Healey et al used histologic criteria to grade mucoepidermoid carcinomas arising in salivary glands. This can help separate patients into prognostically important groups. The authors are from Columbia University in New York City.
Selection criteria: focus of mucicarmine positivity
Histologic parameters:
(1) cystic vs solid growth
(2) cellular anaplasia
(3) mitotic activity
(4) invasiveness
Growth Pattern
Anaplasia
Mitotic Activity
Invasiveness
Grade
predominantly cystic
nuclei not hyperchromatic and nucleoli not prominent
extremely rare
none or broad advancing edge
I
both cystic and solid
slight to moderate pleomorphism; occasional prominent nucleoli
occasional
infiltrates into adjacent tissue
II
usually predominantly solid; occasionally cystic
marked pleomorphism; prominent nucleoli in most cells
numerous
extensive infiltration
III
Metastases to regional lymph nodes:
(1) extremely rare in Grade I tumors
(2) infrequent with Grade II tumors
(3) common with Grade III tumors
Prognostic factors:
(1) involvement of surgical margins
(2) metastases to regional lymph nodes
(3) Grade III tumor
Involvement of surgical margins was more ominous if the tumor was obviously unresectable due to location or extent of invasion or both.
In patients with Grade III tumors, patients with positive surgical margins did worse and were far more likely to have positive lymph node metastases.
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