Investig Magn Reson Imaging.  2016 Mar;20(1):66-70. 10.13104/imri.2016.20.1.66.

Mucoepidermoid Carcinoma with Distant Metastases to the Kidney, Adrenal Gland, Skull and Gluteus Maximus Muscle: a Case Report

• Son SW
• Lee KH
• Lee JH
• Myong NH
• Yoo DS

• KMID: 2161372
• DOI: http://doi.org/10.13104/imri.2016.20.1.66

Abstract

INTRODUCTION
Distant metastases of mucoepidermoid carcinoma (MEC) are reported with the most common sites being the soft tissue of skin, lung, liver, and bone. We report here a very rare case of MEC with multiple metastases to the kidney, adrenal gland, skull and gluteus maximus muscle.
CASE REPORT
A 63-year-old male patient presented with left-sided headache. Radiologic evaluations including CT and MRI showed ill-defined soft tissue lesion involving the left infratemporal fossa and left sphenoid sinus, and multiple enlarged lymph nodes in neck and mediastinum. PET-CT demonstrated multiple hypermetabolic lesions in and around the left kidney, left adrenal gland, right ischium, right gluteus maximus and skull base. These lesions were confirmed as MEC with multiple metastases through biopsy. DISCUSSION: Only one case of metastasis to the skull has been previously reported, and moreover, there has not been a case of metastatic MEC to the kidney, adrenal gland and gluteus maximus muscle so far in the medical literature. It is important to acknowledge the possibility of every unusual MEC metastases, since the presence of metastasis has statistically significant influence on the survival of MEC.

Keyword

Mucoepidermoid carcinoma; Metastases; Computed tomography; Magnetic resonance imaging; Positron emission tomography

MeSH Terms

Adrenal Glands*
Biopsy
Carcinoma, Mucoepidermoid*
Headache
Humans
Ischium
Kidney*
Liver
Lung
Lymph Nodes
Magnetic Resonance Imaging
Male
Mediastinum
Middle Aged
Neck
Neoplasm Metastasis*
Positron-Emission Tomography
Skin
Skull Base
Skull*
Sphenoid Sinus

Figure

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  Fig. 1 A computed tomography (CT) of the paranasal sinus and neck. (a) Soft tissue window setting shows ill-defined soft tissue lesion involving the left infratemporal fossa. (b) Bone window setting shows abnormal soft tissue lesion in the left sphenoid sinus (arrows), associated with erosion and sclerosis of the left sphenoid bone (arrowheads). Multiple enlarged lymph nodes with central necrosis are shown in (c) the both level IV and (d) AP window. (Enlarged lymph nodes in other nodal stations are not shown here.) Fluid collection is also noted in left pleural space, but the patient has not undergone a pleural fluid analysis. It spontaneously resolved in a month.

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  Fig. 2 A magnetic resonance imaging (MRI) of the paranasal sinus. Axial T1WI shows ill-defined soft tissue lesion involving (a) the left infratemporal fossa (arrow) and (c) left sphenoid sinus (arrow) with iso-signal intensity. (b, d) Contrast enhanced T1WI shows enhancement of the lesion (arrows).

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  Fig. 3 FDG PET-CT fused images depicting metastases on (a) the skull base, (b) in and around left kidney and left adrenal gland, (c) right gluteus maximus and (d) right ischium.

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  Fig. 4 The specimen obtained by endoscopic sinus biopsy. The tumor cells are consistent with those of intermediate to high grade of mucoepidermoid carcinoma, which is composed of epidermoid cell nests with rarely scattered mucous cells (H & E staining, × 200).

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