Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(6) > 1032510

J Korean Assoc Oral Maxillofac Surg. 2011 Dec;37(6):505-509. Korean.
Published online December 27, 2011.  https://doi.org/10.5125/jkaoms.2011.37.6.505
Copyright © 2011 by The Korean Association of Oral and Maxillofacial Surgeons
Epithelial-myoepithelial carcinoma on the superficial lobe of the parotid gland: a case report
Sun-Mi Jin, Hyun-Ho Ryu, Seok-Hwan Ryu, Dong-Yoon Shin, Hie-Sung Hwang, Chul-Hoon Kim and Bok-Joo Kim
Department of Oral and Maxillofacial Surgery, Department of Dentistry, Dong-A University Medical Center, Busan, Korea.

Corresponding author: Bok-Joo Kim. Department of Oral and Maxillofacial Surgery, Department of Dentistry, Dong-A University Medical Center, Dongdaeshin-dong 3-1, Seo-gu, Busan 602-103, Korea. TEL: +82-51-240-5470, FAX: +82-51-241-5475, Email: samehope@naver.com
Received June 02, 2011; Revised August 30, 2011; Accepted October 12, 2011.

Abstract

Epithelial-myoepithelial carcinoma (EMC) is a low-grade malignant salivary gland neoplasm that was first described in 1972. EMC occurs in the older age group, there is a female predilection and mainly involves the parotid gland. Most authors recommend superficial parotidectomy as a treatment for low-grade malignant tumor in the superficial lobe of parotid gland. The treatment of epithelial-myoepithelial tumors typically includes surgical excision aimed at achieving a R0 resection. This paper reports a case of EMC of the parotid gland treated only by a conservational surgical excision. The lesion was exposed by the retromandibular approach and detached. After the parotid gland envelop was exposed, the mass was observed and was easy to remove due to capsulation. The preoperative diagnosis was a pleomorphic adenoma on the left parotid gland. The tumor was removed surgically with a conservative extracapsular dissection. The postoperative diagnosis was EMC, so superficial parotidectomy or radiation therapy was considered. Nevertheless, the patient was observed and no additional treatment was attempted because the patient was old and a successfully excision of the tumor had been achieved.

Keywords: Epithelial-myoepithelial carcinoma; Parotid gland

Figures


Fig. 1
Facial view illustrating the 3-4 cm swelling on patient's left cheek.
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Fig. 2
Computed tomography (CT) scan. A. Transverse view of CT scan. B. Coronal view of CT scan.
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Fig. 3
Macroscopic view (external) shows well-circumscribed, thinly encapsulated mass with soft consistency.
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Fig. 4
Macroscopic view (cross section) shows a relatively well defined grayish white soft tissue mass with focal cystic change on sectioning. The tumor is confined to the gland.
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Fig. 5
Microscopic view (H&E staining, ×100). The parotid gland mass is composed of double layered tubules and solid area of clear cells (short arrows). The tubules are lined by inner cuboidal cells with eosinophilic cytoplasm and outer layer of clear, myoepithelial type cells (long arrow).
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Fig. 6
Microscopic view (H&E staining, ×40). The tumor also shows cystic area with papillary fronds (arrows).
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Fig. 7
The immunohistochemical stain confirms the outer layer of tubules are lined by p63 positive myoepithelial cells (arrows) (anti-p63 immunohistochemistry, ×100).
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References
1. Seifert G, Sobin LH. WHO. In: World Health Organization International Classification of Tumors: Histological Typing of Salivary Gland Tumors. 2nd ed. Berlin: Spring-Verlag; 1991. Epithelial-myoepithelial carcinoma; pp. 23-24.
2. Dorothy MP. Surgical Pathology and Fine Needle Aspiration Cytopathology. In: John EN, Mark MG, editors. Color Atlas and Text of the Salivary Glands. 1st ed. Barcelona: Mosby-Wolfe; 1995. pp. 78.
3. Saksela E, Tarkkanen J, Wartiovaara J. Parotid clear cell adenoma of possible myoepithelial origin. Cancer 1972;30:742–748.
4. Bauer WH, Fox RA. Adenomyoepithelioma (Cylindroma) of palatal mucous glands. Arch Pathol 1945;39:96–102.
5. Donath K, Seifert G, Schmitz R. Diagnosis and ultrastructure of the tubular carcinoma of salivary gland ducts. Epithelial-myoepithelial carcinoma of the intercalated ducts. Virchows Arch A Pathol Pathol Anat 1972;356:16–31.
6. Yamada H, Kawaguchi K, Yagi M, Morita Y, Mishima K, Uno K, et al. Epithelial-myoepithelial carcinoma of the submandibular gland with a high uptake of 18F-FDG: a case report and image diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:243–248.
7. Kokemueller H, Swennen G, Brueggemann N, Brachvogel P, Eckardt A, Hausamen JE. Epithelial malignancies of the salivary glands: clinical experience of a single institution-a review. Int J Oral Maxillofac Surg 2004;33:423–432.
8. Baek S, Ha JW, Oh HK, Ryu SY, Kim WJ. A clinical study on the parotid gland tumors. J Korean Assoc Maxillofac Plast Reconstr Surg 2002;24:398–405.
9. Woods JE, Chong GC, Beahrs OH. Experience with 1,360 primary parotid tumors. Am J Surg 1975;130:460–462.
10. Park TW, Lee SL, Kim JD, Park CS, Choi SC, Ko KJ, et al. In: Oral and Maxillofacial Radiology. 3rd ed. Seoul: Narae Publishing; 2001. pp. 476-477.
11. Corio RL, Sciubba JJ, Brannon RB, Batsakis JG. Epithelial/myoepithelial carcinoma of intercalated duct origin. A clinicopathologic and ultrastructural assessment of sixteen cases. Oral Surg Oral Med Oral Pathol 1982;53:280–287.
12. Cheung FM, Hioe F, Kong JH. Histologic variant of the epithelial/myoepithelial carcinoma of the salivary gland: a case report. Head Neck 1995;17:437–444.
13. Di Palma S. Epithelial/myoepithelial carcinoma with co-existing multifocal intercalated duct hyperplasia of the parotid gland. Histopathology 1994;25:494–496.
14. Deere H, Hore I, McDermott N, Levine T. Epithelial-myoepithelial carcinoma of the parotid gland: a case report and review of the cytological and histological features. J Laryngol Otol 2001;115:434–436.
15. Spiro RH, Huvos AG, Strong EW. Cancer of the parotid gland. A clinicopathologic study of 288 primary cases. Am J Surg 1975;130:452–459.
16. Harish K. Management of primary malignant epithelial parotid tumors. Surg Oncol 2004;13:7–16.
17. Lim YC, Lee SY, Kim KB, Lee JS, Koo BS, Shin HA, et al. Conservative parotidectomy for the treatment of parotid cancers. Oral Oncol 2005;41:1021–1027.