Thyroid gland
Other carcinoma
Sclerosing mucoepidermoid carcinoma with eosinophilia

Author: Shuanzeng Wei, M.D., Ph.D. (see Authors page)
Editor: Zubair W. Baloch, M.D., Ph.D.
Editorial Board Member Review: Andrey Bychkov, M.D., Ph.D.

Revised: 10 August 2017, last major update March 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Sclerosing mucoepidermoid carcinoma with eosinophilia
Cite this page: Sclerosing mucoepidermoid carcinoma with eosinophilia. PathologyOutlines.com website. http://pathologyoutlines.com/topic/thyroidsclerosing.html. Accessed November 19th, 2017.
Definition / general
Essential features
  • Squamous and mucus secreting cells with fibrosis and eosinophilic infiltrate in a background of sclerosing Hashimoto thyroiditis
Epidemiology
  • Almost always women (M / F = 1 / 16)
  • Mean age: 55 years
  • Associated with Hashimoto thyroiditis and solid cell nest hyperplasia
Etiology
  • Associated with sclerosing Hashimoto thyroiditis
  • Possibly derives from metaplastic squamous epithelium or solid cell nests
  • Negative for MAML2 rearrangements, typically seen in salivary mucoepidermoid carcinoma (Mod Pathol 2017;30:329)
Clinical features
  • Slowly growing thyroid mass in patients with sclerosing Hashimoto thyroiditis
  • Death due to disease is uncommon, although lymph nodes metastases, extracapsular spread with extensive tumor invasion into the adjacent soft tissues and organs, vascular invasion and perineural invasion are common (Hum Pathol 2015;46:725)
Radiology description
  • Ultrasound scan: ill defined, heterogeneous and hypoechoic nodule
  • Cold on radionuclide scan
Case reports
Treatment
  • Total thyroidectomy with/without neck dissection
Gross description
  • White, homogenous, firm, usually ill defined border
Gross images

Images hosted on Pathout server:

Contributed by Dr. Mark R. Wick

Well circumscribed tumor (not typical) with dense fibrosis (AFIP)

Mucoepidermoid carcinoma,
sclerosing type

Microscopic (histologic) description
  • Infiltrating solid / nested squamous tumor cells with mild to moderate atypia in dense fibrohyaline stroma with marked eosinophil infiltration; keratin pearls and keratin debris can be identified
  • Mucus secreting cells, small mucin pools present; background of chronic lymphocytic thyroiditis
  • Lymph nodes metastasis, extracapsular spread, vascular invasion and perineural invasion are common
  • May have focal clear cells (Ann Diagn Pathol 2003;7:348)
Microscopic (histologic) images

Images hosted on Pathout server:

COW #230, contributed by Dr. Hillary Zalaznick, Myriad Genetics, Inc., Utah (USA)



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Small irregular strands of tumor cells (AFIP)



Images hosted on other servers:

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Biopsy

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CK19, HBME1

Various images

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Tumor cells with a keratin pearl

Virtual slides
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USCAP 2017

Cytology description
Cytology images

Images hosted on other servers:

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Epithelial pearl-like structure

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Cell block

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Cell block, p40

Positive stains
Negative stains
Differential diagnosis
Board review question #1
    Which item is correct regarding sclerosing mucoepidermoid carcinoma with eosinophilia:

    A. Sclerosing mucoepidermoid carcinoma with eosinophilia is not associated with Hashimoto thyroiditis
    B. Lymph nodes metastases, extracapsular spread, vascular invasion and perineural invasion are common
    C. Death due to sclerosing mucoepidermoid carcinoma with eosinophilia is common
    D. Eosinophil infiltration is common, and no keratin pearls and keratin debris are seen
    E. The squamous component is highly malignant
Board review answer #1
    B. Lymph nodes metastases, extracapsular spread, vascular invasion and perineural invasion are common.

    Death due to disease is uncommon, although lymph nodes metastases, extracapsular spread, vascular invasion and perineural invasion are common.