Epithelial-Myoepithelial Carcinoma of Parotid Gland—A Surprising Clinical Entity

Jaimanti Bakshi, Grace Budhiraja, Karan Gupta, Sourabha K. Patro, Nalini Gupta

Department of Otolaryngology & Head-Neck Surgery & Department of Cytopathology, PGIMER, Chandigarh, India.

DOI: 10.4236/ss.2012.35055                

Abstract

Objective: Objective of this study is to highlight the importance of considering clinical and radiological findings in parotid tumors before operating tumors with high suspicion of malignancy though reported as benign on histopathology. Material and Methods: 20 years old female patient underwent radical parotidectomy for epithelial-myoepithelial carcinoma of the left parotid gland which was diagnosed on FNAC. Contrast CT and contrast MRI also showed a tumor involving left parotid gland with destruction of ramus of mandible and loss of tissue planes medially & laterally. Facial nerve was infiltrated by tumor, thus sacrificed. Post operatively, patient had left facial palsy and was discharged after 7 days without any other sequelae. Postoperative histopathology showed pleomorphic adenoma with positive resection margins medially, superiorly & posteriorly. No further treatment was given in view of the benign nature of the tumor. Results: Patient was kept on monthly follow up and was disease free at one year follow up. Conclusion: Aggressive surgical treatment should be planned for malignant parotid tumors to give a better tumor free survival. Misdiagnosis can occur on FNAC as it can hit only one part of the tumor thus missing a malignant tumor or can interpret pleomorphic adenoma as epithelial-myoepithelial carcinoma.

Keywords

Myoepithelial; Parotid; Carcinoma; Pleomorphic Adenoma

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. G. Batsakis, A. K. El-Naggar and M. A. Luna, “Epithelial-Myoepithelial Carcinoma of the Salivary Glands,” Annals of Otology, Rhinology and Laryngology, Vol. 101, No. 6, 1992, pp. 540-542.
[2]	T. A. Morrow, T. Chun and N. Mirani, “Epithelial Myoepithelial Carcinoma of the Parotid Gland,” Ear, Nose & Throat Journal, Vol. 69, No. 9, 1990, pp. 646-648.
[3]	K. Donath, G. Seifert and R. Schmitz, “Zur Diagnose und Ultrastruktur des Tubularen Speichelgangkarzinoms,” Virchows Archiv, Vol. 356, No. 1, 1972, pp. 16-31. http://dx.doi.org/10.1007/BF00543554
[4]	G. Seifert and L. H. Sobin, “Epithelial-Myoepithelial Carcinoma, in World Health Organization International Histological Classification of Tumours,” Histological Typing of Salivary Gland Tumours, 2nd Edition, Springer-Veflag, Berlin, 1991, pp. 23-24.
[5]	L. Barnes, B. N. Appel, H. Perez and A. M. El-Attar, “Myoepithelioma of the Head and Neck: Case Report and Review,” Oncology & Radiotherapy, Vol. 28, No. 1, 1985, pp. 21-28. http://dx.doi.org/10.1002/jso.2930280107
[6]	R. L. Corio, J. J. Sciubba, R. B. Brannon and J. G. Batsakis, “Epithelial-Myoepithelial Carcinoma of Intercalated Duct Origin. A clinicopathologic and Ultrastructural Assessment of Sixteen Cases,” Oral Surgery, Oral Medicine, Oral Pathology, Vol. 53, No. 3, 1982, pp. 280-287. http://dx.doi.org/10.1016/0030-4220(82)90304-8
[7]	V. Tralongo and E. Daniele, “Epithelial-Myoepithelial Carcinoma of Salivary Glands: A Review of Literature,” Anticancer Research, Vol. 18, No. 1998, pp. 603-638.
[8]	R. H. W. Simpson, “Salivary Gland Tumours,” In: P. P. Anthony, R. N. M. MacSween, D. Lowe, Eds., Recent Advances in Histopathology, Churchill Livingstone, Edinburgh, 1997, pp. 167-190.
[9]	M. Michal, A. Skalova, R. H. Simpson, V. Rychterova and I. Leivo, “Clear Cell Malignant Myoepithelioma of the Salivary Glands,” Histopathology, Vol. 28, No. 4, 1996, pp. 309-315. http://dx.doi.org/10.1046/j.1365-2559.1996.d01-439.x
[10]	G. L. Ellis and P. L. Auclair, “Tumors of the salivary glands,” In: J. Rosai, L. H. Sobin, Eds., Atlas of Tumor Pathology, Armed Forces Institute of Pathology, Washington DC, 1995. pp. 337-343.
[11]	A. T. Savera, A. Sloman, A. G. Huvos and D. S. Klimstra, “Myoepithelial Carcinoma of the Salivary Glands: A Clinicopathologic Study of 25 Patients,” American Journal of Surgical Pathology, Vol. 24, No. 6, 2000, pp. 761-774. http://dx.doi.org/10.1097/00000478-200006000-00001
[12]	T. Nagao, I. Sugano, Y. Ishida, Y. Tajima, O. Matsuzaki, A. Konno, et al., “Salivary Gland Malignant Myoepithelioma: A Clinicopathologic and Immunocytochemical Study of Ten Cases,” Cancer, Vol. 83, No. 7, 1998, pp. 1292-1299.
[13]	S. Di Palma and M. Guzzo, “Malignant Myoepithelioma of Salivary Glands: Clinicopathological Features of Ten Cases, Virchows Archiv, Vol. 423, No. 5, 1993, pp. 389-396. http://dx.doi.org/10.1007/BF01607152
[14]	M. E. Tortoledo, M. A. Luna and J. G. Batsakis, “Carcinomas Ex Pleomorphicadenoma and Malignant Mixed tumors: Histomorphologic Indexes,” Archives of Otolaryngology, Vol. 110, No. 3, 1984, pp. 172-176. http://dx.doi.org/10.1001/archotol.1984.00800290036008
[15]	R. Singh and R. A. Cawson, “Malignant Myoepithelialcarcinoma (Myoepithelioma) Arising in a Pleomorphic Adenoma of the Parotid Gland. An Immunohistochemical Study and Review of the Literature,” Oral Surgery, Oral Medicine, Oral Pathology, Vol. 66, No. 1, 1988, pp. 65-70. http://dx.doi.org/10.1016/0030-4220(88)90069-2
[16]	L. Alos, A. Cardesa, J. A. Bombi, C. Mallofre, A. Cuchi and J. Traserra, “Myoepithelial Tumors of Salivary Glands: A Clinicopathologic Immunohistochemical, Ultrastructural, and Flow-Cytometric Study,” Seminars in Diagnostic Pathology, Vol. 13, No. 2, 1996, pp. 138-147.
[17]	V. Tralongo, V. Rodolico, F. Burruano, S. Tortorici, A. Mancuso and E. Daniele, “Malignant Myoepithelioma of the Minor Salivary Glands Arising in a Pleomorphic Adenoma,” Anticancer Research, Vol. 17, No. 4A, 1997, pp. 2671-2675.
[18]	V. K. Arora, K. Misra and A. Bhatia, “Cytomorphologic Features of the Rare Epithelial-Myoepithelial Carcinoma of the Salivary Gland,” Acta Cytologica, Vol. 34, No. 2, 1990, pp. 239-242.
[19]	R. Carillo, E. Poblet, A. Rocamora and J. L. Rodriguez-Peralto, “Epithelial-Myoepithelial Carcinoma of the Salivary Gland. Fine Needle Aspiration Cytologic Findings,” Acta Cytologica, Vol. 34, No. 2, 1990, pp. 243-247.
[20]	G. Kocjan, C. Milroy, E. W. Fisher and J. W. Eveson, “Cytological Features of Epithelial-Myoepithelial Carcinoma of Salivary Gland: Potential Pitfalls in Diagnosis,” Cytopathology, Vol. 4, No. 3, 1993, pp. 173-180. http://dx.doi.org/10.1111/j.1365-2303.1993.tb00083.x
[21]	L. J. Layfield and B. J. Glasgow, “Aspiration Cytology of Clear-Cell Lesions of the Parotid Gland: Morphologic Features and Differential Diagnosis,” Diagnostic Cytopathology, Vol. 9, No. 6, 1993, pp. 705-711. http://dx.doi.org/10.1002/dc.2840090621
[22]	T. Wax and L. J. Layfield, “Epithelial-Myoepithelial Cell Carcinoma of the Parotid Gland: A Case Report and Comparison of Cytologic Features with Other Stromal, Epithelial and Myoepithelial Cell Containing Lesions of the Salivary Glands,” Diagnostic Cytopathology, Vol. 14, No. 4, 1996, pp. 298-304. http://dx.doi.org/10.1002/(SICI)1097-0339(199605)14:4<298::AID-DC4>3.0.CO;2-C
[23]	C. J. R. Stewart, S. Hamilton, I. L. Brown and K. Mackenzie, “Salivary Epithelial-Myoepithelial Carcinoma: Report of a Case Misinterpreted as Pleomorphic Adenoma on Fine Needle Aspiration (FNA),” Cytopathology, Vol. 8, No. 3, 1997, pp. 203-209. http://dx.doi.org/10.1046/j.1365-2303.1997.4375043.x
[24]	D. P. C. Lau, M. J. Goddard, I. D. Bottrill and D. A. Moffat, “Epithelial-Myoepithelial Carcinoma of the Parotid Gland. An Unusual Cause of Ear Canal Stenosis,” Journal of Laryngology & Otology, Vol. 110, No. 5, 1996, pp. 493-495. http://dx.doi.org/10.1017/S0022215100134085
[25]	R. H. Simpson, T. J. Clarke, P. T. Sarsfield, P. G. Gluckman, “Epithelial-Myoepithelial Carcinoma of Salivary Glands,” Journal of Clinical Pathology, Vol. 44, No. 5, 1991, pp. 419-423. http://dx.doi.org/10.1136/jcp.44.5.419
[26]	M. A. Luna, N. G. Ordonez, B. Mackay, J. G. Batsakis, O. Guillamondegui, “Salivary epithelial-Myoepithelial Carcinomas of Intercalated Ducts: A Clinical, Electron Microscopic, and Immunocytochemical Study,” Oral Surgery, Oral Medicine, Oral Pathology, Vol. 59, No. 5. 1985, pp. 482-490.