|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 447-448
Aggressive primary malignant myoepithelioma of the maxillary sinus
AH Hakeem1, IH Hakeem2
1 Head and Neck Surgeon, Department of Surgical Oncology, Fortis Cancer Institute, Mulund West Mumbai, India
2 Department of Internal Medicine, Florida Hospital Medical Center, Orlando, Florida, Water Lake, United States
|Date of Web Publication||18-Feb-2016|
A H Hakeem
Head and Neck Surgeon, Department of Surgical Oncology, Fortis Cancer Institute, Mulund West Mumbai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hakeem A H, Hakeem I H. Aggressive primary malignant myoepithelioma of the maxillary sinus. Indian J Cancer 2015;52:447-8
Myoepitheliomas are benign and very rare tumors that constitute about 1% of the salivary gland tumors. Only 10% of the myoepithelioma's are malignant. Most common site of occurrence is parotid, with only few case reports from the maxillary sinus.,, We report a case of 31-year-old female who presented to us with residual tumor in the region of left maxillary sinus. The lesion had been enucleated in the regional hospital one month ago with histopathological diagnosis of spindle cell tumor. On oral examination, she hadfleshy mass involving left upper alveolus. She had no palpable cervical lymphadenopathy. CT scan revealed residual mass lesion in the left maxillary alveolus along its lingual and buccal cortices. There was destruction of the anterior wall and posterior-lateral wall of the left maxillary antrum. Metastatic work up did not reveal any distant metastases. Total maxillectomy was performed. Histopathology established the diagnosis of a malignant myoepithelioma [Figure 1] and [Figure 2]. Immuno-histochemical reactions were positive for cytokeratins, vimentin, SMA, S-100 proteincalponin and negative for CD-10, which confirmed the diagnosis of malignant myoepithelioma.
|Figure 1: Under low power showing sheets and cords of ovoid to spindle component with moderate amount of pale to eosinophilic cytoplasm|
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|Figure 2: Under high power showing ovoid to spindle cells with uniform, mildly hyperchromatic nuclei, and inconspicuous nucleolei|
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Post-operative period was uneventful. She also received 60 Gy/33# of adjuvant radiotherapy. Eight months after completion of the radiotherapy, tumor recurred locally and she complained of pain in the right lower quadrant of abdomen. There was vague mass in the right lower abdomen, which was tender to palpation. CT abdomen revealed huge variegated partially necrotic adnexal mass extending to the right para-umbilical region with mass displacing the uterus to the left [Figure 3]. This mass was adherent to the small bowel. Enlarged left para-aortic nodes were also seen [Figure 4]. Patient refused any further diagnostic or therapeutic intervention.
|Figure 3: CT scan abdomen showing huge varigated partially necrotic right adnexal mass extending to right para-umbilical region with mass displacing uterus to left and adherent to adjacent small bowel|
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Malignant myoepitheliomas may arise denovo or develop from a pre-existing myoepithelioma or pleomorphic adenoma. Only few cases of the primary maxillary sinus malignant myoepitheliomas have been reported in the English language literature since Graadt van Roggen et al. reported the first case in 1998.
Controversy exists as to degree of malignancy and metastasis of malignant myoepithelioma, but the rate of recurrence is high.,,, In the present case, recurrence at the primary site andnecrotic lesions inthe adnexa, probably metastases was seen in only 8 months post-surgery, and radiotherapy reveals the aggressive biological nature of the malignant myoepitheliomas.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]