title: Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: more aggressive than previously reported.
abstract: Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid is a rare traditionally "low-grade" tumor that predominantly occurs in women. Approximately 50 cases have been reported in the literature. It arises in a background of Hashimoto thyroiditis and is characterized by nests of epidermoid and mucin-secreting cells located within an eosinophil-rich sclerotic stroma. Herein, we outline the clinicopathological and immunohistochemical characteristics of 6 cases of thyroid SMECE. All tumors were detected in women (age, 36-89 years; average, 59 years), and all patients underwent total thyroidectomies. Clinicopathological findings included extensive tumor invasion into the adjacent soft tissues, trachea, pharynx, and esophagus. Of 6 specimens, 5 had positive surgical margins. Cervical lymph node metastases were seen in 4, and distant metastases were in 3 patients. Immunohistochemically, all tumors were positive for CK19, galectin 3, and p63 and negative for calcitonin, calponin, S-100, and smooth muscle actin. Interestingly, 2 tumors also showed faint focal staining for thyroglobulin, and 2 others had focal positivity for thyroid transcription factor 1. Together, galectin 3 and CK19 expression supported the malignancy of these lesions, and p63 expression raised the possibility that these tumors originated from the ultimobranchial body. In summary, SMECE tumors in our series exhibit a clear female predominance with aggressive behavior and appear to arise from pluripotent solid cell nests. A correct diagnosis is crucial to providing SMECE patients with the appropriate treatment options, and we recommend a closer follow-up schedule than previously considered.
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Quiroga-Garza
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030; Department of Pathology, Korea University Medical Center, Anam Hospital, Seoul, 152-703, Republic of Korea.
authors.forename: Jeong Hyeon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030.
authors.forename: Adel
authors.initials: A
authors.lastname: El-Naggar
authors.affiliation: Department of Pathology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN 37232.
authors.forename: Jennifer O
authors.initials: JO
authors.lastname: Black
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030; Weill Medical College of Cornell University, Houston, TX 77030.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Amrikachi
authors.affiliation: Department of Pathology, The Mayo Clinic, Jacksonville, FL 32224.
authors.forename: Qihui J
authors.initials: QJ
authors.lastname: Zhai
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030; Weill Medical College of Cornell University, Houston, TX 77030.
authors.forename: Alberto G
authors.initials: AG
authors.lastname: Ayala
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030; Weill Medical College of Cornell University, Houston, TX 77030. Electronic address: jaero@houstonmethodist.org.
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Ro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018277:Carcinoma, Mucoepidermoid / Q000175:diagnosis / Q000473:pathology*; D018450:Disease Progression; D004802:Eosinophilia / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000473:pathology*; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000473:pathology
keywords: Females; Hashimoto thyroiditis; Mucoepidermoid carcinoma; Sclerosis; Thyroid; Tissue eosinophilia