We report a case of High grade Mucoepidermoid carcinoma of the middle ear. A 67 year old gentleman was referred to our centre for persistent otalgia associated with facial weakness for four months. Examination revealed a middle ear mass with House Brackmann Grade 3 Facial Palsy and ipsilateral lymhadenopathy. Biopsies suggested a squamous cell carcinoma of the middle ear, and he successfully underwent an Extended Temporal bone resection with External canal reconstruction and neck dissection. Postoperative Histopathology revealed that the tumour was in fact a High Grade Mucoepidermoid carcinoma. He received postoperative radiotherapy and is well one year post operatively.
Primary mucoepidermoid carcinoma (MEC) of thyroid is an uncommon tumour and reports on its' cytology are consequently scanty. A 46-year-old male presented with a thyroid nodule of nine months duration. Fine needle aspiration (FNA) cytology of the nodule showed features of a malignant tumor that was different from the usual types of thyroid carcinoma. Monolayers and syncytial clusters of round and spindle tumour cells with large vesicular nuclei and single macronucleoli were present. A diagnosis of carcinoma was given with the comment that this was unlike any of the usual types of thyroid cancer and that a metastatic malignancy should be ruled out. The cytological picture of MEC may not always be distinctive enough for accurate tumour typing. Nevertheless the cytological features are usually sufficiently different to rule out all of the usual types of thyroid carcinoma. This distinction may be important from the point of view of differing prognosis in MEC of thyroid (as compared to differentiated thyroid cancers) and the need to exclude a metastatic carcinoma, especially from a primary in one of the salivary glands.
We present a case of a 20-year-old woman presenting initially with an asymptomatic palatal swelling. Radiographic examination showed a cyst at the right maxilla with bucco-lingual expansion and perforation of palatal bone. Incisional biopsy was carried out via a buccal approach and the result revealed a benign odontogenic cyst, in keeping with radicular cyst. The patient was then scheduled for cyst enucleation. During the procedure, it was found that the palatal lesion was unrelated to the maxillary cyst. Incisional biopsy of the palatal mass was carried out and revealed a low-grade mucoepidermoid carcinoma. The patient then had a partial maxillectomy with fibula flap reconstruction. There was no recurrence at postoperative 1 year follow-up and she was rehabilitated with dental implants.
Mucoepidermoid carcinoma and squamous cell carcinoma are tumors found predominantly in the elderly. Most of the cases reported were from patients of more than 50 years old. In our case, it affects a young patient, a 26 year old lady who has a history of a severely burnt and scarred face since childhood. She represents a rare case of a high grade aggressive tumor involving her right eyelid and right parotid gland.
A 40-year-old man presented with right eye axial proptosis and ophthalmoplegia for 3 months. Imaging study showed a right intraconal mass with the erosion of the orbital floor. Incisional biopsy revealed mucoepidermoid carcinoma. Nasal endoscopy was normal and systemic tumor screening was negative for a primary source. The patient underwent right orbital exenteration, uncinectomy, nasal and maxillary mucosal biopsy. Malignant cells were found present in the mucosa of maxillary sinus roof and uncinate bone. The postoperative positron emission tomography scan showed residual active lesion in right orbital apex and maxilla but no primary lesion elsewhere. The patient subsequently underwent 35 cycles of postoperative radiotherapy. Primary mucoepidermoid carcinoma of the orbit is rare and typically arises from the lacrimal gland or sac. Those tumors not arising from lacrimal apparatus should be presumed metastatic in origin, and the thorough systemic survey should be undertaken in the search for the primary tumor.
We report an extremely rare case of mucoepidermoid carcinoma of the nasal septum. A patient with a history of right-sided nasal obstruction presented to our clinic. Clinical examination revealed a mass in the right nasal cavity originating from the nasal septum. Biopsy revealed a high-grade mucoepidermoid carcinoma. The patient was treated with surgical resection only. Surgery alone might be suitable for small tumors when direct inspection of the surgical site is feasible to detect early recurrence.
Mucoepidermoid carcinoma (MEC) is a rare tumour of the trachea accounting for up to 0.2% of reported primary lung malignancy. We report a case of a 54-year-old man, ex-smoker, whose presentation mimicked adult onset asthma with cough and wheezing, which did not respond to conventional treatment. He had occasional haemoptysis and weight loss in which CT scan performed for malignancy screening showed a protruding mass in the distal trachea causing endobronchial obstruction. Bronchoscopic intervention was performed to relieve the obstruction that resulted in resolution of asthmatic symptoms. Histological diagnosis confirmed MEC. This case emphasised the importance of a high index of suspicion in an unusual presentation of a common disease and the pivotal role of bronchoscopic intervention in malignant central airway obstruction.
Hyalinizing clear cell carcinoma presents as a painless submucosal mass commonly located at the palate and base of tongue. It is a rare tumour and has often been misdiagnosed for other more common tumours with clear cytoplasm, such as acinic cell carcinoma, clear cell oncocytoma or mucoepidermoid carcinoma. HCCC has been reported as a low grade malignant tumour with a high rate of cervical metastases. Due to its rarity, there is no treatment protocol. However, the treatment of choice is wide local excision and the neck disease is treated with neck dissection or ra- diotherapy or both with no conclusive outcome as incidence is too low or underreported with no long term follow up. Our case highlights the diagnosis difficulties in such rare cases, and the need for longer follow up post excision to determine outcome and recurrence rates.
A 69-year-old lady was diagnosed to have mucoepidermoid carcinoma of hard palate 3 years ago. She completed 20 cycles of external beam radiotherapy and 5 cycles of mould brachytherapy and remained asymptomatic until she again presented to us with the recurrence of a painless mass at the hard palate. The hard mass appeared as an ulcerated dimple measuring 2 x 1 cm located at the junction of the hard and soft palate, more towards the right. Excision biopsy of the mass was done with a 1cm circumferential margin deep to the periosteum, with the resulting exposed bony defect covered with a rotational flap from the soft palate. During follow-up, the patient complained that the saliva came up into the nose whenever she swallowed. Oral examination (Figure 1) and flexible nasopharyngolaryngoscopy (FNPLS) (Figure 2) were performed. What is your diagnosis?