MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian dental academy

MUCOEPIDERMOID CARCINOMA
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

At the end of the presentation learner should be able to
describe clinical, radiological , histopathological features,
differential diagnosis and plan management of patient
with gingival swelling

S.No Learning objectives Domain level criteria condition
1 Initiate examination of
gingival swelling
Cognitive &
psychomotor
Must
know
All
2 Explain clinical and
radiological features of
gingival swelling
Cognitive &
psychomotor
Must
know
All
3 Explain histopathological
features of gingival
swellings
Cognitive &
psychomotor
Must
know
All
3 Explain and plan the
management of gingival
swellings
Cognitive &
psychomotor
Must
know
All

At the end of the seminar the learner should be able to know
about Mucoepidermoid carcinoma:-
 Introduction
Clinical features
Histological features
Variants of tumor
Treatment and prognosis

•Tumors of salivary glands constitute a heterogeneous group
of lesions of great morphologic variation.
•Neoplasms of the major salivary glands constitute minor
portion of head and neck neoplasms
•Less than 2% are malignant.

 Most neoplasms in parotid 75%, 0.8% in sublingual glands.
 Remainder equally distributed between submandibular gland and
minor salivary glands
 Incidence of malignant neoplasm increases after 4increases 4th
and 5th decades and peaks 65and 65-75 years.
 Benign neoplasm present slightly earlier.
 Malignant neoplasm occur most often in men
 Cancers of the salivary glands account for only 6% of H&N
cancers
 Only 0.3% of all cancers

Saliva transported from central structure (acini) in complex
ductal system to the oral cavity.
System is a bilayer with internal luminal layer and external
reserve layer.
Internal layer forms
acini and ductal
epithelium.
External layer forms
myoepithelium and
reserve cells

INTERCALATED DUCTS
• Pleomorphic adenoma
• Warthin’s tumor
• Oncocytoma
• Acinic cell
• Adenoid cystic carcinoma
EXCRETORY DUCTS
• Squamous cell carcinoma
• Mucoepidermoid
carcinoma

Striated duct - Oncocytic Tumors
Acinar cells - Acinic Cell Carcinoma
Excretory Duct - Squamous cell and Mucoepidermoid
carcinoma
Intercalated duct and myoepithelial cells – Pleomorphic
tumors

It was first studied and described as a separate entity by
Stewart et al. in 1945.
Definition (WHO) :
Mucoepidermoid carcinoma is a malignant glandular epithelial
neoplasm characterized by mucous, intermediate and
epidermoid cells, with columnar, clear cell and oncocytoid
features.

Mucoepidermoid carcinoma (MEC) is the most common
primary salivary gland malignancy in both adults and
children
It is the common malignant neoplasm observed in both
major and minor salivary glands

Histo-morphogenesis

CLINICAL FEATURES:
Adulthood tumor
Significant female
predilection (3:2 )
Peak incidence in 3rd and
5th decade of life
Most common in children
previously exposed to
radiation
Slowly enlarging, painless
mass

CLINICAL FEATURES:
Facial nerve palsy (high
grade)
Trismus, drainage for ear
and dysphagia.
Numbness of adjacent
areas.
Sometimes, ulceration is
seen

SITE:
Extraorally:
50% MEC occur in the parotid
gland (arising in superficial lobe)
Intraorally :
20% occur on the palate
Rest of the lesions arising from the minor salivary glands
with the buccal mucosa, lips, tongue and retro molar areas to
be the favored sites.

Clinical manifestation:
Slowly-enlarging,
Painless mass (low grade),
Painful (high grade),
Seldom exceeds 5 cm,
Not completely
encapsulated,
Often contains cysts,
Maybe filled with a viscoid,
mucoid material

Clinical manifestation:
High grade: trismus,
Drainage from the ear,
Dysphagia,
 Numbness of the adjacent
areas and ulceration.

 Well circumscribed.
 Partially encapsulated.
 Firm , pinkish, or yellowish
tan.
 Extreme induration is
occasionally present.

 Majority of cut surface is
cystic.
 If cyst space present it
contain viscid, translucent
mucoid material that may
be blood tinged.

It is basically composed of mucous secreting cells, epidermoid cells
and intermediate cells.
Mucous cells:- are of various shapes and sizes with abundant, pale,
foamy cytoplasm staining positive for mucin.
Epidermoid cells:- having squamatoid features having polygonal
shape with intercellular bridges and sometimes keratinization.

A group of highly prolific, basaloid cells referred to as the
intermediate cells is seen being larger than basal cells and
smaller than Squamous cells. They are believed to be
progenitors of epidermoid and mucous cells.
Occasionally, clusters of clear cells can be present which are
mucin and glycogen free.

Epidermoid cells, together with intermediate and mucous
cells line cystic spaces or form solid masses or cords.
 Other types of cell : Basal cells called as maternal cells.

 Mucoepidermoid carcinoma is graded into:-
 Low grade
 Intermediate grade
 High grade

 Low grade:- well formed glandular structures and prominent
mucin filled cystic spaces, minimal cellular atypia and a high
proportion of mucous.
 Intermediate grade:- they have solid areas of epidermoid cells
or squamous cells with intermediate basaloid cells. Fewer
cyst formations as compared to low grade.
 High grade:- it consists of cells present as solid nests and
cords of intermediate basaloid cells and epidermoid cells.
Prominent nuclear pleomorphism and mitotic activity.
Necrosis and perineural invasion maybe present.

 Histology – Low grade
 Mucus cell > epidermoid
cells
 Prominent cysts
 Mature cellular elements

 Histology –Intermediate
grade
 Mucus = epidermoid
 Fewer and smaller cysts
 Increasing pleomorphism
and mitotic figures

 Histology - High grade
 Epidermoid > mucus
 Solid tumor cell
proliferation
 Mistaken for SCCA
 Mucin stainingMucin
staining

Mucoepidermoid Carcinoma
LOW GRADE / HIGH GRADE

CLINICAL
• Minor Salivary Gland
Malignancy
• Peripheral Odontogenic
Tumor
• Connective Tissue
Malignancy
HISTOPATHOLOGICAL
• Cystadenoma.
• Adenosquamous
carcinoma.
• Polymorphous low grade
adenocarcinoma.
• Primary or metastatic
squamous cell carcinomas
of major salivary gland.
• Cystadenocarcinoma

•25 %

Sclerosing mucoepidermoid carcinoma:-
This variant is extremely rare
Tumor infarction and extravasations of mucin resulting in
reactive fibrosis is suggested as the cause of this morphologic
variant.
It is characterized by an intense central sclerosis that occupies
the entirety of an otherwise typical tumor frequently with an
inflammatory infiltrate of plasma cells,eosinophils or
lymphocytes.

Sheets of
cells
Cystic Space
with basophilic
material in
the lumen

Intraosseous mucoepidermoid carcinoma:-
It may originate within the jaws. it is thought to form by
malignant transformation of epithelial lining of odontogenic
cysts.
It presents as an asymptomatic radiolucent lesion and
histologically of low grade malignancy.
The mandible is three times more commonly affected than the
maxilla.

 Conservative excision with preservation of facial nerve.
 Radical neck dissection.
 Low-grade lesions had a 5 year rate of 92%,intermediate-
grade and 49% five-year curerate.

 Shafer’s Oral Pathology(5 th edition)
 Surgical pathology of salivary gland (Ellis)
 Neville Textbook of oral pathology

MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian dental academy

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