Epithelial-myoepithelial carcinoma: A review of the clinicopathologic spectrum and immunophenotypic characteristics in 61 tumors of the salivary glands and upper aerodigestive tract

被引:188
作者
Seethala, Raja R.
Barnes, E. Leon
Hunt, Jennifer L.
机构
[1] Univ Pittsburgh, Dept Pathol, Med Ctr, Head & Neck Endocrine Div, Pittsburgh, PA 15213 USA
[2] Cleveland Clin, Dept Pathol, Cleveland, OH 44106 USA
关键词
epithelial-myoepithelial carcinoma; histologic variants; immunohistochemistry; sebaceous; oncocytic;
D O I
10.1097/01.pas.0000213314.74423.d8
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
To further define the clinicopathologic spectrum of epithelial-myoepithelial carcinoma (EMCa), we report the gross, histologic, and immunophenotypic characteristics of 61 tumors seen within a 30-year-period. The mean age at presentation was 60.9 years, with a female predominance (1.5:1). The most common sites were parotid (62.1%), sinonasal mucoserous glands (10.3%), palate (8.6%), and submandibular (8.6%). Most EMCas showed a characteristic nodular/multinodular growth pattern and classic biphasic tubular histology. However, new morphologies in EMCa such as ancient change (8.2%), "Verocay"-like change (3.3%), and sebaceous differentiation (13.1 %) were noted. Specific histologic variants were dedifferentiated EMCa (3.3%), oncocytic EMCa (8.2%), EMCa ex pleomorphic adenoma (1.6%), double-clear EMCa (3.3%), and EMCa with myoepithelial anaplasia (3.3%). All cytokeratin cocktails selectively highlighted the epithelial component well. Of the myoepithelial markers, p63, smooth muscle actin and vimentin performed best. Bcl-2 and c-kit were frequently positive (66.7% and 69.2%, respectively). p53 was highly expressed only in I dedifferentiated EMCa. The recurrence rate was 36.3% (median disease-free survival 11.34y), but death was rare with 5-year and 10-year disease-specific survivals of 93.5% and 81.8%, respectively. The most important univariate predictors of recurrence were margin status (log rank P = 0.006), angiolymphatic invasion (P = 0.002), tumor necrosis (P = 0.004), and myoepithelial anaplasia (P = 0.038). Thus, EMCa is generally a low-grade tumor with a broader morphologic spectrum than previously thought, with several key features predictive of recurrence. Immunohistochemistry can aid diagnosis by highlighting the biphasic nature of the tumor.
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页码:44 / 57
页数:14
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