Epithelial-Myoepithelial Carcinoma of the Inferior Turbinate: A Case Report

Eunsang Lee; Seungjae Lee; Min Jung Jung; Ji Ho Choi

doi:10.18787/jr.2019.26.2.113

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Lee, Lee, Jung, and Choi: Epithelial-Myoepithelial Carcinoma of the Inferior Turbinate: A Case Report

Case Report

J Rhinol 2019;26(2):113-116.

Published online: 20 January 2019

DOI: https://doi.org/10.18787/jr.2019.26.2.113

Epithelial-Myoepithelial Carcinoma of the Inferior Turbinate: A Case Report

Eunsang Lee, MD¹, Seungjae Lee, MD¹, Min Jung Jung, MD², Ji Ho Choi, MD^1,

¹Department of Otorhinolaryngology-Head and Neck Surgery and² Pathology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea

교신저자：최지호, 14584 경기도 부천시 조마루로 170 순천향대학교 의과대학 부천병원 이비인후-두경부외과 Tel: +82-32-621-5015, Fax: +82-32-621-5016, E-mail: handsomemd@naver.com 교신저자：정민정, 14584 경기도 부천시 조마루로 170 순천향대학교 의과대학 부천병원 병리과 Tel: +82-32-621-5962, Fax: +82-32-621-5961, E-mail: mj@schmc.ac.kr

Received 4 April 2019 Revised 31 May 2019 Accepted 4 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Epithelial-myoepithelial carcinoma (EMC) is a rare and low-grade malignant salivary gland tumor including epithelial and myoep-ithelial components. EMC frequently arises in the parotid gland but infrequently originates from the salivary glands of the nasal cavity. Here, we report the case of an EMC arising from the inferior turbinate, one of the most uncommon sites. A 60-year-old female patient presented with left nasal obstruction for several months, and PNS CT showed an about 4×1.4-cm-sized heteroge-neously enhancing polypoid mass originating from the inferior turbinate of the left nasal cavity. After surgical treatment, the patient was diagnosed with EMC based on pathologic examinations including histopathological and immunohistochemical tests. We report a case of a patient with EMC in the inferior turbinate who was observed over 18 months without radiation therapy after successful wide excision.

Keywords: Epithelial-myoepithelial carcinomaㆍ, Inferior turbinateㆍ, Pathology

References

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Fig. 1.

Preoperative endoscopic and CT findings. (A) Preoperative endoscopic finding presents bloody red-colored, necrotic mass originating from inferior turbinate of left nasal cavity. (B) Axial and (C) coronal paranasal sinus CT images present about 4×1.4 cm sized heterogeneously enhancing polypoid mass originated from left inferior turbinate.

Fig. 2.

Microscopic findings. (A) The polypoid tumor shows predominantly biphasic tubular histology, which are characteristic features of epithelial-myoepithelial carcinoma (H&E, ×40). (B) The inner luminal layer is formed by more hyperchromatic ductal cells and the outer layer is formed by myoepithelial cells with indistinct borders. Mitotic features are frequently identified (B, H&E, ×100). (C, D) Cyto-keratin and p63 immunostains highlight luminal-ductal cells and myoepithelial cells, respectively. This biphasic appearance of immu-nohistochemical stain supports the diagnosis of epithelial-myoepithelial carcinoma ([ C], Cytokeratin immunostain, ×40; [ D], p63 im-munostain, ×40).

Fig. 3.

Postoperative PET-CT and endoscopic findings. (A) Focal hypermetabolism of the left nasal cavity in PET-CT findings after 1st op-eration. (B) 2nd operation was performed due to the possibility of residual tumor. (C) There was no any local recurrence in the follow-up for 18 months.

Table 1.

Cases of epithelial-myoepithelial carcinoma of inferior turbinate

Study	Sex/age	Symptom/duration	Origin site	Tumor size	Metastasis	Surgical therapy	Adjuvant radiation therapy	Outcome&recurrence
Current study, 2019	Female/ 60	Nasal obstruction/ 4 months	Inferior turbinate	4 cm	None	Endoscopic removal	No	No recurrence at 18 months
Flam et al., 2015	Male/ 63	Epiphora/2 years, Epistaxis/1 year	Inferior turbinate	1.6 cm (obstruction of nasolacrimal duct)	None	Endoscopic medial maxillectomy	No	No recurrence at 12 months
Park et al., 2011	Female/ 36	Unspecified	Inferior turbinate	0.5 cm	Distant (bone)	Endoscopic removal	No	Recurrence at 15 months in contralateral nasal cavity
Cho et al., 2010	Female/ 72	Nasal obstruction& epistaxis/4–5 months	Inferior turbinate	2.4 cm	None	Endoscopic removal	Stopped after 22 Gy	No recurrence at 12 months
Yamanegi et al., 2008	Female/ 70	Epistaxis/3 months	Inferior turbinate	3.6 cm	None	Unspecified	No	No recurrence at 12 months
Lee et al., 2000	Male/ 22	Nasal obstruction/ 1 year	Inferior turbinate	3 cm (extension to maxillary sinus and soft palate)	None	Partial maxillectomy including a wide palatal excision	55 Gy	No recurrence at 40 months

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