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All You Have Ever Wanted To Know About Mucoepidermoid Carcinoma
All You Have Ever Wanted To Know About Mucoepidermoid Carcinoma
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Grading
High grade lesions, Grade III
Opposite of low grade lesion
Grading
Intermediate lesions, Grade II
Not low and not high, but features of both
Grading
A SEER database study by Chen et al in 2014
2400 patients
522 low grade
1137 Intermediate
741 High grade
Tumor grade (mostly AFIP) correlated with disease
specific survival HR of 14.9
Additional factors correlating with decreased DSS
Tumor size >4cm (HR 12.02), Distant Mets (HR 10.79),
Extraparenchymal extension (HR 6.96)
Workup
Done: To do:
CT Neck Other imaging?
Excisional bx neck mass Why no FNA?
Path indicative of high Treatment?
grade MEC
Bx tongue lesion
Path similar to neck mass
Margins positive
Imaging
Common findings:
CT with contrast
Low grade:
Well circumscribed
mass with cystic
features
Solid portions enhance
Rare calcifications
Imaging
Common findings:
CT with contrast
High grade:
Poorly defined lesion
Infiltrate locally
Appear solid
Q
Typical signal intensities on MRI for a low grade
mucoepidermoid carcinoma are:
a) T1 High, T2 High
b) T1 High, T2 Low
c) T1 Low, T2 High
d) T1 Low, T2 Low
Q
Typical signal intensities on MRI for a low grade
mucoepidermoid carcinoma are:
a) T1 High, T2 High
b) T1 High, T2 Low
c) T1 Low, T2 High
d) T1 Low, T2 Low
Imaging
MRI
GENERALLY-
Benign epithelial
masses and low-grade
malignancies:
Low T1 signal
High T2 signal
High grade
carcinomas:
Low-intermediate
T1
Low-intermediate
T2
Gadolinum useful
adjunct
MRI Low Grade MEC
The Pretender(s)
Necrotizing Sialometaplasia is an
oral lesion than looks frankly
malignant
History typically includes some
sort of trauma
Traumatic intubation, perhaps?
Necrosis of salivary tissue
following ischemia
Location typically hard palate
Typically minor salivary glands
Treatment = do nothing, once
diagnosis is certain
Resolves in a matter of weeks
Numerous oral lesions may look
similar early in their course
Thank you Dr. Darling for that excellent discussion of mucoepidermoid carcinoma. I
think we all have taken some part in the care of this kind. I think one important thing
about his initial staging and probably the most ominous initial thing was that his neck
disease was contralateral to his primary, although it wasnt until later in the workup
that with the imaging we were later to identify the primary lesion in the contralateral
side of the neck. So he was NTC to start out with, and I believe he has failed not in that
neck but in the ipsilateral neck. Hes undergoing palliative chemotherapy with very
little evidence-base, but thats the option that he has remaining at this point.
I think that your final discussion of the pretenders is really important, especially of the
hard and soft palate. The morbidity of an operation or even an unnecessary large
biopsy in this area is pretty high. In addition to necrotizing metaplasia some of the
infections like tb and histo and blasto can also cause bad looking lesions like that. And
you know, psuedoepithelial hyperplasia, though more common on the tongue, can also
appear on the palate.
I will end by quoting Dr. Quinn, Do anything you want to it for a month, but then you
have to biopsy it. Steroids, antibiotics, observation, magic, then biopsy.
---
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Special thanks to Cummings Otolaryngology, Radiopaedia, American Cancer Association, and the Atlas of Genetics and Cytogenetics in
Oncology and Haematology