Unusual mucoepidermoid carcinoma of the liver misdiagnosed as squamous cell carcinoma by intraoperative histological examination - PubMed (original) (raw)

Case Reports

Unusual mucoepidermoid carcinoma of the liver misdiagnosed as squamous cell carcinoma by intraoperative histological examination

Xiao-qin Guo et al. Diagn Pathol. 2014.

Abstract

As rare condition, mucoepidermoid carcinoma may occur in liver although its etiology and pathogenesis is still unclear. We report here a case of intrahepatic mucoepidermoid carcinoma misdiagnosed as cholangiocarcinoma and squamous cell carcinoma by preoperative radiologic and intraoperative histological examinations, respectively. A 60-year-old woman presented with a 1-month history of progressive jaundice, epigastric discomfort, and weight loss with slightly increased carbohydrate antigen 19-9 (CA19-9). Computed tomography (CT) showed a large tumor, 8.0 cm in diameter, in the left lobe of the liver. A preliminary diagnosis of a cholangiocarcinoma of the liver was made. In the intraoperative histological examination, a diagnosis of squamous cell carcinoma was made based on predominantly invasive epidermoid cells with abundant keratinization and absence of mucin-producing cell component. However, postoperative histological diagnosis of the lesion was mucoepidermiod carcinoma of liver by thoroughly microscopical inspection and the presence of mucin-producing cells confirmed by Alcian blue staining. Despite surgical excision and chemotherapy, the tumor showed very aggressive malignancy with tumor recurrence. The patient died shortly afterward, surviving 6 months after surgery. Due to its rarity and distinct morphological features, mucoepidermoid carcinoma might be erroneously interpreted as squamous cell carcinoma by those who were not familiar with this condition in unusual locations. Therefore, removal of sufficient tissue from different portions of the lesion is essential for the surgeons and pathologists to make a precise diagnosis in the intraoperative histological examination.

Virtual slide: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4956311271136060.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Preoperative and gross findings of tumor. (A) Computed tomography (CT) showed a large tumor lesion, 8.0 cm in diameter, in the left lobe of the liver. (B) Gross examination of resected liver mass showed an irregular, yellowish white solid tumor without a fibrous capsule. The border between the tumor and normal liver tissue was indistinct.

Figure 2

Figure 2

Micrographs of liver mass in intraoperative histological examination. (A) Intraoperative tumor tissue showed the tumor mass was predominantly composed of solid and invasive nests of epidermoid cells with abundant keratinization in desmoplastic stroma. (B) Alcian blue staining showed that there was no mucin-producing cells intermingled within the epidermoid cells nest. (A, HE staining with original magnification × 400; B, Alcian blue staining with original magnification × 400).

Figure 3

Figure 3

Postoperative micrographs of liver mass. (A) Postoperative histological examination of tumor exhibited that nests of malignant epidermoid cells were intimately mixed with mucus-producing cells. (B) The Alcian blue-positive material was seen in lumen of gland structure and the mucin-producing cells within the nest of epidermoid cells. (C) Tumor cells were diffusely positive for CK7. (D) The epidermoid cells were observed to be positive for p63, but the mucin-producing cells (black arrows) were p63-negative. (E) The lymph nodes metastasis of tumor was observed. (F) The metastatic tumor cells were also positive for p63 partially. (A and E, HE staining with original magnification × 400; B, Alcian blue staining with original magnification × 400; C, D and F, immunohistochemical staining with original magnification × 400).

References

    1. Singh A, Pandey KC, Pant NK. Cavitary mucoepidermoid carcinoma of lung with metastases in skeletal muscles as presenting features: a case report and review of the literature. J Cancer Res Ther. 2010;6:350–352. doi: 10.4103/0973-1482.73363. - DOI - PubMed
    1. Turkyilmaz A, Eroglu A, Gursan N. Mucoepidermoid carcinoma of the oesophagus: a case report. Acta Chir Belg. 2009;109:416–418. - PubMed
    1. Palermo MH, Pinto MB, Zanetti JS, Ribeiro-Silva A. Primary mucoepidermoid carcinoma of the breast: a case report with immunohistochemical analysis and comparison with salivary gland mucoepidermoid carcinomas. Pol J Pathol. 2013;64:210–215. - PubMed
    1. Nonaka D, Klimstra D, Rosai J. Thymic mucoepidermoid carcinomas: a clinicopathologic study of 10 cases and review of the literature. Am J Surg Pathol. 2004;28:1526–1531. doi: 10.1097/01.pas.0000137999.23780.2a. - DOI - PubMed
    1. Pianzola LE, Drut R. Mucoepidermoid carcinoma of the liver. Am J Clin Pathol. 1971;56:758–761. - PubMed

Publication types

MeSH terms

LinkOut - more resources