Prognosis and predictive factors

Recurrence occurs in around 40% of cases and metastasis in 14%. The most common metastatic sites are cervical lymph nodes, lung, liver and kidney. Death from disease complications occurs in less than 10% of the patients {436,493,614,784,1580}. Five- and 10 year overall survival rates are 80% and 72%, respectively {784}. Size and rapid tumour growth are associated with worse prognosis {42,783}.

Margin status is a major pathological prognostic factor. Incomplete surgical excision is associated with recurrence and metastasis. The poorer prognosis associated with tumours located in minor salivary glands may be due to the higher frequency of recurrences due to incomplete surgery. Atypia is associated with unfavourable outcome {784} whenever present in more than 20% of tumour area. EMC is usually diploid {784,992}. Aneuploidy and high mitotic counts have been reported in cases with unfavourable prognosis {784}. Areas of dedifferentiation also predict poor outcome, with recurrence and metastasis in 70% of patients {42,783}.

Fig. 5.12 Epithelial-myoepithelial carcinoma (EMC) of the parotid gland. A Dedifferentiated EMC. Low molecular weight cytokeratins emphasizes the loss of the biphasic pattern (lower). The differentiated component (upper) retains focal epithelial differentiation (CAM 5.2). B Immunostained for smooth muscle actin (SMA): the reverse image of that of the differrentiated area is obtained, with intense staining of the outer layers. C Tumour cells of the outer layer are also strongly immunoreactive for calponin.

Fig. 5.12 Epithelial-myoepithelial carcinoma (EMC) of the parotid gland. A Dedifferentiated EMC. Low molecular weight cytokeratins emphasizes the loss of the biphasic pattern (lower). The differentiated component (upper) retains focal epithelial differentiation (CAM 5.2). B Immunostained for smooth muscle actin (SMA): the reverse image of that of the differrentiated area is obtained, with intense staining of the outer layers. C Tumour cells of the outer layer are also strongly immunoreactive for calponin.

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