Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
CASE REPORT
Year : 2010  |  Volume : 6  |  Issue : 3  |  Page : 350-352

Cavitary mucoepidermoid carcinoma of lung with metastases in skeletal muscles as presenting features: A case report and review of the literature


Department of Radiotherapy and Clinical Oncology, Swami Ram Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand, India

Date of Web Publication29-Nov-2010

Correspondence Address:
Abhishek Singh
Department of Radiotherapy and Clinical Oncology, Swami Ram Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.73363

Rights and Permissions
 > Abstract 

Mucoepidermoid carcinomas (MECs) of lung are rare neoplasms originating in bronchial submucosal glands and comprising 0.1-0.2% of primary lung cancers. MECs, the most common malignancy in salivary glands, were earlier thought to occur only in salivary glands. Later studies showed that they can arise as a primary in bronchus, esophagus, lacrimal glands, pancreas, thymus and thyroid gland. Initially described as a benign adenoma, it is now considered to be a malignant epithelial tumor. There have been reports of metastases to regional lymph nodes, other parts of the lung and distant organs. Cavitary lesion in MEC of lung is rare. Here, we report a case of MEC of lung with metastases to skeletal muscles of thigh and arm. To the best of our knowledge, this is the only case of MEC of lung presenting with such unusual pattern of metastasis as presenting feature with almost no symptoms of primary lesion.

Keywords: Lung carcinoma, mucoepidermoid carcinoma, skeletal muscle metastases


How to cite this article:
Singh A, Pandey KC, Pant NK. Cavitary mucoepidermoid carcinoma of lung with metastases in skeletal muscles as presenting features: A case report and review of the literature. J Can Res Ther 2010;6:350-2

How to cite this URL:
Singh A, Pandey KC, Pant NK. Cavitary mucoepidermoid carcinoma of lung with metastases in skeletal muscles as presenting features: A case report and review of the literature. J Can Res Ther [serial online] 2010 [cited 2020 Jul 8];6:350-2. Available from: http://www.cancerjournal.net/text.asp?2010/6/3/350/73363


 > Introduction Top


Mucoepidermoid carcinomas (MECs) of lung are rare neoplasms comprising 0.1-0.2% of primary lung cancers. They mimic the distinct morphology of same tumors found in salivary glands first described by Stewart et al. in 1945 and were earlier thought to occur only in salivary glands. [1] Later studies showed primary in bronchus, esophagus, lacrimal glands, pancreas, thymus and thyroid gland. As a disease entity, it is unique for the infrequency with which it occurs, and its variable clinical expression. [2],[3],[4] The cavitary lesion in MEC of lung is rare. Initially described as benign adenoma, it is now considered to be a malignant epithelial tumor with reports of metastases to regional lymph nodes, other parts of the lung and distant organs. Here, we report, to the best of our knowledge, the only case of MEC of lung with metastases to skeletal muscles as presenting feature.


 > Case Report Top


A 54-year-old male presented with multiple hard lumps developing and gradually increasing in size in right thigh, right groin and left arm for a period of one year, which were ignored by patient until the one in groin became painful and he developed high grade fever. On examination, patient had a hard painless lump approximately 3 × 3 cm in size arising from muscles of anterior compartment of thigh; two similar lumps of size approximately 2 × 2.5 cm and 1 × 1 cm were palpable in left arm biceps muscle; one such tender lump with cystic areas and signs of inflammation was present in right groin. On auscultation, bronchial sounds were heard in right infra-scapular area with occasional wheeze. His total leucocyte counts and C-reactive proteins were found to be raised while liver and renal function tests were within normal limits. Fine needle aspiration cytology from the lumps was suggestive of metastatic mucoepidermoid carcinoma [Figure 1]. Computed tomography revealed multiple enlarged necrotic lymphnodes in the subcarinal and right hilar region. A cavitary lesion was seen along the pleura- pulmonary interface in the region of the right postero-lateral costophrenic sulcus [Figure 2]. Necrotic lymphnodes were seen within the inguinal canal. Respiratory function tests showed obstructive respiratory changes. The tumor markers serum carcinoembryonic antigen, cancer antigen 19.9 and urinary 5-hydroxyindoleacetic acid were all within normal limits. Bronchoscopy revealed partial effacement of lower lobe and middle lobe bronchi by a polypoid growth with histopathology in favor of high grade MEC of lung [Figure 3]. Patient was administered two cycles of systemic chemotherapy with cisplatin and paclitaxel. An increase in size of muscle lesions was observed after two cycles though patient had symptomatic relief. Second line chemotherapy was started with cisplatin, adriamycin and 5-flourouracil. Reduction in size was noted after four cycles but patient's general condition deteriorated. Targeted therapy with geftinib was started. Despite all treatments, patient's condition deteriorated and he died seven months after diagnosis.
Figure 1: Photomicrograph of fine needle aspiration cytology of skeletal muscle lumps showing clusters of hyperchromatic nuclei and raised N/C ratio with vacuolated mucin filled cytoplasm. 40× MGG stain

Click here to view
Figure 2: Contrast enhanced computed tomography scan showing a cavity along the pleura pulmonary interface in the region of the right postero-lateral costophrenic sulcus

Click here to view
Figure 3: Photomicrograph of histopathology lung lesion showing compact clusters of malignant cells with hyperchromatic nuclei. H and E stain, 40×

Click here to view



 > Discussion Top


MECs are malignant tumors that are composed of squamous epithelial cells mixed with mucin producing cells. MECs of tracheo-bronchial tree were first reported by Smetana et al. in 1952. [5] Earlier believed to be benign, dissemination was later described by Ozlu et al. in 1961. [6] Both lymphangitic and hematogenous metastases have been demonstrated. The usual sites of metastases are the regional lymph nodes (48%), other portions of the lung (25%), bone marrow (25%), distant lymph nodes (18%), adrenal gland (14%), brain (14%), and skin (14%). Few cases have been reported of metastases to kidney, pleura, pericardium, mediastinum, duramater, and gastro-intestinal tract. [2],[3],[6],[7] No case of metastasis to skeletal muscles has been reported so far. MECs are divided into high grade and low grade according to their histological and ultrastructural characteristics in an attempt to predict malignant potential. Necrosis and mitoses were found only in high grade MEC. The metastatic potential of low grade type is extremely low, and death is very unusual. The high grade type has high metastatic potential and histology of metastases may indicate even more aggressive features than the primary. MECs are seen in a broad age range including childhood but mostly in fifth decades. Although some studies have reported a male pre-dominance for this tumor type, most studies have failed to confirm this. It has been found that low grade MECs occur more frequently in younger patients and has female predominance. Smoking habit is not associated with risk of developing this tumor. The patient reported here too was a non smoker.

Most patients present with cough and hemoptysis followed by recurrent pneumonia and fever. Few patients with high grade tumor may present with sustained chest pains. This patient's presentation was unusual as he had no symptoms or complaints due to primary lung lesion and presented with metastatic lumps in skeletal muscles and distant lymphnodes. Presence of cavitary lesion is also unusual. One case of cavitary presentation of MEC of lung has been reported by Tanvetyanon et al. [7]

Surgery is the treatment of choice for patients with MECs if the lesion is resectable. Low grade tumors should be removed completely for best results. Neodymium yttrium aluminum garnet (Nd-YAG) laser has been used successfully in two cases by Li et al. [8] Adjuvant treatment is not suggested for patients with low grade MECs. Re-excision is better option for margin positive cases. Adjuvant chemotherapy or radiotherapy can be considered for incomplete resection if re-excision is not possible or in advanced disease. Combination chemotherapies of platins, taxanes, gemcitabine, adriamycin and pemetrexed; targeted therapy with geftinib and erlotinib have been used. High grade tumors have reported to be fatal in sixteen to twenty seven months after diagnosis. [9],[10] Adjuvant therapy was less effective for the patients with high grade tumors. The prognostic factors include histological tumor grading, stage and achievement of surgical intervention.


 > Conclusion Top


MEC of the lung is a rare type of malignancy distinctive for the frequency of its occurrence and variable presentation. Surgical intervention is the treatment of choice for all resectable tumors. Combination chemotherapies or targeted therapies can be tried in patients with distant metastasis but with varied results. Metastasis to skeletal muscles though rare may be the initial and only manifestation of the tumor and requires high index of suspicion on part of clinician.

 
 > References Top

1.Stewart FW, Foote FW, Becker WF. Mucoepidermoid tumors of salivary glands. Ann Surg 1945;122:820-44.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Axelsson C, Burcharth F, Johansen A. Mucoepidermoid lung tumors. J Thorac Cardiovasc Surg 1973;65:902-8.  Back to cited text no. 2
[PUBMED]    
3.Barsky SH, Martin SE, Matthews M, Gazdar A, Costa JC. "Low grade" mucoepidermoid carcinoma of the bronchus with "high grade" biological behavior. Cancer 1983;51:1505-9.  Back to cited text no. 3
[PUBMED]    
4.Metcalf JS, Maize JC, Shaw EB. Bronchial mucoepidermoid carcinoma metastatic to skin: Report of a case and review of the literature. Cancer 1986;58:2556-9.   Back to cited text no. 4
    
5.Smetana HF, Iverson L, Swan LL. Bronchogenic carcinoma; an analysis of 100 autopsy cases. Mil Surg 1952;111:335-51.  Back to cited text no. 5
[PUBMED]    
6.Ozlu C, Christopherson WM, Allen JD. Mucoepidermoid tumors of the bronchus. J Thorac Cardiovasc Surg 1961;42:24-31.  Back to cited text no. 6
    
7.Tanvetyanon T, Ratanatharathorn V, Leopairat J. Mucoepidermoid carcinoma of the lung presenting as a cavitary lesion. J Med Assoc Thai 2004;87:988-91.   Back to cited text no. 7
[PUBMED]    
8.Li CH, Huang SF, Li HY. Bronchoscopic Nd-YAG laser surgery for tracheo-bronchial mucoepidermoid carcinoma: A report of two cases. Int J Clin Pract 2004;5:979-82.  Back to cited text no. 8
    
9.Heitmiller RF, Mathisen DJ, Ferry JA, Mark EJ, Grillo HC. Mucoepidermoid lung tumors. Ann Thorac Surg 1989;47:394-9.  Back to cited text no. 9
[PUBMED]    
10.Huang HK, Cheung YL, Chang H, Tzao C, Lee SC. Mucoepidermoid carcinoma of the lung. J Med Sci 2009;29:305-8.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Unusual mucoepidermoid carcinoma of the liver misdiagnosed as squamous cell carcinoma by intraoperative histological examination
Xiao-qin Guo,Bin Li,Yang Li,Xiao-ying Tian,Zhi Li
Diagnostic Pathology. 2014; 9(1): 24
[Pubmed] | [DOI]
2 Detection of skeletal muscle metastases on initial staging of lung cancer: a retrospective case series
Marialuisa Bocchino,Tullio Valente,Francesco Somma,Ilaria Rosa,Marco Bifulco,Gaetano Rea
Japanese Journal of Radiology. 2014;
[Pubmed] | [DOI]
3 Unusual Synchronous Lung Tumors: Mucoepidermoid Carcinoma and Mucinous Adenocarcinoma
Ana M. Ponea,Creticus P. Marak,Ying Sun,Achuta Kumar Guddati,Amit S. Tibb
Case Reports in Oncological Medicine. 2014; 2014: 1
[Pubmed] | [DOI]
4 Whole body computed tomographic characteristics of skeletal and cardiac muscular metastatic neoplasia in dogs and cats
Vignoli, M. and Terragni, R. and Rossi, F. and Frühauf, L. and Bacci, B. and Ressel, L. and Capitani, O. and Marconato, L.
Veterinary Radiology and Ultrasound. 2013; 54(3): 223-230
[Pubmed]
5 Orthopaedic case of the month: A 72-year-old man with a painful flexion contracture of the left thigh tumor
Cafferky, N.L. and Malone, W.J. and Bowen, T.R.
Clinical Orthopaedics and Related Research. 2013; 471(1): 346-351
[Pubmed]
6 Orthopaedic Case of the Month: A 72-year-old Man With a Painful Flexion Contracture of the Left Thigh
Nathan L. Cafferky,W. James Malone,Thomas R. Bowen
Clinical Orthopaedics and Related Research®. 2013; 471(1): 346
[Pubmed] | [DOI]
7 Classification 2014 des carcinomes bronchopulmonaires : nouveautés et implications cliniques. Cas no 8 : les carcinomes mucoépidermoïdes pulmonaires
Cécile Badoual
Annales de Pathologie. 2013; 33(5): 332
[Pubmed] | [DOI]
8 Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder
Donna M. Graham,Kate M. O’Connor,John Hinchion,Linda E. Coate,Louise Burke,Derek G. Power
Reports of Practical Oncology & Radiotherapy. 2013;
[Pubmed] | [DOI]
9 A 76-year-old Man with a Right Lung Adenocarcinoma and Invasive Aspergillosis
Vitorino Modesto dos Santos,Marcos Correa da Trindade,Diogo Wagner da Silva de Souza,Ana Isabel Costa de Menezes,Patricia Midori Oguma,Afonso Lucas Oliveira Nascimento
Mycopathologia. 2013; 176(1-2): 113
[Pubmed] | [DOI]
10 WHOLE BODY COMPUTED TOMOGRAPHIC CHARACTERISTICS OF SKELETAL AND CARDIAC MUSCULAR METASTATIC NEOPLASIA IN DOGS AND CATS
Massimo Vignoli,Rossella Terragni,Federica Rossi,Lukas Frühauf,Barbara Bacci,Lorenzo Ressel,Ombretta Capitani,Laura Marconato
Veterinary Radiology & Ultrasound. 2013; 54(3): 223
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Case Report>Discussion>Conclusion>Article Figures
  In this article
>References

 Article Access Statistics
    Viewed4375    
    Printed200    
    Emailed4    
    PDF Downloaded458    
    Comments [Add]    
    Cited by others 10    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]