Epithelial-myoepithelial Carcinoma of Parotid Gland: A Diagnostic and Therapeutic Conundrum

Abstract

Introduction: Epithelial-Myoepithelial Carcinoma (EMC) is a rare, biphasic salivary gland tumour primarily affecting the parotid gland, with an oddly high tendency to recur locally after surgical excision. Owing to its infrequent incidence, there are no established treatment protocols. Wide local excision with adequate margins remains the primary treatment modality. It is often supplemented by adjuvant radiotherapy, particularly in cases with high-risk features. Case Report: A 60-year-old female presented with a painless, progressive swelling in the right pre-auricular region. Imaging and cytological examination suggested pleomorphic adenoma. She underwent right superficial parotidectomy. Histopathological examination revealed EMC with capsular invasion. Immunohistochemistry confirmed biphasic epithelial- myoepithelial differentiation. Adjuvant radiotherapy (60Gy/30#) was delivered owing to close margins and perineural invasion. Patient is currently disease free since last 3 years. Conclusion: EMC poses a diagnostic challenge due to its morphological resemblance to benign counterparts. Complete excision with or without adjunctive radiotherapy offers excellent local control and long term disease-free survival.