Unusual pulmonary nodules diffusion from epithelial‑myoepithelial carcinoma on <sup>18</sup>F‑FDG PET/CT: A case report

Wang,Yicong; Guo,Ningjie; Zhao,Yanan; Xin,Wenbin; Sun,Hongshuang

doi:10.3892/ol.2024.14765

Unusual pulmonary nodules diffusion from epithelial‑myoepithelial carcinoma on ¹⁸F‑FDG PET/CT: A case report

Authors:
- Yicong Wang
- Ningjie Guo
- Yanan Zhao
- Wenbin Xin
- Hongshuang Sun
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Affiliations: Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China, Department of Pathology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China, Department of Medical Imaging, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China, Department of Ultrasound Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
Published online on: October 22, 2024 https://doi.org/10.3892/ol.2024.14765
Article Number: 19
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Epithelial‑myoepithelial carcinoma (EMC) is a rare low‑grade malignant tumor with uncommon regional lymph node metastasis and distant metastasis. The diagnosis of this disease primarily relies on the examination of pathological morphology and immunohistochemical staining, as its clinical symptoms and imaging findings are non‑specific. This makes it more difficult to provide specific information about EMC lung metastasis. The present report describes a biopsy‑confirmed case of pulmonary metastases arising from EMC of the parotid. The pulmonary nodules were dispersed throughout both lungs and exhibited varying degrees of fluorodeoxyglucose (FDG) uptake on positron emission tomography‑computed tomography scans. Additionally, the pathological and immunohistological presentation of the lung mass was similar to that of the primary lesion. Several pulmonary nodules exhibiting varying degrees of FDG uptake may be considered a distinctive sign of metastasis on EMC imaging. Reviewing the present case, along with other similar rare cases in the literature, is crucial to accurately evaluate the imaging examinations of such patients to identify and establish an appropriate treatment plan for potential metastatic lung cancer. It also highlights the importance of not underestimating the malignant potential of EMC and the necessity for close follow‑up.

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1	Donath K, Seifert G and Schmitz R: Diagnosis and ultrastructure of the tubular carcinoma of salivary gland ducts. Epithelial-myoepithelial carcinoma of the intercalated ducts. Virchows Arch A Pathol Pathol Anat. 356:16–31. 1972.(In German). View Article : Google Scholar
2	Seifert G and Sobin LH: The World Health Organization's histological classification of salivary gland tumors. A commentary on the second edition. Cancer. 70:379–385. 1992. View Article : Google Scholar
3	Nakaguro M and Nagao T: Epithelial-myoepithelial carcinoma. Surg Pathol Clin. 14:97–109. 2021. View Article : Google Scholar
4	Sharma D, Neiweem A, Davis K, Prendes M, Chundury R and Illing E: Epithelial-myoepithelial carcinoma of the lacrimal sac and literature review of the lacrimal system. Allergy Rhinol (Providence). 11:21526567209206002020. View Article : Google Scholar
5	Wockner RS, Seethala RR, Emeto TI, McCaul JA and Subramaniam SS: Epithelial-myoepithelial carcinoma of the maxillofacial and sinonasal region: A systematic review of presenting characteristics, treatment modalities, and associated outcomes. Int J Oral Maxillofac Surg. 52:1–12. 2023. View Article : Google Scholar
6	Zhang W, Wang XX, Wang XL, Zhang Y, Li XF, Li Y, Cai YY, Ren HQ, Zhang YX and Hao FR: Epithelial-myoepithelial carcinoma of the nasopharynx: A case report and review of the literature. Front Oncol. 12:9235792022. View Article : Google Scholar
7	Lavin V, Callipo F, Donofrio CA, Ellwood-Thompson R, Metcalf R, Djoukhadar I, Higham CE, Kearney T, Colaco R, Gnanalingham K and Roncaroli F: Primary epithelial-myoepithelial carcinoma of the pituitary gland. Neuropathology. 40:261–267. 2020. View Article : Google Scholar
8	Sanz Sánchez CI, Pérez Villa L and Cazorla Ramos OE: Epithelial-myoepithelial carcinoma of the base of tongue. Acta Otorrinolaringol Esp (Engl Ed). 72:198–200. 2021.(In English, Spanish). View Article : Google Scholar
9	Huang HC, Zhao L, Cao XH, Meng G, Wang YJ and Wu M: Primary salivary gland tumors of the lung: Two cases date report and literature review. Respir Med Case Rep. 32:1013332020.
10	Wu H, Zhang F, Peng J, Wu Z, Zhang X and Wu X: Epithelial-myoepithelial carcinoma of the esophagus: A case report. Front Surg. 9:9420192022. View Article : Google Scholar
11	Sharma S, Tayal A, Khatri S, Mohapatra SG and Mohanty SK: Primary pulmonary epithelial-myoepithelial carcinoma: Report of a rare and under-diagnosed low-grade malignancy. J Cancer Res Ther. 18:795–800. 2022. View Article : Google Scholar
12	Grenier K, Altinel G, Dastani Z and Omeroglu A: Epithelial-myoepithelial carcinoma of the breast with rhabdoid features. Case Rep Pathol. 2020:88790352020.
13	Gore MR: Epithelial-myoepithelial carcinoma: A population-based survival analysis. BMC Ear Nose Throat Disord. 18:152018. View Article : Google Scholar
14	Civan C, Has Şimşek D, Vurallı Bakkaloğlu D and Kuyumcu S: ¹⁸F-FDG and ⁶⁸Ga-FAPI-04 PET/CT findings of a rare epithelial-myoepithelial carcinoma arising from ex pleomorphic adenoma of parotid. Mol Imaging Radionucl Ther. 33:125–128. 2024.
15	Mäkelä R, Arjonen A, Suryo Rahmanto A, Härmä V, Lehtiö J, Kuopio T, Helleday T, Sangfelt O, Kononen J and Rantala JK: Ex vivo assessment of targeted therapies in a rare metastatic epithelial-myoepithelial carcinoma. Neoplasia. 22:390–398. 2020. View Article : Google Scholar
16	Chen MY, Vyas V and Sommerville R: Epithelial-myoepithelial carcinoma of the base of tongue with possible lung metastases. Case Rep Otolaryngol. 2017:49735732017.
17	Hsieh MS, Chen JS, Lee YH and Chou YH: Epithelial-myoepithelial carcinoma of the salivary gland harboring HRAS codon 61 mutations with lung metastasis. Int J Surg Pathol. 24:227–231. 2016. View Article : Google Scholar
18	Yamazaki H, Ota Y, Aoki T and Kaneko A: Lung metastases of epithelial-myoepithelial carcinoma of the parotid gland successfully treated with chemotherapy: A case report. J Oral Maxillofac Surg. 71:220–226. 2013. View Article : Google Scholar
19	Yang S and Chen X: Epithelial-myoepithelial carcinoma with high grade transformation. Int J Oral Maxillofac Surg. 41:810–813. 2012. View Article : Google Scholar
20	Pierard S, Gregoire V, Weynand B and Machiels JP: Epithelial-myoepithelial carcinoma of the submandibular gland with symptomatic lung metastases treated with chemotherapy. Eur Arch Otorhinolaryngol. 263:1158–1160. 2006. View Article : Google Scholar
21	Kasper HU, Mellin W, Kriegsmann J, Cheremet E, Lippert H and Roessner A: Epithelial-myoepithelial carcinoma of the salivary gland-a low grade malignant neoplasm? Report of two cases and review of the literature. Pathol Res Pract. 195:189–192. 1999. View Article : Google Scholar
22	Noel S and Brozna JP: Epithelial-myoepithelial carcinoma of salivary gland with metastasis to lung: Report of a case and review of the literature. Head Neck. 14:401–406. 1992. View Article : Google Scholar
23	Skálová A, Hyrcza MD and Leivo I: Update from the 5th edition of the World Health Organization classification of head and neck tumors: Salivary glands. Head Neck Pathol. 16:40–53. 2022. View Article : Google Scholar
24	Luna MA, Ordonez NG, Mackay B, Batsakis JG and Guillamondegui O: Salivary epithelial-myoepithelial carcinomas of intercalated ducts: A clinical, electron microscopic, and immunocytochemical study. Oral Surg Oral Med Oral Pathol. 59:482–490. 1985. View Article : Google Scholar
25	Seethala RR, Barnes EL and Hunt JL: Epithelial-myoepithelial carcinoma: A review of the clinicopathologic spectrum and immunophenotypic characteristics in 61 tumors of the salivary glands and upper aerodigestive tract. Am J Surg Pathol. 31:44–57. 2007. View Article : Google Scholar
26	Vázquez A, Patel TD, D'Aguillo CM, Abdou RY, Farver W, Baredes S, Eloy JA and Park RCW: Epithelial-myoepithelial carcinoma of the salivary glands: An analysis of 246 cases. Otolaryngol Head Neck Surg. 153:569–574. 2015. View Article : Google Scholar
27	Kong M, Drill EN, Morris L, West L, Klimstra D, Gonen M, Ghossein R and Katabi N: Prognostic factors in myoepithelial carcinoma of salivary glands: A clinicopathologic study of 48 cases. Am J Surg Pathol. 39:931–938. 2015. View Article : Google Scholar
28	Skálová A, Weinreb I, Hyrcza M, Simpson RHW, Laco J, Agaimy A, Vazmitel M, Majewska H, Vanecek T, Talarčik P, et al: Clear cell myoepithelial carcinoma of salivary glands showing EWSR1 rearrangement: Molecular analysis of 94 salivary gland carcinomas with prominent clear cell component. Am J Surg Pathol. 39:338–348. 2015. View Article : Google Scholar
29	Suto T, Kato H, Kawaguchi M, Kobayashi K, Miyazaki T, Ando T, Noda Y, Hyodo F, Matsuo M, Ishihara H and Ogawa T: MRI findings of epithelial-myoepithelial carcinoma of the parotid gland with radiologic-pathologic correlation. Jpn J Radiol. 40:578–585. 2022. View Article : Google Scholar
30	Urano M, Nakaguro Y, Yamamoto Y, Hirai H, Tanigawa M, Saigusa N, Shimizu A, Tsukahara K, Tada Y, Sakurai K, et al: Diagnostic significance of HRAS mutations in epithelial-myoepithelial carcinomas exhibiting a broad histopathologic spectrum. Am J Surg Pathol. 43:984–994. 2019. View Article : Google Scholar
31	Kim JW, Oh JS, Roh JL, Kim JS, Choi SH, Nam SY, et al: Prognostic significance of standardized uptake value and metabolic tumour volume on ¹⁸F-FDG PET/CT in oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 42:1353–1361. 2015. View Article : Google Scholar
32	Çimen F, Aloglu M, Düzgün S, Şentürk A, Atikcan Ş and Özmen Ö: What is the effect of tumor diameter, lymph node metastases, and SUVmax value on prognosis in limited-stage small cell lung cancer? Rev Assoc Med Bras (1992). 68:1252–1258. 2022. View Article : Google Scholar
33	Kim CH, Jeong JS, Kim SR and Lee YC: Endobronchial epithelial-myoepithelial carcinoma of the lung. Thorax. 73:593–594. 2018. View Article : Google Scholar
34	El Hallani S, Udager AM, Bell D, Fonseca I, Thompson LDR, Assaad A, Agaimy A, Luvison AM, Miller C, Seethala RR and Chiosea S: Epithelial-myoepithelial carcinoma: Frequent Morphologic and molecular evidence of preexisting pleomorphic adenoma, common HRAS mutations in PLAG1-intact and HMGA2-intact cases, and occasional TP53, FBXW7, and SMARCB1 alterations in high-grade cases. Am J Surg Pathol. 42:18–27. 2018. View Article : Google Scholar
35	Rumboldt Z, Gordon L, Gordon L, Bonsall R and Ackermann S: Imaging in head and neck cancer. Curr Treat Options Oncol. 7:23–34. 2006. View Article : Google Scholar
36	Inan HC and Issin G: Epithelial myoepithelial carcinoma of the parotid gland: A rare tumor with oncocytic changes. Niger J Clin Pract. 23:266–269. 2020. View Article : Google Scholar
37	Dzuko Kamga J, Leclere JC, Uguen A, Amrane K and Abgral R: Case report: Nasal cavity epithelial-myoepithelial carcinoma with high fluoro-D-glucose uptake on positron emission tomography/computed tomography. Front Med (Lausanne). 8:6645202021. View Article : Google Scholar
38	Takumi K, Fukukura Y, Kamiyama T, Nakajo M, Ohori J, Kurono Y and Higashi M: Epithelial-myoepithelial carcinoma of the parotid gland: Correlation of dynamic magnetic resonance imaging, (18)F-fluorodeoxyglucose-positron emission tomography, and pathological findings. Jpn J Radiol. 28:618–622. 2010. View Article : Google Scholar
39	Saleh D and Al Ghamdi D: Rare development of primary parotid gland epithelial-myoepithelial carcinoma in a child. Case Rep Pathol. 2020:58376592020.
40	Schwenck J, Sonanini D, Cotton JM, Rammensee HG, la Fougère C, Zender L and Pichler BJ: Advances in PET imaging of cancer. Nat Rev Cancer. 23:474–490. 2023. View Article : Google Scholar
41	Yanagawa N, Sato A, Nishiya M, Suzuki M, Sugimoto R, Osakabe M, Uesugi N, Saito H and Sugai T: Pulmonary epithelial-myoepithelial carcinoma without AKT1, HRAS or PIK3CA mutations: A case report. Diagn Pathol. 15:1052020. View Article : Google Scholar