|Year : 2021 | Volume
| Issue : 2 | Page : 66-68
Shivani Bhandari, Seema Sharma, Manu Gupta, Kanika Bhalla, Upma Tomar
Department of Oral Pathology and Microbiology, Santosh Dental College, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||6-Dec-2021|
Department of Oral Pathology and Microbiology, Santosh Dental College, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the major salivary glands. It represents 5%–10% of all salivary gland tumors and rarely arises within the jaws. It is the second most common minor salivary gland tumor (12%–40% globally). It mainly occurs in the parotid gland and appears as an asymptomatic swelling in minor salivary glands, mostly on the palate. The treatment protocol of MEC is surgical excision followed by postoperative radiotherapy as in most types of salivary gland malignancies. Here, we present a case of MEC in a male patient aged 65 years with emphasis on the importance of early diagnosis so that the malignant neoplasm can be identified early and treated efficiently.
|How to cite this article:|
Bhandari S, Sharma S, Gupta M, Bhalla K, Tomar U. Mucoepidermoid carcinoma. Santosh Univ J Health Sci 2021;7:66-8
| Introduction|| |
Mucoepidermoid carcinoma (MEC) is the epithelial salivary gland neoplasm of the oral cavity. It arises from pluripotent reserve cells of excretory ducts that are capable of differentiating into squamous, columnar, and mucous cells. MEC is composed of mucus-producing, squamous, and intermediate type of cells in varying proportions. It occurs most frequently in adults during the fifth and sixth decades of life with a sight female predilection. Around two-third of MECs arise most commonly in the parotid gland and one-third arise in minor salivary gland, especially in the palate. When MEC arises in minor salivary glands, it is located on the palate, retromolar area, floor of the mouth, buccal mucosa, lips, and tongue. It rarely arises as a primary jaw tumor or as laryngeal, lacrimal, nasal, paranasal, tracheal, or pulmonary tumor. Histologically, MECs are classified into low-grade, intermediate grade, and high-grade tumors. The main treatment mode of MEC ranges from simple surgical excision for low-grade tumors to radical surgical resection for high-grade tumors with postoperative radiotherapy.
| Case Report|| |
A 65-year-old male patient reported to the Department of Oral Pathology and Microbiology with a history of swelling and pain in lower right back region of the jaw. He had noticed redness over that area 5 months earlier; thereafter, the lesion slowly progressed in size and became painful. Pain was gradual in onset, continuous, and moderate in intensity. It was aggravated on chewing food and relieved on taking medications. The patient had no positive, associated medical, family history, and dental history. Extraoral examination revealed no facial asymmetry.
Intraoral examination showed a swelling with ulcerated area of approximately 1.0 cm × 0.8 cm in size and reddish in color. The base of the ulcer was indurated involving the alveolar mucosa extending from region of 46–48. Lesion was firm on palpation and associated with tenderness. The associated lymph nodes were nontender and nonpalpable.
The orthopantomogram revealed no osseous invasion of the lesion. Hematological evaluation showed normal hematological parameters. An incisional biopsy was performed under local anesthesia, and the tissue sample was submitted for histopathological evaluation to the Department of Oral Pathology and Microbiology, Santosh Dental College and Hospital.
Considering the patient history, clinical examination, and radiographic examination, a provisional diagnosis of squamous cell carcinoma was made.
The H and E-stained section showed islands of neoplastic epithelial cells in fibrocollagenous stroma. The neoplastic epithelial cells consisted of a mixture of mucous secreting cells, intermediate cells, and epidermoid (squamous) cells. The mucous cells contained abundant foamy cytoplasm that stained positively with mucin stains. Intermediate cells were basaloid in appearance with scanty pale eosinophilic cytoplasm. The epidermoid cells were polygonal in shape and characterized by squamoid features and intercellular bridges. Intense hemorrhage and hyalinized areas were noted around the islands.
Cyst formation was less prominent, and all three major cell types were present, with the intermediate cells in predominance. The overall histopathological features were suggestive of MEC-intermediate grade.
| Discussions|| |
MEC is a common malignant salivary gland tumor. MEC represents 29%–34% of neoplasm originating from both major and minor salivary glands. Among the major salivary glands, the parotid gland is most commonly involved, and in minor salivary gland, palate is commonly involved. It's a malignant epithelial tumor and was first described by Volkmann in 1895. Later, it was again modified by Masson and Berger in 1924 and was further elaborated by Stewart in 1945 as mucoepidermoid tumor. The exact pathogenesis of this lesion is unknown; there are various theories of its origin. The following may represent origins for this tumor: (a) ectopic salivary gland tissue: remnants of embryonic salivary glands trapped within the bone; (b) transformation of mucous cells found in odontogenic cysts; and (c) maxillary sinuses or submucosal and mucosal glands with intraosseous extension. In all the salivary gland tumors, MEC is the most commonly diagnosed malignancy.
This paper reports a case of MEC in the retromolar area in a male patient. The clinical presentation appears as swelling with ulcerated areas that lead to a provisional diagnosis of squamous cell carcinoma. The patient presented with painful symptoms but no lymphadenopathy is observed. In the radiographic examination, no bone changes are detected. Pain is not always present in the cases of MEC. At the same time, there are reports of cases associated with lymphadenopathy, ulceration, or bone involvement. Isolated tumors in the retromolar area are uncommon site for the MEC, and in general, most neoplastic processes diagnosed in that anatomic site are squamous cell carcinomas.
Histologically, MECs are divided into low-grade, intermediate-grade, and high-grade types, which correlate with clinical behavior. Low-grade tumors are microscopically characterized by the presence of more mucous-producing cells. The high-grade tumors demonstrate solid islands of squamous and intermediate cells which demonstrate considerable pleomorphism and mitotic activity. The intermediate-grade MECs comprise solid rather than cystic architecture with more intermediate cells. The present case showed all of these features; therefore, a final diagnosis of intermediate grade MEC was made. The present case is discussed because of its unique clinical presentation as MECs on retromolar area are relatively rare to be found and can easily be confused with squamous cell carcinoma.
MECs are best treated by surgery, the extent of which depends on location, size, and histopathological grading. Local resection is the treatment option for less aggressive low-grade tumors, while high-grade tumors require wide resection with the involvement of adjacent structures. Low-to-intermediate grade MECs originating from intraoral minor salivary glands have a very low recurrence rate. Radiotherapy should be used only for selected cases due to long-term adverse effects. The role of chemotherapy in the management of MEC is generally reserved for patients with aggressive local or metastatic disease which is not amenable to surgical or radiation therapy. Prognosis is dependent on clinical stage, site, grading, and adequacy of surgery.
| Conclusion|| |
The present case highlights how important it is to understand the clinical pathological features of MEC aiming at early detection and adequate treatment. This disease must be considered a diagnostic hypothesis in oral lesions of proliferative or ulcerative aspect, even when its clinical appearance does not suggest malignancy. The present case enlightens us about the importance of histopathology as the gold standard in the confirmation of diagnosis.
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