Mucoepidermoid carcinoma classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2] Maria Fernanda Villarreal, M.D. [3]

Overview

Mucoepidermoid carcinoma may be classified according to location into 2 subtypes: salivary gland-confined carcinomas and other organ mucoepidermoid carcinomas. Based on histological features, it is divided into low, intermediate and high grade tumors.

Classification

Mucoepidermoid carcinoma may be classified according to location into 2 subtypes:

Classification: Mucoepidermoid Carcinomas
Salivary gland-confined carcinomas	Major salivary glands (50%)	Parotid gland (40%) Submandibular gland (7%) Sublingual gland (3%)
	Minor salivary glands (50%)	Palate (most common) Retromolar area Floor of the mouth Buccal mucosa Lip Tongue
Other organ mucoepidermoid carcinomas	Thyroid Lung

Grading based on Histopathology:

• Mucoepidermoid carcinoma are graded into three sub types based on histopathological features:
  • Low
  • Intermediate
  • High grade
• The three most popular grading systems are:
  • The AFIP grading system
  • Modified Healey system
  • The Brandwein system
• All categories are based on similar set of parameters which include both cytomorphologic and architectural, particularly perineural and angiolymphatic invasion.

Category	Histopathologic findings
Low grade	Macrocysts, microcysts, Transition with excretory ducts, Differentiated mucin producing epidermoid cells, often in a 1:1 ratio, minimal to moderate intermediate cell population Daughter cyst proliferation from large cysts     Minimal to absent pleomorphism, rare mitoses     Broad-front, often circumscribed invasion     Pools of extravasated mucin with stromal reaction
Intermediated grade	No macrocysts, few microcysts Solid nests of cells Large duct, but not conspicuous Slight to moderate pleomorphism, few mitoses, prominent nuclei and nucleoli Invasive quality, usually well defined and uncircumscribed     Chronic inflammation at periphery Fibrosis separates nests of cells and groups of nests
High grade	No macrocysts Predominantly solid but may be nearly all glandular Cell constituents range from poorly differentiated to recognizable epidermoid and intermediate to ductal type adenocarcinoma Considerable pleomorphism, mitoses     Unquestionable soft tissue, perineural and intravascular invasion Chronic inflammation less prominent, desmoplasia of stroma may outline invasive clusters