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Clinical Problem Solving: Pathology
July 2009

Pathology Quiz Case 1: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2009;135(7):720-723. doi:10.1001/archoto.2009.62-b

While mucoepidermoid carcinoma is one of the most common salivary gland cancers, it rarely originates in the thyroid. To date, approximately 40 cases of MECT have been reported.14There are 2 distinct subtypes of MECT: conventional MECT and sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE). Each subtype has a distinctive clinicopathologic presentation: SMECE more frequently affects women, often around the age of 60 years.1It appears histologically as a dense fibrosclerotic stroma infiltrated with nests of mucin and squamous cells as well as abundant eosinophils and scattered lymphocytes, and it invariably occurs in a background of chronic lymphocytic thyroiditis.2In contrast, conventional MECT, which is histologically similar to mucoepidermoid carcinoma of salivary origin, affects a slightly younger age group and does not have a sex predilection. It is composed of 3 distinct types of cells (squamoid, mucous, and intermediate), which are arranged in mucin-containing cysts and solid epithelial nests. Intracytoplasmic mucin can be demonstrated with mucicarmine staining of mucin cells lining the cysts. As in our patient, conventional MECT presents together with papillary thyroid carcinoma in approximately 50% of cases.5,6

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