Nicholas Robert G, Hanson Josh A, Meiklejohn Duncan A
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, UNM School of Medicine, Albuquerque, NM, USA.
Department of Pathology, University of New Mexico Hospital, UNM School of Medicine, Albuquerque, NM, USA.
Clin Med Insights Oncol. 2019 Apr 2;13:1179554919838254. doi: 10.1177/1179554919838254. eCollection 2019.
Myoepithelial cell carcinoma is a rare malignant neoplasm of salivary gland origin that typically presents in the parotid gland and minor salivary glands. It has been described previously in head and neck sites such as buccal mucosa, alveolar ridge, and base of tongue.
A 55-year-old man presented with 30 years of right-sided tongue pain and 10 years of gradually worsening ulceration. Physical examination demonstrated a 2.5 cm ulcerative lesion of the anterior right oral tongue. An initial biopsy was consistent with moderately to poorly differentiated squamous cell carcinoma. Imaging included a positron emission tomography (PET)/computed tomography (CT) scan that demonstrated the right tongue lesion as well as hypermetabolic right level II adenopathy. The patient underwent surgical excision of the right tongue, upper aerodigestive tract endoscopy, and a bilateral supraomohyoid neck dissection. The tongue defect was closed primarily.
Final pathology of the surgical specimen demonstrated myoepithelial cell carcinoma. All of the margins were free of tumor and no cervical lymph nodes showed metastasis. Immunohistochemistry demonstrated myoepithelial differentiation. The tumor did not show EWSR1 gene rearrangement on genetic testing, suggesting salivary gland origin. Multidisciplinary tumor board evaluation recommended no adjuvant therapy. The patient recovered well after surgery and nearly a year later is without evidence of recurrent or residual disease.
We present the first reported case of myoepithelial cell carcinoma with primary origin in the oral tongue and review the available literature on this unusual tumor. We discuss the clinical, pathological, and immunohistochemical features and treatment of myoepithelial cell carcinoma.
肌上皮细胞癌是一种罕见的起源于唾液腺的恶性肿瘤，通常发生于腮腺和小唾液腺。此前曾在颊黏膜、牙槽嵴和舌根等头颈部部位有过相关描述。
一名55岁男性，有30年右侧舌部疼痛病史及10年逐渐加重的溃疡病史。体格检查发现右侧舌前部有一个2.5厘米的溃疡性病变。初次活检结果符合中分化至低分化鳞状细胞癌。影像学检查包括正电子发射断层扫描（PET）/计算机断层扫描（CT），显示右侧舌部病变以及右侧II区淋巴结代谢增高。患者接受了右侧舌部手术切除、上消化道内镜检查及双侧肩胛舌骨上颈部淋巴结清扫术。舌部缺损进行了一期缝合。
手术标本的最终病理显示为肌上皮细胞癌。所有切缘均无肿瘤，且无颈部淋巴结转移。免疫组化显示有肌上皮分化。基因检测显示肿瘤未出现EWSR1基因重排，提示起源于唾液腺。多学科肿瘤委员会评估建议不进行辅助治疗。患者术后恢复良好，近一年后无复发或残留疾病迹象。
我们报告了首例原发于舌部的肌上皮细胞癌病例，并回顾了关于这种罕见肿瘤的现有文献。我们讨论了肌上皮细胞癌的临床、病理、免疫组化特征及治疗方法。
