DOI:10.2214/AJR.05.0280
AJR 2006; 187:W418-W419
© American Roentgen Ray Society
Giant Myoepithelioma of the Face: MDCT with 2D and 3D Images
Omer Onbas1,2,
R. Murat Karasen3,
Nesrin Gursan4,
Mecit Kantarci1,
Fatih Alper1 and
Adnan Okur1
1 Department of Radiology, School of Medicine, Atatürk University, Erzurum,
Turkey.
2 Atatürk Üniversitesi Lojmanlar
40. Blok No:8 25240, Erzurum,
Turkey.
3 Department of Otorhinolaryngology, School of Medicine, Atatürk
University, Erzurum, Turkey.
4 Department of Pathology, School of Medicine, Atatürk University, Erzurum,
Turkey.
Received February 18, 2005;
accepted after revision April 22, 2005.
Address correspondence to O. Onbas.
WEB This is a Web exclusive article.
Keywords: arteriography • CT • MDCT
Introduction
Myoepitheliomas of the salivary gland are very rare tumors, with an
incidence of less than 1% of all salivary gland tumors. Most of these
neoplasms arise in the parotid gland, and only a few occur in the
submandibular or minor salivary glands. The peak incidence is in the sixth and
seventh decades. Approximately 60% of patients are women. Myoepitheliomas are
mostly benign but 10% are malignant and are prone to local recurrence that may
metastasize
[1-5].
Case Report
A 65-year-old woman presented with an 11-month history of a gradually
growing mass in the left side of the face. Examination showed very prominent
facial asymmetry; the nose was deviated to the ride side and the left eye was
repressed superiorly and laterally. Visual activity was normal, but eye
movements were limited on the left side. The patient had no palpable neck
nodes. A 50-mL dose of iohexol (Omnipaque 300, Nycomed Amersham) was
automatically injected IV at a rate of 3.5 mL/s. High-resolution 16-MDCT was
performed using an Aquilion scanner (Toshiba Medical Systems). The images were
obtained to define the caudocranial extent of the neck-to-head region
(collimation, 1 mm x 16 rows; pitch, 3; gantry rotation speed, 0.75
second per round; voltage, 120 kV; current, 300 mA). Three-dimensional images
were reconstructed using maximum intensity projection and 3D-rendering
algorithms with imaging software (Vitrea 2, Vital Images, Inc.).
Contrast-enhanced axial (Fig.
1A) MDCT images revealed a large mass that completely filled the
left maxillary region, including the left maxillary sinus, left nasal cavity,
and left pterygopalatine fossa. It also extended into the right nasal cavity,
bilaterally in the hard palate, and the left orbita. Anterolateral
volume-rendered 3D CT (Fig. 1B)
and maximum-intensity-projection (Fig.
1C) images showed that the arterial supply of the mass was the
external carotid artery branches, including a facial artery.
Histopathologically, myoepithelial cells tend to be spindle-shaped,
plasmacytoid, epithelioid, clear, or combinations of these
(Fig. 1D).
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Fig. 1A —65-year-old woman with malignant myoepithelioma.
Contrast-enhanced axial MDCT scan shows huge mass totally filling left
maxillary region, including left maxillary sinus, left nasal cavity, and left
pterygopalatine fossa. Nasal septum is totally destroyed by mass.
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Our case had myoepithelioma that originated in a minor salivary gland, with
no involvement of the major salivary glands. Treatment of benign
myoepithelioma typically is done with a wide surgical resection. In malignant
myoepitheliomas, selective neck dissection may be indicated if nodal
metastases are clinically suspected. Recurrences are seen in slightly more
than 30% of patients. In our case, neither cervical lymph node metastasis nor
distant metastasis was observed; therefore, we recommended wide surgical
resection without neck dissection but with facial reconstruction. However, the
patient did not accept surgery.
In summary, a very unusual case of giant myoepithelioma arose from a minor
salivary gland. Preoperative diagnosis and surgical planning are important in
patients who require facial surgery, especially in cases with disturbed
anatomic structures caused by giant masses. MDCT imaging, especially
multiplanar reconstruction and 3D reconstruction, is a very useful tool for
preoperative evaluation and management of such pathologies.
References
- Kumagai M, Suzuki H, Matsuura K, et al. Epithelial-myoepithelial
carcinoma of the parotid gland. Auris Nasus Larynx2003; 30:201
-203[CrossRef][Medline]
- Silvers AR, Som PM, Brandwein M. Epithelial-myoepithelial carcinoma
of the parotid gland. AJNR Am J Neuroradiol1996; 17:560
-562[Abstract]
- Amin KS, McGuff HS, Cashman SW, Newman R. Recurrent
epithelial-myoepithelial carcinoma of the parotid with direct intracranial
extension. Otolaryngol Head Neck Surg2002; 126:83
-84[CrossRef][Medline]
- Hiwatashi A, Matsumoto S, Kamoi I, et al. Imaging features of
myoepithelioma arising from the hard palate: a case report. Acta
Radiol 2000; 41:417
-419[CrossRef][Medline]
- Magliulo G, Pulice G, Fusconi M, et al. Malignant myoepithelioma of
the rhinopharnyx: case report. Skull Base2005; 15:113
-116[CrossRef][Medline]
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Introduction
Case Report
