMID: 33319619 DOI: 10.1177/1066896920980804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMCA) is a rare low-grade carcinoma of the salivary glands with multiple morphological variants. One such variant, sebaceous EMCA (SEMCA), has been reported in the literature. Distinguishing it from other tumors such as sebaceous carcinoma is crucial, as SEMCA typically behaves more indolently. We present a case of a SEMCA in the right parotid of a 71-year-old man that shows features of aggressive behavior such as facial nerve invasion and extraparenchymal extension. Also, we report evidence of preexisting pleomorphic adenoma within this tumor.
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Affiliation(s)
| | | | - Jean Piché
- Pierre-Boucher Hospital, Longueuil, Quebec, Canada
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13
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Lavin V, Callipo F, Donofrio CA, Ellwood-Thompson R, Metcalf R, Djoukhadar I, Higham CE, Kearney T, Colaco R, Gnanalingham K, Roncaroli F. Primary epithelial-myoepithelial carcinoma of the pituitary gland. Neuropathology 2020; 40:261-267. [PMID: 31900996 DOI: 10.1111/neup.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 12/30/2022]
Abstract
Primary salivary gland-like tumors of the sella are rare and often challenging to diagnose. They reportedly derive from serous and mucinous glands that remain trapped in the infundibulum during embryogenesis. We report a 68-year-old man who presented with partial left third cranial nerve palsy, visual loss in the left eye without visual field defects, headache, weight loss and reduced muscle bulk. Neuroimaging studies demonstrated a solid and cystic, avidly enhancing lesion expanding the pituitary fossa and extending to the left cavernous sinus. The patient underwent craniotomy and the tissue removed showed features of epithelial-myoepithelial carcinoma similar to the salivary gland, skin and breast counterpart. No primary tumor was found outside the sella. The lesion behaved aggressively despite radio-chemotherapy and the patient died 22 months from the onset. The tumor showed a novel TP53 in-frame deletion (Gly154del) while no variants were found in H-RAS hotspot regions (codons 12, 13 and 61). Our report expands the spectrum of salivary gland-like tumors primarily occurring in the sella and emphasizes the need for specialist review of rare, non-neuroendocrine tumors of the pituitary and sella regions.
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Affiliation(s)
- Victoria Lavin
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Fabio Callipo
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Carmine A Donofrio
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rhianedd Ellwood-Thompson
- All Wales Medical Genetics Laboratory, Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Robert Metcalf
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | | | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tara Kearney
- Department of Endocrinology, Salford Royal Foundation Trust, Salford, UK
| | - Rovel Colaco
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | | | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hira I, Sahin M, Bayram A, Kaya A, Karaman H, Ozcan I. Epithelial-myoepithelial carcinoma of the supraclavicular region: An unusual cause of dyspnea. North Clin Istanb 2019; 6:404-6. [PMID: 31909389 DOI: 10.14744/nci.2018.25932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/12/2018] [Indexed: 11/20/2022] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is an extremely rare disease and usually develops in major salivary glands, such as the parotid gland. EMC is regarded as a low grade-malignancy tumor, and the treatment protocol involves wide surgical excision with secure clear margins although postoperative radiotherapy is generally performed to reduce local recurrence. The present study aims to report a case of EMC with a supraclavicular location due to its rare occurrence and atypical location.
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16
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Baum JE, Sung KJ, Tran H, Song W, Ginter PS. Mammary Epithelial-Myoepithelial Carcinoma: Report of a Case With HRAS and PIK3CA Mutations by Next-Generation Sequencing. Int J Surg Pathol 2018; 27:441-445. [PMID: 30585117 DOI: 10.1177/1066896918821182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We present the case of a 73-year-old woman with an epithelial-myoepithelial carcinoma of the left breast (ie, malignant adenomyoepithelioma). In both the initial needle core biopsy and in the subsequently performed lumpectomy, the tumor consisted of nests of neoplastic epithelium and myoepithelium with cytologic atypia, increased mitoses, and infiltrative growth into the surrounding tissue. Mutational analysis showed oncogenic driver mutations in HRAS and PIK3CA. In this article, we describe an epithelial-myoepithelial carcinoma of the breast with focal metaplastic differentiation, an extremely rare entity, and report the results of targeted next-generation sequencing. Our patient has not shown any evidence of recurrent or metastatic disease at 29 months follow-up.
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Affiliation(s)
| | - Kap-Jae Sung
- 2 New York-Presbyterian/Queens, New York, NY, USA
| | - Hung Tran
- 1 Weill Cornell Medicine, New York, NY, USA
| | - Wei Song
- 1 Weill Cornell Medicine, New York, NY, USA
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Park CH, Shiwa N, Sumimoto J, Kimitsuki K. Epithelial-Myoepithelial Carcinoma in a Canine Salivary Gland. J Comp Pathol 2018; 165:52-56. [PMID: 30502796 DOI: 10.1016/j.jcpa.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 11/26/2022]
Abstract
A 7-year-old male cavalier King Charles spaniel was presented with a cervical subcutaneous mass. The mass had a multilobular growth pattern and each individual lobule contained ductal epithelial cells and myoepithelial cells surrounding the ductal cells. Immunohistochemically, the ductal epithelial cells were positive for cytokeratin (CK) 7 and CAM5.2 and the myoepithelial cells were positive for α-smooth muscle actin and p63. Both types of cells were positive for CK14, a myoepithelial cell marker. Ultrastructurally, the ductal epithelial cells were attached by desmosomes and contained abundant intracytoplasmic tonofilaments. Some ductal epithelial cells contained myofilaments characteristic of myoepithelial cells. Based on these findings, a diagnosis of epithelial-myoepithelial carcinoma was made. It is presumed that the tumour originated from an intercalated duct in a parotid salivary gland.
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Affiliation(s)
- C-H Park
- Department of Veterinary Pathology, School of Veterinary Medicine, Kitasato University, 23-35-1, Higashi, Towada, Aomori, Japan.
| | - N Shiwa
- Department of Veterinary Pathology, School of Veterinary Medicine, Kitasato University, 23-35-1, Higashi, Towada, Aomori, Japan
| | - J Sumimoto
- Department of Veterinary Pathology, School of Veterinary Medicine, Kitasato University, 23-35-1, Higashi, Towada, Aomori, Japan
| | - K Kimitsuki
- Department of Microbiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
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18
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Mori M, Hanagiri T, Nakanishi R, Ashikari S, Yasuda M, Tanaka F. Primary epithelial-myoepithelial carcinoma of the lung with cavitary lesion: A case report. Mol Clin Oncol 2018; 9:315-7. [PMID: 30155254 DOI: 10.3892/mco.2018.1678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/19/2018] [Indexed: 11/05/2022] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) typically arises in the salivary glands, whereas EMC of the lung is an extremely rare histological form that originates from the bronchial glands. Although cavitation in primary lung cancer is not uncommon, to the best of our knowledge, a case of EMC with a cavitary lesion has not been reported to date. We herein describe a case of cavity-forming pulmonary EMC. A 72-year-old man was referred to our department due to a thickened cystic wall discovered in the upper lobe of the left lung and underwent thoracoscopic left upper lobectomy. Microscopically, the tumor was characterized by biphasic architecture, with glands surrounded by myoepithelial cells. The pathological diagnosis was EMC. The patient has remained in good health for 2 years postoperatively, without any evidence of recurrence. As regards the mechanism of cavity formation, it was hypothesized that the bronchial gland in the primary cystic lesion had been present 3 years prior to the development of the EMC, and grew to become a cavitary lesion. Therefore, although the mechanism of cavity formation remains to be elucidated, EMC of the lung may include a cavitary lesion.
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Abstract
RATIONALE Epithelial-myoepithelial carcinoma (EMC) is regarded as a rare low-grade malignant tumor of the salivary gland, accounting for 0.4% to 1% of all salivary gland tumors. However, epithelial-myoepithelial carcinoma with high-grade transformation (EMC with HGT) is extremely rare, therefore it is easily to be inappropriately diagnosed and treated. Herein, we report an unusual case of EMC with HGT involving the parotid gland and discuss the clinical features and histological characteristic of EMC with HGT, in order to remind the doctors to take appropriate diagnosis and treatment. PATIENT CONCERNS A 77-year-old female sought for treatment in our hospital due to pain mass in the left parotid gland for 6 months with rapid growth recently. DIAGNOSES EMC with HGT was confirmed by final pathology, and then the result showed there were 2 distinctly different areas in the tumor, including the typical EMC component and intensive spindle cells component. INTERVENTIONS The extensive resection surgery was performed. OUTCOMES The patient was uneventful after surgery and no recurrence or metastasis has been observed after follow-up of 4 years. LESSONS A review of literature suggested that EMC with HGT patients trend to be more aged, more aggressive and poorer prognosis than typical EMC patients. In order to avoid misdiagnosis and inappropriate treatment, it is necessary to accurately recognize the differences between the EMC with HGT and typical EMC.
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20
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Abstract
BACKGROUND The most common histological diagnosis of bilateral parotid gland neoplasm is Warthin tumor. Bilateral malignant tumors of the parotid gland are extremely rare. METHODS A 60-year-old man presented with a painless mass in the right preauricular area and an MRI scan showed multiple masses in the parotid glands, bilaterally. A standard superficial parotidectomy was performed on the right parotid gland followed by subtotal parotidectomy on the left. The diagnosis was synchronous bilateral epithelial-myoepithelial carcinoma arising in the parotid glands. RESULTS Histopathology of the tumor on both sides indicated epithelial-myoepithelial carcinoma. There was no evidence of locoregional or remote disease during a 5-year follow-up period. CONCLUSION Malignant tumors should be included in the differential diagnosis of bilateral parotid gland tumors. Management of unilateral malignant parotid tumors should involve careful observation of the contralateral parotid gland.
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Affiliation(s)
- Kayoko Hattori
- Department of Otolaryngology, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Norihiko Murai
- Department of Otolaryngology, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Junko Kusano
- Department of Otolaryngology - Head and Neck Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuka Takahashi
- Department of Otolaryngology, Kyoto-Katsura Hospital, Kyoto, Japan
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21
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Vázquez A, Patel TD, D’Aguillo CM, Abdou RY, Farver W, Baredes S, Eloy JA, Park RCW. Epithelial-Myoepithelial Carcinoma of the Salivary Glands. Otolaryngol Head Neck Surg 2015. [DOI: 10.1177/0194599815594788] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective Epithelial-myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands. In this study, we aim to examine the demographic, clinicopathologic, and survival features of EMC using a population-based approach. Study Design and Setting Retrospective cohort study. Subjects and Methods The Surveillance, Epidemiology, and End Result (SEER) database (1973-2010) was queried for EMC of the major salivary glands. Data were analyzed with respect to various demographic and clinicopathologic factors. Survival was analyzed using the Kaplan-Meier and Cox proportional hazards models. Results In total, 246 cases were available for frequency analysis and 207 for survival analysis. Mean ± SD age at diagnosis was 63.8 ± 15.4 years. EMC affected females more frequently (57.3%). Distant metastases were present at diagnosis in only 4.5% of cases. Overall disease-specific survival (DSS) at 60, 120, and 180 months was 91.3%, 90.2%, and 80.7%, respectively. Patients with low-grade histology had significantly better survival at 180 months relative to those with high-grade tumors (90.6% vs 0.0%, P = .0246). When stratified by tumor size, patients with lesions >4 cm had the worst survival at 180 months (58.8%, P = .0003). All but 9 of the 207 cases available for survival analysis underwent surgery. A total of 85 patients (41.1%) received radiotherapy in addition to surgery. No survival benefit was noted for patients who received radiotherapy compared with those who did not ( P = .4832). Conclusion This report represents the largest series of EMC to date. Despite being regarded as a low-grade, indolent tumor, a significant fraction of our cohort underwent radiotherapy in addition to surgery, with no apparent added survival benefit.
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Affiliation(s)
- Alejandro Vázquez
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Tapan D. Patel
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christine M. D’Aguillo
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rami Y. Abdou
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - William Farver
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan W. Park
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Kim SH, Park SE, Bae HG, Song DH, Oh HH, Cho KR, Kim HJ, Sohn BS. Epithelial-myoepithelial carcinoma of the nasopharynx: A case report and review of the literature. Oncol Lett 2015; 10:927-930. [PMID: 26622597 DOI: 10.3892/ol.2015.3314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 05/15/2015] [Indexed: 11/06/2022] Open
Abstract
An 80-year-old female with complaints of right-sided nose blockage and occasional epistaxis for several months was referred to Sanggye Paik Hospital (Seoul, Korea). Nasal examination revealed a hemorrhagic mass protruding towards the right posterior nasal cavity, for which the patient was subjected to excisional biopsy. The pathological diagnosis was epithelial-myoepithelial carcinoma, as immunohistochemical analysis revealed that the inner cells stained positive for cytokeratin 7, an epithelial cell marker, whereas the outer cells stained positive for smooth muscle actin and P63, consistent with a myoepithelial phenotype. The patient received concurrent chemoradiation therapy followed by systemic chemotherapy. Following the achievement of a partial response, the patient's treatment course was uneventful. Follow-up at 24 months revealed a stable status at partial response, with no subsequent progression.
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Affiliation(s)
- Sul-Hee Kim
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Sung-En Park
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Hyung-Gi Bae
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Doo-Han Song
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Hyun-Ho Oh
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Kyoung-Rai Cho
- Department of Otolaryngology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Hyun-Jung Kim
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Byeong Seok Sohn
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
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Sentani K, Ogawa I, Uraoka N, Ikeda M, Hayashi N, Hattori T, Hattori Y, Oue N, Takata T, Yasui W. High-grade epithelial-myoepithelial carcinoma of the parotid gland with mucous cell differentiation. Pathol Int 2015; 65:490-4. [PMID: 26037059 DOI: 10.1111/pin.12315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor with a low-grade malignancy, and EMC with high-grade histopathological features is exceedingly rare. Furthermore, EMC with intracellular mucin is also extremely rare. We report an uncommon case of a high-grade EMC of the parotid gland with mucous cell differentiation in a 66-year old Japanese woman who noticed a right palpable parotid mass increasing in size within a one-year period. The cytological specimen showed a focally biphasic structure and included isolated or discohesive piled-up clusters with hyaline globules surrounded by neoplastic cells with nuclear atypia. The gross examination revealed a relatively well-demarcated, multinodular gray-whitish and solid mass. Histologically, the tumor consisted of variably sized solid nests or trabeculae with central necrosis and increased mitotic activity, and invaded into adjacent skeletal muscles. Immunohistochemically, the biphasic ductal and myoepithelial differentiation of this tumor confirmed the diagnosis of high-grade EMC. Furthermore, numerous small nests with d-PAS and alcian blue-positive mucous cells predominated in about 5% of the whole tumor, and these mucous cells were encompassed by neoplastic myoepithelial cells. We should recognize this variant of EMC because we can't rule out the possibility of EMC even in the presence of mucous cells.
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Affiliation(s)
- Kazuhiro Sentani
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ikuko Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Naohiro Uraoka
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | | | | | - Takuya Hattori
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yui Hattori
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naohide Oue
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takashi Takata
- Department of Oral and Maxillofacial Pathobiology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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24
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Mann JM, Kellman RM, Hahn SS, de la Roza GL, Gajra A. Radiation-induced epithelial-myoepithelial carcinoma in a patient previously treated with mantle-field radiation therapy for Hodgkin lymphoma. Head Neck 2015; 37:E96-8. [PMID: 25242451 DOI: 10.1002/hed.23873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Radiation-induced salivary gland tumors are well described in the literature, with mucoepidermoid cancer being the most common histologic entity. Epithelial-myoepithelial carcinoma is a rare tumor accounting for <1% of all tumors in the salivary glands. METHODS AND RESULTS We describe the first case of radiation-induced epithelial-myoepithelial carcinoma in the English-language medical literature. A 48-year-old man presented with right-sided mandibular pain and trismus, 25 years after mantle-field radiation therapy (RT) for Hodgkin lymphoma. He underwent excision of a right submandibular mass, which revealed a diagnosis of epithelial-myoepithelial carcinoma. Although typically a low-grade tumor, the histology revealed extensive necrosis and high mitotic activity. The patient required multiple resections and adjuvant therapy after multiple recurrences over a 4-year period. CONCLUSION Reports of epithelial-myoepithelial carcinoma are relatively rare and this case highlights the importance of long-term follow-up and increased awareness of the risks of salivary gland tumors in this population.
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Affiliation(s)
- Justin M Mann
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York
| | - Robert M Kellman
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, New York
| | - Seung S Hahn
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York
| | | | - Ajeet Gajra
- Department of Hematology/Oncology, SUNY Upstate Medical University, Syracuse, New York
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Tajima S, Aki M, Yajima K, Takahashi T, Neyatani H, Koda K. Primary epithelial-myoepithelial carcinoma of the lung: A case report demonstrating high-grade transformation-like changes. Oncol Lett 2015; 10:175-181. [PMID: 26170995 DOI: 10.3892/ol.2015.3169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 03/19/2015] [Indexed: 01/05/2023] Open
Abstract
Primary salivary gland-type tumors of the lung are rare; among them, epithelial-myoepithelial carcinomas (EMC) represent a minor histological subtype. The present case documents an EMC that occluded the B8 segment of the left lung in a 72-year-old woman. Macroscopically, the tumor was well-demarcated; however, microscopic examination demonstrated that it had infiltrated the lung parenchyma. The majority of the tumor mass was composed of a myoepithelial overgrowth in conjunction with conventional bilayered ductal structures comprising epithelial and myoepithelial cells. At the advancing edge of the tumor, the myoepithelial overgrowth was observed to be gradually transitioning to a higher-grade component, which demonstrated venous invasion. The Ki-67 labeling index was reduced compared with high-grade transformation (HGT) of salivary gland EMC; p53 was sparsely observed on immunostaining. However, cyclin D1, which is reported to be overexpressed in certain subtypes of salivary gland carcinomas with HGT, was overexpressed in the higher-grade component of the tumor, indicating a potential HGT initiation. The surgical margin was tumor free, and no recurrence has been observed for 4 months. A thorough follow-up is required considering the HGT-like changes and venous invasion of the tumor. Additional studies are required to elucidate the characteristics of pulmonary EMC, with an emphasis on detecting HGT or HGT-like changes.
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Affiliation(s)
- Shogo Tajima
- Department of Pathology, Shizuoka Saiseikai General Hospital, Shizuoka, Shizuoka 422-8021, Japan
| | - Michihiko Aki
- Department of Cell Biology and Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan
| | - Kiyoshige Yajima
- Department of Chest Surgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka 426-0077, Japan
| | - Tsuyoshi Takahashi
- Department of Chest Surgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka 426-0077, Japan
| | - Hiroshi Neyatani
- Department of Chest Surgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka 426-0077, Japan
| | - Kenji Koda
- Department of Pathology, Fujieda Municipal General Hospital, Fujieda, Shizuoka 426-0077, Japan
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Abstract
Epithelialmyoepithelial carcinoma (EMEC) is a rare low-grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. Here, we present a case of EMEC in a 60-year-old male patient with a huge swelling in the left parotid gland region. Clinically and radiologically, it simulated a benign salivary gland neoplasm. However, fine-needle aspiration cytology and histologic examination revealed atypical myoepithelial cells in solid sheets or nests suggestive of epithelial-myoepithelial carcinoma. Diagnosis was further confirmed by positive immunohistochemical staining with calponin (CALP) and periodic acid-Schiff (PAS) for glycogen.
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Affiliation(s)
- Shubhra Sharma
- Department of Oral Pathology, Terna Dental College, Maharashtra, India
| | - Sangeeta Patankar
- Yerala Medical Trust's Dental College, Navi Mumbai, Maharashtra, India
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27
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Seethala RR. Oncocytic and apocrine epithelial myoepithelial carcinoma: novel variants of a challenging tumor. Head Neck Pathol 2013; 7 Suppl 1:S77-84. [PMID: 23821213 DOI: 10.1007/s12105-013-0461-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 06/09/2013] [Indexed: 10/26/2022]
Abstract
Epithelial myoepithelial carcinoma (EMCa) is a rare but well characterized biphasic salivary gland malignancy with several variant morphologies. Oncocytic and apocrine EMCa are uncommon variants that constitute up to 8 % of all EMCa. Both variants invoke an eosinophilic or oncocytic differential diagnosis and challenge the traditional requirement of clear myoepithelial cells for EMCa. Oncocytic EMCa occurs in patients a decade older than conventional EMCa. This variant is often papillary with calcification and associated with sebaceous components and occurs in older individuals. Apocrine EMCa is named for its apocrine ductal component, which may be mistaken for salivary duct carcinoma. In this variant, the epithelial component often shows overgrowth in a cribriform or even solid pattern and is immunophenotypically defined by androgen receptor and gross cystic disease fluid protein 15 positivity. The most important aspect of differentiating both oncocytic and apocrine EMCa from other salivary oncocytic tumors is recognition of the biphasic nature of these variants and confirmation that the abluminal outer layer consists of plump, 'activated' myoepithelial cells, regardless of tinctorial characteristics. Both oncocytic and apocrine EMCa behave very indolently in the limited literature to date.
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28
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Li Y, Kim HS, Kang MS, Shin SH, Koo KH, Kim CM, Kim KH, Peck C, Bae HI, Jeong JY, Kang JS, Kang BH. A spontaneous epithelial-myoepithelial carcinoma of the submandibular gland in a sprague-dawley rat. J Toxicol Pathol 2013; 26:67-72. [PMID: 23723571 PMCID: PMC3620217 DOI: 10.1293/tox.26.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/03/2012] [Indexed: 01/05/2023] Open
Abstract
The present report describes a rare case of spontaneous tumor of the salivary gland in a male Sprague-Dawley rat. The clinically confirmed mass rapidly developed in the cervical region between 19 and 21 weeks of age, and the animal was subsequently euthanized. At necropsy, a well-circumscribed nodule approximately 7 × 6 cm in diameter was found at the site of the salivary gland. The cut surface of the nodule was lobulated and soft and had a pinkish tan fish-flesh appearance. One large cyst (approximately 3 × 2 cm in size) containing reddish fluid was also present in the nodule. Histopathologically, the tumor, with a partially lobulated structure, was surrounded by a thin fibrous capsule. The majority of tumor cells formed a diffuse solid sheet structure that mainly consisted of small ovoid or spindle-shaped cells. In the tumor periphery, some cells were arranged in nest-like structures. Small duct-like structures lined with a monolayer of cuboidal epithelial cells resembling an intercalated duct or large polygonal clear cells with a myoepithelial component were also observed. Mitotic figures and necrotic foci were frequently observed in solid areas. Immunohistochemically, the tumor cells were positive for cytokeratin, epithelial membrane antigen, vimentin, p63, α-smooth muscle actin and calponin. The cells were negative for calcitonin, synaptophysin and chromogranin A. On the basis of these findings, the tumor was diagnosed as an epithelial-myoepithelial carcinoma originating from the luminal epithelial cells and myoepithelial cells in the submandibular gland.
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Affiliation(s)
- Yinghua Li
- Department of Pathology, Chemon Co., Ltd., 240 Nampyeongro, Yangji-Myeon, Cheoin-Gu, Yongin-Si, Gyeonggi-Do 449-826, Republic of Korea
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29
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Hussaini HM, Angel CM, Speight PM, Firth NA, Rich AM. A double-clear variant of epithelial-myoepithelial carcinoma of the parotid gland. Head Neck Pathol 2012; 6:471-5. [PMID: 22427262 PMCID: PMC3500893 DOI: 10.1007/s12105-012-0350-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
The hallmark of the histology of epithelial-myoepithelial carcinoma (EMC) is the presence of a regular repetitive mixture of bilayered duct-like structures with an outer layer of myoepithelial cells and inner ductal epithelial cells. Clear cell change in the myoepithelial component is common, but clearing of both cell types, giving an impression of a monocellular neoplasm, is rare. A parotid biopsy was received from an 83-year-old male and subject to routine histologic processing for conventional staining and immunohistochemistry. The encapsulated tumour was composed of sheets of PAS/diastase negative clear cells, separated by fibrous septae. The clear myoepithelial cells were positive for S-100 protein, SMA, and p63 and negative for CK19 and surrounded CK19-positive luminal cells. It is important to utilise immunohistochemistry to differentiate this tumour from others with a similar histologic pattern. Information about the behaviour of the double-clear EMC is limited since there are few cases reported.
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Affiliation(s)
| | - Christopher M. Angel
- School of Dental Science, University of Melbourne and St John of God Pathology, Melbourne, VIC Australia
| | - Paul M. Speight
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Norman A. Firth
- MedLab Dental Oral Pathology Diagnostic Service and the Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 647, Dunedin, 9054 New Zealand
| | - Alison M. Rich
- MedLab Dental Oral Pathology Diagnostic Service and the Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 647, Dunedin, 9054 New Zealand
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