Mucoepidermoid Carcinoma (MEC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO

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  • Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the mayor and minor salivary glands:
    • They encompass between 2.8% to 15.5% of all salivary gland tumors
    • They represent 12% to 35% of malignant salivary gland tumors
    • They encompass 6.5% to 41% of all minor salivary gland tumors:
      • Representing the most common type of malignant minor salivary gland tumor in most series:
        • Other series mention that adenoid cystic carcinoma is the most common malignant minor salivary gland tumor
  • Approximately half of the cases of MEC occur in the major salivary glands:
    • 65% to 80% of these occur in the parotid
    • 8% to 13% occur in the submandibular gland
    • 2% to 4% involve the sublingual gland

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  • MEC of the minor salivary glands ordinarily arises on the palate:
    • But a number may also be found in the:
      • Retro molar area, floor of the mouth, buccal mucosa, lip, and tongue
  • Its prevalence is highest in the fourth to fifth decade of life:
    • 35 to 65 years of age:
      • With a female preponderance as high as 4:1
  • Grossly:
    • The tumor is poorly circumscribed
    • Measures from 3 to 5 cm

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  • Histologically:
    • They are characterized by a mixed population of cells:
      • Including, mucin-producing cells, epidermoid cells with squamoid differentiation, clear cells, and intermediate cells that may predominate in numbers and are believed to be the progenitor of the other types of cells:
        • No myoepithelial cells are present

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  • The clinical behavior of MEC has proved to be difficult to predict but correlations to tumor grade and stage have been reported:
    • The histologic features that are most useful in predicting the aggressive nature of these tumors are:
      • A minor cystic component (less than 20%)
      • Tumor necrosis
      • Neural invasion
      • Cellular anaplasia
      • Brisk mitotic activity
    • Based on the presence or absence of these features and the clinical behavior, MEC are classified as:
      • Low, intermediate, and high grade:
        • Low-grade MEC are well circumscribed, with pushing margins and dilated cystic areas containing mucin:
          • Mucin- producing, intermediate, or epidermoid cells make up the lining of these cystic structures.

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  • As the grade worsens:
    • The tumors become more infiltrative, poorly circumscribed, cystic formations are lost, and nests of tumor become more solid and irregular with intermediate or epidermoid cells dominating.
  • High-grade MEC are characterized by:
    • The invasion of adjacent structures
    • Atypical, brisk mitoses
    • Tumor necrosis
    • Perineural invasion
    • Cellular anaplasia
    • Lymph node (40% to 50%) metastasis
    • Distant metastases (33%).
      • These high-grade lesions are differentiated from primary of metastatic squamous cell carcinoma by the presence of intracellular mucin:
        • Sebaceous and clear cell carcinomas are additional differential diagnosis to consider.

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Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British CowdrayMedical Center in Mexico City:

  • He is an expert in the management of salivary gland neoplasms:

    • If you have any questions about salivary gland neoplasms  please fill free to ask Dr. Arrangoiz

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

 

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http://www.sociedadquirurgica.com

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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