Epithelial-myoepithelial carcinoma of floor of mouth: A case report of double clear cell variant with immunohistochemical correlation


Epithelial-myoepithelial carcinoma of floor of mouth: A case report of double clear cell variant with immunohistochemical correlation


Mohamed.H.Ibrahim1, Hossam Abdel Halim2, Ihab S. Abd Elhamid3, Marwa M. Elshafei4 Shaimaa E. Ghazy5, Nermeen S. Afifi6, Ismail M. Shebl7

1Master’s degree in Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, 2Master’s Degree Oral and maxillofacial surgery, Cairo University, Egypt,  3Professor of Oral Pathology, Faculty of Dentistry, Badr University, Cairo, Egypt,  4Professor of Oral pathology, Faculty of Oral and Dental Medicine, Misr International University,  5Lecturer of Oral Pathology, Oral Pathology Department, Faculty of Dentistry, Ain Shams University and Misr International University, Cairo, Egypt,  6Lecturer of Oral Pathology, Oral Pathology Department, Faculty of Dentistry, Ain Shams University and Misr International University, Cairo, Egypt,  7Lecturer of Oral Pathology, Faculty of Oral and Dental Medicine, Misr International University


Epithelial-myoepithelial carcinoma (EMC) is a rare biphasic low-grade malignancy accounting for only 0.5% of all salivary gland tumors. Commonly, EMC affects parotid gland (70%) and rarely affecting other salivary glands. Clearing of both, epithelial and myoepithelial cell types, is rare and gives an impression of a monocellular neoplasm. Case report: A 42-year-old male reported to Oral and Maxillofacial Surgery Department in Faculty of Oral and Dental Medicine, Misr International University with a painless growth in the floor of mouth since 5 years. The soft tissue window of computerized tomography (CT) revealed a well-circumscribed swelling in the sublingual space. The provisional diagnosis was pleomorphic adenoma. Results: The histopathological examination showed solid sheets of rounded to polyhedral clear cells forming lobes and lobules separated by connective tissue mucoid septa. A thin fibrous capsule, invaded with some tumor cells was also present. The presented pattern of clear cells together with the encapsulation of the tumor provides an impression of clear cell variant of monocellular neoplasm. Conclusion: The presented case relates to an epithelial-myoepithelial carcinoma originating from the sublingual salivary gland, which is a rare site for this lesion. Based on immunohistochemical staining, differentiation between the double clear cell types was confirmed using S-100 protein and SMA for the myoepithelial nature of the outer cells while the epithelial nature of the inner cells was confirmed by CK-19 and EMA. Thus, the diagnosis of double clear cell variant of EMC was given.


Keywords: epithelial-myoepithelial carcinoma, double clear cell, S-100, SMA, EMA, CK-19


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Mohamed.H.Ibrahim, Hossam Abdel Halim, Ihab S. Abd Elhamid, Marwa M. Elshafei, Shaimaa E. Ghazy, Nermeen S. Afifi, Ismail M. Shebl. Epithelial-myoepithelial carcinoma of floor of mouth: A case report of double clear cell variant with immunohistochemical correlation. International Journal of Case Reports, 2020 4:181. DOI: 10.28933/ijcr-2020-11-1305


References:

1. Irene P, Luca M, Andrea F, Franca D, Marinella N, Zorika C, Alessia C, Salvatore D and Stefano L.: Epithelial-myoepithelial carcinoma of the pa-rotid gland, unusual malignancy radiologically simulating a benign lesion: case report, Interna-tional Seminars in Surgical Oncology. 2007; 4:25. doi: 10.1186/1477-7800-4-25
2. 2. Thackray A and Sobin L (1972).: Histological typing of salivary gland tumors. (International histological classification of tumors, no 7) World Health Organization, Geneva.
3. Thackray A and Lucas R.: Tumors of the major salivary glands. (Atlas of tumor pathology, 2nd ser, fasc 10) Armed Forces Institute of Patholo-gy, Washington DC. 1974; pp 62–63.
4. Kainuma K, Oshima A, Suzuki H, Fukushima M, Shimojo H and Usami S.: Hybrid carcinoma of the parotid gland: Report of a case (epithelial-myoepithelial carcinoma and salivary duct carci-noma) and review of the literature. Acta Oto-laryngol. 2010; 130:185-189. https://doi.org/10.3109/00016480902930458
5. Daneshbod Y, Negahban S, Khademi B and Daneshbod K.: Epithelial myoepithelial carci-noma of the parotid gland with malignant ductal and myoepithelial components arising in a ple-omorphic adenoma: A case report with cytolog-ic, histologic and immunohistochemical correla-tion. Acta Cytol. 2007; 51:807-813. https://doi.org/10.1159/000325847.
6. Mohanty S. and Pathak H.: Epithelial – my-oepithelial carcinoma of floor of mouth: A case report with cytological, histological and immunohistochemical correlation.Natio. J of Maxillofac. Surg. 2014; 5(2): 195–197. doi: 10.4103/0975-5950.154835
7. Hamamoto Y, Harada H, Suzuki M, Fujii T and Nakatsuka S.: Salivary Duct Carcinoma of the Parotid Gland Originating from an Epithelial-Myoepithelial Carcinoma: Report of a Rare Case. Head Neck Pathol. 2020; 14(1):283-289. https://doi.org/10.1007/s12105-019-01034-0
8. Fukuda M, Kikuchi K, Kusama K and Sakashita H.: Epithelial-myoepithelial carcinoma arising in the oral floor: Report of a case and review of the literature. J Oral Maxillofac Surgery, Med Pathol. 2016; 28(4):344-349. https://doi.org/10.1016/j.ajoms.2016.02.009
9. Seethala R, Barnes E and Hunt J.: Epithelial-myoepithelial carcinoma: a review of the clini-copathologic spectrum and immunophenotypic characteristics in 61 tumors of the salivary glands and upper aerodigestive tract. Am J Surg Pathol. 2007; 31(1):44-57. https://doi.org/10.1097/01.pas.0000213314.74423.d8.
10. Cheuk W and Chan J.: Advances in salivary gland pathology. Histopathology. 2007; 51(1):1-20. https://doi.org/10.1111/j.1365-2559.2007.02719.x.
11. Arora S and Sharma N.: Epithelial myoepithelial carcinoma of head and neck region. Indian J Otolaryngol Head Neck Surg. 2013; 65:163-166. https://doi.org/10.1007/s12070-011-0414-4
12. Nagao T, Sato E, Inoue R, Oshiro H, Takahashi R, Nagai T, Yoshida M, Suzuki F, Obikane H, Yamashina M and Matsubayashi J.: Immuno-histochemical analysis of salivary gland tumors: application for surgical pathology practice. Acta Histochem Cytochem. 2012;45(5):269-282. https://doi.org/10.1267/ahc.12019.
13. Gore M.: Epithelial-myoepithelial carcinoma: a population-based survival analysis. BMC Ear, Nose and Throat Disorders. 2018; 18:15. https://doi.org/10.1186/s12901-018-0063-2.
14. Bobati S., Pati B. and Dombale D.: Histo-pathological study of salivary gland tumors. J Oral Maxillofac Pathol. 2017; 21(1): 46-50. https://doi.org/10.4103/0973-029X.203762.


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