SESSION TYPE: Cancer Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Mucoepidermoid carcinoma (MEC) of the tongue base with metastasis to the parietal and visceral pleura of the lung is rare. This is a tumor of the minor salivary glands with a malignant potential that is poorly understood. These tumors contain three cellular elements: epidermoid cells, mucus secreting cells, and intermediate cells. Distant metastasis of MEC is associated with high-grade tumor and is rarely reported. Furthermore, involvement of the lung pleura can lead to respiratory compromise and respiratory failure.
CASE PRESENTATION: A 71 year old African American male had MEC of the base of the tongue, diagnosed fourteen months ago. He was treated with surgical resection, chemotherapy, and radiation therapy with three month interval follow up visits. He then presented to the ED with dyspnea, non-productive cough, and dull lower right chest pain for one week. His symptoms persisted despite the use of analgesics and bed rest. He reported a decrease in appetite with an unintentional four pound weight loss, as well as night sweats over the course of two weeks. Physical examination demonstrated hypoxemia and diminished breath sounds in the right lower lobe. A chest X-ray and CT scan revealed a moderately large right-sided pleural effusion. A thoracentesis revealed hemorrhagic pleural fluid. The cytology report showed the presence of malignant cells consistent with the MEC originally found at the base of the tongue. He then required video-assisted thoracoscopy followed by talc pleurodesis due to the rapid recurrence of the pleural effusion. Cytology of the pleura confirmed infiltrating carcinoma with squamous differentiation consistent with metastatic high-grade MEC. Following the procedure, a chest tube was placed for drainage of the pleural space. The patient remained hypoxemic and his respiratory status quickly declined. After discussing the implications of the patient’s clinical status and poor prognosis, the patient opted for home hospice care. He subsequently passed away two days later.
DISCUSSION: MEC is a rare carcinoma that can metastasize to the pleura of the lung despite aggressive surgical resection, chemotherapy, and radiation therapy. Current guidelines by the National Comprehensive Cancer Network recommend vigilant observation and follow-up imaging after surgical resection.
CONCLUSIONS: Close follow up of the pulmonary status in patients with MEC will prevent severe complications and shed light into the management of MEC.
1) Leong S C L. Singapore Medical Journal 2007; 48(10): e272
2) Goldblatt LI, Ellis GL. Salivary gland tumors of the tongue. Cancer; 1987 Jul 1;60 (1):74-81
DISCLOSURE: The following authors have nothing to disclose: Manuel Jimenez, Ranjodh Singh
No Product/Research Disclosure InformationThe Jewish Hospital, Cincinnati, OH