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Difference between revisions of "Mucoepidermoid carcinoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Mucoepidermoid_carcinoma_-_2a_-_very_high_mag.jpg | | Image = Mucoepidermoid_carcinoma_-_2a_-_very_high_mag.jpg | ||
| Width = | | Width = | ||
| Caption = Mucoepidermoid carcinoma. [[H&E stain]]. | | Caption = Mucoepidermoid carcinoma. [[H&E stain]]. | ||
| Micro = mucous cells (abundant fluffy cytoplasm and large mucin vacuoles - nucleus distorted by mucin vacuole, cells may be scarce); epidermoid cells (non-keratinized, polygonal squamoid cell with clear or oncocytic cytoplasm); architecture - cystic (low grade) or solid (high grade) | | Micro = mucous cells (abundant fluffy cytoplasm and large mucin vacuoles - nucleus distorted by mucin vacuole, cells may be scarce); epidermoid cells (non-keratinized, polygonal squamoid cell with clear or oncocytic cytoplasm); architecture - cystic (low grade) or solid (high grade) | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = | | LMDDx = [[squamous cell carcinoma of the head and neck]], [[adenosquamous carcinoma]], [[pleomorphic adenoma]] | ||
| Stains = mucous cells: [[alcian blue stain]] +ve, [[mucicarmine stain]] +ve | | Stains = mucous cells: [[alcian blue stain]] +ve, [[mucicarmine stain]] +ve | ||
| IHC = | | IHC = | ||
| Line 31: | Line 31: | ||
==General== | ==General== | ||
*Most common malignant neoplasm of salivary gland in all age groups.<ref>URL: [http://path.upmc.edu/cases/case715/dx.html http://path.upmc.edu/cases/case715/dx.html]. Accessed on: 2 February 2012.</ref> | *Most common malignant neoplasm of salivary gland in all age groups.<ref>URL: [http://path.upmc.edu/cases/case715/dx.html http://path.upmc.edu/cases/case715/dx.html]. Accessed on: 2 February 2012.</ref><ref name=pmid16003616>{{Cite journal | last1 = Bell | first1 = RB. | last2 = Dierks | first2 = EJ. | last3 = Homer | first3 = L. | last4 = Potter | first4 = BE. | title = Management and outcome of patients with malignant salivary gland tumors. | journal = J Oral Maxillofac Surg | volume = 63 | issue = 7 | pages = 917-28 | month = Jul | year = 2005 | doi = | PMID = 16003616 }}</ref> | ||
*Female:male ~= 3:2. | *Female:male ~= 3:2. | ||
*Site: parotid > submandibular. | *Site: parotid > submandibular. | ||
==Gross== | ==Gross== | ||
*Cystic or solid, | *Cystic or solid, usually a mix of both. | ||
Note: | |||
*May mimic a benign cystic lesion grossly. | |||
*Unicystic mucoepidermoid carcinoma is rare.<ref name=pmid22843640>{{cite journal |authors=Qannam A, Bello IO, Al-Kindi M, Al-Hindi M |title=Unicystic mucoepidermoid carcinoma presenting as a salivary duct cyst |journal=Int J Surg Pathol |volume=21 |issue=2 |pages=181–5 |date=April 2013 |pmid=22843640 |doi=10.1177/1066896912454918 |url=}}</ref> | |||
==Microscopic== | ==Microscopic== | ||
| Line 55: | Line 59: | ||
*Mucin vacuoles may be rare; in a superficial glance -- it may mimic [[squamous cell carcinoma]]. | *Mucin vacuoles may be rare; in a superficial glance -- it may mimic [[squamous cell carcinoma]]. | ||
*The thought of high-grade MEC should prompt consideration of squamous cell carcinoma. | *The thought of high-grade MEC should prompt consideration of squamous cell carcinoma. | ||
DDx:<ref name=pmid22262946>{{Cite journal | last1 = Mokhtari | first1 = S. | last2 = Mokhtari | first2 = S. | title = Clinical features and differential diagnoses in laryngeal mucoepidermoid carcinoma. | journal = Clin Med Insights Pathol | volume = 5 | issue = | pages = 1-6 | month = | year = 2012 | doi = 10.4137/CPath.S8435 | PMID = 22262946 }}</ref> | |||
*[[Squamous cell carcinoma of the skin]] - 75% of metastases to the parotid region are from the skin.<ref name=pmid2694753>{{Cite journal | last1 = Zanetti | first1 = D. | last2 = Renaldini | first2 = G. | last3 = Peretti | first3 = G. | last4 = Antonelli | first4 = AR. | title = [Intra-parotid lymph node metastasis of malignant skin neoplasms of the head]. | journal = Acta Otorhinolaryngol Ital | volume = 9 | issue = 4 | pages = 381-90 | month = | year = | doi = | PMID = 2694753 }}</ref> | |||
*[[Squamous cell carcinoma of the head and neck]]. | |||
*[[Adenosquamous carcinoma]]. | |||
*[[Pleomorphic adenoma]].<ref name=pmid15754364>{{Cite journal | last1 = Siddiqui | first1 = NH. | last2 = Wu | first2 = SJ. | title = Fine-needle aspiration biopsy of cystic pleomorphic adenoma with adnexa-like differentiation mimicking mucoepidermoid carcinoma: a case report. | journal = Diagn Cytopathol | volume = 32 | issue = 4 | pages = 229-32 | month = Apr | year = 2005 | doi = 10.1002/dc.20215 | PMID = 15754364 }}</ref> | |||
===Images=== | ===Images=== | ||
| Line 65: | Line 75: | ||
</gallery> | </gallery> | ||
www: | www: | ||
*[http:// | *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256999/figure/f2-cpath-5-2012-001/ Low-grade MEC (nih.gov)].<ref name=pmid22262946>{{Cite journal | last1 = Mokhtari | first1 = S. | last2 = Mokhtari | first2 = S. | title = Clinical features and differential diagnoses in laryngeal mucoepidermoid carcinoma. | journal = Clin Med Insights Pathol | volume = 5 | issue = | pages = 1-6 | month = | year = 2012 | doi = 10.4137/CPath.S8435 | PMID = 22262946 }}</ref> | ||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256999/figure/f3-cpath-5-2012-001/ Intermed. grade MEC (nih.gov)]. | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256999/figure/f4-cpath-5-2012-001/ High-grade MEC (nih.gov)]. | |||
[[File: 5_20985699291686_sl 1.png|Mucoepidermoid carcinoma of parotid, low grade]] | |||
[[File: 5_20985699291686_sl 2.png|Mucoepidermoid carcinoma of parotid, low grade]] | |||
[[File: 5_20985699291686_sl 3.png|Mucoepidermoid carcinoma of parotid, low grade]] | |||
[[File: 5_20985699291686_sl 4.png|Mucoepidermoid carcinoma of parotid, low grade]] | |||
Low grade mucoepidermoid carcinoma in left parotid of 51 year old woman. A. Tumor shows blue squamoud differentiation with cystic dilatation. B This focus shows more obvious cyst formation. C. Squamous component with round to spindled cancer cells; note that currently squamous pearls and high grade squamous cancer elements render the tumor a squamous carcinoma, according to Barnes. D. Glandular cell component. | |||
===Subtypes=== | ===Subtypes=== | ||
| Line 89: | Line 108: | ||
====AFIP==== | ====AFIP==== | ||
#Low cystic | #Low cystic component (<20%) - 2 points. | ||
#[[Perineural invasion]] - 2 points. | #[[Perineural invasion]] - 2 points. | ||
#[[Necrosis]] - 3 points. | #[[Necrosis]] - 3 points. | ||
| Line 114: | Line 133: | ||
*Alcian blue +ve. | *Alcian blue +ve. | ||
*Mucicarmine +ve. | *Mucicarmine +ve. | ||
Notes: | |||
*Above useful for MEC versus [[squamous cell carcinoma]].<ref name=pmid23960993>{{Cite journal | last1 = Jastrzebski | first1 = A. | last2 = Brownstein | first2 = S. | last3 = Jordan | first3 = DR. | last4 = Gilberg | first4 = SM. | title = Histochemical analysis and immunohistochemical profile of mucoepidermoid carcinoma of the conjunctiva. | journal = Saudi J Ophthalmol | volume = 26 | issue = 2 | pages = 205-10 | month = Apr | year = 2012 | doi = 10.1016/j.sjopt.2012.01.004 | PMID = 23960993 }}</ref> | |||
==IHC== | |||
*CK7 +ve. | |||
*CK20 -ve. | |||
*CEA +ve.<ref>{{Cite journal | last1 = Hassanin | first1 = MB. | last2 = Ghosh | first2 = L. | last3 = Das | first3 = AK. | last4 = Waterhouse | first4 = JP. | title = Immunohistochemical and fluorescent microscopic study of histogenesis of salivary mucoepidermoid carcinoma. | journal = J Oral Pathol Med | volume = 18 | issue = 5 | pages = 291-8 | month = May | year = 1989 | doi = | PMID = 2475619 }}</ref> | |||
==Sign out== | |||
<pre> | |||
A. Lymph Node, Deep Lobe of Left Parotid Gland, Excision: | |||
- One lymph node NEGATIVE for malignancy (0/1). | |||
B. Parotid Gland - Left Deep Lobe, Excision: | |||
- MUCOEPIDERMOID CARCINOMA, low (AFIP) grade. | |||
-- Margins clear. | |||
-- Please see synoptic report. | |||
</pre> | |||
==Molecular== | ==Molecular== | ||
| Line 123: | Line 161: | ||
==See also== | ==See also== | ||
*[[Salivary glands]]. | *[[Salivary glands]]. | ||
*[[Squamous cell carcinoma]]. | |||
*[[Sclerosing mucoepidermoid carcinoma with eosinophilia]]. | |||
==References== | ==References== | ||