Mucoepidermoid carcinomas are rare and comprise 5% of head and neck malignancies and are seen in 2.6 cases for every
100,000 people. We report the case of a 49 year old blacksmith from Guadalajara, Mexico who presents to office and who is later
diagnosed with a mucoepidermoid carcinoma located in the left side of the submandibular gland, tumor was treated with two
surgery for removal of the mass with patient now being seen under periodic moments.
Currently mucoepidermoid carcinomas are very rare they count
for less than 5% of head and neck tumor and most of them occur
in Young adults and women, nowadays it can be divided into three
types one for mucin producing cells, another one for intermediate
or clear cells and squamoid cells. Three grades are given to classify
the tumor which are grade 1 for a tumor that does not usually
metastasize and that is cured by an appropriate surgery, grade two
is given to tumors that are in an in-between spectrum with grade 3
and that have a risk for developing disease progression and a certain
mortality rate, and finally a grade 3 tumor is one with a major risk
for presenting positive lymph nodes and disease progression and
related mortality [1].
A 49 year old man presented to office in the San Martin Clinic
located in Guadalajara, Mexico with a history of 6 month halitosis,
as well as 2 year history of swelling in his lower left side of the
retromolar region, the swelling had increase in size gradually, with
medical and dental history being normal until now patient did not
have any chronic illness or history of smoking, he drank occasionally
and had no major problem in his personal background, he was
performed an intraoral examination a solitary well defined oval
shaped erythematous swelling on the left side of the retromolar
area is seen with a size of about 2.0 x 1.5 cm with irregular borders,
it was not painful to the touch and had a firm tenderness (Figure 1).
A Computed Tomography Scans for Head and Neck with contrast
material revealed a ganglion located in the submandibular gland a
1b stage pair of ganglions augmented in size located in suprahyoid
and infrahyoid muscles with a size of 18 x 14 mm located anterior
to the submandibular gland the other ganglions observed had a
diameter of 10 mm or below (Figures 2-4).
Figure 1: Clinical photograph of solitary swelling mass in
left side of retromolar region.
Figure 2: CT of head and neck showing swollen lymph nodes in submandibullary gland.
Figure 3: CT of head and neck showing swollen lymph nodes in submandibular gland.
Figure 4: CT of head and neck showing swollen lymph nodes in submandibular gland.
After evaluation patient was schedule to perform two surgeries
for removal of the tumour which were carried out on the San Martin
Clinic, surgical intervention included wide excision of the tumour
located the submandibular gland and second surgery included wide
excision of lymph nodes located in adjacent areas in the suprahyoid
muscles and infrahyoid muscles reconstruction.
A biopsy was taken during surgery and it was analyzed by a
pathologist where I teas diagnosed as a low-grade stage 1 malignant
mucoepidermoid carcinoma with dimension of 2 x 3 x 1 cm with
granulomatous chronic peripheric inflammatory process (Figure
5) [2].
Figure 5: Postsurgical photograph showing wide excision of mass located in retromolar area.
These type of tumors are very rare they comprise only 5% of
neoplasms and are seen in 0.4-2.6 for every 100,000 cases around
the world, the mucoepidermoid tumor affects parotid and minor
salivary glands in adults and is mostly seen in women and Young
adults, most of the cases arise in the parotid gland with this case
accounting for only 2-4% of the cases because it was seen in the
submandibular gland, this patient is currently under treatment he
was performed two surgeries for removal of ganglions located in
neck and in the submandibular gland, highest prevalence for this
type of tumor is around the fifth decade of life and they can be
asymptomatic like in this case with the patient having few to no
symptoms. It has a pluripotent cell origin and as we mention can be
classified into three stages [3].