You cannot miss it: Pancreatic mucoepidermoid carcinoma: A case report and literature review.

RATIONALE: Pancreatic mucoepidermoid carcinoma (MEC) is a rare disease with no more than 10 cases reported in literature. The prognosis is poor and few patients can survival more than 1 year. PATIENT CONCERNS: We presented a case of patient manifested as left upper abdominal pain. Computed tomography demonstrated a low-density shadow measuring 2.1 × 2.4 cm situated at the transition area of neck and body of the pancreas with obscure boundary and irregular enhancement. The preoperative symptoms and imaging features were unspecific. DIAGNOSES: Pancreatic MEC. INTERVENTIONS: Curative surgery of distal pancreatectomy was conducted. Postoperatively, the patient subsequently underwent 8 cycles of chemotherapy using cisplatin (25 mg/m) on day 1 to day 3; and gemcitabine (1000 mg/m) on day 1 and day 8, repeated every 21 days. OUTCOMES: The patient was monitored on a regular basis at our outpatient department and survived 23 months after surgery. LESSONS: Preoperative diagnosis of pancreatic MEC is difficult. Patients with pancreatic MEC may have a survival benefit from the multimodal treatment of curative surgery combined with chemotherapy.

Giant cystic primary mucoepidermoid carcinoma of mandible: a rare case and literature review.

Primary intra-osseous mucoepidermoid carcinoma arising from jaw is an extremely rare condition accounting to less than 2% of all mucoepidermoid carcinomas. In the jaw, it occurs more commonly in mandible than maxilla. They are low-grade cancers and affect jaw as uni- or multi-locular radiographic lesions. Here we discuss a rare case of giant cystic primary intra-cystic mucoepidermoid carcinoma of the mandible which was excised in toto. Here we discuss the clinical features, radiological and histological characteristics of this rare lesion, and review the literature.

Ardipusilloside I induces apoptosis by regulating Bcl-2 family proteins in human mucoepidermoid carcinoma Mc3 cells.

BACKGROUND: Ardisia pusilla A. DC., family Myrsinaceae, is a traditional Chinese medicine named Jiu Jie Long with a variety of pharmacological functions including anti-cancer activities. In this study, we purified a natural triterpenoid saponin, ardipusilloside I, from Ardisia pusilla, and show that it exhibits inhibitory activities in human mucoepidermoid carcinoma Mc3 cells. We also investigated the underlying mechanisms of proliferation inhibition that ardipusilloside I exerts on Mc3 cells. METHODS: MTT test was used to detect cell proliferation. Cell apoptosis was detected by transmission electron microscopy, Hoechst-33342 staining, DNA fragmentation detection, and flow cytometry. We also used western blot analysis to detect the potential mechanisms of apoptosis. RESULTS: Ardipusilloside I affected the viability of Mc3 cells in a dose- and time-dependent manner. The IC50 of ardipusilloside I was approximately 9.98 µg/ml at 48 h of treatment. Characteristic morphological changes of apoptosis, including nuclear condensation, boundary aggregation and splitting, and DNA fragmentation, were seen after treatment with 10 µg/ml ardipusilloside I for 48 h. Western blots demonstrated that ardipusilloside I caused Mc3 cell death through the induction of apoptosis by downregulation of Bcl-2 protein levels and upregulation of Bax and caspase-3 protein levels. CONCLUSIONS: Our results revealed that ardipusilloside I could be a new active substance for mucoepidermoid carcinoma treatment. We demonstrated that the potential mechanism of inhibition might be through the induction of apoptosis by regulation of Bcl-2 family protein levels. This suggests a further rationale for the development of ardipusilloside I as an anti-cancer agent.

'Flaccid neoglottis' following supracricoid partial laryngectomy: laryngoscopic revision assisted by navigation system.

OBJECTIVE: Supracricoid partial laryngectomy is a reliable laryngeal preservation procedure for tumour stage 2 and selected stage 3 to 4 laryngeal cancers. Of 70 patients thus treated, two (3 per cent) had 'flaccid neoglottis', i.e. redundant mucosa at the inner arytenoid edge which intermittently obstructed the neoglottis. We discuss the mechanism and management of this complication. METHOD: The two cases are presented. A navigation system was used to assist surgery. Neoglottal spatial alteration (specifically cross-sectional area) was assessed pre- and post-operatively using three-dimensional computed tomography. Voice was also evaluated. RESULTS: Inspiratory stridor and delayed stomal closure were the main symptoms. Minimum neoglottal cross-sectional area was smaller in case one than in non-affected patients. Both patients had relatively rougher and breathier voices, but had adapted well to this. CONCLUSION: Flaccid neoglottis is mainly due to excessive anterior retraction of residual laryngeal mucosa and to excessive mucosal pliability with age. A navigation system was useful for confirmation, but the potential for incorrect image recognition should be kept in mind. Flaccid neoglottis was treatable, with improved laryngeal function.

Cystatin C - a fast and reliable biomarker for glomerular filtration rate in head and neck cancer patients.

PURPOSE: Determination of renal function is a prerequisite for planning therapy in cancer patients. Limitations of creatinine as marker for the glomerular filtration rate (GFR) led to the proposal of cystatin C as a more accurate biomarker especially in mild renal insufficiency or in patients with low muscle mass. We compared the accuracy of cystatin C- and creatinine-based equations to estimate GFR in head and neck cancer (HNC) patients receiving platinum-based radiochemotherapy. PATIENTS AND METHODS: The study population consisted of 52 HNC patients (GFR range, 37-105 mL/min/1.73 m(2) complemented by 17 patients with known renal insufficiency (GFR range, 10-60 mL/min/1.73 m(2)). Intraclass correlation coefficients were calculated between the reference method (51)Cr-EDTA clearance and estimated GFR by creatinine clearance and equations based on creatinine (Cockroft-Gault, modification of diet in renal disease (MDRD), Wright) or cystatin C (Larsson, Dade-Behring, Hoek). In addition, sensitivity and specificity to discriminate GFR > 60 mL/min/1.73 m(2) were evaluated by receiver operating characteristic curve (ROC). RESULTS: The highest correlation coefficients were found for the cystatin C-based estimates in comparison with creatinine-based estimates or creatinine clearance, even though Bland-Altman plots revealed GFR overestimation for all equations tested. The cystatin C-based Hoek formula exhibited the highest overall precision and accuracy. GFR of < 60 mL/min/1.73 m(2) was assumed as a cut-off for chemotherapy. ROC analyses revealed the highest AUC to predict a GFR > 60 mL/min/1.73 m(2) for the creatinine-based Wright formula, closely followed by the MDRD formula and cystatin C-based equations of Larsson, Dade-Behring, and Hoek. CONCLUSION: Cystatin C-based GFR estimates showed the overall strongest correlation to the reference method. Thus, we recommend cystatin C for GFR estimation in HNC patients as an alternative method to the estimated creatinine clearance in clinical practice.

Mucoepidermoid carcinoma of the lung arising at the primary site of a bronchogenic cyst: clinical, cytogenetic, and molecular findings.

Primary lung tumors are rare in children, and mucoepidermoid carcinoma (MEC) represents less than 10% of them. Additionally, MEC arising from bronchogenic cysts (BC) is particularly unusual. We describe the clinical and genetic findings on a MEC occurring within a previous location of a BC in an adolescent. This particular association has not been previously reported. The lesion revealed normal karyotype without the typical t(11;19)(q21;p13) translocation. Cyclin D1 overexpression (165-fold increase) was demonstrated by real-time PCR although FISH assessment showed normal hybridization at 11q13. Information on these unusual clinical presentations may present relevant insight on tumorigenesis of infrequent pediatric pulmonary tumors.

Intraepithelial and invasive squamous neoplasms of the conjunctiva in Ibadan, Nigeria: a clinicopathological study of 46 cases.

BACKGROUND/AIMS: To retrospectively evaluate the clinicopathological features, treatment modalities and factors affecting prognosis in patients with both conjunctival intraepithelial and invasive squamous neoplasms. METHOD: Review and analysis of clinical and pathological records of all cases histologically diagnosed in the Department of Pathology, University College Hospital, Ibadan, Nigeria between January 1990 and December 2004. RESULTS: There were a total of 46 cases in 45 patients (eight intraepithelial carcinomas, 37 invasive squamous cell carcinomas (SCC) and a single case of mucoepidermoid carcinoma in a 71-year-old man). The intraepithelial neoplasms occurred in patients aged between 20 and 90 years. Seven of these patients had actinic changes on histology. For invasive SCC, patients' ages ranged from 18 to 84 years with a mean age of 53 years. Male to female ratio was 1:1. The majority presented with an orbital mass and loss of vision. Twenty-two (60%) of the patients with invasive SCC had enucleation or exenteration as the primary modality of treatment with or without radiotherapy or chemotherapy. Altogether for intraepithelial and invasive squamous neoplasms, the duration of presenting complaints ranged from 1 month to 5 years with an average of 2 years. Human immunodeficiency virus (HIV) infection and smoking were not significantly associated with these cases but a significant number had outdoor occupation. Low socioeconomic status and inability to afford treatment was common among our patients. CONCLUSION: Patients with invasive SCC in Nigeria present late and have significant delay before having any form of treatment. This contributes to the poor outcome. Human papilloma virus (HPV) and actinic aetiology are possible strong causative agents in Nigerians.

Rapidly progressive and metastatic mucoepidermoid carcinoma: application of serological tumor markers.

Mucoepidermoid carcinoma (MEC) of the salivary gland is a rare entity. A distinction of 2 variants has been proposed: the low-grade tumor with a favourable prognosis and the high-grade tumor with a poor prognosis. Indeed, MEC is a cancer with a relative favourable outcome and more than 90% of patients survive for more than 5 years after diagnosis, reduced to about 70% after 10 years. This excellent prognosis might contribute to the unacceptable retention of the term "mucoepidermoid tumor" in the medical terminology, even in current medical textbooks. However, the distinction of MEC by grading is a guideline only and it is not appropriate to use this histological term as a prediction for individual cases. We describe the rapid fatal outcome of a patient with MEC in order to emphasize the malignant characteristics of this tumor and the possible application of tumor markers for the diagnosis of metastasizing MEC.

Mucoepidermoid carcinoma of the bronchus presenting with a negative chest X-ray and normal pulmonary function in two teenagers: two case reports and review of the literature.

Two adolescents presented with a history of dyspnea upon exertion and cough. In both cases, the chest X-ray and pulmonary function testing, including flow-volume loop, were normal. A bronchial tumor was diagnosed by CT scan, which was ordered after each patient had an episode of hemoptysis. The sedimentation rate was the only abnormal laboratory test in both cases. Mucoepidermoid carcinoma of the bronchus, a rare tumor in childhood, was found at pathology in both cases. There was no evidence of metastases to local lymph nodes or distal sites. There were 47 previously reported cases in children. Recurrent pneumonia and persistent cough were the most common presenting findings. These tumors are of low-grade malignant potential but they can become locally invasive, extending into cartilage and surrounding soft tissue. Prognosis is good with complete resection.

Hypotensive endovascular test occlusion of the carotid artery in head and neck cancer.

OBJECT: To evaluate the reliability of balloon test occlusion with hypotensive challenge (BTO and HC) as a predictor of neurological complications before internal carotid artery (ICA) sacrifice in patients with advanced head and neck cancer, the authors retrospectively reviewed the medical records of patients presenting to their institutions between 1992 and 1997 in whom this preoperative assessment was performed. METHODS: Eleven patents who were candidates for extended comprehensive neck dissection (ECND) and potential ICA sacrifice were included in the study. Eight patients tolerated the test and underwent endovascular occlusion or surgical ligation of the ICA before ECND (four patients), preservation of the ICA at the time of surgery (three patients), or palliative therapy (one patient). Of three patients in whom BTO and HC failed, one patient received palliative treatment only; the other two underwent ECND with preservation of the ICA. In the group of patients who passed the test and underwent ICA occlusion or ligation before ECND, fatal thromboembolic stroke occurred within 24 hours of permanent balloon occlusion in one patient, resulting in a combined neurological morbidity/mortality rate of 25% in this subset of patients and an overall complication rate of 9% in this series. CONCLUSIONS: The authors found that BTO and HC offers a simple and reliable method of preoperative risk assessment when ICA resection is planned for regional control of disease in advanced head and neck cancer. This management option, however, is associated with a potential for neurological complication that must be weighed against the natural course of the disease and the risks and benefits of other treatment modalities.

Difficult asthma: consider all of the possibilities.

Asthma is a common respiratory disease that can often be managed successfully. However, there are patients that do not respond to the maximum doses of standard therapy and subsequently have a reduced quality of life. Many factors can contribute to a failure to respond to treatment, and a comprehensive approach is important when assessing and evaluating these patients. This report describes a patient referred for 'difficult to control asthma' who had multiple emergency department visits and hospitalizations. In addition to a history of wheezing, spirometry showed impaired flow and vital capacity was reduced. Further investigation showed a normal total lung capacity, and a computed tomography scan revealed main bronchus blockage by a tumour, which was confirmed by bronchoscopy. This led to a surgical resection of a mucoepidermoid carcinoma. This case highlights the need to consider all possibilities during the evaluation of patients with difficult asthma.

Mucoepidermoid carcinoma of the trachea with airway hyperresponsiveness.

We report a case of mucoepidermoid carcinoma of the trachea in a 23-year-old pregnant female in her 39th week. The patient had cough and wheezing in the early morning for 9 months before admission. No abnormalities were detected on a chest roentgenogram. At Caesarean section, fiberscopy revealed a polypoid lesion narrowing the trachea. The pathologic diagnosis made from the biopsy specimen obtained was low-grade mucoepidermoid carcinoma and the lesion was resected. Airway hyperresponsiveness was shown before resection with airflow limitation, however, airway reactivity and airflow limitation improved 1 year after resection.

Ausência de diferenciaçäo mioepitelial em carcinomas mucoepidermóides de glândulas salivares menores / Absence of myoepithelial differentiation in minor salivary gland mucoepidermoid carcinomas

No presente estudo investigamos a presença da diferenciaçäo mucoepitelial na morfogênese do carcinoma mucoepidermóide (CME) das glândulas salivares menores. Dezessete casos foram investigados, usando-se a técnica imunoistoquímica da estreptavidina-biotina e anticorpos monoclonais anticitoceratina 14 (CK14), antivimentina e antiactina muscular específica (AME). Foram empregados cortes histológicos de 3mm de espessura, de material fixado em formalina 10 por cento e incluído em parafina. Previamente à incubaçäo do anticorpo primário do anticorpo primário anti-CK14, as seçöes teciduais foram submetidas ao tratamento com ácido cítrico 10mM, ph 6, em ambiente de microondas. Nossos achados revelaram que a marcaçäo para CK14 restringiu-se às células intermediárias e epidermóides; nas áreas císticas, em especial, foi identificada nas células basais e parabasais dos revestimentos neoplásicos. Nenhum caso foi positivo para AME, e dois casos mostraram marcaçäo ocasional para vimentina, de fraca intensidade. Estes achados traduzem uma ausência, de fraca intensidade. Estes achados traduzem uma ausência de direnciaçäo mioepitelial nos CMEs de glândulas salivares menores

Carcinoma mucoepidermoide esclerosante com eosinofilia primario da tireoide: relato de um caso e analise de literatura / Sclerosing mucoepidermoid carcinoma with primary eosinophilia of thyroid: case report and literature analysis

O carcinoma da glandula tireoide e uma neoplasia maligna de rara ocorrencia na pratica medica, perfazendo apenas 1 por cento de todos os canceres. O carcinoma mucoepidermoide da tireoide (CME) foi descrito pela primeira vez em 1977, com 32 relatos, ao nosso conhecimento na literatura, ate o momento. Esse trabalho objetiva relatar um novo caso dessa rarissima patologia assim como revisar a literatura. Um homem de 36 anos com diagnostico previo de anemia esferocitica e tireoidite de Hashimoto foi submetido a intervencao cirurgica para investigacao de nodulo em lobo direito devido a suspeita de neoplasia papilifera a puncao com agulha fina. Foi realizada tireoidectomia total apos verificacao de ausencia de acometimento...

Carcinoma Mucoepidermóide: estudo clínico e histológico / Mucoepidermoid carcinoma: clinical and histologic study

Verificamos, no presente estudo, que o carcinoma mucoepidermóide (CME) ocorre preferencialmente em pacientes na 4ª década de vida, sem preferência para sexo, localizando-se, usualmente, no palato. Apresenta-se comumente como crescimento nodular, mostrando, eventualmente, dor, ulceraçäo, reabsorçäo óssea e linfadenopatia. Histologicamente percebemos dois padröes principais de crescimento: sólido e cístico, com a presença de células claras e epidermóides em menor proporçäo. No padräo cístico, diferentes organizaçöes do revestimento epitelial foram notadas: a) epitélio colunar; b)epitélio colunar pseudoestratificado; c) epitélio estratificado com múltiplas camadas de células intermediárias com diferenciaçäo luminal colunar, cubóide ou muco-secretora; d) áreas com estratificaçäo em que predominou diferenciaçäo epidermóide, cujas células luminais apresentavam-se cubóides ou muco-secretoras. No crescimento sólido, observou-se a formaçäo de espaços císticos ou ductiformes, cujas células de revestimento mostravam-se cubóides ou mucosas

Histocytologic grading of mucoepidermoid carcinoma of major salivary glands in prognosis and survival: a clinicopathologic and flow cytometric investigation.

BACKGROUND: Controversy exists regarding the role of a 3-tiered grading system for mucoepidermoid carcinoma (MEC) of salivary glands in prognosis and survival. This retrospective investigation evaluated a 3-tiered grading system modified from Healey by Batsakis and Luna and compared various clinical, pathologic, and flow cytometric parameters and overall survival among MECs of differing grades. METHODS: Forty-eight patients with 7 low-grade (LG), 23 intermediate-grade (IG), and 18 high-grade (HG) MECs of parotid (n = 43) and submandibular (n = 5) glands were studied. Data were analyzed using categorical statistics (Wilcoxon, Kruskal-Wallis and Chi-squared tests where appropriate). RESULTS: Mean ages were 42 years for patients with LG tumors; 47 years, IG; and 59 years, HG (p = 0.02). Gender ratio (p < 0.001) changed from female predominance in LG (6 F:1 M) and IG (2.1 F:1 M) to male predominance in HG (3.5 M:1 F). Mean tumor stage was 1.4 LG, 2.4 IG, and 3.6 HG (p < 0.005). Tumor size increased from 2.1 cm for LG to 3.8 cm for HG (p = 0.01). Margins were involved by tumor in 0% LG, 44% IG, and 61% HG (p < 0.001). Lymph node involvement was 0% LG, 22% IG, and 72% HG (p < 0.001). DNA aneuploidy (DNA index < 0.9 or > 1.1) was present in 0% LG, 13% IG, and 28% HG (p = 0.05). Proliferative fraction (S + G2M) was 5% LG, 7% IG, and 13% HG (p = 0.008). Radiotherapy was administered in 14% LG, 35% IG, and 61% HG (p = 0.03). Recurrences (local and/or metastatic) occurred in 0% LG, 39% IG, and 61% HG (p = 0.009). Survival was decreased significantly (p < 0.0001) with increasing tumor grade (100% LG, 70% IG, and 22% HG). CONCLUSION: Histologic grading of mucoepidermoid carcinomas of major salivary glands, using the modified Healey 3-tiered system, correlates well with clinical, pathologic, and flow cytometric factors which influence the prognosis and overall survival in affected individuals.

Prognostic significance of cell proliferation in mucoepidermoid carcinomas of the salivary gland: clinicopathological study using MIB 1 antibody in paraffin sections.

Mucoepidermoid carcinomas of salivary gland origin have an uncertain clinical course not directly predictable by histomorphology. The MIB 1 antibody, which detects Ki-67 antigen in formalin-fixed, paraffin-embedded tissues, was used to study cell proliferation in these tumors. An MIB 1 index was developed to express the percentage of MIB 1-positive proliferating cells, and the results were compared with histomorphological tumor grade and clinical outcome. All patients with MIB 1 indices lower than 10% in their primary tumors had a favorable clinical outcome. Most patients with MIB 1 indices higher than 10% developed a recurrent or metastasizing disease. All patients who died of their tumor or who had persistent tumor had MIB 1 indices higher than 10%. Thus, the MIB 1 index defines two virtually nonoverlapping forms of the disease, an indolent one and an aggressive one. Cell proliferation in mucoepidermoid carcinomas, assessed with the MIB 1 antibody, thus represents a significant prognostic factor for improving the accuracy of conventional histological grading.