Sclerosing polycystic adenosis of the oral cavity

Minor salivary glands are ubiquitous in the oral cavity, and related diseases are often indolent and asymptomatic. We describe the unusual features of sclerosing polycystic adenosis, and its similarities to more sinister conditions of the minor salivary glands. Its importance is currently uncertain and research points to a pathogenesis that is neoplastic, which can create ambiguity. Sclerosing polycystic adenosis is a newly-discovered condition that merits further discussion and research to evaluate its full impact.     

Warthin样黏液表皮样癌、Warthin瘤合并黏液表皮样癌及伴黏液化生3例

Warthin样黏液表皮样癌是一种新近发现的涎腺黏液表皮样癌亚型,形态类似于Warthin瘤,但具有与黏液表皮样癌相似的t(11;19)(q21;p13)染色体易位.因此鉴别诊断非常重要.Warthin瘤合并黏液表皮样癌极为罕见.本文报告了1例Warthin样黏液表皮样癌、1例Warthin瘤合并黏液表皮样癌、1例Wa...     

组织蛋白酶D在涎腺黏液表皮样癌中的表达

目的探讨组织蛋白酶D(Cath-D)在涎腺黏液表皮样癌中表达的意义。方法采用苏木素-伊红染色方法筛选典型病例与免疫组织化学方法分析21例黏液表皮样癌中Cath-D的表达。结果 Cath-D在正常涎腺组织的基底膜、腺管部位有弱阳性表达,在黏液表皮样癌中有强阳性表达,其强弱程度与病理分级存在相关性(r=0.54,P<0.01)。染色强度与染色面积评分之和与病理分级存在相关性(r=0.66,P<0.01)。在肿瘤浸润前沿表达显著。结论在涎腺黏液表皮样癌中Cath-D表达强弱程度与病理分级密切联系,癌症浸润前沿表达情况可以为临床治疗提供参考。     

涎腺粘液表皮样癌诊断与治疗

目的：探讨涎腺黏液表皮样癌的诊断、治疗及疗效。方法：收集2001～2008年收治的20例涎腺黏液表皮样癌病例资料进行回顾分析。结果：20例黏液表皮样癌中腮腺13例（65%）,副腮腺1例（5%）,腭部2例（10%）,颌骨2例（10%）,颌下腺1例（5%）,颊黏膜1例（5%）。其中11例为高分化,4例为中分化,1例为低分化,其余未分级。20例患者均行手术切除（切除范围视肿瘤部位及分级而定）,其中4例行同侧颈部选择性淋巴清扫术,17例行术后放疗。3例因面神经受累同时切除面神经,其中1例行面神经吻合术,1例行耳大神经移植术,手术半年后患者面神经功能恢复良好。随访1～5年,失访2例,平均随访时间2.44年。获随访的18例均无复发。结论：手术切除时应重视原发灶切除的彻底性,在疑有颈部淋巴结转移时应同期进行选择性颈部淋巴清扫术;对于术中切除不彻底,有颈部淋巴结转移,病理结果显示为中低分化病例应进行术后放疗。     

Ultrastructural study of the histogenesis of salivary gland mucoepidermoid carcinoma

This electronmicroscope study of the histogenesis of mucoepidermoid carcinoma is based on 15 cases from the major and minor salivary glands. Six major cell types were identified: undifferentiated (cuboid) stem cells, intermediate (columnar) cells, serous/mucoid secretory cells, mucus-producing goblet cells, squamous/epidermoid cells and myoepithelium. It is proposed that undifferentiated stem cells serve as pluripotential reserves which give rise to the various cell types seen in mucoepidermoid carcinoma. Reserve cells in the acinar-intercalated duct components of the salivary glands appeared to give rise to the serous/mucoid and myoepithelial cell populations of mucoepidermoid carcinoma. Reserve cells in the proximal ducts system (intra/extralobular striated ducts and excretory ducts) differentiated into myoepithelium, intermediate (columnar) cells, squamous/epidermoid and mucus-producing goblet cell lines. It is proposed that neoplastic reserve cells give rise to different tumor types in the salivary glands. These types result from varying admixtures and arrangements of tumor cells at different stages of their structural and functional cytodifferentiation from reserve cells. It is further proposed that neoplastic reserve cells differentiate along similar cell lines as the embryonic "stem cells" in the development of normal salivary glands.     

Prevalence of mucoepidermoid carcinoma among intraoral minor salivary gland tumors: A systematic review and meta-analysis

This study aimed to synthetize and critically appraise available evidence regarding mucoepidermoid carcinoma (MEC) prevalence among intraoral minor salivary gland tumors (MiSGT). Five main electronic databases and three grey literature databases were searched. The risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Proportion meta-analyses were performed. From 1321 studies identified, 82 were included in qualitative synthesis and 80 in meta-analyses. Sixteen were classified as high, 33 as moderate, and 33 as low RoB. A total of 12 774 MiSGT were found, of which overall MEC prevalence was 16.5% (95% Confidence Interval [95% CI] = 14.8%-18.4%). Most MiSGT were found in the palate (n = 7115), although MEC pooled prevalence in this anatomic location was only 13.6% (95% CI = 11.7%-15.6%). The retromolar area presented the highest pooled prevalence (58.9%; 95% CI = 47.0%-70.3%), followed by gingiva (28.8%; 95% CI = 22.7%-35.4%) and tongue (27.2%; 95% CI = 21.2%-33.6%). Regarding geographic location, Middle East presented the highest pooled prevalence (20.8%; 95% CI = 14.8%-27.6%), followed by America (20.0%, 95% CI = 17.2%-23%) and Europe (15.6%; 95% CI = 9.2%-23.5%). Among MiSGT, the MEC overall prevalence was approximately 16.5%. Although most MiSGT were found in the palate, the retromolar area was proportionally more affected by MEC.     

桩蛋白在涎腺黏液表皮样癌中的表达

目的:探讨桩蛋白(paxillin)在涎腺黏液表皮样癌中表达的意义。方法:采用HE染色方法筛选典型病例与免疫组织化学方法分析21例黏液表皮样癌中paxillin的表达。结果:paxillin在正常涎腺组织的基底膜、腺管部位有弱阳性表达,在黏液表皮样癌中有强阳性表达,其强弱程度与病理分级存在相关性(r=0.75,P<0.01),染色强度与染色面积评分之和与病理分级存在相关性(r=0.93,P<0.01),在肿瘤浸润前沿表达显著。结论:在涎腺黏液表皮样癌中paxillin表达强弱程度与病理分级密切联系,癌症浸润前沿表达情况可以为临床治疗提供参考。     

17-β雌二醇对人粘液表皮样癌Mc3细胞增殖的影响

目的 :研究 17-β雌二醇 (E2 )对体外培养的人粘液表皮样癌Mc3细胞增殖的调节作用。方法 :不同浓度、时间的E2 处理Mc3细胞 ,采用细胞计数、克隆形成测定、流式细胞术、免疫组织化学染色等方法 ,检测E2 对人粘液表皮样癌Mc3细胞系细胞群体倍增时间、克隆形成率、细胞周期分布以及对PCNA、Bcl -2阳性表达的影响。结果 :对照组E2 浓度为 10 -9、10 -8、10 -7mol/L时 ,其细胞群体倍增时间分别为 :3 6.0h、2 7.9h、2 8.8h、2 5 .7h ;细胞克隆形成率分别为 :13 .7%、18.1%、17.6%、2 0 .8% ;PCNA的阳性表达率分别为 :62 %、78%、74%、98% ;Bcl-2的阳性表达率分别为 :48%、82 %、77%、93 %。流式细胞术检查结果显示 10 -7mol/L的E2 处理 12、18、2 4h后 ,细胞周期中S期细胞所占比例分别为 :11.3 %、7.0 %、46.7%。结论 :一定浓度的雌激素具有促进细胞G1/S期转换 ,增加S期细胞数量 ,加速DNA合成 ,从而促进细胞增殖。     

Prognostic value of CRTC1-MAML2 translocation in salivary mucoepidermoid carcinoma: Systematic review and meta-analysis

The presence of the CRTC1-MAML2 translocation has been described in mucoepidermoid carcinoma (MEC) as a predictor of better survival rates. However, the real prognostic value of the translocation has been debated due to recent controversial findings. The aim of this study was to perform a systematic review to understand the prognostic potential of the CRTC1-MAML2 translocation in MEC. An electronic search was carried out using the MEDLINE/PubMed, EMBASE and Scopus databases. Articles that assessed the association between the CRTC1-MAML2 translocation and survival of MEC patients were selected for the systematic review. Ten published articles were included in the qualitative synthesis. The prevalence of the translocation varied from 33.7% to 69.7%. Seven studies observed a significant association between the presence of the CRTC1-MAML2 translocation and a favourable clinical outcome, which could improve disease-free, disease-specific or overall survival. Five studies were included in the quantitative synthesis. Fixed-effects model confirmed that translocation-positive patients have a decreased risk of death (combined odds ratio 0.08, 95% confidence interval – 0.03-0.23, P < .00001). The detection of the CRTC1-MAML2 translocation appears to be useful as a prognostic factor in MEC. However, the level of evidence is not as high as it could be once important limitations were found in the published studies.     

Mucoepidermoid carcinoma of minor salivary glands: a clinical study of 16 cases and review of the literature

OBJECTIVE: Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of salivary glands with a widely diverse biologic behavior that is correlated with the histological grade of the tumor. The purpose of this study was to evaluate the clinical outcomes of MEC of minor salivary glands in a group of 16 patients, who were treated in our clinic, and to discuss the management of this carcinoma. MATERIALS AND METHODS: Between 1985 and 2000, 16 patients with MEC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the 'G. Papanikolaou' General Hospital, in Thessaloniki. The age range was 16-65 years. The distribution of the primary sites was: hard plate (one), soft palate (two), hard and soft palate (three), hard and soft palate with spread in paranasal sinus and nasal cavity (one), buccal mucosa (three), hard palate, alveolar process and buccal mucosa (two), and retromolar triangle (our). The tumors were clinically staged according to the tumor nodes metastase (TNM) system (Seifert, 1991). All patients were treated radically with surgery. The surgery was combined with radiotherapy in nine patients. Radiotherapy was delivered using Co-60. Doses ranged from 50 to 60 Gy and the duration of the therapy ranged from 25 to 35 days. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. RESULTS: The mean follow-up range was 4-14 years. From the 16 patients with MECs 10 (62.5%) were alive and five (35.6%) had died from the disease. Four patients were free of the disease for more than 5 years (range 8-14), five patients were free of the disease for 5 years and one patient was free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence developed in one patient 10 years after the initial treatment. Lymph node metastases occurred in one patient within the first year after the initial surgical treatment. Distant metastases (two in bones and one in lungs) occurred in three patients within 2 years after completing the treatment. The Pearson chi-square statistical analysis was used for comparing the Ki-67 values in correlation with histological grade of the tumors. The Ki-67 expression was only 1% in low-grade MECs, while in intermediate-grade tumors it was estimated between 3 and 4%. The high-grade tumors had increased expression (10%) of tumor cells. CONCLUSION: Complete surgical excision is the treatment of choice for MECs. Adequate excision is important in all grades of tumors. Prognosis of MECs is a function of the histological grade, adequacy of excision and clinical staging. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.     

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.     

抑癌基因PTEN在腮腺粘液表皮样癌中的突变与缺失

目的 :探讨抑癌基因PTEN在腮腺粘液表皮样癌发生、发展过程中的作用。方法 :应用聚合酶链反应(PCR)及克隆、基因测序的方法来分析腮腺粘液表皮样癌及正常腺体组织中PTEN基因第 5、6、8外显子有无突变及缺失。结果 :通过对PTEN基因 3个外显子的克隆测序 ,均未发现有突变及缺失。结论 :初步推断 ,在DNA水平抑癌基因PTEN在腮腺粘液表皮样癌的发生过程中不起作用     

Minor salivary gland carcinoma involving the oral cavity or oropharynx

BACKGROUND: Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection. METHODS: Patients referred to the multidisciplinary head and neck clinic at Westmead Hospital between 1980-2002 with a diagnosis of minor salivary gland carcinoma of the oral cavity or oropharynx were retrospectively identified. Data were collected on histology, treatment, outcome and the referring practitioner. RESULTS: A total of 30 patients diagnosed with a malignant minor salivary gland carcinoma were identified. Many patients, 16/30 (53 per cent), were referred by dentists. There were 15 males and 15 females with a mean age of 62 years (range, 22-86 yrs). Most (73 per cent) presented with early stage disease (stage 1/11). Adenoid cystic carcinoma was the most common histological subtype (40 per cent) followed by mucoepidermoid carcinoma (30 per cent) and polymorphous low-grade adenocarcinoma (20 per cent). All but two patients underwent surgery with 12/30 (40 per cent) also receiving adjuvant radiotherapy usually in the setting of an incomplete/close margin. One patient developed local recurrence and one developed widespread metastatic disease. At last follow-up 83 per cent of patients were alive and disease free. CONCLUSIONS: Early diagnosis and treatment of minor salivary gland carcinoma is likely to lead to a better outcome. In our study dentists were responsible for half of all referrals to our multidisciplinary head and neck clinic. Awareness of this uncommon entity is important for dental practitioners.     

Expression pattern of PLUNC proteins as an auxiliary tool for the diagnosis of high-grade mucoepidermoid carcinoma of the salivary gland

J Oral Pathol Med (2012) 41: 589-597 Background: Mucoepidermoid carcinomas are the most frequent malignant neoplasia of the salivary glands and are histologically classified as low, intermediate, and high grade. At present, histochemical stains such as periodic acid-Schiff or mucicarmine are useful tools in making a diagnosis. Recently, expression of the PLUNC proteins has been described in mucin-producing salivary gland tumors, with the suggestion that they could provide a powerful tool for the diagnosis of difficult cases. Methods: This study evaluates the expression of PLUNC proteins in 30 cases of salivary gland mucoepidermoid carcinomas. Tumors were reviewed and classified according to histological grade. Periodic acid-Schiff, mucicarmine, and immunohistochemical staining for SPLUNC1, LPLUNC1, SPLUNC2, and LPLUNC2 were carried out. Immunostaining was classified as positive or negative. Results: The majority of the tumors (63%) were classified as low grade, 13% were intermediate grade, and 23% were high grade. SPLUNC1 (90%) and LPLUNC1 (93%) were positive in the majority of cases, mainly in mucous cells, mucin plugs, and intermediate cells. SPLUNC2 and LPLUNC2 did not present significative expression within the tumors; however, LPLUNC2 was found to stain positively in mast cells in 83% of the samples. Conclusions: SPLUNC1 and LPLUNC1 showed a similar pattern of expression and could prove useful in the diagnosis of high-grade cases because of the differential staining in intermediate and epidermoid cells. The expression of LPLUNC2 in mast cells has not previously been reported, but further studies are necessary to validate this finding and to determine its significance.     

Immunohistochemical and fluorescent microscopic study of histogenesis of salivary mucoepidermoid carcinoma

The purpose of the present investigation was to study the histogenesis of the mucoepidermoid carcinoma of the salivary glands. Eleven cases of mucoepidermoid carcinoma of the minor salivary glands and five of the major glands were extensively studied employing immunohistochemical and fluorescent microscopic techniques. Both the intermediate cells and the duct cells showed a rather similar pattern of reactivity for vimentin, actin and EMA. Also, the intermediate cells and the myoepithelial cells showed a similar reaction pattern for keratin and UGA-1. The intermediate, myoepithelial and duct cells shared a similar reaction pattern for desmin, myosin, CEA, and S-100 protein. However, the rest of the tumor markers studied (AFP, PNA and WGA) were found to be non contributary. We also found that the intermediate and to some extent the epidermoid tumor cells showed a positive reaction with Azophloxine GA, which is a selective stain for myoepithelial cells in the normal glands. Based on these findings, the duct cells, the myoepithelial cell in the normal glands and the intermediate cells of the mucoepidermoid carcinoma share certain similar characteristics. The intermediate cells may actually be a mixed population, some having characteristics of the myopithelial cells and others of duct cells. These findings are relevant to the possible role of the intermediate cell in the histogenesis of the mucoepidermoid carcinoma.