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The gastrointestinal system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Sharon J. White, Francis A. Carey
The most common malignant salivary neoplasm is mucoepidermoid carcinoma (MEC) which may affect children as well as adults. Histologically it shows a variable mixture of squamoid, mucous, and intermediate cell types. The behaviour of mucoepidermoid carcinoma is variable with prognosis reflecting tumour grade. A t(11;19)(q21;p13) translocation and CRTC1-MAML2 gene fusion is found in most MECs. Adenoid cystic carcinoma tends to occur in older individuals and often shows a distinctive cribriform or ‘lace-like’ growth pattern (Figure 10.16). It has a particular tendency for perineural spread, thus making it very difficult to eradicate surgically. The majority of tumours have a t(6;9) translocation and MYB-NFIB gene fusion.
Head and Neck Pathology
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Ram Moorthy, Adrian T. Warfield, Max Robinson
The tumour consists of varying proportions of admixed mucinous, epidermoid and intermediate cells (Figure 26.13). Low-grade tumours are macrocystic and microcystic with plentiful mucocytes, fewer epidermoid cells and infrequent intermediate cells. Extravasated, dissecting mucin pools may be seen. There may be a sclerosing/fibrosing component. Reactive tumour-associated lymphoproliferation is characteristic. High-grade tumours are more solid and contain fewer mucinous elements with a preponderance of atypical epidermoid cells. High-grade tumours are easily mistaken for SCC and recourse to exhaustive sampling augmented by a panel of mucin histochemistry may be diagnostic. This diversity makes FNAB interpretation challenging. The behaviour of mucoepidermoid carcinoma is very varied and various systems have been proposed to attempt to grade tumours and hence predict outcome. A commonly used system is outlined in Table 26.7.39
Perianal and Anal Canal Neoplasms
Published in Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens, Neoplasms of the Colon, Rectum, and Anus, 2007
This general category encompasses a number of different microscopic appearances, including large-cell keratinizing, large-cell nonkeratinizing (transitional), and basaloid (Fig. 7). The term “cloacogenic” carcinoma has been used especially for the basaloid and large-cell nonkeratinizing (transitional) forms of squamous carcinoma. Keratinizing squamous cell carcinomas are rare in the anal canal above the dentate line. Mucoepidermoid carcinoma is extremely rare, if it exists at all in this site. Previously reported examples probably represent squamous cell carcinoma with mucinous microcysts (Fig. 8). When carcinomas contain a mixture of cell types, they should be classified according to the appearance that predominates (1). Because of their similar response to treatment, it is reasonable to group them together as squamous cell carcinoma. To comply with the WHO and the AJCC terminology (1,2), we use the term squamous cell carcinoma instead of epidermoid carcinoma.
A rare case of tonsillar mucoepidermoid carcinoma
Published in Acta Oto-Laryngologica Case Reports, 2023
Charbél Talani, Karin Frånlund, Crina Unguras
A 46-year-old previous smoking male presented with a lump in the left neck at level IIa. The lump had been present for almost 2 months and had been growing. Intra oral and flexible endoscopy was normal. An ultrasound of the left neck detected a 29 × 24 × 12 millimeter necrotic node. Fine needle aspiration and core needle biopsy showed malignant cells and a high suspicion of mucoepidermoid carcinoma. A computer tomography (CT) of the neck and thorax showed contrast enhancement in the left palatine tonsil but symmetric conditions in the oropharynx regarding tonsillar size. The necrotic lymph node was the most prominent one in neck level IIa (Figure 1). CT also showed a couple enlarged lymph nodes in left level III. The case was discussed at a Multi Disciplinary Tumor Board meeting (MDTB). The treatment decision was radical tonsillectomy with left side neck dissection levels I–V. The operative pathology report showed a MEC of the left tonsil, measuring 18 × 9×5 millimeter (Figure 2). The tumor was graded according to Brandwein [13] and Armed Forces Institute of Pathology [14] and was scored 9 and 8, respectively thus being a high grade MEC. Two metastases were present in neck levels IIa and Vb. Ki-67 was estimated to 70%. The tumor was graded as pT1N3bM0 according to AJCC [15]. The case was discussed once again at MDTB and postoperative radiotherapy was decided. The patient received 68 Gray to the oropharynx and the left neck. A FDG-PET, three months after the radiotherapy, was conducted showed no pathologic uptake in the head and neck or thorax.
Clinical profile and management outcomes of lacrimal drainage system malignancies
Published in Orbit, 2022
Md. Shahid Alam, Bipasha Mukherjee, Subramanian Krishnakumar
Majority of patients with lacrimal sac malignancies present in their fifth decade of life with lymphoproliferative lesions presenting almost two decades later.15–17 The mean age in this cohort of patients was almost a decade younger (42.5 years). When we compared the demographic data from China to that from the western world we noticed a younger trend compared to the west.12–14 The youngest case of lacrimal sac malignancy reported by Schenck et al. was a 3-year-old boy diagnosed with lacrimal sac sarcoma.11 The two young patients in our series were 16 and 24 years old, who were diagnosed to have mucoepidermoid carcinoma, and poorly differentiated carcinoma, respectively. While overall a male preponderance has been noted, lymphoproliferative lesions have been noted to have strikingly female preponderance.16 While bilateral involvement with epithelial tumors is exceptionally rare,15 the same has been noted for lymphoproliferative lesions.16
Response to “A rare case of mucoepidermoid carcinoma ex pleomorphic adenoma of the lacrimal gland”
Published in Orbit, 2022
In their discussion, the authors refer to a series of nine patients2 that they describe as “the largest series of lacrimal carcinoma ex pleomorphic adenoma (CEPA) patients” and highlight that “none had the mucoepidermoid carcinoma subtype.” Font and Gamel3 have described the largest series of CEPA patients to date (n = 34), referring to these as ‘malignant mixed tumours’ in their study, albeit they did not specify whether the malignant component of these tumours included mucoepidermoid carcinoma. Also, a recent study of 26 CEPA patients4 (published online March 2021) included three cases with mucoepidermoid carcinoma (one non-invasive and two minimally invasive), all excised intact and one treated with adjuvant radiotherapy, with no recurrence after 2, 19.5, and 19.6 years, respectively.