Original ArticlesEpithelial-Myoepithelial Carcinoma With High Grade TransformationRoy, Paromita MD* †; Bullock, Martin J. MD‡; Perez-Ordoñez, Bayardo MD* †; Dardick, Irving MD* †; Weinreb, Ilan MD* †Author Information *Department of Pathology, University Health Network †Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario ‡Department of Pathology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada Correspondence: Ilan Weinreb, MD, Department of Pathology, University Health Network, 200 Elizabeth Street, Room 11E403, Toronto, Ontario, Canada M5G 2C4 (e-mail: [email protected]). The American Journal of Surgical Pathology: September 2010 - Volume 34 - Issue 9 - p 1258-1265 doi: 10.1097/PAS.0b013e3181e366d2 Buy Metrics Abstract Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor of presumed intercalated duct origin with a low risk of metastasis and mortality. Factors shown to affect behavior include positive margins, vascular invasion, necrosis, and myoepithelial anaplasia. The latter category and dedifferentiated EMCs have been separated on the basis of presumed myoepithelial versus ductal origin, respectively. Three additional cases of typical EMC with transition to high-grade carcinoma are presented. Two of the tumors were stained with CAM5.2, 34βE12, cytokeratin 14, p63, S100, calponin, smooth muscle actin, and muscle-specific actin. All tumors showed a gradual transition to a high-grade carcinoma from an EMC, each composed of clear cells even in the high-grade regions. One case also showed a discrete area with ductal lumina and another had plasmacytoid morphology. Squamous differentiation was seen in all cases as well. A consistent immunostaining pattern was not noted. Areas with focal lumina were diffusely positive for CAM5.2 only. Areas with clear cells showed patchy S100 positivity only, whereas cytokeratin 14 and 34βE12-stained squamous pearls. The case with plasmacytoid morphology was diffusely positive for p63. No immunoexpression was noted with smooth muscle actin, muscle-specific actin, or calponin. It was not possible to convincingly separate the high-grade component in these cases into ductal dedifferentiated EMC versus myoepithelial. Recently, there has been a move to abandon the term “dedifferentiation” in favor of “high-grade transformation” in other salivary gland malignancies. We report these 3 such cases, review the literature and propose that these lesions be regarded as “EMC with high-grade transformation.” © 2010 Lippincott Williams & Wilkins, Inc.