Mucoepidermoid carcinoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Mucoepidermoid carcinomas arise from mucous cells, which are normally involved in the secretion of mucous and the protection of the surrounding tissue. The pathogenesis of mucoepidermoid carcinoma consists of abnormal production of mucin from mucous cells, associated with the aberrant overgrowth of squamous and epidermoid cells. Genes involved in the pathogenesis of mucoepidermoid carcinoma include the MECT1 and MAML2 fusion genes. On gross pathology, mucoepidermoid carcinomas have a cystic, solid or mixed appearance, are normally located on the parotid or submandibular gland, and range in size from 1 to 8 cm. On microscopic histopathological analysis, mucoepidermoid carcinomas are characterized by mucous cells with abundant fluffy cytoplasm and large mucin vacuoles.

Pathogenesis

• Mucoepidermoid carcinomas arise from mucous cells, which are normally involved in the secretion of mucous and protection of the surrounding tissue.
• The pathogenesis of mucoepidermoid carcinoma consists of abnormal production of mucin from mucous cells, associated with the aberrant overgrowth of squamous and epidermoid cells.

Genetics

• Development of mucoepidermoid carcinoma may be the result of multiple genetic mutations.
• Genes involved in the pathogenesis of include:

• MECT1 fusion gene
• MAML2 fusion gene

Associated Conditions

• Mucoepidermoid carcinomas have no associated conditions.

Gross Pathology

• On gross pathology, mucoepidermoid carcinoma has a cystic, solid, or mixed appearance. Mucoepidermoid carcinoma usually occurs in the parotid or submandibular gland.
• Other findings on gross pathology include:

• Tumor size ranging from 1 to 8 cm
• Gray or white in color, with mucin filled cysts

Microscopic Pathology

The characteristic findings of mucoepidermoid carcinoma on microscopic histopathological analysis are listed below.

• Mucus secreting cells (visible with musicarmine staining)
• Composed of three cell types: epidermoid, intermediate, and mucin producing
• Mucin vacuoles may be rare; in a superficial glance (mimics squamous cell carcinoma)
• Mucoepidermoid tumors are graded histologically into: low grade, intermediate grade, and high grade.
• Low grade is characterized by well-differentiated cells with little cellular atypia, high proportion of mucous cells, and prominent cyst formation
• Intermediate grade is characterized by intermediate features
• High grade is characterized by poorly differentiated with cellular pleomorphism, high proportion of squamous cells, and solid with few if any cysts

Gallery

• 
  Histopathologic image of mucoepidermoid carcinoma of the major salivary gland. H & E stain.
• 
  Histopathologic image of mucoepidermoid carcinoma of the major salivary gland.
• 
  Histopathologic image of mucoepidermoid carcinoma. Postoperative recurrence of the submandibular tumor. Alcian blue-PAS stain.
• 
  Gross pathology mucoepidermoid carcinoma.

References

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