W418 AJR:187, October 2006 AJR 2006; 187:W418–W419 0361–803X/06/1874–W418 © American Roentgen Ray Society M E D I C A L I M A G I N G A C E N T U R Y O F Onbas et al. MDCT for Myoepithelio ma of the Face Head and Neck Imaging • Case Report Giant Myoepithelioma of the Face: MDCT with 2D and 3D Images Omer Onbas 1,2 R. Murat Karasen 3 Nesrin Gursan 4 Mecit Kantarci 1 Fatih Alper 1 Adnan Okur 1 Onbas O, Karasen RM, Gursan N, Kantarci M, Alper F, Okur A Keywords: arteriography, CT, MDCT DOI:10.2214/AJR.05.0280 Received February 18, 2005; accepted after revision April 22, 2005. 1 Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey. 2 Atatürk Üniversitesi Lojmanlarý 40. Blok No:8 25240, Erzurum, Turkey. Address correspondence to O. Onbas. 3 Department of Otorhinolaryngology, School of Medicine, Atatürk University, Erzurum, Turkey. 4 Department of Pathology, School of Medicine, Atatürk University, Erzurum, Turkey. WEB This is a Web exclusive article. yoepitheliomas of the salivary gland are very rare tumors, with an incidence of less than 1% of all salivary gland tumors. Most of these neoplasms arise in the parotid gland, and only a few occur in the submandibular or minor salivary glands. The peak incidence is in the sixth and seventh decades. Approxi- mately 60% of patients are women. Myoepi- theliomas are mostly benign but 10% are ma- lignant and are prone to local recurrence that may metastasize [1–5]. Case Report A 65-year-old woman presented with an 11- month history of a gradually growing mass in the left side of the face. Examination showed very prominent facial asymmetry; the nose was deviated to the ride side and the left eye was re- pressed superiorly and laterally. Visual activity was normal, but eye movements were limited on the left side. The patient had no palpable neck nodes. A 50-mL dose of iohexol (Om- nipaque 300, Nycomed Amersham) was auto- matically injected IV at a rate of 3.5 mL/s. High-resolution 16-MDCT was performed us- ing an Aquilion scanner (Toshiba Medical Sys- tems). The images were obtained to define the caudocranial extent of the neck-to-head region (collimation, 1 mm × 16 rows; pitch, 3; gantry rotation speed, 0.75 second per round; voltage, 120 kV; current, 300 mA). Three-dimensional images were reconstructed using maximum in- tensity projection and 3D-rendering algo- rithms with imaging software (Vitrea 2, Vital Images, Inc.). Contrast-enhanced axial (Fig. 1A) MDCT images revealed a large mass that completely filled the left maxillary region, including the left maxillary sinus, left nasal cavity, and left ptery- gopalatine fossa. It also extended into the right nasal cavity, bilaterally in the hard palate, and the left orbita. Anterolateral volume-rendered 3D CT (Fig. 1B) and maximum-intensity-pro- jection (Fig. 1C) images showed that the arterial supply of the mass was the external carotid artery branches, including a facial artery. Histo- pathologically, myoepithelial cells tend to be spindle-shaped, plasmacytoid, epithelioid, clear, or combinations of these (Fig. 1D). Our case had myoepithelioma that origi- nated in a minor salivary gland, with no in- volvement of the major salivary glands. Treat- ment of benign myoepithelioma typically is done with a wide surgical resection. In malig- nant myoepitheliomas, selective neck dissec- tion may be indicated if nodal metastases are clinically suspected. Recurrences are seen in slightly more than 30% of patients. In our case, neither cervical lymph node metastasis nor distant metastasis was observed; there- M A Fig. 1—65-year-old woman with malignant myoepithelioma. A, Contrast-enhanced axial MDCT scan shows huge mass totally filling left maxillary region, including left maxillary sinus, left nasal cavity, and left pterygopalatine fossa. Nasal septum is totally destroyed by mass. (Fig. 1 continues on next page) Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved