Archives of Otol

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American Head & Neck Society
July 21-25, 2012
Metro Toronto Convention Centre
Toronto, ON, Canada

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Presentation: P795
Topic: Skin and Salivary Gland
Type: Poster
Date: Sunday - Tuesday, July 22 - 24, 2012
Session: Designated Poster viewing times
Authors: A Najihah, Dr, MY Mohd Razif, Assoc Prof, AJ Nazimi, Dr, MR Isa, Assoc Prof, SHA Primuharsa Putra, Dr
Institution(s): Department of Otorhinolaryngology-Head & Neck Surgery, Department of Oral & Maxillofacial Surgery, Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre & KPJ Seremban Specialist Hospital, Malaysia

Introduction: Epithelial-myoepithelial carcinoma (EMC) is one of the tumours of the salivary glands. It rarely occurs and accounts for less than 1% of all salivary gland tumours. It commonly arises in the major salivary gland especially in the parotid gland, and less frequently in the minor salivary gland.
Methods: A 28-year man presented with history of right intermittent palatal pain for 5 years duration. He underwent two dental extraction procedures but the pain persisted. He also noted a swelling at the right palatal region that was progressively increases in size over that period of time but he did not seek treatment for it. Examination revealed a tumour bulge at the right posterior maxillary region involving soft-hard palate junction and nasal cavity. Neck palpation revealed a right small (1x1cm) level II cervical lymphadenopathy. A contrast-enhanced computed tomography (CECT) scan of paranasal sinuses showed soft tissue mass arising from the right maxillary sinus, heterogeneously enhances with an area of hypodensity suggestive of cystic component within. Posterior, lateral and medial walls of the maxillary sinus were remodelled associated with erosions. Right pterygoid bone was eroded, and the plane between the mass and medial and lateral pterygoid muscles was obliterated at its attachment. The mass was encroaching into the right nasal cavity. Tissue biopsy from the right nasal cavity mass revealed myoepithelial carcinoma with positive stain of S100.
Results: He underwent tracheostomy, right subtotal maxillectomy and right selective neck dissection. Histopathological examination of the hard palate revealed malignant cells in lobules, mostly in solid stuctures. There were bilayered duct-like structures lined by cuboidal cells with dense, fine granular cytoplasm. The outer cells were round to oval mildly pleomorphic cells with vesicular nucleous, inconspicuous nucleoli and ill-defined eosinophilic granular cytoplasmic boder. The findings were consistent with epithelial-myoepithelial carcinoma. There is evidence of vascular invasion and the tumour is 2mm away from the lateral soft tissue margin. Tissue sample from the pterygoid muscle showed presence of malignant infiltration. Post-operatively, patient was referred to the Oncology team for completion of the treatment.
Conclusions: EMC of hard palate is a rare tumour that can occur in the salivary glands. Not many cases of the tumour in this region have been reported in the literature so far.



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