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Sinonasal Tract Mucoepidermoid Carcinoma: A Clinicopathologic and Immunophenotypic Study of 19 Cases Combined with a Comprehensive Review of the Literature

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Abstract

Primary sinonasal tract mucoepidermoid carcinomas (MEC) are uncommon tumors that are frequently misclassified, resulting in inappropriate clinical management. The design of this study is retrospective. Nineteen cases of MEC included 10 females and 9 males, aged 15–75 years (mean, 52.7 years); males, on average were younger by a decade than females (47.2 vs. 57.7 years). Patients presented most frequently with a mass, obstructive symptoms, pain, and/or epistaxis present for a mean of 12.6 months. The majority of tumors involved the nasal cavity alone (n = 10), maxillary sinus alone (n = 6), or a combination of the nasal cavity and paranasal sinuses (n = 3) with a mean size of 2.4 cm. Most patients presented at a low clinical stage (n = 15, Stage I & II), with only 4 patients presenting with Stage III disease. Histologically, the tumors were often invasive (bone or perineural invasion), with invasion into minor mucoserous glands. Surface involvement was common. The neoplastic cells were composed of a combination of squamoid cells, intermediate cells, and mucocytes. Cystic spaces were occasionally large, but the majoritywere focal to small. Pleomorphism was generally low grade. Necrosis (n = 5) and atypical mitotic figures (n = 6) were seen infrequently. Over half of the tumors were classified as low grade (n = 11), with intermediate (n = 4) and high grade (n = 4) comprising the remainder. Mucicarmine was positive in all cases tested. Immunohistochemical studies showed positive reactions for keratin, CK5/6, p63, CK7, EMA, and CEA in all cases tested, while bcl-2 and CD117 were rarely positive. GFAP, MSA, TTF-1, and S100 protein were non-reactive. p53 and Ki-67 were reactive to a variable degree. MEC need to be considered in the differential diagnosis of a number of sinonasal lesions, particularly adenocarcinoma and necrotizing sialometaplasia. The patients were separated into stage I (n = 9), stage II (n = 6), and stage III (n = 4), without any patients in stage IV at presentation. Surgery occasionally accompanied by radiation therapy (n = 2) was generally employed. Six patients developed a recurrence, with 5 patients dying with disease (mean, 2.4 years), while 14 patients are either alive (n = 9) or had died (n = 5) of unrelated causes (mean, 14.6 years). MEC probably arises from the minor mucoserous glands of the upper aerodigestive tract, usually presenting in patients in middle age with a mass. Most patients present with low stage disease (stage I and II), although invasive growth is common. Recurrences develop in about a third of patients, who experience a shorter survival (mean, 6.5 years). The following parameters, when present, suggest an increased incidence of recurrence or dying with disease: size ≥4.0 cm (P = 0.034), high mitotic count (P = 0.041), atypical mitoses (P = 0.007), mixed anatomic site (P = 0.032), development of recurrence (P = 0.041), high tumor grade (P = 0.007), and higher stage disease (P = 0.027).

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References

  1. Eveson JW. Salivary gland-type carcinoma. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. Pathology and genetics head and neck tumours. Lyon, France: IARC Press; 2005. P. 24–5.

  2. Franchi A, Santucci M, Wenig BM. Adenocarcinoma. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. Pathology and genetics head and neck tumours. Lyon, France: IARC Press; 2005. P. 20–3.

  3. Kleinsasser O, Schroeder HG. Adenocarcinomas of the inner nose after exposure to wood dust. Morphological findings and relationships between histopathology and clinical behavior in 79 cases. Arch Otorhinolaryngol. 1988;245:1–15.

    Article  PubMed  CAS  Google Scholar 

  4. Barnes L. Intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses. Am J Surg Pathol. 1986;10:192–202.

    Article  PubMed  CAS  Google Scholar 

  5. Gnepp DR, Heffner DK. Mucosal origin of sinonasal tract adenomatous neoplasms. Mod Pathol. 1989;2:365–71.

    PubMed  CAS  Google Scholar 

  6. Bhattacharyya N. Survival and staging characteristics for non-squamous cell malignancies of the maxillary sinus. Arch Otolaryngol Head Neck Surg. 2003;129:334–7.

    Article  PubMed  Google Scholar 

  7. da Cruz Perez DE, Pires FR, Lopes MA, de Almeida OP, Kowalski LP. Adenoid cystic carcinoma and mucoepidermoid carcinoma of the maxillary sinus: report of a 44-year experience of 25 cases from a single institution. J Oral Maxillofac Surg. 2006;64:1592–7.

    Article  PubMed  Google Scholar 

  8. Donald PJ, Boggan JE. Sphenoid sinus malignancies. J Craniofac Surg. 1995;6:15–23.

    Article  PubMed  CAS  Google Scholar 

  9. Haraguchi H, Ebihara S, Saikawa M, Mashima K, Haneda T, Hirano K. Malignant tumors of the nasal cavity: review of a 60-case series. Jpn J Clin Oncol. 1995;25:188–94.

    PubMed  CAS  Google Scholar 

  10. Heffner DK, Hyams VJ, Hauck KW, Lingeman C. Low-grade adenocarcinoma of the nasal cavity and paranasal sinuses. Cancer. 1982;50:312–22.

    Article  PubMed  CAS  Google Scholar 

  11. Katz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Villaret DB. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck. 2002;24:821–9.

    Article  PubMed  Google Scholar 

  12. Kokemueller H, Brueggemann N, Swennen G, Eckardt A. Mucoepidermoid carcinoma of the salivary glands–clinical review of 42 cases. Oral Oncol. 2005;41:3–10.

    Article  PubMed  Google Scholar 

  13. Parsons JT, Mendenhall WM, Mancuso AA, Cassisi NJ, Million RR. Malignant tumors of the nasal cavity and ethmoid and sphenoid sinuses. Int J Radiat Oncol Biol Phys. 1988;14:11–22.

    Article  PubMed  CAS  Google Scholar 

  14. Qureshi SS, Chaukar DA, Talole SD, Dcruz AK. Clinical characteristics and outcome of non-squamous cell malignancies of the maxillary sinus. J Surg Oncol. 2006;93:362–7.

    Article  PubMed  Google Scholar 

  15. Triantafillidou K, Dimitrakopoulos J, Iordanidis F, Koufogiannis D. Mucoepidermoid carcinoma of minor salivary glands: a clinical study of 16 cases and review of the literature. Oral Dis. 2006;12:364–70.

    Article  PubMed  CAS  Google Scholar 

  16. Davis JP, Maclennan KA, Schofield JB, Watkinson JC, Gluckman P. Synchronous primary mucosal melanoma and mucoepidermoid carcinoma of the maxillary antrum. J Laryngol Otol. 1991;105:370–2.

    Article  PubMed  CAS  Google Scholar 

  17. Schaeffer BT, Som PM, Sacher M, Lanzieri CF, Solodnik P, Lawson W, et al. Coexistence of a nasal mucoepidermoid carcinoma and sphenoid mucoceles: CT diagnosis and treatment implications. J Comput Assist Tomogr. 1985;9:803–5.

    Article  PubMed  CAS  Google Scholar 

  18. Kapadia SB, Barnes L, Pelzman K, Mirani N, Heffner DK, Bedetti C. Carcinoma ex oncocytic Schneiderian (cylindrical cell) papilloma. Am J Otolaryngol. 1993;14:332–8.

    Article  PubMed  CAS  Google Scholar 

  19. Rosdeutscher JD, Burnette R. Nasal mucoepidermoid carcinoma. Otolaryngol Head Neck Surg. 2003;129:291–2.

    Article  PubMed  Google Scholar 

  20. Esposito F, Kelly DF, Vinters HV, DeSalles AA, Sercarz J, Gorgulhos AA. Primary sphenoid sinus neoplasms: a report of four cases with common clinical presentation treated with transsphenoidal surgery and adjuvant therapies. J Neurooncol. 2006;76:299–306.

    Article  PubMed  Google Scholar 

  21. Weinstein IR, Nagai I, Yamanaka H. Mucoepidermoid tumor of the maxilla. Report of a case. Oral Surg Oral Med Oral Pathol. 1967;23:1–11.

    Article  PubMed  CAS  Google Scholar 

  22. Thomas GR, Regalado JJ, McClinton M. A rare case of mucoepidermoid carcinoma of the nasal cavity. Ear Nose Throat J. 2002;81:519–22.

    PubMed  Google Scholar 

  23. Lee K, Suei Y, Yamada T, Masuda S, Ogawa I, Tanimoto K. Bone formation in a carcinoma of the maxillary antrum. Dentomaxillofac Radiol. 1999;28:375–7.

    Article  PubMed  CAS  Google Scholar 

  24. Kaznelson DJ, Schindel J. Mucoepidermoid carcinoma of the air passages: report of three cases. Laryngoscope. 1979;89:115–21.

    Article  PubMed  CAS  Google Scholar 

  25. Ichimura K, Nozue M, Hoshino T, Yano J. Bilateral primary malignant neoplasms of the maxillary sinus: report of a case and statistical analysis of the reports in Japan. Laryngoscope. 1981;91:804–10.

    Article  PubMed  CAS  Google Scholar 

  26. Simpson RJ, Hoang KG, Hyams VJ, Jarchow RC. Mucoepidermoid carcinoma of the maxillary sinus. Otolaryngol Head Neck Surg. 1988;99:419–23.

    PubMed  CAS  Google Scholar 

  27. McKee DF, Rao RN, Elliott DC, Harmon JD, Porubsky ES. Simultaneous mucoepidermoid carcinoma and Paget’s disease of the maxillary sinus. Otolaryngol Head Neck Surg. 1987;97:339–40.

    PubMed  CAS  Google Scholar 

  28. Peison B, Benisch B, Schwartz IS, Gordon RE. Clear-cell mucoepidermoid carcinoma arising in the nasal cavity: case report with ultrastructural observations. Mt Sinai J Med. 1988;55:417–20.

    PubMed  CAS  Google Scholar 

  29. Bergman F. Tumors of the minor salivary glands. A report of 46 cases. Cancer. 1969;23:538–43.

    Article  PubMed  CAS  Google Scholar 

  30. Healey WV, Perzin KH, Smith L. Mucoepidermoid carcinoma of salivary gland origin. Classification, clinical-pathologic correlation, and results of treatment. Cancer. 1970;26:368–88.

    Article  PubMed  CAS  Google Scholar 

  31. Hayashi Y, Matsuyama Z, Murai M, Shimokawa K, Amano Y, Hashizume T, et al. A case of meningeal carcinomatosis due to the ethmoid sinus mucoepidermoid carcinoma. Rinsho Shinkeigaku. 2005;45:422–5.

    PubMed  Google Scholar 

  32. Kraus DH, Sterman BM, Levine HL, Wood BG, Tucker HM, Lavertu P. Factors influencing survival in ethmoid sinus cancer. Arch Otolaryngol Head Neck Surg. 1992;118:367–72.

    Article  PubMed  CAS  Google Scholar 

  33. Littman MS, Kirsh IE, Keane AT. Radium-induced malignant tumors of the mastoid and paranasal sinuses. AJR Am J Roentgenol. 1978;131:773–85.

    PubMed  CAS  Google Scholar 

  34. Carinci F, Curioni C, Padula E, Calearo C. Cancer of the nasal cavity and paranasal sinuses: a new staging system. Int J Oral Maxillofac Surg. 1996;25:34–9.

    Article  PubMed  CAS  Google Scholar 

  35. Suzuki S, Hanata K, Nanjo H, Ishikawa K. Adenosquamous carcinoma of maxillary sinus: case showing complete response to S-1. J Laryngol Otol 2009; 1–5.

  36. Bridger MW, Beale FA, Bryce DP. Carcinom of the paranasal sinuses—a review of 158 cases. J Otolaryngol. 1978;7:379–88.

    PubMed  CAS  Google Scholar 

  37. Ogawa T. A clinico-pathological study of adenocarcinomas of the nasal cavity and paranasal sinuses. Nippon Jibiinkoka Gakkai Kaiho. 1989;92:317–33.

    Article  PubMed  CAS  Google Scholar 

  38. Wyllie JW III, Kern EB, Djalilian M. Isolated sphenoid sinus lesions. Laryngoscope. 1973;83:1252–65.

    Article  PubMed  Google Scholar 

  39. Subramaniam V, Kumar P, Thahir M. Mucoepidermoid carcinoma of a nasal cavity—a rare tumour. Klin Onkol. 2010;23:354–7.

    PubMed  CAS  Google Scholar 

  40. Thorup C, Sebbesen L, Dano H, Leetmaa M, Andersen M, Buchwald C, et al. Carcinoma of the nasal cavity and paranasal sinuses in Denmark 1995–2004. Acta Oncol. 2010;49:389–94.

    Article  PubMed  Google Scholar 

  41. Loh KS, Barker E, Bruch G, O’Sullivan B, Brown DH, Goldstein DP, et al. Prognostic factors in malignancy of the minor salivary glands. Head Neck. 2009;31:58–63.

    Article  PubMed  Google Scholar 

  42. AJCC Cancer Staging Manual, 7th ed. New York: Springer, 2009.

  43. Goode R, El-Naggar AK. Mucoepidermoid carcinoma. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. Pathology and genetics of head and neck tumours. Lyon, France: IARC Press; 2005. P. 219–20.

  44. Barbareschi M, Murer B, Colby TV, Chilosi M, Macri E, Loda M, et al. CDX-2 homeobox gene expression is a reliable marker of colorectal adenocarcinoma metastases to the lungs. Am J Surg Pathol. 2003;27:141–9.

    Article  PubMed  CAS  Google Scholar 

  45. Damiani JM, Damiani KK, Hauck K, Hyams VJ. Mucoepidermoid-adenosquamous carcinoma of the larynx and hypopharynx: a report of 21 cases and a review of the literature. Otolaryngol Head Neck Surg. 1981;89:235–43.

    PubMed  CAS  Google Scholar 

  46. Keelawat S, Liu CZ, Roehm PC, Barnes L. Adenosquamous carcinoma of the upper aerodigestive tract: a clinicopathologic study of 12 cases and review of the literature. Am J Otolaryngol. 2002;23:160–8.

    Article  PubMed  Google Scholar 

  47. Thompson LDR. Squamous cell carcinoma variants of the head & neck. Curr Diag Pathol. 2003;9:384–96.

    Article  Google Scholar 

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Acknowledgments

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of Southern California Permanente Medical Group nor of the Department of Navy.

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Correspondence to Lester D. R. Thompson.

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Wolfish, E.B., Nelson, B.L. & Thompson, L.D.R. Sinonasal Tract Mucoepidermoid Carcinoma: A Clinicopathologic and Immunophenotypic Study of 19 Cases Combined with a Comprehensive Review of the Literature. Head and Neck Pathol 6, 191–207 (2012). https://doi.org/10.1007/s12105-011-0320-9

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