Salivary gland malignant myoepithelioma: a clinicopathologic and immunohistochemical study of ten cases.
BACKGROUND
Malignant myoepithelioma (MME) of the salivary gland, also known as myoepithelial carcinoma, is rare and its biologic behavior has not been clarified fully.


METHODS
Ten cases of MME were analyzed for their clinicopathologic features and immunohistochemical characteristics, focusing on prognostic factors and tumor differentiation. In addition, six cases of benign myoepithelioma (BME) also were examined for comparison.


RESULTS
The ten patients with MME (3 men and 7 women) ranged in age from 48-81 years (mean, 61.9 years). Seven cases of MME arose in the parotid salivary gland, two in the submandibular salivary gland, and one in minor salivary glands of the soft palate. In the current series, the incidence of MME was 0.45% among 1945 cases of major salivary gland tumors. Seven cases of MME developed from a benign preexisting tumor (six in pleomorphic adenoma and one in BME). Four of nine patients with MME died of the disease and two patients developed a recurrence. It was shown that MMEs were comprised of one cell type or a combination of two cell populations; these included, in order of incidence, epithelioid, spindle, and plasmacytoid cells. Patients with MME with marked cellular pleomorphism and perineural invasion had a poor prognosis. Immunohistochemically, putative myoepithelial markers such as muscle actins, cytokeratin 14, vimentin, and calponin, and S-100 protein were expressed highly in MME. High and low molecular weight cytokeratins and epithelial membrane antigen also frequently were positive in MME. p53 expression was observed in five MME cases, four of which either recurred or were fatal. Cellular proliferative activity assessed by mitotic count and the Ki-67 labeling index was significantly higher in MME cases than in BME cases. In limited cases, such cellular proliferative activity was shown to have prognostic value. Ultrastructurally, the tumor cells displayed certain myoepithelial characteristics.


CONCLUSIONS
MME is a rare salivary gland tumor showing clinicopathologic diversity and presenting with various stages of myoepithelial differentiation. Histologic aggressiveness, marked cellular pleomorphism, p53 expression, and high cell proliferative activity were found to be correlated with a poor clinical outcome.
Department of Surgical Pathology, Teikyo University, School of Medicine, Ichihara Hospital, Chiba, Japan.
T
T
Nagao
I
I
Sugano
Y
Y
Ishida
Y
Y
Tajima
O
O
Matsuzaki
A
A
Konno
Y
Y
Kondo
K
K
Nagao
D000199:Actins / Q000032:analysis; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D002135:Calcium-Binding Proteins / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008840:Microfilament Proteins; D008875:Middle Aged; D009208:Myoepithelioma / Q000473:pathology*; D009218:Myosins / Q000032:analysis; D010307:Parotid Neoplasms / Q000473:pathology; D009418:S100 Proteins / Q000032:analysis; D012468:Salivary Gland Neoplasms / Q000473:pathology*; D013365:Submandibular Gland Neoplasms / Q000473:pathology; D016159:Tumor Suppressor Protein p53 / Q000032:analysis; D014746:Vimentin / Q000032:analysis; D000096985:Calponins
D000199:Actins; D014408:Biomarkers, Tumor; D002135:Calcium-Binding Proteins; D007633:Keratins; D019394:Ki-67 Antigen; D008840:Microfilament Proteins; D009218:Myosins; D009418:S100 Proteins; D016159:Tumor Suppressor Protein p53; D014746:Vimentin; D000096985:Calponins