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Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E283-6. Central mucoepidermoid carcinoma
Journal section: Oral Medicine and Pathology Publication Types: Case Report
Central mucoepidermoid carcinoma: Report of a case with 11 years’ evolution and peculiar macroscopical and clinical characteristics
Renata Tucci 1, Luciana-Fasanella Matizonkas-Antonio 1, Artur-Aburad de Carvalhosa 2, Paulo-Henrique-de Sousa Castro 3, Fabio-Daumas Nunes 4, Décio-dos Santos Pinto Jr 4
1 DDS, MS, PHD, Institute of Health Research, Sao Paulo, Brazil
2 DDS, PHD, Cuiaba Cancer Hospital, Mato Grosso, Brazil
3 DDS, MS, Cuiaba Cancer Hospital, Mato Grosso, Brazil
4 DDS, MS, PHD, Oral Pathology, School of Dentistry, University of Sao Paulo, Brazil
Correspondence:
Institute of Health Research Av. Indianópolis, 153 São Paulo - SP - Brazil CEP:04063-000 renata-tucci@uol.com.br
Received: 21/06/2008 Accepted: 24/01/2009
Tucci R, Matizonkas-Antonio LF, de Carvalhosa AA, Castro PH, Nunes FD, Pinto Jr DS. Central mucoepidermoid carcinoma: Report of a case with 11 years’ evolution and peculiar macroscopical and clinical charac- teristics. Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E283-6.
http://www.medicinaoral.com/medoralfree01/v14i6/medoralv14i6p283.pdf
Abstract
Central mucoepidermoid carcinomas (CMC) are uncommon tumours, comprising 2-3% of all mucoepidermoid carcinomas reported. They have been reported in patients of all ages, ranging from 1 to 78-years, with the overwhelming majority occurring in the 4th and 5th decades of life. They are histologically low-grade cancers, usually affecting the mandible as uniocular or multiocular radiographic lesions. The authors report a case of CMC of the mandible with a long evolution, and peculiar clinical and macroscopical features related with the long term evolution of the disease. A 53-year-old male patient had expansion of buccal and lingual cortices of the anterior region of the mandible, covered by ulcerated mucosa, with 11 years evolution. An incisional biopsy was performed, and the histopathological fi ndings confi rm low-grade mucoepidermoid carcinoma. The patient was treated with a mandibulectomy, followed by supraomohyoid neck dissection. There was no evidence of local recurrence, regional or distant metastasis revealed; and the patient was alive and without disease after a follow- up interval of 36 months.
Keywords:Mucoepidermoid carcinoma, central, intraosseous, salivary gland neoplasms.
Article Number: 5123658886 http://www.medicinaoral.com/
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Introduction
Some 90% of oral cancers consist of squamous cell car- cinomas that arise from the oral mucosa. The remaining 10% of malignancies consist of malignant melanomas, carcinomas of the intraoral salivary glands, sarcomas of the soft tissues and the bones, malignant odontogen- ic tumors, non-Hodgkin’s lymphomas and metastases from primary tumors located elsewhere in the body (1).
Salivary gland tumours are an important part of the Oral and Maxillofacial Pathology (2) and represent 3-5% of all head and neck neoplasms (3).
Central mucoepidermoid carcinomas (CMC) are ex- tremely rare, comprising 2-3% of all mucoepidermoid carcinomas reported (4). We found reports of about 120 cases of central mucoepidermoid carcinomas (5,6).
The origin of the CMC is controversial and several pos-
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Fig. 1A.Expansive lesion in mandible with 11 years evolution.
Fig. 1B. Intra-oral examination revealed a large and fi rm lesion partially covered by an ulcerated mucosa causing expansion of buccal and lingual cortices of the anterior region of the mandible
Fig. 1C and 1D. A computed tomography showed lobulated osteolytic lesion inside the mandibular body with inexate limits and cortical rupture.
sibilities have been considered, including: metaplasia of odontogenic cysts epithelium, entrapment of salivary tissues from the submandibular, sublingual or minor salivary glands, during embryonic development, en- trapment of minor salivary glands from the retromolar area, maxillary sinus epithelium, iatrogenic entrapment of minor salivary glands (e.g. chronic osteomielitis and sinusitis) and odontogenic remnants of the dental lamina (7,8). More recently, intraosseous salivary tis- sue was demonstrated in 0.3% of bone specimens of all jawbones studied by Bouquot et al. (8), providing new evidences for the origin of intraosseous salivary carci- nomas (9). Although its etiology is questionable, CMC is a well-accepted entity (9).
We report a case the CMC in a mandible of a 53-year- old man with 11 years evolution, showing clinical, to- mographic, macro and microscopical characteristics.
Case Report
A 53-year-old man was referred to the Oral Medicine Service at the Cancer Hospital, Cuiabá, Mato Grosso, Brazil, for the diagnosis of mandibular lesion with 11 years evolution (Fig.1A). The patient refers growth of the lesion in the last month. His medical history was not signifi cant. Clinical examination of the oral cavity revealed expansion of buccal and lingual cortices of the anterior region of the mandible, covered by ulcer- ated mucosa (Fig.1B). Cervical lymphadenopathy was absent. A computed tomography showed lobulated os- teolytic lesion inside the mandibular body with inexate limits and cortical rupture (Fig.1C and 1D).
An incisional biopsy of the intraosseous lesion was per- formed. Histological examination of the specimen re- vealed a neoplasm composed predominantly of cystic spaces, containing myxoid material produced by clear
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Fig. 2. Histological examination of the specimen revealed a neo- plasm composed predominantly of nests of epidermoid cells with intermediate differentiation in a fi brous stroma and clear cells. (Hae- matoxylin an eosin, magnifi cation X200).
Fig. 3.A. After sectioning the surface, pseudo-cystic cavities show- ing green mucous secretion.
3. B. 20 ml of mucous secretion were removed from the cavities.
3. C. The histopathological characteristics of pseudo-cystic cavity showing mucous secretion are observed (Haematoxylin an eosin, magnifi cation X100).
cells, and nests of epidermoid cells with intermediate differentiation in a fi brous stroma (Fig.2).
With a diagnosis of low-grade mucoepidermoid carci- noma a mandibulectomy with preservation of the con- diles was performed, because the size of tumor. Gross examination of the ressected specimen revealed brown- ish tumoral mass involving all the jaw body, buccal and lingual cortical, from left to right molars. After cutting the surface, pseudo-cystic cavities showing green mu- cous secretion were observed (Fig.3A). 20 ml of mucous secretion were removed into the cavities (Fig.3B). The histopathological characteristics of pseudo-cystic cavity showing mucous secretion are observed in (Fig.3C). A histopathological analysis the surgical specimen recon-
fi rmed the diagnosis of the low-grade mucoepidermoid carcinoma. The patient is on regular follow-up and is disease free after 3 years.
Discussion
Primary central salivary gland carcinomas of the man- dible are uncommon neoplasms (10). Mucoepidermoid carcinoma generally affects the salivary glands and only rarely is located in the jaws (11,12). CMC affects females twice more frequently than males and involves the mandible twice more often than maxilla. The most common site of occurrence is the premolar-molar-angle region of mandible (13).
The criteria for diagnosing CMCs include: (a) presence of a radiographic distinct osteolytic lesion; (b) positive mucicarmine staining; (c) absence of rupture of one or more cortical plates; (d) clinical and histological exclu- sion of a metastasis or an odontogenic lesion; (e) exclu- sion of the origin from a soft tissue salivary gland; (9) histologic confi rmation (14).
Our case showed rupture of cortical plate, but it has been shown in the literature that intact cortical plates should not be an essential feature for diagnosis of CMCs (15).
Moreover we excluded other possibilities as metastases and odontogenic lesions.
Brookstone et al. in 1992 (14) proposed a staging system based on the condition of the overlying bone. Lesions with intact cortical plates with no evidence of bone ex- pansion are Staged I; tumors with intact plates but intra- osseous expansion are Staged II; and lesions associated with cortical perforation or nodal disease are Staged III. Our case is in staged III, because showed rupture of cortical plate.
Most of the reported, CMC are histologically low-grade tumours and usually carry a favorable prognosis (10).
As a rule, even being low-grade tumours, CMC should be managed by wide local resection. Our case shows that, although the CMC is considered a low malignant potential carcinoma, in long-term evolution, it can be locally aggressive and requires wide en bloc resection.
In conclusion, CMC is a rare entity. Although CMC don’t show clinic characteristics and un favorable prognosis, it can, how our case, showed destruction, local infi ltration and ulcerated mucosa commonly in long time evolution cases. In these cases, bloc resection and effective follow- up are necessary for the success of the treatment.
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