Repeated Surgery in a Case of Epithelial-Myoepithelial Carcinoma of the Parotid Gland that was Difficult to Distinguish from Pleomorphic Adenoma

Reo Miura; Hiroumi Matsuzaki; Xiaoyan Tang; Takeshi Oshima

doi:10.1007/s12070-023-03799-x

Repeated Surgery in a Case of Epithelial-Myoepithelial Carcinoma of the Parotid Gland that was Difficult to Distinguish from Pleomorphic Adenoma

Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):2534-2537. doi: 10.1007/s12070-023-03799-x. Epub 2023 Apr 29.

Authors

Reo Miura¹, Hiroumi Matsuzaki¹, Xiaoyan Tang², Takeshi Oshima¹

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610 Japan.
² Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610 Japan.

PMID: 37636663
PMCID: PMC10447724 (available on 2024-09-01)
DOI: 10.1007/s12070-023-03799-x

Abstract

Epithelial-myoepithelial carcinoma (EMC) of the parotid gland is a comparatively rare tumor that accounts for less than 1% of all salivary gland tumors. A patient with EMC of the parotid gland that was initially diagnosed as pleomorphic adenoma and that recurred locally during the watchful waiting period but was controlled by surgery under local anesthesia is reported. An 80-year-old man had noticed a swelling in the left infra aural region. A left parotid gland tumor was suspected, and he was referred to our department. Magnetic resonance imaging (MRI) and fine-needle aspiration cytology findings were suggestive of pleomorphic adenoma of the superficial lobe of the parotid gland, and this was therefore resected under general anesthesia. Postoperative histopathological examination, immunostaining, and genetic tests resulted in a diagnosis of EMC. Postoperative pathological review showed that part of the resection margin was positive. The possibility of recurrence was explained to the patient, and additional treatment was recommended, but since the patient did not desire this, a policy of watchful waiting was adopted. Signs of cutaneous metastasis in the left infra aural region were detected at 13 months postoperatively, and this metastasis was excised under local anesthesia. The resection margin was negative, and the patient's course remains uneventful. EMC is classified as a low-grade malignant tumor, but it requires stringent monitoring because of its frequent local recurrence. Since local control can usually be achieved by surgical treatment alone, and postoperative adjuvant therapy may not necessarily warranted.

Keywords: Epithelial-myoepithelial carcinoma (EMC); Immunostaining; Parotid gland; Surgery.

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