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Table of Contents   
SHORT COMMUNICATION  
Year : 2010  |  Volume : 21  |  Issue : 4  |  Page : 609-610
Central mucoepidermoid carcinoma of the mandible


1 Department of Oral Medicine and Radiology, Rural Dental College of Pravara Institute of Medical Sciences, Loni, India
2 Department of Pathology, RMC, Loni, India
3 Department of Oral Pathology, Rural Dental College of Pravara Institute of Medical Sciences, Loni, India
4 Department of Oral and Maxilofacial Surgery, Rural Dental College of Pravara Institute of Medical Sciences, Loni, India

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Date of Submission13-Apr-2009
Date of Decision14-Oct-2009
Date of Acceptance23-Jan-2010
Date of Web Publication24-Dec-2010
 

   Abstract 

Central mucoepidermoid carcinoma are extremely rare tumors, representing about 2 to 4% of all mucoepidermoid carcinomas. They are histologically low-grade cancers, usually affecting the mandible as uni- or multilocular radiographic lesions. Effective surgical treatment involving wide local excision or en bloc resection, allows patients to have a favorable prognosis after a long-term follow up. We report a case of central mucoepidermoid carcinoma affecting the mandible and discuss its clinical, radiographic, and histological findings, with a review of the literature.

Keywords: Central, mandible, intraosseous, mucoepidermoid carcinoma

How to cite this article:
Munde A, Karle R, Metgud R, Rudgi B M. Central mucoepidermoid carcinoma of the mandible. Indian J Dent Res 2010;21:609-10

How to cite this URL:
Munde A, Karle R, Metgud R, Rudgi B M. Central mucoepidermoid carcinoma of the mandible. Indian J Dent Res [serial online] 2010 [cited 2020 Sep 23];21:609-10. Available from: http://www.ijdr.in/text.asp?2010/21/4/609/74230
Central mucoepidermoid carcinoma are extremely rare tumors, representing about 2 to 4% of all mucoepidermoid carcinomas. They are histologically low-grade cancers, usually affecting the mandible as uni- or multilocular radiographic lesions.


   Case Report Top


A 56-year-old man was referred for mild pain in the area of the lower right posterior jaw since one month. On clinical examination a fixed prosthesis was evident, extending from the first premolar to the third molar. The first and second molars were missing. Teeth in the affected region were non-mobile and non-tender. There was no evidence of swelling or expansion of the cortical plates. The oral mucosa was normal and intact. Radiographic examination [Figure 1] showed a large, well-defined, multilocular lesion extending from the third molar into the ascending ramus, with an approximate size of 3.5×2 cm. Its margins were mostly well-circumscribed. A provisional diagnosis of odontogenic keratocyst was made. An incisional biopsy was advised. Microscopic examination of the hematoxylin-eosin stained, soft tissue sections revealed islands of mucous cells, epidermoid cells, and intermediate cells, with cystic areas. The cells were also arranged in the form of strands and there was a predominance of mucous cells present in the islands. The connective tissue was fibrocellular with blood vessels and chronic inflammatory cells. The diagnosis was low-grade mucoepidermoid carcinoma [Figure 2]. The patient was treated using a wide local excision. The histopathological features and special stain (mucicarmine) confirmed the diagnosis of mucoepidermoid carcinoma.
Figure 1: Panoromic radiograph showing the radiolucent lesion in the body and ramus of the mandible

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Figure 2: H and E section showing cystic spaces and nests of neoplastic squamous cells

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   Discussion Top


The first case of Central mucoepidermoid carcinomas (CMEC) was reported in the mandible of a 66-year-old woman, by Lepp, in 1939. [1] CMECs have since been reported only sporadically because of their rarity. According to Pires et al, [2] about less than 200 cases have been published. However, the true number of cases is difficult to estimate because of the non-uniform criteria adopted for diagnosis and because some cases have not been reported or were published in non-English language literature.

Its origin remains controversial and several possibilities have been considered including, (1) Metaplasia of the odontogenic cyst epithelium, (2) Entrapment of salivary tissues from the submandibular, sublingual or minor salivary glands during development, (3) Entrapment of minor salivary glands from the retromolar area, (4) Maxillary sinus epithelium, (5) Iatrogenic entrapment of minor salivary glands (chronic osteomyelitis, sinusitis), (6) Odontogenic remnants of dental lamina. [3]

CMEC affects female twice more than male and involves the mandible (molar angle region) twice more often than the maxilla. It has been reported in all ages ranging from one to 78 years, with the overwhelming majority occurring in fourth and fifth decades of life. Eversole et al, [3] found that approximately 50% of the cases were associated with dental cyst and/or impacted teeth.

The main symptoms are swelling and pain with trismus, parasthesia, and tooth mobility being noted occasionally. The radiologic features are usually a well-circumscribed uni-or multilocular radiolucency in the mandibular posterior region, involving the molar and ramus region. The periphery of the lesion is mostly well-defined, corticated and often crenated or undulating in nature, which is similar to a benign odontogenic lesion. [4] The multilocular lesion has an internal structure that resembles a soap bubble or honeycomb.

The clinical and radiographic differential diagnosis should include an odontogenic keratocyst, ameloblastoma, dentigerous cyst, ameloblastic fibroma, and metastatic lesions to the jaw. [5] Criteria for diagnosing CMECs include (1) Presence of a radiographic, distinct, osteolytic lesion, (2) Positive mucicarmine staining, (3) Absence of rupture of one or more cortical plates, (4) Clinical and histological exclusion of a metastasis or an odontogenic lesion, (5) Exclusion of the origin from a soft tissue salivary gland, (6) Histological confirmation. [4]

Besides clinical and radiographic parameters, biopsy is necessary for the final diagnosis and treatment plan in all cases of CMECs. Most of the reported CMECs are histologically low-grade tumors and usually carry a favorable prognosis. [3],[6] However, maxillary cases have a worse prognosis due to the possibility of local extension to important vital structures. As a rule, even being low-grade tumors, CMECs should be managed by wide local resection, en bloc resection or hemi-mandibulectomy. A conservative approach is undesirable and can favor recurrences. [3],[6] Neck dissection is indicated when the regional lymph nodes are involved and radiotherapy seems to be an adjunctive useful measure in cases with close surgical margins and high-grade tumors. [4]

CMEC patients must be followed up for long periods due to the possibility of late local recurrence or regional metastasis. According to different studies the recurrence rate varies from 13 - 50%. [3] Surely, these values depend on the biological behavior of these tumors and the surgical approach.

In conclusion, central CMECs are uncommon salivary gland tumors that usually affect the posterior mandible as uni- or multilocular lesions. They are commonly low-grade tumors and the treatment essentially includes wide local excision. Long-term follow up is necessary as some cases can develop late local recurrences and regional metastasis even after decades.

 
   References Top

1.Namin AK, Moshref M, Shahoon H, Mashhadi A, Khojasteh A. An intraosseous mucoepidermoid carcinoma of the maxilla in a teenager: A case report and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:93-6.  Back to cited text no. 1
    
2.Pires FR, Paes de Almeida O, Lopes MA, Elias da Cruz Perez D, Kowalski LP. Central mucoepidermoid carcinoma of the mandible: A report of four cases with long term follow up. Int J Oral Maxillofac Surg 2003;32:378-82.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Eversole LR, Sabes WR, Rovin S. Aggressive growth and neoplastic potential of odontogenic cysts with special reference to central mucoepidermoid and mucoepidermoid carcinomas. Cancer 1975;35:270-82.  Back to cited text no. 3
[PUBMED]    
4.Simon D, Somanathan T, Ramdas K, Pandey M. Central mucoepidermoid carcinoma of mandible: A case report and review of literature. World J Surg Oncol 2003;1:1.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Darling MR, Wehrli BM, Ciavarro C, Daley TD. Pericoronal radiolucency in posterior mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:139-43.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Waldron CA, Koh ML. Central mucoepidermoid carcinoma of the jaws: Report of four cases with analysis of the literature and discussion of the relationship to the mucoepidermoid sialo odontogenic and glandular odontogenic cyst. J Oral Maxillofac Surg 1990;48:871-7.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Anita Munde
Department of Oral Medicine and Radiology, Rural Dental College of Pravara Institute of Medical Sciences, Loni
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.74230

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    Figures

  [Figure 1], [Figure 2]

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