Primary epithelial submandibular salivary gland tumours--review of management in a district general hospital setting

Primary epithelial submandibular gland (SMG) tumours are uncommon, accounting for 8-12% of all salivary gland neoplasms, and most studies come from large specialised centres. There is little published about the relative frequency and outcome of SMG tumours treated in general hospitals. A retrospective study from two district general hospitals over a 10 year period (1996-2005). Seventeen benign (68%) and eight malignant (32%) tumours were included. A painless mass was the most common presentation. Pain and paraesthesia were not pathognomonic of malignancy. Pleomorphic adenoma accounted for all 17 benign tumours and adenoid cystic carcinoma was the commonest malignant tumour. Fine needle aspiration cytology (FNAC) accurately identified 78% of the benign tumours but none of the malignant tumours. Pre-operative imaging was also unable to distinguish malignant from benign tumours. Incomplete excision was reported in 20% of cases and was more common for malignant tumours. It may be difficult to distinguish benign from malignant SMG tumours on clinical examination and pre-operative investigations. Any suspected submandibular tumour should be considered for early treatment even when FNAC is suggestive of a benign tumour.     

An immunohistochemical study of the incidence and significance of human gonadotrophin and prolactin binding sites in normal and neoplastic human ovarian tissue

An immunoperoxidase technique has been utilised for the demonstration of follicle stimulating hormone (FSH), luteinising hormone (LH) and prolactin (PRL) binding sites in normal human ovaries and in a wide range of benign and malignant epithelial tumours of the ovary. The incidence of FSH, LH and PRL binding was, respectively, 32%, 41% and 39% in normal ovaries, 30%, 18.5% and 22.5% in benign epithelial tumours and 51%, 32% and 43% in malignant epithelial neoplasms. The incidence of FSH binding was significantly higher in malignant epithelial neoplasms than in either normal ovaries or benign epithelial tumours but otherwise no correlation was found between hormone binding capacity and the degree of malignancy of epithelial ovarian tumours, the histological type of the tumour, the degree of differentiation of the malignant epithelial tumours or the presence or absence of metastatic disease. Well differentiated malignant tumours did, however, tend to stain more strongly than did poorly differentiated neoplasms, thus suggesting that the number of binding sites per cell tends to decrease with decreasing degrees of differentiation.     

Uncommon primary mediastinal tumours

The mediastinum is a unique anatomic area containing several structures and pluripotent cells that allow for the development of a range of tumours. Uncommon neoplasms of the mediastinum account for less than 10% of all mediastinal masses and include primary thymic carcinomas, neuroendocrine carcinomas, germ-cell tumours (GCTs), lymphomas, and neurogenic, endocrine, and mesenchymal tumours. Primary thymic carcinomas and neuroendocrine carcinomas, although rare, are highly malignant lesions. GCTs are thought to derive from primitive germ cells and can be classified in seminomatous and non-seminomatous GCTs. They are located predominantly in the anterior mediastinum, as are the primary mediastinal lymphomas that include Hodgkin lymphoma, large B cell lymphoma, and lymphoblastic lymphoma. Neurogenic tumours may arise from peripheral nerves, sympathetic ganglia, or rarely parasympathetic ganglia and are located predominantly in the posterior mediastinum. Endocrine tumours are the ectopic thyroid and parathyroid tumours. Mesenchymal tumours are rare tumours and no less problematic than they are in peripheral sites. The clinical, radiological, and therapeutic aspects of these tumours are reviewed.     

Comparative study of the carcinogenic effect of BHP and BAP on NMRI mice

The carcinogenic effects of N-bis(2-hydroxypropyl)nitrosamine (BHP) and N-bis(2-acetoxypropyl)nitrosamine (BAP) were studied in NMRI mice treated subcutaneously once weekly for life. The highest incidences of tumours were found in the lung (73–100%), in the liver (67–100%) and nasal cavity (0–33%) in both sexes of mice. Data were similar in animals treated with BHP or BAP. These tumours were adenomas, adenocarcinomas and squamous cell carcinomas (nasal cavity and lung) as well as hemangioendotheliomas and hemangioendotheliosarcomas (liver). The lung tumours were found in the control mice (27–50%) 20 weeks later than in the experimental animals. The rate of malignant neoplasms rose with increasing survival and decreasing dose levels.     

Childhood and adolescent cancer survival: a period analysis of data from the Canadian Cancer Registry

This study provides up-to-date estimates of childhood and adolescent (ages 0-19) cancer survival in Canada using data from the Canadian Cancer Registry (CCR). Cases were classified according to the third edition of the International Classification of Childhood Cancer classification scheme. Follow-up for vital status was determined through record linkage to the Canadian Mortality Data Base, and from information reported by provincial/territorial cancer registries. Observed survival proportions (OSPs) were based on period analysis (1999-2003). The 1-, 3- and 5-year OSPs for all cancers combined were 92%, 85% and 82%, respectively. Among diagnostic groups, five-year survival estimates were highest for retinoblastoma (99%), carcinomas and other malignant epithelial neoplasms and malignant melanomas (91%) and for renal tumours (91%); they were poorest for hepatic tumours (68%) and for malignant bone tumours (68%). Survival for childhood and adolescent cancer in Canada has improved substantially since last reported.     

Primary pancreatic cystic neoplasms of the pancreas revisited. Part IV: rare cystic neoplasms

Primary pancreatic cystic neoplasms are being recognized with increasing frequency due to modern imaging techniques. In addition to the more common cystic neoplasms-serous cystadenoma, primary mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm-there are many other less common neoplasms that appear as cystic lesions. These cystic neoplasms include solid pseudopapillary neoplasm of the pancreas (the most common rare cystic neoplasm), cystic neuroendocrine neoplasm, cystic degeneration of otherwise solid neoplasms, and then the exceedingly rare cystic acinar cell neoplasm, intraductal tubular neoplasm, angiomatous neoplasm, lymphoepithelial cysts (not true neoplasms), and few others of mesenchymal origin. While quite rare, the pancreatic surgeon should at the least consider these unusual neoplasms in the differential diagnosis of potentially benign or malignant cystic lesions of the pancreas. Moreover, each of these unusual neoplasms has their own natural history/tumor biology and may require a different level of operative aggressiveness to obtain the optimal outcome.     

Soft tissue tumours of the retroperitoneum

Purpose. This review summarizes the more prevalent soft tissue tumours arising in the retroperitoneum and highlights some recent fundamental and diagnostic developments relevant to mesenchymal tumours.Discussion. The retroperitoneum is an underestimated site for benign and malignant neoplastic disease, and represents the second most common site of origin of primary malignant soft tissue tumours (sarcomas) after the deep tissues of the lower extremity. In contrast to the predominance of benign soft tissue lesions over malignant sarcomas elsewhere, retroperitoneal mesenchymal lesions are far more likely to be malignant. The differential diagnosis is primarily with the more common lymphoproliferative and parenchymatous epithelial lesions arising in this area, and with metastatic disease from known or unknown primary sites elsewhere.The most prevalent mesenchymal tumours at this site are of a lipomatous, myogenic or neural nature.Their generally late clinical presentation and poorly accessible location provides numerous clinical challenges; optimal radiological imaging and a properly performed biopsy are essential cogs in the management route. Histopathological diagnosis may be complicated, but has been aided by developments in the fields of immunohistochemistry and tumour (cyto)genetics. Despite significant advances in oncological management protocols, the prognosis remains generally less favourable than for similar tumours at more accessible sites.     

Malignant ovarian tumours in childhood in Britain, 1962-78

The files of the Childhood Cancer Research Group and of the Oxford Survey of Childhood Cancers were scrutinized for all the ovarian neoplasms registered in England, Scotland and Wales in children under age 15 years throughout the period 1962-78. Among 172 cases confirmed as malignant ovarian tumours, 145 (84%) were tumours of germ cell origin (54 dysgerminomas, 36 malignant teratomas, 26 endodermal sinus tumours, 4 embryonal carcinomas, 2 pure choriocarcinomas, 20 mixed germ cell neoplasms, 3 gonadoblastomas), 13 (8%) were epithelial carcinomas (3 serous or undifferentiated, 10 mucinous), 9 (5%) were sex-cord stromal tumours (3 granulosa cell, 3 Sertoli-Leydig, 3 unclassified) and 5 (3%) were other miscellaneous tumour types. Less than 10% of the neoplasms occurred at age less than 5 years, approximately 20% from 5-9, and greater than 70% from 10-14 years. Germ cell neoplasms of greater malignancy (immature teratomas, endodermal sinus tumours) occurred in a significantly higher proportion at younger age (less than 10 years) than dysgerminomas (P = 0.01). The overall incidence (approximately 1.7 cases per 10(6) per annum) did not show any noticeable trend over the 17-year period considered. The clustering of two confined cases and, possibly, a third case, of germ cell neoplasms in three generations of the same family pointed to a genetic component in the aetiology of some of these neoplasms. A large number of sex related and mental or neurological abnormalities was also reported in case children. The 10-year survival rates, determined by the life-table method were: epithelial carcinomas 73%, sex-cord stromal tumours 44%, dysgerminomas 73%, malignant teratomas 33%, endodermal sinus tumours 39%, embryonal carcinomas 25%, other germ cell neoplasms 30% and gonadoblastomas 100%. Apart from cell-type, factors associated with prognosis were clinical stage (in all types), size and degree of histological differentiation (in malignant teratomas, but only when stage was not allowed for). The adoption of efficacious polychemotherapy regimens completely changed the prognosis of germ cell tumours other than dysgerminomas (from 29% to greater than 85% disease-free survivors in the present series).     

Role of anti-LFA-1 and anti-ICAM-1 combined mab treatment in the rejection of tumors induced by moloney murine sarcoma virus (M-MSV)

This report has the dual purpose of describing patterns of cancer incidence among adolescents in New South Wales (NSW), Australia, and comparing adult and childhood cancer classification schemes. All cases of cancer incident between 1972 and 1991 in NSW residents aged 10–19 years were obtained from the population-based NSW Central Cancer Registry and coded according to Birch and Marsden (1987) in addition to routine coding by the Ninth Revision of the International Classification of Diseases. The average incidence rate for all cancers combined was 158 and 140 per million in males and females respectively. The Birch and Marsden category of “carcinomas and other epithelial neoplasms” comprised 22% of all cancers in male adolescents and 37% in females. Melanoma alone accounted for 16% of all cancers in males and 26% in females. Rates of leukaemias and central nervous system tumours were simitar in the age groups 10–14 years and 15–19 years. By contrast, lymphomas, bone tumours (males only), soft tissue (males only), “germ-cell, trophoblastic and other gonadal tumours” and “carcinomas and other epithelial neoplasms” were more common in the older age group. The Birch and Marsden classification with its emphasis on morphology provided a clearer picture of some types of cancer which occurred frequently among teenagers. Cancers common in adults did occur in older adolescents but were less well described by the childhood scheme. Cancers of colon and lung were often of unusual histological type compared to adult tumours. It would appear appropriate to use the childhood classification scheme to describe cancer incidence in adolescent age groups, perhaps with minor modification. © 1995 Wiley-Liss, Inc.     

Metastasis to the thyroid gland: Characterization and survival of an institutional series spanning 28 years

IntroductionSecondary neoplasms in the thyroid are rare. The study aim was to provide an overview of non-thyroid tumours that metastasize to the thyroid through our institutional experience.Materials and methodsThis study entailed a review of the pathology database searching for patients with metastasis to the thyroid at the Karolinska University Hospital between 1992 and 2019 and review of their medical files.ResultsOut of 1939 surgical procedures with a histopathological diagnosis of a thyroid malignancy, 31 cases (1.6%, 65% females) with a diagnosis of metastatic epithelial neoplasms to the thyroid gland were identified. The median age at discovery of the thyroid metastasis was 68 years (range 48–85). The most common primary tumours were clear cell renal cell carcinoma (ccRCC) (36%), followed by non-small cell lung cancer (19%), oesophageal cancer (16%), head and neck malignancies (16%), malignant melanoma (10%) and unknown primary tumour (3%). The median time from the diagnosis of the primary tumour to diagnosis of the thyroid metastasis was 20 months (0–232) and was longest for patients with ccRCC (median 107 months). At 12 months after the non-thyroid metastasis diagnosis 48% had died. The longest survival was observed in ccRCC and the shortest in lung cancer. Surgical management of the metastasis was associated with improved survival (25 vs 3.8 months, p = 0.001).ConclusionsNon-thyroid metastases to the thyroid were rare but should be suspected in patients with previous history of non-thyroid malignancy and a thyroid nodule. Prognosis was poor, but surgical management was beneficial in selected patients.     

Diagnosis and management of neoplastic lesions of the submandibular triangle

Review of submandibular triangle neoplasms (benign and malignant) treated at a tertiary referral centre in the United Kingdom (1986-2004). One hundred and seven cases identified via computerised search of histopathology records over the 18 year review period. Retrospective review clinical notes and collation with data maintained prospectively by the senior author. Forty nine benign and 58 malignant neoplasms of the submandibular triangle were reviewed. Definitive diagnosis was by excision and pathological examination. Pleomorphic adenoma (n=37) were the most common benign neoplasms. For malignant lesions (n=58), 48 were primary malignancies and 10 metastatic lesions. The most frequent primary lesions were malignant non-Hodgkin lymphoma (n=22), adenoid cystic carcinoma (n=9) and mucoepidermoid carcinoma (n=9). The mainstay treatment for both benign and malignant lesions was surgical either by extracapsular excision of the gland/lesion or selective levels I, IIa and III neck dissection. The main post-operative complication was temporary weakness of the marginal mandibular nerve (13%). Submandibular triangle neoplasms are rare and pose many diagnostic and therapeutic challenges. There is a relatively high incidence of malignant neoplasms in this region (54%). Benign tumours manifest a mild course of disease and have an excellent prognosis following adequate excision. Malignant tumours have a poor symptomatology that can result in late (often post-operative) diagnosis. The adequacy of primary surgery is crucial and would support the approach of a more radical excision primarily with a selective levels I, IIa and III neck dissection; ensuring a definitive operation for benign lesions, avoiding the risks of tumour spillage associated with a more limited excision; and removing the primary echelon of lymph nodes at risk of metastasis if the pathology in fact turns out to be malignant; without a significantly higher morbidity in comparison with an extracapsular gland/lesion excision.     

Incidence of malignant disease in childhood: a 24-year review of the Manchester Children's Tumour Registry data

The Manchester Children's Tumour Registry data for the period 1954-1977 have been analysed. The overall incidence of malignant disease in children aged 0-14 years in the north-west of England is estimated to be 100 per million person-years. The most common disease group is leukaemia, which forms about one third of the total number of cases. Among solid tumours, by far the most common presenting site is the central nervous system, representing nearly a quarter of all neoplasms. Wilms' tumour, neuroblastoma and soft-tissue sarcomas comprise approximately 5%, 6.5% and 6% respectively of the total. The tumours most frequently seen in adults (e.g. carcinoma of colon, lung and breast) are extremely rare in childhood. A significant excess of males was seen in acute lymphoid leukaemia, non-Hodgkin's lymphoma, Hodgkin's disease, medulloblastoma and hepatoblastoma. A female excess was found among germ-cell tumours. During the study period significant increases in incidence were seen among acute lymphoid leukaemia and epithelial tumours, and an increase in germ cell tumours approached significance.     

Malignant tumours of the heart: a review of tumour type, diagnosis and therapy

Primary cardiac neoplasms are rare and occur less commonly than metastatic disease of the heart. In this overview, current published studies concerning malignant neoplasms of the heart are reviewed, together with some insights into their aetiology, diagnosis and management. We searched medline using the subject ‘cardiac neoplasms’. We selected about 110 articles from between 1973 and 2006, of which 76 sources were used to complete the review. Sarcomas are the most common cardiac tumours and include myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, neurofibrosarcoma, malignant fibrous histiocytoma and undifferentiated sarcoma. The classic symptoms of cardiac tumours are intracardiac obstruction, signs of systemic embolisation, and systemic or constitutional symptoms. However, serious complications including stroke, myocardial infarction and even sudden death from arrhythmia may be the first signs of a tumour. Echocardiography and angiography are essential diagnostic tools for evaluating cardiac neoplasms. Computed tomography and magnetic resonance imaging studies have improved the diagnostic approach in recent decades. Successful treatment for benign cardiac tumours is usually achieved by surgical resection. Unfortunately, resection of the tumour is not always feasible. The prognosis after surgery is usually excellent in the case of benign tumours, but the prognosis of malignant tumours remains dismal. In conclusion, there are limited published data concerning cardiac neoplasms. Therefore, a high level of suspicion is required for early diagnosis. Surgery is the cornerstone of therapy. However, a multi-treatment approach, including chemotherapy, radiation as well as evolving approaches such as gene therapy, might provide a better palliative and curative result.     

Streptozotocin-induced renal tumours in rats.

Forty-six separate renal tumours developed in 36/80 Wistar male rats given a single i.v. dose of streptozotocin (25 mg/kg body wt) to induce diabetes mellitus. Fourteen of the tumours were epithelial in type, 8 were wholly mesenchymal and 24 were largely mesenchymal but also contained epithelial elements. The purely epithelial tumours correspond to the renal adenomas and adenocarcinomas seen in man. The mesenchymal tumours were composed either of undifferentiated spindle cells or of a mixutre of poorly differentiated mesenchyme and epithelial glands. Microscopically, the mixed tumours resembled the nephroblastomas seen in man; both elements appeared to be malignant, but in the absence of metastases this remains unproven. The management of the diabetic state did not influence the incidence of tumours, but insulin appeared to enhance tumour growth.     

Childhood Cancer Survival in Brunei Darussalam

Background: This study aims to determine the survival rates for children and adolescents aged 0-19 years diagnosed with childhood cancer and to evaluate the associated factors for childhood cancer survival in Brunei Darussalam. Methods: The analysis was based on de-identified data of 263 childhood cancer for the period 2002 to 2017 retrieved from a population-based cancer registry. Overall survival was estimated using the Kaplan-Meier method. Univariate analysis, using the log-rank test, was used to examine the differences in survival between groups. Multivariate analysis, using the Cox Proportional Hazard (PH) regression model, was used to estimate the hazard ratios (HRs) and select the significant associated factors for childhood cancer patients’ survival. Results: The overall 1-, 5- and 10-year survival rates for all childhood cancers combined were 79.4%, 70.0% and 68.8% respectively. The most common types of cancer were leukemias, malignant epithelial neoplasms, lymphomas and tumours of the central nervous system (CNS). The 5-year survival estimates were highest for malignant epithelial neoplasms (84.2%) while the lowest was tumours of the CNS (44.1%). Log rank tests showed significant differences in childhood cancer patients’ survival between tumour types and period of diagnosis. In the Cox PH analysis, the presence of lymphomas, gonodal and germ cell neoplasms, and malignant epithelial neoplasms compared to leukemia; children aged 1-4 and 5-9 years compared to adolescents aged 15-19 years; and periods of diagnosis in 2002-2006 and 2007-2011 compared to 2012-2017 were significantly associated with lower hazard of death in this study. Conclusion: This study provides a baseline measurement of childhood cancer survival for monitoring and evaluation of cancer control programmes, to allow planning of cancer control program strategies such as surveillance, screening, and treatment to improve childhood survival rates in Brunei Darussalam.     

Les tumeurs des glandes salivaires : étude anatomopathologique à propos de 105 cas

Introduction

Salivary gland tumours are rare and extremely varied. They represent 3% of all tumours in the body, and 6% of those of the head and neck. From a morphological point of view, they are dominated by their lesional polymorphism. This polymorphism is further increased, especially on a clinical level, by the diversity of the possible sites.

Material and methods

Our retrospective study investigated 105 cases of salivary gland cancer, diagnosed in the pathology department at the Mohammed V Military Teaching Hospital in Rabat, over a period of nine years, from 2000 to 2008. The main aim of our work was to report on the experience of the anatomical pathology department of the Mohammed V Military Teaching Hospital in Rabat, to highlight the epidemiological criteria and the different anatomopathological aspects and compare them with data found in the literature.

Results

There is a peak in frequency found between 30 and 40 years old, with patients being predominantly male (58%). The average age is 42, with extremes at 13 and 82 years old. This average is greater for malignant tumours (53 years old), than for benign tumours, which is 43 years of age. Benign tumours (77%) are far more common than malignant tumours (23%). The most common malignant tumour is adenoid cystic carcinoma (10%). Tumours are commonly found in the parotid gland (60%), and here benign tumours (90%) are a lot more frequent than malignant tumours (10%), with the most common benign tumour being pleomorphic adenoma (66%). The submandibular glands represent the second most common site (22%), and here benign tumours (88%) are also a lot more common than malignant tumours (12%). The minor salivary glands represent the third most frequent location (18%), and here, unlike other sites, it is malignant tumours (57%) that are more common than benign tumours (43%). The most common malignant tumour is adenoid cystic carcinoma.

Conclusion

On the whole, the results obtained are comparable with those found in the literature. The predominant histological type in our series was pleomorphic adenoma, followed byWarthin??s tumour. The most common malignant tumour was adenoid cystic carcinoma (10%), and in disagreement with data found in the literature, mucoepidermoid carcinoma was rarely observed. Adenoid cystic carcinoma is far more common in the minor salivary glands. Finally, it should be noted that the sublingual glands are rarely affected.     

Soft tissue sarcoma: the predominant primary malignancy in the retroperitoneum

Purpose. In the clinical work-up of a retroperitoneal mass, the diagnosis of soft tissue sarcoma is often not considered. Incidence rates of various malignant and benign retroperitoneal tumours were studied to determine the incidence of soft tissue sarcoma in comparison with other neoplasms in the retroperitoneal space.Method. Nation-wide data on retroperitoneal tumours, collected prospectively over a 5-year period (1 January 1989- 1 January 1994), were supplied by the Netherlands Cancer Registry and The Dutch Network and National Database for Pathology.Results. Seven hundred and six patients with a primary retroperitoneal neoplasm were identified; 566 patients had a malignant tumour (80%). A soft tissue sarcoma (STS) was the most frequently diagnosed malignant tumour (n = 192), The agestandardised incidence of retroperitoneal STS was 2.5 per million person-years. The male/female ratio for STS was 0.73. In females, STS comprised 41%of all malignant retroperitoneal tumours, carcinoma of unknown primary tumour site (CUP) comprised 31%, and malignant lymphomas (ML) comprised 22%, whereas in males these values were 28% (STS), 30% (CUP), and 32% (ML), respectively.Discussion. Soft tissue sarcomas, albeit rare, are relatively common primary tumours in the retroperitoneum, especially in women.     

The range and demographics of salivary gland tumours diagnosed in a UK population

Salivary gland tumours are relatively rare and comprise a diverse range of neoplasms. The aim of this study was to determine the range and demographics of all histologically diagnosed salivary tumours in a European population. All entries for salivary gland tumours from 1974 to 2005 inclusive were retrieved and analysed for each diagnosis including number of specimens, male:female ratio and age range. These data were then analysed for the distribution of benign and malignant salivary tumours in major and minor salivary glands. 58,880 specimens were received; of these, 741 cases (1.3% of all specimens) were diagnosed as salivary gland tumours with a male to female ratio of 0.7:1. There were 481 (64.9%) benign and 260 (35.1%) malignant neoplasms, with the most common tumours being pleomorphic adenoma and mucoepidermoid carcinoma, respectively. Our study provides demographic data on a large series of salivary gland tumours in a European population. Accurate diagnosis is essential as salivary lesions have diverse clinical and prognostic outcomes. This study has confirmed that some tumours have a predilection for certain sites and that the risk of malignant disease is also greater at specific sites within the oral cavity.