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. 2015 Jul;39(7):931-8.
doi: 10.1097/PAS.0000000000000452.

Prognostic factors in myoepithelial carcinoma of salivary glands: a clinicopathologic study of 48 cases

Max Kong  1 , Esther N Drill, Luc Morris, Lyndsay West, David Klimstra, Mithat Gonen, Ronald Ghossein, Nora Katabi
Affiliations

Prognostic factors in myoepithelial carcinoma of salivary glands: a clinicopathologic study of 48 cases

Max Kong et al. Am J Surg Pathol. 2015 Jul.

Abstract

Myoepithelial carcinoma (MECA) is an underrecognized rare tumor with a diverse clinical behavior. The histologic features of this tumor are not well characterized, much less its grading, which is controversial. The objective of this study is to provide a better characterization of MECA and its prognostic factors. A total of 48 cases were retrieved from the pathology files. The cases were subjected to a detailed histopathologic, immunohistochemical, statistical, and clinical analysis. Tumors were classified as de novo MECA in 22 cases (46%) and carcinoma ex-pleomorphic adenoma (CA ex-PA) in 26 cases (54%). Tumor necrosis, high mitotic count (≥6/10 high-power fields), and severe pleomorphism were identified in 38%, 33%, and 21%, respectively. Perineural invasion, vascular invasion, and positive margins were noted in 10%, 12%, and 47%, respectively. Median follow-up was 38 months. Four patients had lymph node metastasis at presentation, 9 developed local recurrences, and 12 had distant metastases with the lung being the most common site (83%). The presence of CA ex-PA, necrosis, and vascular invasion correlated significantly with disease-free survival (P=0.02, 0.01, 0.03, respectively). No distant recurrence was noted in all 23 patients lacking necrosis in their neoplasms (median follow-up: 44 mo). MECA is a relatively aggressive tumor that is associated with a high rate of distant metastasis (27%). Compared with de novo MECA, CA ex-PA correlates with worse clinical outcome. A grading system based on the presence of tumor necrosis should be used to identify high-grade MECA and predict its clinical behavior.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Figures

FIGURE 1
FIGURE 1
A, Multinodular architecture with lobulated borders and zonal cellular arrangement with a hypercellular peripheral rim (arrow) surrounding a hypocellular center (star). B, High-power view showing tumor necrosis (star).
FIGURE 2
FIGURE 2
A, Epithelioid cells: polygonal cells with eosinophilic cytoplasm and inconspicuous nucleoli. B, Spindle cells showing elongated nuclei and light eosinophilic cytoplasm.
FIGURE 3
FIGURE 3
A, Low-power view of myoepithelial CA ex-PA with a discrete central pleomorphic adenoma component (star). B, High-power view of the pleomorphic adenoma component showing benign ductal structures. C, High-power view of the malignant MECA component.
FIGURE 4
FIGURE 4
Correlation between recurrence and the presence of tumor necrosis (A) and the presence of pleomorphic adenoma component (CA ex-PA) (B).
FIGURE 5
FIGURE 5
Qualitative stratification analysis suggesting that CA ex-PA and necrosis may have independent effects on clinical outcome (P = 0.018).
See this image and copyright information in PMC

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