Salivary duct carcinoma in major and minor salivary glands. A clinicopathological analysis of four cases

Salivary duct carcinomas are an uncommon but distinct group of highly malignant salivary gland tumours. We report the clinical course, pathological findings and surgical treatment of this tumour in 4 patients. In one patient an intraductal tumour developed in a minor salivary gland, while in the other three patients, a major salivary gland was involved by an infiltrating salivary duct carcinoma. We point out the highly aggressive biological behaviour of the tumour when occurring in the major salivary glands, in contrast to the benign course of the intraductal carcinoma in the minor salivary gland.     

Pleomorphic adenoma with extensive squamous metaplasia and keratin cyst formations in minor salivary gland: a case report

Pleomorphic adenoma (PA), the most common salivary gland tumor, accounts for 54 to 65% of all salivary gland neoplasias and 80% of the benign salivary gland tumors. It most frequently affects the parotid gland, followed by the submandibular and the minor salivary glands. Microscopically, mucous, sebaceous, oncocytic and squamous metaplasia, sometimes with the formation of keratin pearls, may be present, but the latter rarely results in the formation of extensive keratin-filled cysts lined by squamous epithelium. Extensive squamous metaplasia can be mistaken for malignancy, including mucoepidermoid carcinoma and squamous cell carcinoma. Here, we present an unusual case of PA with extensive squamous metaplasia and keratin cyst formations in a minor salivary gland, and discuss its microscopic features, including the immunohistochemical characteristics, and differential diagnosis of this uncommon presentation.     

Sebaceous adenoma of the parotid gland

Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven.     

Salivary gland tumors: a single institution experience in India

Between 1991 and 2006, 684 cases of salivary gland tumours were analysed retrospectively, of which 422 (62%) were benign and 262 (38%) malignant. Sixty-one percent of tumours were in the parotid gland, 22% in the minor salivary glands, and 17% in the submandibular glands. The most common benign tumour was pleomorphic adenoma (86%), and the most common malignant tumours were adenoid cystic carcinoma (25%) and mucoepidermoid carcinoma (18%). Among the minor salivary gland tumours, most were seen in the palate (68%).We analyse the incidence and distribution of all types of salivary gland tumours in an Indian series, and provide data for comparison with other epidemiological studies from different geographical sites and races. Demographic data from these studies should help us to a better understanding of the biological and clinical characteristics of the disease.     

腮腺皮脂腺癌1例

本文报告1例腮腺皮脂腺癌。患者男67岁,右侧腮腺区无痛性肿物1年。专科检查右腮腺区触及一大小约2 cm×2 cm×1.5 cm肿物。CT检查右侧腮腺浅部类圆形肿块影,边界模糊。病理镜下见透亮细胞、泡沫样细胞呈巢状、腺样或片状排列,免疫组化示:ACTIN(-)、CK(+)、GFAP(-)、P63(+)、S-100(-)、Vinmentin(-)。诊断为腮腺皮脂腺癌。     

Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child

Salivary gland tumours are rare in childhood, and almost all of them occur in parotid gland. Minor salivary gland tumours are even rarer, pleomorphic adenoma being the most frequently found tumour. Only seventeen cases of pleomorphic adenoma arising in the minor salivary gland tumour have been reported in children and adolescents. Pleomorphic adenoma of minor salivary gland represents about 45% of all the tumours of the minor salivary glands. Pleomorphic adenoma is slowly enlarging tumour indistinguishable from adenoid cystic carcinoma clinically, except for pain and ulceration, which is more common in the latter. Carcinoma arising from pleomorphic adenoma has been reported in 3% cases amongst the minor salivary gland tumours. This report presents a case of pleomorphic adenoma of minor salivary gland in a 14 year old female patient with a brief review of literature.     

唾液腺肿瘤中血小板衍生内皮细胞生长因子的表达和意义

目的:检测唾液腺肿瘤组织中血小板衍生内皮细胞生长因子(platelet derived endothelial cell growth factor,PD-ECGF)的表达及与微血管密度(microvessel density,MVD)值的相关性,探讨其在唾液腺常见肿瘤中的表达和意义。方法:用SP免疫组织化学法检测9例正常唾液腺组织、28例多形性腺瘤、25例黏液表皮样癌、33例腺样囊性癌组织中PD-ECGF的表达和MVD值。结果:PD-ECGF在正常唾液腺组织、多形性腺瘤、黏液表皮样癌、腺样囊性癌的表达阳性率分别为0、35.71%、80.00%、78.79%(P<0.05)。PD-ECGF主要表达于唾液腺肿瘤细胞的胞质中。PD-ECGF表达阳性的唾液腺肿瘤组织中MVD值高于PD-ECGF表达阴性的唾液腺肿瘤组织(P<0.05)。结论:PD-ECGF可能通过促进唾液腺肿瘤血管形成而在唾液腺肿瘤的生长和侵袭中发挥作用,可作为反映唾液腺肿瘤良、恶性的参考指标。     

睑板腺癌腮腺及下颌下区颈淋巴结转移1例报告

睑板腺癌常发生于上眼睑,转移至腮腺及下颌下淋巴结者较为少见,临床上需与腮腺原发肿瘤相鉴别。本文报告1例上眼睑睑板腺癌转移至腮腺及下颌下区淋巴结病例,为此类疾病的诊断及治疗提供指导。     

下颌下腺涎石病伴发黏液表皮样癌1例报告

黏液表皮样癌是最常见的唾液腺恶性肿瘤之一,最常发生于腮腺（约占2/3）,其次为腭部、小唾液腺（特别是磨牙后腺）及下颌下腺,而发生于由涎石病导致的慢性炎性下颌下腺者极为罕见。本文报告1例发生于慢性炎性下颌下腺中的黏液表皮样癌病例,并对其诊断和治疗方法进行讨论。     

A case of sebaceous carcinoma of the parotid gland

Sebaceous carcinoma of salivary gland origin is an extremely rare malignancy. It occurs mainly in the parotid gland. This is a case report of a sebaceous carcinoma in a 57-year-old woman who had a lump over the right parotid region for 8-9 months. The tumour was composed of small basaloid cells and large foamy cells. Sebaceous differentiation was evident in some tumour islands. This is the first case reported in the Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya.     

细胞外基质金属蛋白酶诱导因子表达与唾液腺肿瘤侵袭性的关系

目的:检测唾液腺肿瘤组织中细胞外基质金属蛋白酶诱导因子(EMMPRIN)的表达和定位,探讨其与唾液腺肿瘤侵袭性生物学行为的关系。方法:采用免疫组织化学方法,检测9例唾液腺正常组织、28例多形性腺瘤(PA)、25例黏液表皮样癌(MC)、33例腺样囊性癌(ACC)中EMMPRIN的表达和定位。采用SPSS10.0软件包进行多个样本率间的χ2检验或确切概率分析。结果:EMMPRIN在正常唾液腺组织、多形性腺瘤、黏液表皮样癌、腺样囊性癌的表达阳性率分别为11.11%、53.71%、84.00%和90.91%(P<0.05)。在正常唾液腺组织的表达主要见于导管上皮细胞的细胞膜;EMMPRIN蛋白在多形性腺瘤、黏液表皮样癌、腺样囊性癌的表达见于肿瘤细胞的胞膜或胞质。腺样囊性癌嗜神经现象组中,EMMPRIN表达的阳性率高于无嗜神经现象组,但差异无统计学意义。结论:EMMPRIN的表达与唾液腺肿瘤侵袭性生物学行为密切相关。     

涎腺非皮脂腺淋巴腺瘤2例报告及文献复习

目的:报告2例涎腺非皮脂腺淋巴腺瘤,并总结其临床病理特点。方法:收集2例非皮脂腺淋巴腺瘤的临床资料,常规切片HE染色观察其组织学特点。结果:2例非皮脂腺淋巴腺瘤男女各1例,年龄分别为59岁和50岁,无痛性肿块。镜下见该瘤由上皮成分和显著的淋巴样间质组成,上皮形成实性岛状、腺腔样结构或囊腔样结构,无皮脂腺细胞分化。结论:非皮脂腺淋巴腺瘤是一种罕见的涎腺上皮性良性肿瘤,组织学上具有特征性。     

Dnmt1和Dnmt3b在唾液腺黏液表皮样癌中的表达及意义

目的： 探讨DNA 甲基转移酶（DNA methyltransferase, Dnmt）在唾液腺黏液表皮样癌（mucoepidermoid carcinoma,MEC）中的表达及意义。方法： 选取2010 年1 月—2013 年9 月间中国医科大学附属盛京医院口腔颌面外科手术切除的唾液腺术后的标本43例,正常唾液腺组织17例,应用免疫组织化学和蛋白免疫印迹（Western blot）方法检测正常组织及MEC组织中Dnmt1和Dnmt3b 的表达。采用SPSS22.0软件包对数据进行统计学分析。结果： Dnmt1在MEC组织中的阳性表达率为37.21%,与正常唾液腺组织的17.65%相比,差异无显著性（P>0.05）;Dnmt3b在MEC组织中的阳性表达率为83.72%,显著高于正常唾液腺组织的11.76%（P<0.01）;但两者的高表达与临床病理参数之间无显著相关性（P>0.05）。结论： Dnmt3b在唾液腺MEC 的发生中可能发挥一定作用。     

Sebaceous adenoma of oral cavity: report of case and comparative proliferation study with sebaceous gland hyperplasia and Fordyce's granules

Sebaceous adenoma (SA) is a rare solitary tumour with a predilection for the forehead and scalp. In the English literature, less than 10 cases of SA have been described in the oral cavity. The objective of this study was to examine the clinicopathologic features and evaluate the expression of epidermal growth factor and its receptor, estrogen receptor and androgen receptor in SA and in its differential diagnoses including sebaceous gland hyperplasia (SGH) and Fordyce's granules (FG). Additionally, we analysed the proliferative potential of sebaceous cells from SA, SGH and FG by measuring proliferating cell nuclear antigen (PCNA) expression and quantification of argyrophilic nuclear organizer regions (AgNORs). The SA showed many clinicopathologic similarities to cases previously reported including the biphasic population of cells, in the periphery of lobules undifferentiated basaloid cells whereas the central area was formed by mature sebocytes. SA was composed of 198 lobules of sebaceous cells, whereas SGH and FG showed a mean of 21 +/- 7.81 and 5.84 +/- 2.83, respectively. The AgNOR and PCNA indices were similar in SA, SGH and FG. These data suggest that lobule counts may be used as additional criteria in distinguishing SA of the oral cavity from other intraoral sebaceous gland lesions.     

Hybrid tumours of salivary glands. Definition and classification of five rare cases

Hybrid tumours are very rare tumour entities which are composed of two different tumour entities, each of which conforms with an exactly defined tumour category. The tumour entities of a hybrid tumour are not separated but have an identical origin within the same topographical area. In contrast, biphasically differentiated tumours are a mixture of two cellular patterns with a corresponding term in the tumour classification. Examples of a biphasic differentiation are: basaloid-squamous carcinoma, adeno-squamous carcinoma or sarcomatoid carcinoma, and epithelial-myoepithelial carcinoma, mucoepidermoid carcinoma or adenoid cystic carcinoma. Hybrid tumours must also be distinguished from the multiple occurrence of salivary gland tumours which can develop syn- or metachronously. In the tissue samples of more than 6600 salivary gland tumours covered by the Salivary Gland Register (Institute of Pathology, University of Hamburg, Germany) only 5 cases of hybrid tumours were recorded between 1965 and 1994. This means less than 0.1% of all registered tumours. Case 1 was a very rare example of a hybrid adenoma with differentiation as a basal cell adenoma and a canalicular adenoma of the parotid gland. The similar cellular origin of both types of adenoma may be an explanation for its development into a hybrid adenoma. Case 2 is a hybrid tumour with a composition of basal cell adenoma and a glandular type of adenoid cystic carcinoma. In both types of tumours the two cell types (duct-lining cells and modified myoepithelial cells) have a similar histogenetic origin. Therefore, the development of both cell types in a hybrid tumour with two trends of differentiation is possible. Case 3 represents a hybrid adenoma as a mixture of a Warthin tumour and a sebaceous adenoma. Although inclusions of sebaceous cells are observed in Warthin tumours, this hybrid tumour shows a composition of two different epithelial structures in a varied mixture. Case 4 is a very rare and unique hybrid carcinoma with two absolutely different components: acinic cell carcinoma and salivary duct carcinoma. The poor prognosis of this hybrid carcinoma is determined by the salivary duct carcinoma. Case 5 represents a hybrid carcinoma whose two components have a similar histogenetical basis: epithelial-myoepithelial carcinoma and a glandular type of adenoid cystic carcinoma. Both carcinomas are composed of variable proportions of ductlining cells and myoepithelial cells.     

Epidermoid carcinoma arising in Warthin's tumour: a case study

We present a case of epidermoid carcinoma arising in Warthin's tumour of parotid gland in an 80–year-old woman. Light microscopy revealed small foci typical of benign Warthin's tumour with transition to epidermoid carcinoma. Immunohistochemical and ultrastructural observations confirmed the epidermoid features of the malignant cells. The differential diagnosis of a metastasis from an epidermoid carcinoma to the stroma of Warthin's tumour and also of the so-called metaplastic variant of Warthin's tumour is discussed.     

Lymphoepithelial carcinoma in the sublingual gland

Lymphoepithelial carcinoma is rare in the salivary glands, with an incidence of 0.4%. The most commonly affected site is the parotid gland, followed by the submandibular gland. Lymphoepithelial carcinoma in the sublingual gland has been reported only four times in the existing English-language literature. Such tumours are characterized by the presence of a poorly differentiated carcinoma that is surrounded and infiltrated by lymphocytes, and they are strongly associated with Epstein–Barr virus infection, patient ethnicity, and prominent radiosensitivity. Wide surgical excision combined with adjuvant therapy has been suggested as the first-choice therapeutic regimen. This report describes the case of a 34-year-old Indonesian woman who was evaluated and treated in Taipei Medical University Hospital. She had a tumour that presented as a painless swelling on the floor of the mouth. The diagnosis was confirmed by conducting an incisional biopsy, and a wide surgical excision with bilateral supraomohyoid neck dissection and free flap reconstruction was performed. The patient also underwent adjuvant chemoradiotherapy. No evidence of local recurrence or distant metastasis was detected during the 6 months of follow-up. Subsequently, the patient returned to her home country, and further follow-ups were not conducted.     

Prognostic factors in head and neck mucoepidermoid carcinoma: experience at a single institution based on 64 consecutive patients over a 28-year period

Mucoepidermoid carcinoma (MEC) is the most common malignancy of the salivary glands. The clinical behaviour of MEC is largely unpredictable, ranging from indolent tumour growth to highly aggressive metastatic spread. The objective of this study was to determine the clinicopathological predictors of recurrence and survival in patients with head and neck MEC. The medical records of 64 patients who underwent surgical treatment for head and neck MEC between 1982 and 2010 were reviewed. The main outcome measures were disease-free survival (DFS) and overall survival (OS). Clinicopathological parameters evaluated were age, sex, anatomical subsite, histological grade, tumour stage, tumour size, adjuvant therapy, and nodal and margin status. For the entire cohort, the 5-year DFS was 82.8% and the 5-year OS was 67.2%. Histological grade and tumour subsite were statistically significant predictors of OS. Furthermore, tumour stage and nodal status were statistically significant predictors with respect to OS. Advanced tumour stage, high histological grade, submandibular/sublingual localization, and positive nodal status were independent predictors of the prognosis in patients with head and neck MEC. Further studies into the molecular biology of MEC are needed in order to provide new therapeutic strategies for patients with locally aggressive and highly metastatic carcinomas.     

Pleomorphic adenoma of the soft palate

Pleomorphic adenoma is the commonest benign salivary gland tumour, accounting for almost three fourths of all such tumours. Pleomorphic adenoma most commonly occurs in the parotid gland; however it is also encountered in the submandibular, sublingual and minor salivary glands.     

Expression of podoplanin in the mouse salivary glands

OBJECTIVE: Podoplanin is one of the most highly expressed lymphatic-specific genes. Here, we report the distribution of cells expressing podoplanin in mouse salivary glands. DESIGN: We immunohistochemically investigated the distribution of cells expressing podoplanin in mouse major salivary glands by laser-scanning microscopy. The expression of endothelial cell marker PECAM-1 was tested to discriminate lymphatic endothelium from salivary gland cells, and myoepithelial cells were identified by an antibody for P-cadherin. RESULTS: The podoplanin expression was rarely found in acini of the parotid gland but clearly found at the basal portion of acini in the submandibular and sublingual glands. The number of portion reacted with anti-podoplanin is greater in the sublingual gland than in the submandibular gland. The expression was also found at the basal portion of ducts in all major salivary glands. The P-cadherin expression was rarely found in acini of the parotid gland but found in acini of the sublingual gland and on ducts in parotid and sublingual glands, corresponding to the area of podoplanin expression. CONCLUSIONS: It was suggested that the acinar and myoepithelial cells in the salivary glands have the ability to express podoplanin, and that the expression may be concerned with the mucous saliva excretion.