Salivary glands
Epithelial / myoepithelial tumors
Mucoepidermoid carcinoma

Author: Adriana Handra-Luca, M.D. (see Authors page)

Revised: 16 March 2018, last major update September 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Mucoepidermoid carcinoma[TI] salivary gland[TI]

See also: Oncocytic mucoepidermoid carcinoma
Cite this page: Handra-Luca, A. Mucoepidermoid carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/salivaryglandsMEC.html. Accessed July 17th, 2018.
Definition / general
  • Cords, sheets and clusters of mucous, squamous, intermediate and clear cells
  • Most common malignant tumor in salivary glands
  • Also most common radiation induced neoplasm
Clinical features
  • 2/3 occur in parotid gland; also in palate
  • Wide age range, mean 49 years, range 15 - 86 years, no gender predominance
  • Low grade: 15% recur, 5 year survival 90 - 98%, usually stage I
  • High grade: 25% recur, 5 year survival 50 - 56%, deaths usually within first 5 years
  • Note: significant grading disparity exists between pathologists (Am J Surg Pathol 2001;25:835)

AFIP point system:
  • 2 points if < 20% intracystic component
  • 2 points if neural invasion
  • 3 points if necrosis
  • 3 points if 4+ mitotic figures/10 HPF
  • 4 points if anaplasia
  • Low grade if total score is 0 - 4 points, intermediate grade if 5 - 6 points, high grade if 7+ points
Prognostic factors
  • Poor prognostic factors: older age, male, submandibular gland, extraglandular extension, vascular invasion, necrosis, high mitotic rate, high histologic grade
Case reports
Treatment
  • Complete excision, possibly radiation therapy
Gross description
  • Low grade: well circumscribed with gray-white, mucin filled cysts
Microscopic (histologic) description
  • Cords, sheets and clusters of mucous, squamous, intermediate and clear cells
  • Low to high grade, although even high grade tumors lack marked nuclear atypia, frequent mitotic figures or extensive necrosis
  • Occasional focal sebaceous cells, goblet type cells, oncocytic change, inflammatory reaction to extravasated mucin or keratin
  • No squamous cell carcinoma in situ
  • Low grade: mucinous and intermediate cells with bland nuclei form glandular spaces
  • High grade: solid and infiltrative growth pattern of atypical epidermoid and intermediate cells with cytoplasmic clearing and small number of mucinous cells; < 20% intracystic component
Microscopic (histologic) images

Images hosted on PathOut server:

Case of the Week #346:

4 year old boy

Ki67

Mucicarmine



Images hosted on other servers:

Cases in children

Spindled morphology

Cytology images

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Low grade with background mucin, two
types of cells with bland nuclear features
(squamoid with dense cytoplasm and
glandular with vacuolated cytoplasm)

High grade with malignant squamous cells

Low grade and oncocytic tumors

Positive stains
  • Low grade: CK7, CK14, antimitochondrial antibodies
Electron microscopy description
  • Mixed luminal epithelial cells and myoepithelial cells
Electron microscopy images

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Spindled morphology

Molecular / cytogenetics description
  • Associated with t(11;19)(q14-21;p12-13)
Differential diagnosis