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Myoepithelioma is a rare benign neoplasm, most commonly derived from salivary glands, but there are limited cases of extra salivary gland involvement too. There is little knowledge on typical investigative findings and, instead, diagnosis relies on immunohistochemistry analysis. To our knowledge, this paper reports the 13th case of sinonasal myoepithelioma in the English literature.
Case report
This paper presents a 25-year-old man who complained of chronic nasal obstruction. A sinonasal mass was noted on examination that appeared benign on imaging. Biopsy revealed a grade 2 chondrosarcoma that was endoscopically resected; however, excisional margins were positive. On histopathological review at the multidisciplinary team meeting, the lesion was more in keeping with chondromyxoid fibroma, but immunohistochemistry analysis confirmed a myoepithelioma lesion. In light of this revised diagnosis, quorate opinion was for follow up with active monitoring.
Conclusion
Sinonasal tumours require a thorough history, examination and investigation before a treatment plan can be formulated. If there is diagnostic uncertainty, it is important to keep a wide differential list and seek a second specialist opinion where possible.
Salivary gland myoepitheliomas are rare tumours, accounting for less than 1 per cent of neoplasms of the salivary glands. Myoepithelioma of the palate is very rare, and only a few cases have been reported in the world literature. Histological and immunohistochemical analysis supports the myoepithelial origin of this tumour. Here, we report three cases of myoepithelioma of the palate in adult males and review previously reported cases.
The present paper describes the first reported case, to our knowledge, of a myoepithelioma arising in an accessory parotid gland. Because pre-operative fine-needle aspiration cytological findings and operative findings suggested that this tumour was malignant, the decision was made to remove the tumour surgically along with the buccal branches of the facial nerve. The resected nerve was reconstructed by nerve transplantation, using the great auricular nerve. Subsequently the tumour was found to be benign. One year after surgery, the patient had excellent facial nerve function and so far there has been no evidence of recurrence.
A case is reviewed of a giant benign myoepithelioma of the soft palate presenting in an elderly female patient. Due to the large size of the lesion and its mass effect the patient developed dysphagia with subsequent significant weight loss. The clinico-pathological features of this rare tumour are described and the literature reviewed.
A 62-year-old male with a myoepithelioma of the right parotid gland was treated with surgical excision followed by adjuvant radiation therapy. Prior to the completion of radiation therapy, the patient developed progressive disease at local, regional, and distant metastatic sites. Combined modality treatment with radiation and chemotherapy resulted in a significant but transient shrinkage of the tumours at all sites. The patient succumbed to metastatic disease 212 days following the diagnostic biopsy. This case illustrates several of the distinctive clinical and pathological characteristics of this rare tumour.
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