 hello everyone welcome back to another session in dentistry and more topic for today is mucoepidemoid carcinoma. So it is a malignant condition as name suggests and the name says it has mucoid and epidermoid components so it got the name mucoepidemoid carcinoma which is seen in salivary gland and it is the most common malignancy of salivary gland. So let's get into the detail of mucoepidemoid carcinoma. So MEc or mucoepidemoid carcinoma which is a most common malignancy of salivary gland and also the most common salivary malignancy in children. So as per WHO classification and its definition it is a distinctive salivary gland malignancy which is composed of musinus, intermediate or clear cell and squamoid tumor cell forming cystic and solid pattern. So which has basically three types musinus, intermediate and squamoid tumor cells. So that is why it has got the specular name mucoepidemoid carcinoma. So every syndrome or every disease or every condition will get name from the peculiar characteristics. So some may get from the person who has discovered or who has reported the disease first like chagrin syndrome. So this mucoepidemoid disease or carcinoma is due to the presence of muco mu musinus and epitomoid cells which is seen in histological section of this neoplasm. So this is coming towards epitomology which is 10 percentage of all salivary gland tumor and 25 percentage of malignant tumors. There is a female predilection and most commonly seen in sixth decade of life and the most common side is parotid gland, then palate, then cheek, lip, tongue and retromolar area. So it is etiology we can say it is secondary to the radiation or chemotherapy mostly since it is affecting parotid gland, the head and neck cancerous conditions or malignancy will be dealt with. Radiation or chemotherapy will be there for any other cancerous conditions. So that could be the etiology of the changes in parotid gland or any of this gland or area. So it can be seen not only in parotid gland but also the sites like cheek, lip, tongue and retromolar areas. So while moving on to the clinical features the tumors are often asymptomatic but may cause symptoms depending on the site and histological grade. The clinical presentation varies depending on tumor size and grade. The cystic intraoral lesions which can mimic a mucosil. So mucosil we know how does a mucosil appear. The mucosil is fluid filled condition which is seen inside mouth. So it looks like a mucosil and it may fluctuate in size and if cyst ruptures it present as a musin draining cutaneous fistula. So if this lesion ruptures it appears as a musin drainage cutaneous fistula. Fistula means there will be an opening. So a cystic lesion it is a completely filled cavity. So once it ruptures it looks like a musin draining cutaneous fistula that is a clinical feature. So while moving on to its cytology basically it has low grade, intermediate grade and high grade lesions. So if we are taking aspirates of low grade mostly cystic lesions which shows the mucous material macrophages occasional plant epithelial cells. So that is in the aspirates of low grade lesions. Okay so whereas the aspirates of high grade lesions it is more cellular showing an admixture of epithelial cell types typical of the lesion and cytological pleomorphism, mitotic activity and necrosis also may be seen in aspirates of high grade lesions. So moving on to histopathology. Histopathology is basically characterized by various components of squamoid, musin producing and intermediate type cells with a cystic and solid growth pattern. So due to the peculiar histopathology feature it got this name that is mycoepidromoid castanoma which is showing a squamoid musin producing and intermediate type cells in histopathology with a cystic and solid growth pattern. Whereas the keratinization is basically rare but have oncocytic clear cell and sclerosing variants. So when we do periodic acid shift staining it will demonstrate intra cytoplasmic staining in musinous cells. So when we do PAS that is periodic acid shift staining. So it will show intra cytoplasmic staining. So the basic diagnosis of this disease is based on the identification of admixture of epidomoid cell and mucus cells. So that's why I was saying this has got this name because of its histopathological feature. So that is the diagnosis point of this mucoepidromoid castanoma. So there will be in histopathological staining we can find out mucus cell and epidomoid cell. So the type of mucoepidromoid castanoma and parotid glands basically low grade and intermediate grade. So whereas the variant in before that usually we see mucoid cell and epidomoid cell in histological staining and the most frequent pattern is always a multi-cystic tumor with cystic spaces which has duct like epidomoid cell and mucus cell as I mentioned. But in almost all cases the solid areas containing another type of cell which is known as intermediate cell. Okay that is why the beginning I mentioned it has intermediate or clear cell. It is basically a bland cell cytologically that is why this name clear cell. So it doesn't have a much organelles it is a bland cell cytologically. So this also will be present histopathologically but mainly it is got mucoid and epidomoid cells. So now we're moving on to various types that is variants of amnesia that is mucoepidromoid castanoma. In parotid gland we have two types that is low grade lesion and intermediate grade. Low grade it is like scattered cysts with cellular mural thickening present only at focal areas. In intermediate grade tumor wear solid islands which predominate over the cystic component. So that is the basic difference in low grade lesion there will be scattered cysts with cellular mural thickening present at focal points that is a very low grade lesion. In intermediate grade the tumor wear solid islands which predominate over the cystic component. Now we have variants of amnesia or mucoepidromoid castanoma. We have three variants oncocytic sclerosing and solid. So oncocytic variant has polygonal or columnar oncocytic cells and scattered mucosites whereas the sclerosing variant which has dense hyalinizing fibrosis. The third one is solid mucoepidromoid castanoma which has squamoid and intermediate cells. Now we'll move on to the differential diagnosis that is adenous squamous castanoma and silomethaplasia or even metastatic squamous castanoma or primary salivary duct castanoma. And the treatment part is basically like any salivary gland tumors we need to undergo surgical removal of the affected part. So various types of surgical corrections are there and prognosis we have excellent prognosis with respect to low grade lesions and comparatively poor prognosis with high grade lesion. So this is what mucoepidromoid castanoma is all about. It is the most common malignancy of salivary gland which has got basically mucoid and epidromoid cells in his top pathology appearance which is due to secondary of radiation or chemotherapy most commonly seen in parotid gland and it has types in parotid, low grade intermediate and various types that is variants, oncocytics, clearosing and solids. So I'll come up with adenoid cystic castanoma in my next session. Thank you.