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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 15  |  Issue : 3  |  Page : 177-179

Mucoepidermoid carcinoma of the vermillion border of the upper lip: A rare occurrence


Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India

Date of Web Publication10-Sep-2018

Correspondence Address:
Renuka Masodkar
E-102 Yamuna Apartments, Alaknanda, New Delhi - 110. 019
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_7_18

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  Abstract 


Mucoepidermoid carcinoma (MEC) is a rare tumor. Very few cases of MEC of the upper lip have been reported in the literature. We report a case of 34-year-old female with MEC of the upper lip treated with surgery and postoperative radiotherapy.

Keywords: Mucoepidermoid, radiotherapy, upper lip


How to cite this article:
Masodkar R, Jadhav G, Verma S. Mucoepidermoid carcinoma of the vermillion border of the upper lip: A rare occurrence. Apollo Med 2018;15:177-9

How to cite this URL:
Masodkar R, Jadhav G, Verma S. Mucoepidermoid carcinoma of the vermillion border of the upper lip: A rare occurrence. Apollo Med [serial online] 2018 [cited 2019 Oct 22];15:177-9. Available from: http://www.apollomedicine.org/text.asp?2018/15/3/177/240947




  Introduction Top


Mucoepidermoid carcinoma (MEC) is a rare tumor. It constitutes <0.5% of all malignancies. It most commonly occurs in the salivary tissue. It arises from pluripotent reserve cells of the excretory ducts that can differentiate into squamous, columnar, and mucous cells.[1] The most common site of occurrence of MEC is the parotid gland.[2] Some cases have been reported in the digestive and respiratory tract.

Tumors arising from the lip, other than squamous cell carcinoma, are an uncommon entity, and tumors of the minor salivary glands account for <2% of all lip tumors.[3] Very few cases of MEC of the lip have been reported in the literature. Furthermore, the occurrence of these tumors is around three times less on the upper lip as compared to the lower lip.[4]

Here, we report a singular case of MEC of the vermillion border of the upper lip.


  Case Report Top


A 34-year-old female, with no known comorbidities, presented with a history of swelling in vermillion border of upper lip on the left side 5 years back. She underwent local excision of the cyst. The histopathology was reported as suggestive of squamous papilloma. She was apparently asymptomatic for 4 years after excision of the cyst, when she noticed a globular swelling approximately of size 2 cm × 2 cm over the same location. The swelling was progressively increasing in size. It was not associated with any pain or discharge. There were no neck nodes on clinical examination. Her magnetic resonance imaging showed a well-circumscribed 1.18 cm × 1.16 cm × 1.5 cm altered signal intensity lesion involving the upper lip just lateral to the philtrum on the left side appearing hypointense on T1-weighted, isointense on T2-weighted, and hyperintense on STIR showing subtle contrast enhancement. [Figure 1] and [Figure 2] show the MRI images of the patient.
Figure 1: Sagittal view of magnetic resonance imaging image showing the upper lip tumor

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Figure 2: Axial view of magnetic resonance imaging image showing the upper lip tumor

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She underwent excision of the swelling. The histopathology report is as follows: Gross-Single globular partially skin covered soft-tissue mass 2.5 cm × 2.1 cm. Cut section showed solid with mucinous areas. Microscopy: partially encapsulated tumor mass extending from subepithelial stromal tissue to underlying skeletal muscle. Tumor is composed of a variable type of cells, clear cells, mucinous cells with intraluminal + intracytoplasmic mucin, and intermediate cells. These tumor cells show mild-to-moderate degree of atypia. There is no area of necrosis. Perineural invasion is absent. Mitosis is infrequent. All margins are very close to tumor <1 mm away. Features are consistent with intermediate-grade MEC.

She was then planned for adjuvant radiotherapy in view of close margins and recurrent nature of the lesion to a total dose of 60 Gy in 30 fractions using a combination of intensity-modulated radiotherapy and electron beam therapy.


  Discussion Top


Most of the MECs occur in the major salivary glands; however, they may also occur from the minor salivary glands. They may also rarely arise from the mucosal glands of the genitalia, anus, and respiratory and digestive tracts. Lip is an infrequent site of occurrence of this tumor.

Mucoepidermoid tumor consists of three types of cells such as the epidermoid, the mucus-secreting, and an intermediate cell. MECs are classified as low-, intermediate-, and high-grade subtypes according to the amount of cyst formation, the presence of neural invasion or necrosis, degree of atypia, and relative number of mucous, epidermoid, and intermediate cells.[5] Low-grade MECs are infiltrating tumors with bland mucin secretion and intermediate cells and a well-differentiated squamous component. Intermediate-grade MEC shows solid tissue architecture rather than cystic. They are irregular, with more of intermediate cells than mucinous cells. Intermediate-grade tumors often have a well-demarcated border and sometimes are associated with perineural invasion. High-grade MECs are less well-differentiated tumors.[6]

Clinically, they present as endophytic growths with a slowly progressive course. Women are more commonly affected than men. The prevalence is highest in the 5th decade. The grade of the tumor seems to correlate well with prognosis.[7],[8]

The standard of treatment for this tumor is surgical resection. Local resection of the tumor is sufficient for low-grade tumors. Intermediate-grade MEC treatment varies from local excision to wide excision with lymphadenectomy and/or postoperative radiotherapy. High-grade tumors require wide local excision followed by postoperative radiotherapy.[8] Patients with close or positive margins warrant adjuvant management. Postoperative radiotherapy in patients with a positive surgical margin has shown to decrease local failure.[9]


  Conclusion Top


We report a case of intermediate-grade MEC occurring in the upper lip treated with surgery and postoperative radiotherapy. It is an infrequent site of occurrence and should be considered as a differential diagnosis while dealing with swellings over the lip for optimal management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Batsakis JG. Salivary gland neoplasia: An outcome of modified morphogenesis and cytodifferentiation. Oral Surg Oral Med Oral Pathol 1980;49:229-32.  Back to cited text no. 1
    
2.
Boahene DK, Olsen KD, Lewis JE, Pinheiro AD, Pankratz VS, Bagniewski SM, et al. Mucoepidermoid carcinoma of the parotid gland: The mayo clinic experience. Arch Otolaryngol Head Neck Surg 2004;130:849-56.  Back to cited text no. 2
    
3.
Owens OT, Calcaterra TC. Salivary gland tumors of the lip. Arch Otolaryngol 1982;108:45-7.  Back to cited text no. 3
    
4.
Garcia NG, Barros FB, Rodrigues MT, Oliveira DT. Mucoepidermoid carcinoma in the upper lip: An unusual occurrence. J Cancer Res Ther 2015;11:1044.  Back to cited text no. 4
    
5.
Neville BW, Damm DD, Allen CM, Chi AC. Salivary gland pathology. In: Neville BW, Damm DD, Allen CM, Chi AC, editors. Oral and Maxillofacial Pathology. 4th ed. St. Louis, MO: Elsevier; 2016. p. 422-72.  Back to cited text no. 5
    
6.
Chan LP, Chiang FY, Lee KW, Kuo WR. Mucoepidermoid carcinoma on the vermilion border of the upper lip: A case report and literature review. Kaohsiung J Med Sci 2007;23:93-6.  Back to cited text no. 6
    
7.
Guzzo M, Andreola S, Sirizzotti G, Cantu G. Mucoepidermoid carcinoma of the salivary glands: Clinicopathologic review of 108 patients treated at the national cancer institute of Milan. Ann Surg Oncol 2002;9:688-95.  Back to cited text no. 7
    
8.
Nance MA, Seethala RR, Wang Y, Chiosea SI, Myers EN, Johnson JT, et al. Treatment and survival outcomes based on histologic grading in patients with head and neck mucoepidermoid carcinoma. Cancer 2008;113:2082-9.  Back to cited text no. 8
    
9.
Hosokawa Y, Shirato H, Kagei K, Hashimoto S, Nishioka T, Tei K, et al. Role of radiotherapy for mucoepidermoid carcinoma of salivary gland. Oral Oncol 1999;35:105-11.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
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Discussion
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