Based on histological, immunohistochemical, and ultrastructural studies, it is now apparent that the modified myoepithelial cell component of pleomorphic adenomas has a considerable range of cytological features. We reasoned that myoepitheliomas could be tumors with a similar spectrum of neoplastic myoepithelium but lacking the ductal element displayed in pleomorphic adenomas. A review of available salivary gland tumors identified 40 examples based on this definition. Architecturally, these myoepitheliomas displayed either nonmyxoid (solid), myxoid (pleomorphic adenoma-like), reticular (canalicularlike), or mixed growth patterns, while cytologically the lesions were composed of spindle-type (32.5%), hyaline-type (7.5%), epithelial-type (45.0%), clear-type (2.5%), or mixed-type (12.5%) tumor cells. Electron microscopy was carried out on eight examples and detailed immunohistochemistry on two methanol-fixed cases. As a result of the current review of myoepitheliomas and the description of similar lesions in the literature, it is our contention that salivary gland myoepitheliomas are not as rare as has been purported.

This study assessed the risk factors driving the epidemic of COVID-19 associated mucormycosis (COVID-Mucor) in Indiathat accompanied the COVID-19 pandemic, particularly the second wave. We analysed the risk factors among 164 participants:132 COVID-Mucor(cases) and 32 non-COVID-Mucor(controls)using the data from a prospective cohort study of mucormycosis over oneyear. Diabetes mellitus remained a pivotal risk factor in both groups (97%) while uncontrolled diabetes mellitus (OR: 4.6; p=0.026)and newly detected diabetes (OR: 3.3; p=0.018), werecommoneramong the cases. Most patients with COVID-Mucor had mild COVID-19. Steroid use, often unwarranted, was highly associated with COVID-Mucorafter adjusting for other risk factors (OR 28.4; P 0.001). Serum ferritin was significantly higher(p=0.041), while C-reactive protein was not, suggesting that alterations in iron metabolism probably predispose to COVID-Mucor. Oxygen was used only in a small minority of patients with COVID-Mucor. The in-hospital mortality in both groups was low. In conclusion, the Indian COVID-Mucorepidemic was likely driven by a convergence of interlinked risk factors –uncontrolled diabetes mellitus, unwarranted steroid use, and perhapsCOVID-19 itself. Appropriate steroid use in patients with severe COVID-19 and screening and optimal control of hyperglycaemia can prevent COVID-Mucor.

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