Mucoepidermoid carcinoma pathophysiology: Difference between revisions
Badria Munir (talk | contribs) |
|||
(21 intermediate revisions by 4 users not shown) | |||
Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Mucoepidermoid carcinoma}} | {{Mucoepidermoid carcinoma}} | ||
{{CMG}}{{AE}}{{MV}} | {{CMG}}{{AE}} {{Badria}} , {{MV}} | ||
==Overview== | ==Overview== | ||
Mucoepidermoid carcinomas arise from mucous cells, which | Mucoepidermoid carcinomas arise from [[Mucous|mucous cells]], which are normally involved in the secretion of [[mucous]] and the protection of the surrounding [[tissue]]. The pathogenesis of mucoepidermoid carcinoma consists of abnormal production of [[mucin]] from [[mucous]] cells, associated with the aberrant overgrowth of [[squamous]] and [[epidermoid cells]]. [[Genes]] involved in the [[pathogenesis]] of mucoepidermoid carcinoma include the MECT1 and [[MAML2]] [[fusion gene]]<nowiki/>s. On gross [[Pathology|pathology,]] mucoepidermoid carcinomas have a [[cystic]], solid or mixed appearance, are normally located on the [[parotid]] or [[submandibular gland]], and range in size from 1 to 8 cm. | ||
The pathogenesis of mucoepidermoid carcinoma consists of abnormal production of mucin from mucous cells, associated with the aberrant overgrowth of squamous and [[epidermoid cells]]. [[Genes]] involved in the [[pathogenesis]] of mucoepidermoid carcinoma include MECT1 and MAML2 fusion | |||
==Pathogenesis== | ==Pathogenesis== | ||
*Mucoepidermoid | * Mucoepidermoid carcinoma originates from [[pluripotent]] cells of the [[excretory]] [[ducts]] of [[glandular]] structures.<ref name="pmid25085946">{{cite journal |vauthors=Devaraju R, Gantala R, Aitha H, Gotoor SG |title=Mucoepidermoid carcinoma |journal=BMJ Case Rep |volume=2014 |issue= |pages=bcr–2013–202776 |date=August 2014 |pmid=25085946 |pmc=4127757 |doi=10.1136/bcr-2013-202776 |url=}}</ref> | ||
*The pathogenesis of mucoepidermoid carcinoma consists of abnormal production of mucin from mucous cells, associated with the aberrant overgrowth of squamous and [[epidermoid cells]]. | * The tumor primarily comprises of [[mucous]], intermediate and epidermoid cells.<ref name="pmid19385480">{{cite journal |vauthors=Ali SA, Memon AS, Shaik NA, Soomro AG |title=Mucoepidermoid carcinoma of parotid presenting as unilocular cyst |journal=J Ayub Med Coll Abbottabad |volume=20 |issue=2 |pages=141–2 |date=2008 |pmid=19385480 |doi= |url=}}</ref><ref name="pmid15006629">{{cite journal |vauthors=Pires FR, Chen SY, da Cruz Perez DE, de Almeida OP, Kowalski LP |title=Cytokeratin expression in central mucoepidermoid carcinoma and glandular odontogenic cyst |journal=Oral Oncol. |volume=40 |issue=5 |pages=545–51 |date=May 2004 |pmid=15006629 |doi=10.1016/j.oraloncology.2003.11.007 |url=}}</ref> | ||
* Mucous cells, which are normally involved in the secretion of [[mucous]] and protection of the surrounding [[tissue]]. | |||
* The [[pathogenesis]] of mucoepidermoid carcinoma consists of abnormal production of [[mucin]] from [[Mucous lining|mucous cells]], associated with the aberrant overgrowth of squamous and [[epidermoid cells]]. | |||
==Genetics== | ==Genetics== | ||
*Development of mucoepidermoid | *Development of mucoepidermoid carcinoma may be the result of multiple genetic [[mutations]]. | ||
* Mucoepidermoid carcinoma is specifically associated with t(11;19)(q21;p13) translocation.<ref name="pmid29353885">{{cite journal |vauthors=Chen Z, Lin S, Li JL, Ni W, Guo R, Lu J, Kaye FJ, Wu L |title=CRTC1-MAML2 fusion-induced lncRNA LINC00473 expression maintains the growth and survival of human mucoepidermoid carcinoma cells |journal=Oncogene |volume=37 |issue=14 |pages=1885–1895 |date=April 2018 |pmid=29353885 |pmc=5889358 |doi=10.1038/s41388-017-0104-0 |url=}}</ref><ref name="pmid29492469">{{cite journal |vauthors=Yan K, Yesensky J, Hasina R, Agrawal N |title=Genomics of mucoepidermoid and adenoid cystic carcinomas |journal=Laryngoscope Investig Otolaryngol |volume=3 |issue=1 |pages=56–61 |date=February 2018 |pmid=29492469 |pmc=5824110 |doi=10.1002/lio2.139 |url=}}</ref> | |||
* [[CRTC1]]-[[MAML2]] [[Fusion gene|fusion]] is a primary driver for mucoepidermoid carcinoma initiation and maintenance.<ref name="pmid20588178">{{cite journal |vauthors=Seethala RR, Dacic S, Cieply K, Kelly LM, Nikiforova MN |title=A reappraisal of the MECT1/MAML2 translocation in salivary mucoepidermoid carcinomas |journal=Am. J. Surg. Pathol. |volume=34 |issue=8 |pages=1106–21 |date=August 2010 |pmid=20588178 |doi=10.1097/PAS.0b013e3181de3021 |url=}}</ref><ref name="pmid16818685">{{cite journal |vauthors=Okabe M, Miyabe S, Nagatsuka H, Terada A, Hanai N, Yokoi M, Shimozato K, Eimoto T, Nakamura S, Nagai N, Hasegawa Y, Inagaki H |title=MECT1-MAML2 fusion transcript defines a favorable subset of mucoepidermoid carcinoma |journal=Clin. Cancer Res. |volume=12 |issue=13 |pages=3902–7 |date=July 2006 |pmid=16818685 |doi=10.1158/1078-0432.CCR-05-2376 |url=}}</ref> | |||
* This translocation creates a MECT1-[[MAML2]] [[fusion protein]] that disrupts the [[Notch signaling pathway]]. | |||
* This [[fusion protein]] is expressed by all cell types of mucoepidermoid when the translocation is present.<ref name="pmid17539914">{{cite journal |vauthors=Cheuk W, Chan JK |title=Advances in salivary gland pathology |journal=Histopathology |volume=51 |issue=1 |pages=1–20 |date=July 2007 |pmid=17539914 |doi=10.1111/j.1365-2559.2007.02719.x |url=}}</ref> | |||
*Genes involved in the pathogenesis of include: | *Genes involved in the pathogenesis of include: | ||
:*MECT1 fusion gene | :*[[Fusion gene|MECT1]] [[fusion gene]] | ||
:*MAML2 fusion gene | :*[[Fusion gene|MAML2]] [[fusion gene]] | ||
* The [[CRTC1]]-[[MAML2]] fusion protein induces the upregulation of the [[epidermal growth factor receptor]] [[EGFR|(EGFR)]] ligand [[Amphiregulin]] ([[AREG]]) by co-activating the [[transcription factor]] [[CREB]]. | |||
* [[AREG]] subsequently activates [[EGFR]] signaling in an [[autocrine]] manner that promotes mucoepidermoid carcinoma [[cell growth]] and survival.<ref name="pmid17075295">{{cite journal |vauthors=Luna MA |title=Salivary mucoepidermoid carcinoma: revisited |journal=Adv Anat Pathol |volume=13 |issue=6 |pages=293–307 |date=November 2006 |pmid=17075295 |doi=10.1097/01.pap.0000213058.74509.d3 |url=}}</ref> | |||
* Aberrantly activated [[AREG]]-[[EGFR]] signaling is essential for [[CRTC1]]-[[MAML2]]<nowiki/>positive mucoepidermoid carcinoma cell growth and survival.<ref name="pmid29419396">{{cite journal |vauthors=Alamri AM, Liu X, Blancato JK, Haddad BR, Wang W, Zhong X, Choudhary S, Krawczyk E, Kallakury BV, Davidson BJ, Furth PA |title=Expanding primary cells from mucoepidermoid and other salivary gland neoplasms for genetic and chemosensitivity testing |journal=Dis Model Mech |volume=11 |issue=1 |pages= |date=January 2018 |pmid=29419396 |pmc=5818080 |doi=10.1242/dmm.031716 |url=}}</ref> | |||
==Associated Conditions== | ==Associated Conditions== | ||
* | [[Human cytomegalovirus]] ([[hCMV]]) [[infection]] is commonly seen associated with development of mucoepidermoid carcinoma. | ||
* As HCMV is commonly resides in [[salivary gland]] ductal epithelium, It is hypothesized that HCMV could be integral part of pathogenesis of mucopidermoid carcinoma. | |||
* Following results were noted when they tested implication of HCMV in development | |||
** Protein markers for active HCMV | |||
** HCMV-specific proteins are present in specific cell types and expression is positive | |||
** HCMV correlates with [[upregulation]] and activation [[oncogenic]] [[Signaling pathway|signaling pathways]] ([[COX]]/[[AREG]]/[[EGFR]]/[[ERK]]). <ref name="MelnickSedghizadeh2012">{{cite journal|last1=Melnick|first1=Michael|last2=Sedghizadeh|first2=Parish P.|last3=Allen|first3=Carl M.|last4=Jaskoll|first4=Tina|title=Human cytomegalovirus and mucoepidermoid carcinoma of salivary glands: Cell-specific localization of active viral and oncogenic signaling proteins is confirmatory of a causal relationship|journal=Experimental and Molecular Pathology|volume=92|issue=1|year=2012|pages=118–125|issn=00144800|doi=10.1016/j.yexmp.2011.10.011}}</ref> | |||
==Gross Pathology== | ==Gross Pathology== | ||
*On gross pathology, mucoepidermoid carcinoma has a cystic, solid or mixed appearance. | *On gross pathology, mucoepidermoid carcinoma has a [[cystic]], solid, or mixed appearance. | ||
*Other gross pathology | * Mucoepidermoid carcinoma usually occurs in the [[parotid]] or [[submandibular gland]]. | ||
:* | * Low grade mucoepidermoid carcinoma are small and partially encapsulated. | ||
:* | * It appears as fluctuant light blue or purplish [[submucosal]] lumps. <ref name="pmid10969433">{{cite journal |vauthors=Flaitz CM |title=Mucoepidermoid carcinoma of the palate in a child |journal=Pediatr Dent |volume=22 |issue=4 |pages=292–3 |date=2000 |pmid=10969433 |doi= |url=}}</ref> | ||
*Other findings on gross pathology include: | |||
:*Tumor size ranging from 1 to 8 cm | |||
:*Gray or white in color, with [[mucin]] filled [[cysts]] | |||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
The characteristic findings of mucoepidermoid carcinoma on microscopic [[histopathological]] analysis are listed below.<ref name="pmid24165756">{{cite journal |vauthors=Vulpe H, Giuliani M, Goldstein D, Perez-Ordonez B, Dawson LA, Hope A |title=Long term control of a maxillary sinus mucoepidermoid carcinoma with low dose radiation therapy: a case report |journal=Radiat Oncol |volume=8 |issue= |pages=251 |date=October 2013 |pmid=24165756 |pmc=3829377 |doi=10.1186/1748-717X-8-251 |url=}}</ref><ref name="pmid17075295">{{cite journal |vauthors=Luna MA |title=Salivary mucoepidermoid carcinoma: revisited |journal=Adv Anat Pathol |volume=13 |issue=6 |pages=293–307 |date=November 2006 |pmid=17075295 |doi=10.1097/01.pap.0000213058.74509.d3 |url=}}</ref><ref name="pmid26813873">{{cite journal |vauthors=Maloth AK, Nandan SR, Kulkarni PG, Dorankula SP, Muddana K |title=Mucoepidermoid Carcinoma of Floor of the Mouth - A Rarity |journal=J Clin Diagn Res |volume=9 |issue=12 |pages=ZD03–4 |date=December 2015 |pmid=26813873 |doi=10.7860/JCDR/2015/15595.6912 |url=}}</ref><ref name="pmid25085946">{{cite journal |vauthors=Devaraju R, Gantala R, Aitha H, Gotoor SG |title=Mucoepidermoid carcinoma |journal=BMJ Case Rep |volume=2014 |issue= |pages=bcr–2013–202776 |date=August 2014 |pmid=25085946 |doi=10.1136/bcr-2013-202776 |url=}}</ref><ref name="pmid22759529">{{cite journal |vauthors=Ritwik P, Cordell KG, Brannon RB |title=Minor salivary gland mucoepidermoid carcinoma in children and adolescents: a case series and review of the literature |journal=J Med Case Rep |volume=6 |issue= |pages=182 |date=July 2012 |pmid=22759529 |doi=10.1186/1752-1947-6-182 |url=}}</ref><ref name="pmid25948939">{{cite journal |vauthors=Joseph TP, Joseph CP, Jayalakshmy PS, Poothiode U |title=Diagnostic challenges in cytology of mucoepidermoid carcinoma: Report of 6 cases with histopathological correlation |journal=J Cytol |volume=32 |issue=1 |pages=21–4 |date=2015 |pmid=25948939 |pmc=4408672 |doi=10.4103/0970-9371.155226 |url=}}</ref> | |||
:*Mucus secreting cells | :*[[Mucus]] secreting [[cells]] | ||
:*Composed of three cell types: | :*Composed of three cell types: | ||
:*Mucin vacuoles may be rare; in a | :**Epidermoid | ||
:*Mucoepidermoid | :**Intermediate | ||
:*Low grade is characterized by well-differentiated cells with little cellular atypia, high proportion of mucous cells, and prominent cyst formation | :**Columnar | ||
:**Clear cells | |||
:* They all demonstrates prominent [[Cyst|cystic]] growth. <ref name="pmid17075295">{{cite journal |vauthors=Luna MA |title=Salivary mucoepidermoid carcinoma: revisited |journal=Adv Anat Pathol |volume=13 |issue=6 |pages=293–307 |date=November 2006 |pmid=17075295 |doi=10.1097/01.pap.0000213058.74509.d3 |url=}}</ref> | |||
:*[[Mucin]] vacuoles may be rare; however they are integral part of histological features of mucoepidermoid carcinoma. | |||
* Hallmark of these tumors are: | |||
** Prominent [[cystic]] structures lined by mature [[mucous]], intermediate, or epidermoid cells | |||
** Solid areas are not evident | |||
** Prominent fibrous [[stroma]] | |||
** It grows in a well-circumscribed manner | |||
:*Mucoepidermoid tumors are graded histologically into: | |||
** Low grade | |||
** Intermediate grade | |||
** High grade. | |||
:*Low grade is characterized by well-differentiated cells with little cellular [[atypia]], high proportion of mucous cells, and prominent cyst formation. | |||
:*Intermediate grade is characterized by intermediate features | :*Intermediate grade is characterized by intermediate features | ||
:*High grade is characterized by poorly differentiated with cellular pleomorphism, high proportion of squamous cells, and solid with few if any cysts | :*High grade is characterized by poorly differentiated with cellular [[Pleomorphism|pleomorphism,]] high proportion of squamous cells, and solid with few if any cysts | ||
==Gallery== | ==Gallery== | ||
Line 54: | Line 87: | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Otolaryngology]] |
Latest revision as of 15:01, 17 January 2019
Mucoepidermoid carcinoma Microchapters |
Differentiating Mucoepidermoid Carcinoma from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Mucoepidermoid carcinoma pathophysiology On the Web |
American Roentgen Ray Society Images of Mucoepidermoid carcinoma pathophysiology |
Risk calculators and risk factors for Mucoepidermoid carcinoma pathophysiology |
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 carcinomas arise from mucous cells, which are normally involved in the secretion of mucous and the protection of the surrounding tissue. The pathogenesis of mucoepidermoid carcinoma consists of abnormal production of mucin from mucous cells, associated with the aberrant overgrowth of squamous and epidermoid cells. Genes involved in the pathogenesis of mucoepidermoid carcinoma include the MECT1 and MAML2 fusion genes. On gross pathology, mucoepidermoid carcinomas have a cystic, solid or mixed appearance, are normally located on the parotid or submandibular gland, and range in size from 1 to 8 cm.
Pathogenesis
- Mucoepidermoid carcinoma originates from pluripotent cells of the excretory ducts of glandular structures.[1]
- The tumor primarily comprises of mucous, intermediate and epidermoid cells.[2][3]
- Mucous cells, which are normally involved in the secretion of mucous and protection of the surrounding tissue.
- The pathogenesis of mucoepidermoid carcinoma consists of abnormal production of mucin from mucous cells, associated with the aberrant overgrowth of squamous and epidermoid cells.
Genetics
- Development of mucoepidermoid carcinoma may be the result of multiple genetic mutations.
- Mucoepidermoid carcinoma is specifically associated with t(11;19)(q21;p13) translocation.[4][5]
- CRTC1-MAML2 fusion is a primary driver for mucoepidermoid carcinoma initiation and maintenance.[6][7]
- This translocation creates a MECT1-MAML2 fusion protein that disrupts the Notch signaling pathway.
- This fusion protein is expressed by all cell types of mucoepidermoid when the translocation is present.[8]
- Genes involved in the pathogenesis of include:
- The CRTC1-MAML2 fusion protein induces the upregulation of the epidermal growth factor receptor (EGFR) ligand Amphiregulin (AREG) by co-activating the transcription factor CREB.
- AREG subsequently activates EGFR signaling in an autocrine manner that promotes mucoepidermoid carcinoma cell growth and survival.[9]
- Aberrantly activated AREG-EGFR signaling is essential for CRTC1-MAML2positive mucoepidermoid carcinoma cell growth and survival.[10]
Associated Conditions
Human cytomegalovirus (hCMV) infection is commonly seen associated with development of mucoepidermoid carcinoma.
- As HCMV is commonly resides in salivary gland ductal epithelium, It is hypothesized that HCMV could be integral part of pathogenesis of mucopidermoid carcinoma.
- Following results were noted when they tested implication of HCMV in development
- Protein markers for active HCMV
- HCMV-specific proteins are present in specific cell types and expression is positive
- HCMV correlates with upregulation and activation oncogenic signaling pathways (COX/AREG/EGFR/ERK). [11]
Gross Pathology
- On gross pathology, mucoepidermoid carcinoma has a cystic, solid, or mixed appearance.
- Mucoepidermoid carcinoma usually occurs in the parotid or submandibular gland.
- Low grade mucoepidermoid carcinoma are small and partially encapsulated.
- It appears as fluctuant light blue or purplish submucosal lumps. [12]
- Other findings on gross pathology include:
Microscopic Pathology
The characteristic findings of mucoepidermoid carcinoma on microscopic histopathological analysis are listed below.[13][9][14][1][15][16]
- Mucin vacuoles may be rare; however they are integral part of histological features of mucoepidermoid carcinoma.
- Hallmark of these tumors are:
- Mucoepidermoid tumors are graded histologically into:
- Low grade
- Intermediate grade
- High grade.
- Low grade is characterized by well-differentiated cells with little cellular atypia, high proportion of mucous cells, and prominent cyst formation.
- Intermediate grade is characterized by intermediate features
- High grade is characterized by poorly differentiated with cellular pleomorphism, high proportion of squamous cells, and solid with few if any cysts
Gallery
-
Histopathologic image of mucoepidermoid carcinoma of the major salivary gland. H & E stain.[17]
-
Histopathologic image of mucoepidermoid carcinoma of the major salivary gland.[17]
-
Histopathologic image of mucoepidermoid carcinoma. Postoperative recurrence of the submandibular tumor. Alcian blue-PAS stain.[17]
-
Gross pathology mucoepidermoid carcinoma.[17]
References
- ↑ 1.0 1.1 Devaraju R, Gantala R, Aitha H, Gotoor SG (August 2014). "Mucoepidermoid carcinoma". BMJ Case Rep. 2014: bcr–2013–202776. doi:10.1136/bcr-2013-202776. PMC 4127757. PMID 25085946.
- ↑ Ali SA, Memon AS, Shaik NA, Soomro AG (2008). "Mucoepidermoid carcinoma of parotid presenting as unilocular cyst". J Ayub Med Coll Abbottabad. 20 (2): 141–2. PMID 19385480.
- ↑ Pires FR, Chen SY, da Cruz Perez DE, de Almeida OP, Kowalski LP (May 2004). "Cytokeratin expression in central mucoepidermoid carcinoma and glandular odontogenic cyst". Oral Oncol. 40 (5): 545–51. doi:10.1016/j.oraloncology.2003.11.007. PMID 15006629.
- ↑ Chen Z, Lin S, Li JL, Ni W, Guo R, Lu J, Kaye FJ, Wu L (April 2018). "CRTC1-MAML2 fusion-induced lncRNA LINC00473 expression maintains the growth and survival of human mucoepidermoid carcinoma cells". Oncogene. 37 (14): 1885–1895. doi:10.1038/s41388-017-0104-0. PMC 5889358. PMID 29353885.
- ↑ Yan K, Yesensky J, Hasina R, Agrawal N (February 2018). "Genomics of mucoepidermoid and adenoid cystic carcinomas". Laryngoscope Investig Otolaryngol. 3 (1): 56–61. doi:10.1002/lio2.139. PMC 5824110. PMID 29492469.
- ↑ Seethala RR, Dacic S, Cieply K, Kelly LM, Nikiforova MN (August 2010). "A reappraisal of the MECT1/MAML2 translocation in salivary mucoepidermoid carcinomas". Am. J. Surg. Pathol. 34 (8): 1106–21. doi:10.1097/PAS.0b013e3181de3021. PMID 20588178.
- ↑ Okabe M, Miyabe S, Nagatsuka H, Terada A, Hanai N, Yokoi M, Shimozato K, Eimoto T, Nakamura S, Nagai N, Hasegawa Y, Inagaki H (July 2006). "MECT1-MAML2 fusion transcript defines a favorable subset of mucoepidermoid carcinoma". Clin. Cancer Res. 12 (13): 3902–7. doi:10.1158/1078-0432.CCR-05-2376. PMID 16818685.
- ↑ Cheuk W, Chan JK (July 2007). "Advances in salivary gland pathology". Histopathology. 51 (1): 1–20. doi:10.1111/j.1365-2559.2007.02719.x. PMID 17539914.
- ↑ 9.0 9.1 9.2 Luna MA (November 2006). "Salivary mucoepidermoid carcinoma: revisited". Adv Anat Pathol. 13 (6): 293–307. doi:10.1097/01.pap.0000213058.74509.d3. PMID 17075295.
- ↑ Alamri AM, Liu X, Blancato JK, Haddad BR, Wang W, Zhong X, Choudhary S, Krawczyk E, Kallakury BV, Davidson BJ, Furth PA (January 2018). "Expanding primary cells from mucoepidermoid and other salivary gland neoplasms for genetic and chemosensitivity testing". Dis Model Mech. 11 (1). doi:10.1242/dmm.031716. PMC 5818080. PMID 29419396.
- ↑ Melnick, Michael; Sedghizadeh, Parish P.; Allen, Carl M.; Jaskoll, Tina (2012). "Human cytomegalovirus and mucoepidermoid carcinoma of salivary glands: Cell-specific localization of active viral and oncogenic signaling proteins is confirmatory of a causal relationship". Experimental and Molecular Pathology. 92 (1): 118–125. doi:10.1016/j.yexmp.2011.10.011. ISSN 0014-4800.
- ↑ Flaitz CM (2000). "Mucoepidermoid carcinoma of the palate in a child". Pediatr Dent. 22 (4): 292–3. PMID 10969433.
- ↑ Vulpe H, Giuliani M, Goldstein D, Perez-Ordonez B, Dawson LA, Hope A (October 2013). "Long term control of a maxillary sinus mucoepidermoid carcinoma with low dose radiation therapy: a case report". Radiat Oncol. 8: 251. doi:10.1186/1748-717X-8-251. PMC 3829377. PMID 24165756.
- ↑ Maloth AK, Nandan SR, Kulkarni PG, Dorankula SP, Muddana K (December 2015). "Mucoepidermoid Carcinoma of Floor of the Mouth - A Rarity". J Clin Diagn Res. 9 (12): ZD03–4. doi:10.7860/JCDR/2015/15595.6912. PMID 26813873.
- ↑ Ritwik P, Cordell KG, Brannon RB (July 2012). "Minor salivary gland mucoepidermoid carcinoma in children and adolescents: a case series and review of the literature". J Med Case Rep. 6: 182. doi:10.1186/1752-1947-6-182. PMID 22759529.
- ↑ Joseph TP, Joseph CP, Jayalakshmy PS, Poothiode U (2015). "Diagnostic challenges in cytology of mucoepidermoid carcinoma: Report of 6 cases with histopathological correlation". J Cytol. 32 (1): 21–4. doi:10.4103/0970-9371.155226. PMC 4408672. PMID 25948939.
- ↑ 17.0 17.1 17.2 17.3 Mucoepidermoid carcincoma Libre Pathology. http://librepathology.org/wiki/index.php/Mucoepidermoid carcincoma Accessed on February 17, 2015