Metastasis of soft-tissue myoepithelial carcinoma to clivus

Case report

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The differential diagnosis for masses involving the clivus is broad. The authors present a case of myoepithelial carcinoma metastatic to the clivus, a lesion that has not been reported to their knowledge. This 14-year-old girl with a history of myoepithelial carcinoma originating in the soft tissues of the left hip and metastatic to the lung presented with left lateral gaze palsy. Imaging demonstrated a 3 × 3–cm osteolytic mass in the clivus. Microscopic transsphenoidal resection with endoscopic assistance was performed. Pathological findings were consistent with the previously diagnosed myoepithelial carcinoma. Within 4 weeks postoperatively and 2 weeks into a chemotherapeutic regimen, the tumor exhibited progression. Radiation therapy was started and growth of the tumor was halted.

Myoepithelial carcinoma should be included in the differential diagnosis for clival masses, especially in patients with previously diagnosed myoepithelial carcinoma. The primary management of this tumor should be with chemotherapy and radiation, with surgery serving only for decompression.

Abbreviation used in this paper:CECT = cyclophosphamide, etoposide, celecoxib, thalidomide.

Article Information

Current address for Dr. Tomcik: Family Medicine Residency Program, Saint Joseph Regional Medical Center, Mishawaka, Indiana.

Address correspondence to: Bradley N. Bohnstedt, M.D., Goodman Campbell Brain and Spine, 1801 North Senate Boulevard, Suite 610, Indianapolis, Indiana 46202. email: bbohnste@iupui.edu.

Please include this information when citing this paper: DOI: 10.3171/2011.11.PEDS11260.

© AANS, except where prohibited by US copyright law.

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Figures

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    Initial survey head CT scan with osteolytic clival mass (arrow).

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    Sagittal (left) and coronal (right) T1-weighted MR imaging studies obtained with contrast demonstrating expansive clival mass.

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    Photomicrographs showing a poorly differentiated tumor composed of cells with epithelioid, spindled, and plasmacytoid morphologies. The cells have large, ovoid-to-irregular nuclei, prominent nucleoli, and generally abundant eosinophilic cytoplasm. Many display vacuolated-to-clear cytoplasm, and mitotic figures are frequent (A). The tumor shows strong immunoreactivity for cytokeratin (B), epithelial membrane antigen (C), and calponin (D). H & E (A) and immunostaining (B–D). Original magnification × 400.

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    Sagittal T1-weighted MR imaging studies obtained with contrast at recurrence (left) and 4 months after recurrence (right).

References

  • 1

    Chimelli LGadelha MRUne KCarlos SPereira PJSantos JL: Intra-sellar salivary gland-like pleomorphic adenoma arising within the wall of a Rathke's cleft cyst. Pituitary 3:2572612000

    • Search Google Scholar
    • Export Citation
  • 2

    Gleason BCFletcher CD: Myoepithelial carcinoma of soft tissue in children: an aggressive neoplasm analyzed in a series of 29 cases. Am J Surg Pathol 31:181318242007

    • Search Google Scholar
    • Export Citation
  • 3

    Hallor KHTeixeira MRFletcher CDBizarro SStaaf JDomanski HA: Heterogeneous genetic profiles in soft tissue myoepitheliomas. Mod Pathol 21:131113192008

    • Search Google Scholar
    • Export Citation
  • 4

    Harada OOta HNakayama J: Malignant myoepithelioma (myoepithelial carcinoma) of soft tissue. Pathol Int 55:5105132005

  • 5

    Hornick JLFletcher CD: Myoepithelial tumors of soft tissue: a clinicopathologic and immunohistochemical study of 101 cases with evaluation of prognostic parameters. Am J Surg Pathol 27:118311962003

    • Search Google Scholar
    • Export Citation
  • 6

    Kagawa KMurakami MHishikawa YAbe MAkagi TYanou T: Preclinical biological assessment of proton and carbon ion beams at Hyogo Ion Beam Medical Center. Int J Radiat Oncol Biol Phys 54:9289382002

    • Search Google Scholar
    • Export Citation
  • 7

    Kilpatrick SEHitchcock MGKraus MDCalonje EFletcher CD: Mixed tumors and myoepitheliomas of soft tissue: a clinicopathologic study of 19 cases with a unifying concept. Am J Surg Pathol 21:13221997

    • Search Google Scholar
    • Export Citation
  • 8

    Kilpatrick SELimon JMixed tumour/myoepithelioma/parachordoma. Fletcher CDMUnni KKMerters F: World Health Organization Classification of Tumours Pathology and Genetics: Tumours of Soft Tissue and Bone LyonIARC Press2002. 198199

    • Search Google Scholar
    • Export Citation
  • 9

    Kimura FKim KSFriedman HRussell EJBreit R: MR imaging of the normal and abnormal clivus. AJNR Am J Neuroradiol 11:101510211990

    • Search Google Scholar
    • Export Citation
  • 10

    Masuya DHaba RHuang CLYokomise H: Myoepithelial carcinoma of the lung. Eur J Cardiothorac Surg 28:7757772005

  • 11

    Nieder CSchneller FGrosu ALPeschel CMolls M: Radiotherapy and chemotherapy for myoepithelioma of the sellar region. Strahlenther Onkol 181:2602632005

    • Search Google Scholar
    • Export Citation
  • 12

    Pallini RSabatino GDoglietto FLauretti LFernandez EMaira G: Clivus metastases: report of seven patients and literature review. Acta Neurochir (Wien) 151:2912962009

    • Search Google Scholar
    • Export Citation

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