Left lower lobe sleeve resection for the clear cell variant of pulmonary mucoepidermoid carcinoma:A case report

BACKGROUND Pulmonary mucoepidermoid carcinoma(PMEC)is a rare malignancy that arises from minor salivary glands within the tracheobronchial tree.The clear cell variant of PMEC is exceptionally uncommon and presents notable diagnostic challenges,primarily attributable to its morphological similarity to other tumors containing clear cells.CASE SUMMARY A 22-year-old male,formerly in good health,came in with a two-month duration of persistent cough and production of sputum.Subsequent imaging and bronchoscopy examinations revealed a 2 cm tumor in the distal left main bronchus,which resulted in complete atelectasis of the left lung.Further assessment via positron emission tomography/computed tomography scans and endoscopic biopsy confirmed the primary malignant nature of the tumor,charac-terized by clear cell morphology in most of the tumor cells.The patient underwent a left lower lobe sleeve resection accompanied by systematic mediastinal lymph node dissection.Molecular pathology analysis subsequently revealed a CRTC3-MAML2 gene fusion,leading to a definitive pathological diagnosis of the clear cell variant of PMEC,staged as T2N0M0.After surgery,the patient experienced a smooth recovery and exhibited no signs of recurrence during the one-and-a-half-year follow-up period.CONCLUSION This article describes an unusual case of a clear cell variant of PMEC characterized by the presence of a CRTC3-MAML2 gene fusion in a 22-year-old male.The patient underwent successful left lower lobe sleeve resection.This case underscores the distinctive challenges associated with diagnosing and treating this uncommon malignancy,underscoring the importance of precise diagnosis and personalized treatment strategies.

The oncofetal protein IMP3 is an indicator of early recurrence and poor outcome in mucoepidermoid carcinoma of salivary glands

Objective: Mucoepidermoid carcinoma(MEC) is the most common primary malignancy of the salivary glands. Insulin-like growth factor-II m RNA-binding protein-3(IMP3) is an important prognostic factor in some cancers and a tool that differentiates between benign and malignant pancreatic lesions. This study aimed to identify a relationship between the expression of IMP3 and the outcome of salivary gland MEC, as well as to differentiate MEC from pleomorphic adenoma(PA).Methods: Tissue specimens from 70 cases of salivary gland MEC, 40 cases of PA, and 10 cases with normal salivary gland were examined immunohistochemically for IMP3. The association among the expression of IMP3, clinicopathological characteristics and patient's survival was assessed.Results: IMP3 was present in 51.4% of MEC but absent in PA and normal salivary gland tissues. IMP3 expression was associated with age > 60 years, submandibular gland tumors, tumor size > 4 cm, high-grade tumors, lymph node metastasis, involvement of surgical margins, perineural invasion, distant metastasis, advanced TNM stage, tumor relapse, and death(P<0.05). Increased expression of IMP3, tumors of the submandibular gland, and lymph node metastasis were independent prognostic factors of disease-free survival(DFS). In addition, IMP3 was a strong predictor of overall survival(OS) together with distant metastasis and intermediate and high-grade tumors.Conclusions: IMP3 expression is highly important in evaluating the outcome of MEC. IMP3 can be used to differentiate MEC from PA of salivary glands.

Endoscopic resection of bronchial mucoepidermoid carcinoma in a young adult man: A case report and review of literature

BACKGROUND Primary tracheobronchial mucoepidermoid carcinoma(MEC),derived from salivary mucus glands,is an uncommon neoplasm in adults.At present,surgery is still the preferred treatment for adult bronchial MEC,although it may cause significant trauma and loss of lung function.Here,we report a patient with endobronchial MEC who received the interventional bronchoscopic therapy to remove the neoplasm and no recurrence occurred during follow-up.CASE SUMMARY A 28-year-old man was admitted to our unit with mild hemoptysis for 3 d.Physical examination did not show any abnormal signs,and the serological indexes were all in the normal range.Chest computed tomography(CT)indicated an intraluminal nodule in the bronchus intermedius with homogeneous density and a well-defined margin.Upon fiberoptic bronchoscopy,an endobronchial pedunculated polypoid was discovered without submucosal involvement.As the neoplasm was confined to the bronchus,interventional bronchoscopy was performed to remove the mass by high-frequency electric knife and laser resection.Tissue was sampled and histopathological examination confirmed the diagnosis of low-grade MEC.As the proliferation index was low,no further treatment was given.During 2 years of follow-up,the patient’s condition was good and no relapse was discovered under fluorescence bronchoscopy or CT scan.CONCLUSION Interventional bronchoscopy can be considered for treatment of low-grade bronchial MEC,with few complications and preserved lung function.

Mucoepidermoid carcinoma in the infratemporal fossa: A case report

BACKGROUND Mucoepidermoid carcinoma is the most common primary epithelial salivary gland malignancy.It mostly occurs in the major or intraoral minor salivary glands but rarely in the infratemporal fossa.Here,we present a case of aggressive mucoepidermoid carcinoma in the infratemporal fossa with neck lymph node metastasis and also discuss diagnostic and treatment strategies.CASE SUMMARY A 39-year-old woman with a mass located in the right submandibular area presented to our department.Physical examination revealed lymphadenopathy on the right submandibular side measuring 2.5 cm×3 cm that was hard and had poor mobility.Results of nasal endoscopy were unremarkable.Ultrasound examination revealed an enlarged lymph node at level II of the right side.Fine needle aspiration cytology of the metastatic lymph node revealed malignant cells with infection.Contrast-enhanced computed tomography revealed an enhancing ill-defined soft tissue mass in the right infratemporal region.Positron emission tomography/computed tomography revealed hyperintensity in the right infratemporal fossa along with lymphadenopathy at level II of the right-side lymph node.The patient underwent extended resection of the primary tumor,and ipsilateral radical neck dissection was also completed.Hematoxylin-eosin staining and immunohistochemistry revealed a high-grade mucoepidermoid carcinoma.No signs and symptoms of recurrence of the neoplasm were present after 20 mo of follow-up.CONCLUSION Positron emission tomography/computed tomography play a key role in primary tumor localization.Furthermore,histopathology and immunohistochemistry play pivotal roles in disease diagnosis.

Overall and cause-specific survival for mucoepidermoid carcinoma of the major salivary glands:Analysis of 2210 patients

BACKGROUND Mucoepidermoid carcinoma(MEC)is a rare malignancy of the head and neck;however,it accounts for a majority of the tumors of the salivary glands.This study used a national population-based registry to describe the pre-treatment and treatment-related prognostic factors that influence survival in patients with MEC of the major salivary glands.To our knowledge,this is the largest populationbased study examining predictors of both overall and cause-specific survival of MEC of the major salivary glands.AIM To identify prognostic factors influencing overall survival(OS)and cause-specific survival(CSS)of patients with MEC of the major salivary glands.METHODS We used the Surveillance,Epidemiology and End-Results Database of the National Cancer Institute to investigate a variety of factors that could influence survival of patients diagnosed with mucoepidermoid carcinoma of the major salivary glands.A total of 2210 patients diagnosed with MEC of the major salivary glands during the years of 1975-2016 were studied.The primary endpoints were OS and CSS.Cox regression analysis was used to perform univariate and multivariate analyses of clinical variables such as age at diagnosis,diagnosis year,sex,race,tumor size,stage,grade,treatment with or without surgical excision,and adjuvant radiotherapy treatment.RESULTS A total of 2210 patients diagnosed with MEC of the major salivary glands met inclusion criteria.In this study,95%of patients underwent surgical excision and 41%received adjuvant radiation therapy.Median OS time for Grade I,II,and III/IV was 401 mo(±48.25,95%CI),340 mo(±33.68,95%CI)and 55 mo(±11.05,95%CI),respectively.Univariate analysis revealed that lack of surgical excision was associated with decreased OS[hazard ratio(HR)4.26,P<0.0001]and that patients with localized disease had improved OS compared to both regional and distant disease(HR 3.07 and 6.96,respectively,P<0.0001).Additionally,univariate analysis demonstrated that male sex,age over 50 at diagnosis,Grade III tumors,and increasing tumor size were associated with worsened OS(P<0.0006).Univariate analysis of CSS similarly revealed that lack of surgical excision and Grade III carcinoma conferred decreased CSS(HR 4.37 and 5.44,respectively,P<0.0001).Multivariate analysis confirmed that increasing age,in 10-year age bands,advanced tumor stage,increasing tumor size,Grade III carcinoma,male sex,and lack of surgical excision were associated with a statistically significant decrease in OS and CSS(P<0.04).Of note,multivariate analysis revealed that the use of adjuvant radiation therapy was not associated with improved OS or CSS.CONCLUSION Multivariate analysis demonstrated increasing age,advanced tumor stage,increasing tumor size,Grade III carcinoma,male sex,and lack of surgical excision were associated with decreased OS and CSS(P<0.04).

Mucoepidermoid carcinoma of the lung with hemoptysis as initial symptom: A case report

BACKGROUND Mucoepidermoid carcinoma of the lung is a rare malignant tumor,accounting for 0.1%–0.2%of all lung malignancies.It is a primary salivary gland tumor of the lung.Surgical resection is the primary treatment for pulmonary mucoepidermoid carcinoma,for which there has been no standardized treatment strategy.This article reports a case of a young woman with pulmonary mucoepidermoid carcinoma with hemoptysis as the first symptom.CASE SUMMARY A 24-year-old female patient presented with"4 d of hemoptysis"as the chief complaint.She had no special history and denied any smoking or drinking history.Physical examination revealed that the vital signs were stable and scattered small wet rales were heard in the left lung.After admission,the lung tumor markers were checked,and no abnormalities were found.After completing the bronchoscopy,a spherical lesion was observed at the main bronchus 1.5 cm away from the protubercle,with obvious pulsation and little blood seepage on the surface,and histopathological biopsy results showed acute and chronic inflammation.She was transferred to the Department of Thoracic Surgery for surgical treatment on the 16th day after admission.After exclusion of surgical conjunctures,the patient underwent resection of the tumor in the left main bronchus with single-pore video-assisted thoracic surgery on the 19th day after admission.The postoperative histopathological biopsy results showed mucoepidermoid carcinoma of the lung.The patient and her family refused to complete genetic testing and she was discharged from the hospital on the 8th day after surgery.During the follow-up period,the patient experienced shortness of breath after feeling active and had no special discomfort.CONCLUSION We have documented a case of moderately differentiated mucoepidermoid lung cancer with hemoptysis as the first symptom to improve clinicians'understanding of the disease and provide a new dimension of thinking for its future diagnosis and treatment.

Primary esophageal sclerosing mucoepidermoid carcinoma with “tissue eosinophilia”

Mucoepidermoid carcinoma (MEC) is a rare primary esophageal malignancy. It is characterized by poor clinical recognition, pre-operative diagnostic challenges and a lack of standardized therapeutic guidelines. We report the clinicopathological features of a hitherto unreported variant of esophageal MEC, sclerosing MEC with &#x0201c;tissue eosinophilia&#x0201d;, in a mid-esophageal location in a 51-year-old female. The diagnosis of the initial biopsy was challenging, because of the small size, poor orientation and inadequate representation of the MEC components. Recognition of the resectability of the tumor prompted surgical resection and enabled a demonstration of the low grade foci containing intermediate cells, mucin pools and the hitherto undescribed presence of stromal sclerosis and tissue eosinophils in esophageal MEC. Heightened clinicopathological awareness of esophageal MEC facilitated a definitive diagnosis and patient management. Increased recognition and global documentation of esophageal sclerosing MEC with &#x0201c;tissue eosinophilia&#x0201d; is necessary to improve the understanding and diagnosis of this malignancy in this location and to improve management guidelines.

Mucoepidermoid Carcinoma of the Eyelid: A Case Report and Review of the Literature

Purpose: To report the clinical features, therapeutic method, and histopathological findings of a case of mucoepidermoid carcinoma in the lower eyelid and review the literature about the mucoepidermoid carcinoma arising from the eye.Methods: Case report and review of the literature.Results: An 88-year-old man developed a painless, indurated nodule in the left lower eyelid for two years and ulceration of the skin existed for a year. He underwent tumor resection and reconstruction of the eyelid. By histopathology, tumor cells showed an admixture of epidermoid and mucus-secreting cells, which was consistent with mucoepidermoid carcinoma. Mucoepidermoid carcinoma is a common malignant tumor of the salivary glands, but rare in the eye tissues among which conjunctiva and lacrimal gland are most commonly involved. It has a higher degree of malignancy than basal cell carcinoma and squamous cell carcinoma. It displays an unusual capacity of aggressive local invasion and recurs easily after simple excision and tumors may require enucleation or exenteration because of the involvement of the intraocular structures and/or orbit.Frequent follow-up is necessary for the patient after operation.Conclusions: Mucoepidermoid carcinoma arising from the eye is rare and has a high degree of malignancy. It should be differentiated from other neoplasms such as basal cell carcinoma and squamous cell carcinoma.

High-Grade Mucoepidermoid Carcinoma Ex-Pleomorphic Adenoma of the Parotid Gland: Case Report and Review of Literature

Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological diagnosis. Methods: We present a case of a 71-year-old male with an enlarging left neck mass over several months. CT showed both a parapharyngeal space mass and a separate level II neck mass. Results: The patient underwent resection of the left parapharyngeal mass and ipsilateral selective level II-IV lymphadenectomy. The final pathologic diagnosis was metastatic high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma. Conclusions: We describe a novel presentation of high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma as a metastatic parapharyngeal mass.

Interventional Bronchoscopic Therapy in Adult Patients with Tracheobronchial Mucoepidermoid Carcinoma

Background： Tracheobronchial mucoepidermoid carcinoma （MEC） is a rare airway tumor in adults for which surgery is considered a first-line treatment. However, some patients already lost the best opportunity of a surgical intervention when diagnoses are confirmed, and surgery causes considerable trauma resulting in partial loss of pulmonary function. Moreover, the tumor is resistant to radiotherapy and chemotherapy. These factors make the treatment of tracheobronchial MEC challenging. This study aimed to evaluate the safety and et^cacy ofinterventional bronchoscopic therapy in adult patients with tracheobronchial MEC. Methods： We retrospectively analyzed the clinical manifestations, bronchoscopic interventions, complications, and outcomes of 11 adult patients with tracheobronchial MEC. Paired t-test was used to analyze the parameters of the American Thoracic Society Dyspnea Index and the Karnofsky Score before and after the first interventional bronchoscopic therapy. Results： All tumors occurred in the main bronchus and were easily visualized by bronchoscopy. After interventional bronchoscopic therapy, the symptoms of all patients showed significant improvement. The American Thoracic Society Dyspnea Index decreased from 1.91 ± 1.22 to 0.27 ± 0.47 （t = 6.708, P 〈 0.001） and the Kamofsky Score increased from 78.18 ±16.62 to 95.46 ± 8.20 （t =-5.190, P 〈 0.001 ）. Bronchoscopic intervention did not result in serious complications or mortality. During the follow-up period between 3 and 96 months after the first therapy, the following results were noted： （ 1 ） among the eight patients with low-grade tracheobronchial MEC, only one patient had a relapse and agreed to surgical treatment; （2） among the three patients with high-grade tracheobronchial MEC, one patient required repeated bronchoscopic interventions, one patient died of pulmonary infection, and one patient died of systemic failure owing to tumor metastasis. Conclusions： Interventional bronchoscopic therapy, as an alternative treatment, shows promise in some adult patients with low-grade tracheobronchial MEC confined to the bronchus. However, for adult patients with high-grade tracheobronchial MEC, early diagnosis and surgical treatment are still strongly recommended.

Correlation between the expression of thrombospondin-1 and neovascularization in mucoepidermoid carcinoma

Background Researchers have recently demonstrated that thrombospondin-1 （TSP-1） has an important function in regulating neovascularization. Whether it inhibits or accelerates neovascularization, however, is still controversial. We found few reports about the correlation between TSP-1 and vascularization in mucoepidermoid carcinoma. In this research, the distribution and expression of TSP-1 in mucoepidermoid carcinoma were investigated. We also analyzed （1） the correlation between the expression of TSP-1 and microvessel density （MVD）, as an indicator of neovascularization activity, and （2） the effect of TSP-1 on neovascularization and tumor growth in the subcutaneous xenotransplanted model of mucoepidermoid carcinoma. Method （1） The sites and intensity of expression of TSP-1 and the MVD were analyzed in 45 cases of mucoepidermoid carcinoma after surgery by the method of streptavidin-peroxidase （SP） immunohistochemistry; and （2） recombinant human thrombospondin-1 （rhTSP-1） was injected twice a week for five consecutive weeks around the tumor in the subcutaneous xenotransplanted tumor model of mucoepidermoid carcinoma in nude mice. Each week, the tumor size was measured, in order to draw the growth curve of the xenotransplanted tumor model of mucoepidermoid carcinoma, and MVD was measured. Results （1） The positive expression of TSP-1 protein was 57.78% （26/45）. Most positive staining for TSP-1 was found in the cytoplasm of the cancer cells, while some staining occurred in the extracellular matrix. The mean MVD in 45 cases of m ucoepidermoid carcinoma was 58.17±19.77 per 100 visual fields. Tumors with a high expression of TSP-1 showed a low MVD value, and the TSP-1 immunocompetence and microvessel density showed a significant negative correlation （rs=-0.947, P 〈0.001）. （2） The xenotransplanted tumors with the injection doses of 1.25, 0.75 and 0.25 ug/ml respectively were 36.97%, 53.36% and 73.61% of the size of the control group （（451±92）, （651±113）, （898±86） and （1220±157） mm^3 respectively, F=-53.167, P 〈0.001）, and their weights were respectively 35.14%, 51.35% and 70.27% of the control group （（1.3±0.5）, （1.9±0.5）, （2.6±0.3）, and （3.7±0.7） g respectively, F=-62.669, P 〈0.001）. Their MVDs were 25.00%, 45.93%, and 72.20% respectively of the control group and concentration dependent （15.43±3.45, 28.35±4.24, 44.57±3.35 and 61.73±5.43 per 100 visual fields respectively, F=54.582, P 〈0.001）. Conclusions The TSP-1 has a higher expression in mucoepidermoid carcinoma and the expression has a significant negative correlation with neovascularization. The TSP-1 inhibits neovascularization and tumor growth, and it might be a new biological therapy for treatment of patients with mucoepidermoid carcinoma.

Mucoepidermoid Carcinomas Presented as Lobar Pneumonia

Mucoepidermoid carcinomas （MECs） had always been recognized as salivary gland tumors mainly steming from parotid and submandibular salivary glands. Eater, studies showed that MECs can occur in bronchus, esophagus, lacrimal glands, pancreas, thymus, and thyroid gland. MECs in bronchus are usually centrally located and are proposed to originate from submucosal minor salivary-type glands in large airways.

Clinicopathological practice in the differential diagnosis of mucoepidermoid carcinoma from neoplasms with mucinous component

Background:The differential diagnosis of mucoepidermoid carcinoma(MEC)from neoplasm undergoing mucinous features brings more pitfalls to pathologists.Combining specific MAML2 gene rearrangement and histological characteristics may be the solution.Methods:Twenty-five tumors with mucinous components were selected for differential diagnosis of MEC.All the cases were detected for MAML2 gene rearrangement.The cases diagnosed as MEC were classified into four variants:classic,oncocytic,Warthin-like,and nonclassified,and they were graded using the Brandwein system.The histological characteristics of non-MECs were summarized for differential diagnosis.Univariate survival analysis was performed on MECs.Results:There were 16 MECs;62.5%were MAML2 rearranged.For the low-,intermediate-,and high-grade MECs,the rate of rearrangement was 83.3%,100%,and 28.6%,respectively.Both the oncocytic and Warthinlike MECs were MAML2 rearranged.For the classic and nonclassified MECs without MAML2 rearrangement,non-keratinized squamoid cells and distinctive mucinous cells were essential diagnostic criteria.On survival analysis,all the disease progression occurred in high-grade MECs(p=0.038).Nine cases were diagnosed as non-MECs:pleomorphic adenoma with mucinous metaplasia showed no ex-capsular involvement;metaplastic Warthin tumor appeared with overt keratinization and residual oncocytic bilayered epithelium;mix squamous cell and glandular papilloma showed an endobronchial papillary growing pattern;adenosquamous carcinoma was accompanied by squamous carcinoma in situ of the overlying mucosa.All the non-MECs were negative for MAML2 rearrangement.Conclusion:The application of combining MAML2 rearrangement and histological characteristics is helpful in the differential diagnosis between MEC and other tumors with mucinous components.

Derived vascular endothelial cells induced by mucoepidermoid carcinoma cells:3-dimensional collagen matrix model

Mucoepidermoid carcinoma undergoes uniquely vigorous angiogenic and neovascularization processes,possibly due to proliferation of vascular endothelial cells(ECs) induced by mucoepidermoid carcinoma cells(MCCs) in their three-dimensional(3D) microenvironment.To date,no studies have dealt with tumor cells and vascular ECs from the same origin of mucoepidermoid carcinoma using the in vitro 3D microenvironment model.In this context,the current research aims to observe neovascularization with mucoepidermoid carcinoma microvascular ECs(MCMECs) conditioned by the microenvironment in the 3D collagen matrix model.We observed the growth of MCMECs purified by immunomagnetic beads and induced by MCCs,and characteristics of tubule-like structures(TLSs) formed by induced MCMECs or non-induced MCMECs.The assessment parameters involved the growth curve,the length,the outer and inner diameters,and the wall thickness of the TLSs,and the cell cycle.Results showed that MCCs induced formation of the TLSs in the 3D collagen matrix model.A statistically significant difference was noted regarding the count of TLSs between the control group and the induction group on the 4th day of culture(t=5.00,P=0.001).The outer and inner diameters(t1=5.549,P1=0.000;t2=10.663,P2=0.000) and lengths(t=18.035,P=0.000) of the TLSs in the induction group were statistically significant larger than those in the control group.The TLSs were formed at the earlier time in the induction group compared with the control group.It is concluded that MCCs promote growth and migration of MCMECs,and formation of the TLSs.The 3D collagen matrix model with MCMECs induced by MCCs in the current research may be a favorable choice for research on pro-angiogenic factors in progression of mucoepidermoid carcinoma.

Postoperative radiotherapy for thymus salivary gland carcinoma:A case report

BACKGROUND Salivary gland cancer is a rare disease in which cancer cells form in the tissues of the salivary glands.It mostly occurs in the glands that have secretion functions,such as the parotid gland,sublingual gland and submandibular gland.This is very rare when it occurs in other nonsecreting glands.Here,we report one case of salivary gland carcinoma occurring in the thymus and discuss related diagnoses and treatment progress.CASE SUMMARY One 33-year-old middle-aged man presented with a thymus mass without any clinical symptoms when he underwent regular physical examination.Later,the patient was admitted to the hospital for further examination.Computed tomography(CT)showed that there was a mass of 3 cm×2.8 cm×1.5 cm in the thymus area.The patient had no symptom of discomfort or tumor-related medical history before.After completing the preoperative examinations,it was confirmed that the patient had indications for surgery.The surgeon performed a transthoracoscope"thymectomy+pleural mucostomy"for him.During the operation,the tumor tissue was quickly frozen,and the symptomatic section showed a malignant tumor.The final pathological result suggested thymus salivary gland carcinoma-mucoepidermoid carcinoma(MEC).In the second month after surgery,we performed local area radiotherapy for the patient,with a total radiation dose of 50.4 Gy/28Fx.After 12 mo of surgery,the patient underwent positron emission tomography-CT examination,which indicated that there was no sign of tumor recurrence or metastasis.After 16 mo of operation,CT scan re-examination showed that there was no sign of tumor recurrence or metastasis.As of the time of publication,the patient was followed up for one and a half years.He had no sign of tumor recurrence and continued to survive.CONCLUSION The incidence of MEC in the thymus is low,and its diagnosis needs to be combined with clinical features and imaging methods.Histopathological analysis plays a key role in the diagnosis of the disease.Patients with early-stage disease have a good prognosis and long survival period.In contrast,patients with advanced-stage disease have a poor prognosis and short survival period.Combining radiotherapy and chemotherapy in inoperable patients may prolong survival.

12例Warthin瘤样黏液表皮样癌影像学分析

目的:总结Warthin瘤样黏液表皮样癌(Warthin-like mucoepidermoid carcinoma,WT-MEC)的超声、CT和MRI表现,探讨其影像学特点,为临床术前诊断提供参考。方法:收集2017年1月—2021年12月上海交通大学医学院附属第九人民医院收治的12例经病理明确诊断的WT-MEC患者的临床信息和超声、CT、MRI资料,回顾性总结其具体特征。结果:12例WT-MEC患者中,男7例,女5例,平均年龄为(42.7±16)岁。7例行超声检查,6例行CT检查,2例行MRI检查。所有肿瘤均表现为腮腺内单发肿块。91.7%(11/12)的病灶(91.7%)边界清晰,83.3%(10/12)的病灶呈囊实性肿块。在超声上,71.4%(5/7)的病变表现为囊实性混合回声、85.7%(6/7)血流不丰富、85.7%(6/7)后方回声增强。在CT上,所有病变(6/6,100%)呈软组织密度肿块,不均匀强化(5/6,83.3%)。在MRI上,肿瘤在平扫T1WI呈低信号或等信号,T2WI呈高信号,增强T1WI呈不均匀强化。结论:WT-MEC多表现为单发、边界清晰、无钙化的囊实性肿块。肿瘤内多发、大小不等的囊性部分是其影像学特征。

原发性肝脏黏液表皮样癌4例临床病理分析并文献复习

目的探讨原发性肝脏黏液表皮样癌(primary mucoepidermoid carcinoma of the liver,PMCL)的临床病理特征。方法回顾性分析4例PMCL患者的病史、临床资料、病理诊断、鉴别诊断、治疗及预后等。结果4例肿瘤均位于左半肝,单发;镜下瘤细胞由三种细胞构成:表皮样细胞、中间细胞、黏液细胞,所占比例各有不同。免疫表型:肿瘤细胞CA199、CK19弥漫强阳性,黏液细胞CEA局灶阳性,CK7主要表达于表皮样细胞及黏液细胞,CK5/6、p40、p63表达于表皮样细胞及中间细胞;特殊染色AB、PAS、黏液卡红染色证实黏液细胞存在,Ki67增殖指数30%~40%。FISH检测:4例PMCL均未检测到MAML2基因断裂重排,1例肿瘤发生MAML2基因扩增。结论PMCL发病率低,临床表现无特异性,极易误诊,诊断时需与胆管腺癌、腺鳞癌等相鉴别,且无明确的标准治疗方案,预后差。

11例原发性肺黏液表皮样癌的临床病理分析

目的 探讨原发性肺黏液表皮样癌(PMEC)的临床病理及分子特征。方法 回顾性分析11例2005年1月至2021年12月经手术切除并确诊为PMEC患者的临床病理资料,并复习相关文献。结果 11例患者中,男性7例,女性4例;年龄19~58岁,中位年龄33岁;肿瘤均发生于段及段以上支气管,临床以支气管刺激症状为主。胸部CT显示10例为边界尚清晰的类圆形结节,1例显示为不规则肿块,5例伴有浅分叶。11例肿块增强扫描后均显示轻-中度的不均匀强化,肿块内有钙化者5例。1例组织学分级为高级别PMEC,10例为低级别PMEC。免疫组织化学染色结果显示,瘤细胞CK7、p63及p40阳性,TTF1、NapsinA、CK20和SMA阴性,增殖指数Ki-67约4%~28%。特殊染色示黏液细胞PAS阳性。6例患者行MAML2的FISH检测,4例患者显示MAML2基因重排阳性。11例患者均行手术治疗,其中3例术后辅助化疗。8例患者随访8~144个月,1例高级别PMEC复发。结论 PMEC是一种罕见肿瘤,其诊断需结合病理组织学特点和免疫组化,FISH检测到MAML2基因易位,主要依据术后组织病理,手术是治疗的主要方法,其预后与病理分级及临床分期相关。

儿童涎腺透明细胞变异型黏液表皮样癌1例

黏液表皮样癌(mucoepidermoid carcinoma,MEC)是儿童与年轻人中最常见的涎腺来源的恶性肿瘤,男女比例约为3∶2。经典的MEC由黏液细胞、表皮样细胞及中间细胞按照不同比例组成,除经典的3种细胞成分外还存在一些少见亚型,其中透明细胞亚型是指肿瘤中透明细胞的比例超过其他3种经典型细胞成分的亚型。分子遗传学方面,多数MEC存在CRTC1/MAML2基因融合。本文报道1例发生于儿童腭部黏膜的透明细胞型中分化MEC。

3D-ASL对舌肿物的诊断价值及与病理学特征的相关性分析

目的 :探讨3D动脉自旋标记灌注成像技术(3D arterial spin labeling,3D-ASL)、肿瘤血流(tumor blood flow,TBF)与舌部肿物组织病理学特征之间的相关性。方法:前瞻性分析2019年12月—2021年12月上海交通大学医学院附属第九人民医院临床拟诊为舌部肿物的患者55例,术前均行颌面部常规MRI平扫、3D-ASL、扩散加权成像(diffusion-weighted imaging,DWI)和动态增强(dynamic contrast-enhanced,DCE)序列扫描。计算病灶的TBF,术后组织切片用CD34及Ki67染色以评估微血管密度(microvessel density,MVD)。利用SPSS 26.0软件中的Mann-Whitney U检验分析不同疾病间的TBF,以及TBF和MVD的相关性。结果:舌异位甲状腺(ectopic thyroid,ET)在ASL的TBF伪彩图上均表现为整体红色的高灌注区(100%),且高灌注的面积最大(100%)。舌鳞状细胞癌(squamous cell carcinoma,SCC)早期高灌注比例较高(13例,13/15,86.7%)。测量瘤体血流最大区域TBFmax、TBFmean、ADC值之间的差异具有统计学意义(P<0.05)。所有肿瘤中MVD与TBFmean、TBFmax呈强正相关(rs=0.89、0.93,R2=0.70、0.84,P<0.01)。结论:3D-ASL可无创评估舌部肿瘤血流,利于区别良、恶性肿瘤。SCC分级越高,高灌注出现越少,可反映出受肿瘤侵犯的程度。