Papillary cystadenocarcinoma originating from a minor salivary gland with lymph node metastases

Papillary cystadenocarcinoma is a rare malignant neoplasm of the salivary glands. This tumor most commonly arises in the major salivary glands, mainly in the parotid gland, and rarely metastasizes to regional lymph nodes. We report here a case of papillary cystadenocarcinoma originating from a minor salivary gland, localized in the lateral portion of the tongue and with neck metastases, in a 57-year old woman. We discuss histopathologic and clinical features of this lesion and review the literature.     

Nasopharyngeal lymphatic tissue in patients infected with human immunodeficiency virus. A prospective clinicopathologic study

A prospective clinicopathologic study of the nasopharyngeal lymphatic tissue, using a standardized approach, was carried out in 66 patients infected with human immunodeficiency virus (HIV) in Aviano, Italy. Two hundred eighteen patients without HIV infection served as a control group. A significantly higher percentage of nasopharyngeal lymphatic tissue hypertrophy was observed in HIV-infected patients compared with the control group, both clinically and pathologically. The finding of a higher incidence of nasopharyngeal lymphatic tissue hypertrophy during some stages of the disease, when cervical lymph nodes are enlarged, suggests that the extranodal nasopharyngeal district behaves in the same way as the lymph nodes. Nasopharyngeal lymphatic tissue hypertrophy should be placed at the forefront of the hitherto known head and neck manifestations of HIV infection. An ear, nose, and throat examination is mandatory for all patients with known or suspected HIV infection.     

Acquired immune deficiency syndrome--related lymphadenopathies presenting in the salivary gland lymph nodes

Homosexual males at risk for acquired immune deficiency syndrome (AIDS) frequently present with peripheral lymphadenopathies that precede the opportunistic infections and neoplasias of this disease. Two homosexual males had enlarged salivary glands due to lymphadenopathies initially affecting intraparotid and perisubmaxillary gland lymph nodes. Both the hyperplastic and the atrophic histologic patterns of AIDS-related lymphadenopathies were observed in the lymph nodes. Subsequently, the two patients developed lymphoma and opportunistic infections, respectively. The AIDS-related lymphadenopathy developing in salivary gland lymph nodes is an entity that should be considered in the differential diagnosis of salivary gland tumors.     

Clinical impact of sonographically guided biopsy of salivary gland masses and surrounding lymph nodes

Although fine-needle aspiration biopsy of salivary gland masses has been reported in the otolaryngology literature, the use of sonography to guide the biopsy of nonpalpable masses and masses seen on other cross-sectional imaging studies has not been described. Our goal was to evaluate sonographically guided biopsy of masses and lymph nodes related to the salivary glands. We analyzed the records of 18 patients who had undergone fine-needle aspiration biopsy of a salivary gland mass or lymph node with a 25-, 22-, or 20-gauge needle. A definitive cytologic diagnosis was made for 13 of the 18 patients (72%); cytology was suggestive but not definitive in three patients (17%) and insufficient in two (11%). Definitive diagnoses were made in three cases of reactive lymph node, in two cases each of lymph node metastasis and Warthin's tumor, and in one case each of pleomorphic adenoma, adenoid-cystic carcinoma, schwannoma-neurofibroma, parotid metastasis, parotid lymphoma, and Sj?gren's-related lymphoid-epithelial lesion. Sonographically guided biopsy allows for confident needle placement in masses seen on computed tomography and magnetic resonance imaging. Sonography can usually distinguish a perisalivary lymph node from true intrasalivary masses, and it can help the surgeon avoid the pitfall of a nondiagnostic aspiration of the cystic component of masses. We conclude that sonographically guided biopsy of salivary gland masses can provide a tissue diagnosis that can have a direct impact on clinical decision making.     

Cervicofacial Mycobacterial Infections Presenting as Major Salivary Gland Disease

Mycobacterium tuberculosis and atypical mycobacterium are well-known causes of cervical lymphadenopathy, most often presenting without symptoms of systemic infection. These organisms may also directly involve the parenchyma of the major salivary glands and their periglandular or intraglandular nodes. The diagnosis of mycobacterial infections of the major salivary glands, compared to cervical lymph nodes, is equally — if not more — difficult to make. The differential must include the same spectrum of inflammatory and neoplastic diseases as well as lesions unique to the salivary glands. Selected cases are presented and discussed to show that principles established for the treatment of cervical mycobacterial infections must also be applied to major salivary gland infections. In particular, cutaneous fistulas may result from incisional biopsy or incision and drainage of the involved gland. Partial parotidectomy or submaxillary gland excision may be required, followed by multidrug, antituberculous chemotherapy for one to two years. Culturing of the organisms is extremely difficult, and the diagnosis of either mycobacterium tuberculosis or atypical mycobacterial infection must be based on a combination of history and clinical examination, skin testing, histopathology, acid-fast stains, culture, and response to surgery and antituberculous chemotherapy.     

Basal cell adenocarcinomas of the submandibular and parotid glands recognized simultaneously report of a case

Basal cell adenocarcinomas (BCAC) of the major salivary glands are rare tumors. We experienced a case of BCACs that were recognized simultaneously in the submandibular and parotid glands. The case like this has not been reported previously. We present the case and discuss clinicopathologically the relation between the both tumors. Macroscopically, there was no direct infiltration between the both tumors. Microscopically, neural and perineural invasion were not found in both tumors. Distant hematogenous metastasis to other organs was not found. The fact that the parotid tumor had strong necrotic change and had no nodal structure suggests that the metastatic node had been rapidly enlarged beyond the size of the normal lymph node. It is reasonable to suppose that the submandibular tumor is a primary lesion and the parotid tumor is a metastatic lymph node.     

Malignant oncocytic tumour of the parotid salivary gland.

A 49-year-old man developed a tumour mass in his right parotid salivary gland nine years after a histologically proven benign mixed tumour of the same salivary gland had been surgically removed. Radical resection of the right parotid salivary gland and associated lymph nodes and soft tissues of the neck was performed. The parotid tumour was composed of oncocytic cells which infiltrated the surviving salivary gland tissue. Most of the excised lymph nodes contained metastatic deposits of oncocytic cells identical to the tumour seen in the parotid. There are no previous reports of the occurrence of both pleomorphic adenoma and malignant oncocytoma in the same salivary gland.     

Küttner's tumor: unusual presentation with bilateral involvement of the lacrimal and submandibular glands

Chronic sclerosing sialadenitis, known as Küttner's tumor (KT), is a chronic inflammatory disease of the salivary gland characterized by progressive periductal fibrosis, dilated ducts with a dense lymphocyte infiltration and lymphoid follicle formation, and acinar atropy. We report a unique case of KT in a 30-year-old female who presented with time-serial involvement of the bilateral lacrimal and submandibular glands with reactive follicular hyperplasia of bilateral upper cervical lymph nodes. All tissue samples of the submandibular and lacrimal glands were typical of KT on pathologic examination. There was no evidence of lymphoepithelial lesions or intraepithelial lymphocytes. This is the first case of KT involving both lacrimal and submandibular glands, suggesting that KT is closely related to an active local immune process.     

Manifestation of malignant lymphoma of the head and neck with special reference to the salivary glands

We found that thirteen per cent of all head and neck malignomas are malignant lymphomas. In 75% of these cases the Non-Hodgkin type could be found. The major salivary glands were involved by the lymphoma in 55% out of 104 patients. Paraglandular lymph nodes of the parotid gland were affected as well as intraglandular lymph nodes and the lymphoid tissue within the gland proper. The submandibular gland normally shows an involvement only with its paraglandular lymph nodes. Two thirds of the Non-Hodgkin lymphomas located in the salivary glands were low-grade. In case of clinical suspicion of a malignant lymphoma, fine needle biopsy is required for cytological diagnosis. However, surgery is mandatory for histological diagnosis, not as a therapeutic measure.     

The effect of clonidine treatment on the salivary glands of the rat. Results of biochemical and histological investigations.

The side-effects of clonidine, dryness of the mouth and parotid pain, as displayed by this clinically frequently used antihypertensive drug prompted us to investigate its effect on the salivary glands of the rat. After daily intraperitoneal injections for 3 weeks clonidine decreased the specific amylase content of the submaxillary glands caused by fall of activity in 2 of the 4 isoamylases. On the other hand, both activity of alpha-amylase and its isoenzyme pattern remained unchanged in the parotid glands as did their histological and histochemical appearance. The lymph nodes situated in front of the submaxillary glands, however, were considerably affected showing large abscesses. In the adjacent glandular parenchyma, round cell infiltrations and, occasionally, acinic cell necroses were observed.     

Adenoid cystic carcinoma secondary to heterotopic salivary gland tissue of the cervical lymph nodes

BACKGROUND: The presence of heterotopic salivary gland tissue in intra-, periparotideal and cervical lymph nodes is not an uncommen finding. In some rare cases the salivary gland inclusions in lymph nodes may undergo neoplastic transformation. PATIENT AND METHODS: An isolated and indolent tumor was detected in level III in the right cervical area in a 60 year-old male patient. The histological assessment of the extirpated node seemed to indicate lymph node metastasis of an adenoid cystic carcinoma. The radiological and endoscopic findings did not reveal a primary tumor. RESULTS: Due to the fact of missing of a primary tumor, the diagnosis of an adenoid cystic carcinoma in heterotopic salivary gland tissue of the cervical lymph node was established after long-term observation. CONCLUSION: After exclusion of an occult carcinoma of the salivary glands, the possibility of malignant transformation of heterotopic intranodal salivary gland inclusions should be considered in patients suffering from salivary gland carcinoma in the area of the cervical lymph nodes.     

Parotid heterotopia with pleomorphic adenoma

We observed an unusual and clinically unsuspected pleomorphic adenoma developing in the anterior midcervical region of a young man. The tumor developed within an ectopic parotid-type salivary gland. Surgical extirpation seems to have been curative. Embryologic concepts explaining the histogenesis of ectopic salivary glands (ESGs) are explored, and the problem of their concurrence with neoplasms is addressed. An additional feature was the presence of well-developed lymph nodes within the glandular complex, a morphologic component of ESGs that has not been previously emphasized.     

Benign lymphoepithelial lesions of the salivary glands.

The benign lymphoepithelial lesion of the salivary glands has been labeled with multiple, confusing terms. We recommend the abandonment of the vague term of Mikulicz disease. The histopathologic findings of lymphoid infiltration, intraductal proliferation, epimyoepithelial islands, and acinar atrophy are presented. The relationship between this lesion and autoimmune diseases, including Sj?gren syndrome, is noted. Difficulty of histopathologic differentiation between this lesion and malignant lymphoma can occur. The association of the benign lymphoepithelial lesion with the simultaneous presence or future development of lymphoma is discussed.     

Malignant lymphoepithelial lesion of the parotid gland: a case report and review of the literature

Malignant lymphoepithelial lesions are rare tumors of the major salivary glands. They most often occur in Asians and Greenland Eskimos and are strongly associated with Epstein-Barr virus infection. We report a case of a malignant lymphoepithelial lesion of the parotid gland that developed in an Italian-American woman whose serology was positive for Epstein-Barr virus antibody. The patient underwent a left total parotidectomy and upper neck dissection, followed by radiation therapy. At the 2-year follow-up, she remained free of disease.     

Salivary gland neoplasms in the years 1991-2006 in the material of the Department of Otolaryngology, Medical University in Bialystok

Complex structure of salivary glands, histological diversity of malignant salivary gland neoplasms and heterogeneous clinical image make therapeutic strategy difficult and controversial. The aim of this work was an epidemiologic analysis of 86 salivary gland tumour cases (in years 1991-2000) and 82 cases treated at the Otolaryngological Clinic of the Medical University of Bialystok (in years 2001-2006). Epidemiologic researches were conducted retrospectively. Age, sex, histological structure, location and local progression of tumour were analysed. The relationship between histological type, local progression and the presence of metastases to the cervical lymph nodes as well as remote metastases was also examined. The study was based on TNM Tumor Classification: large salivary glands (1977). It was found that malignant epithelial salivary gland tumours affect most commonly the parotid gland in men aged over 50 years. Adenoid cystic carcinoma was the most frequently represented histological type. Remote metastases were observed most commonly in patients with polymorphic adenoma.     

Distribution pattern of the cellular oral immune system in the major and minor salivary glands. Immunocytochemical findings

The cellular distribution of lymphocytes and immunocytes in the major and minor salivary glands was analysed comparatively by a semiquantitative method on mastoids from 53 random autopsies. In a second step, the immunoglobulin producing immunocytes were cytochemically distinguished by their content of IgA, IgG and IgM. In addition to the major salivary glands (parotid, sublingual and submandibular), seven minor salivary gland regions (palate, floor of the mouth, upper lip, lower lip, cheek, retrolingual region and tip of the tongue) were studied. The immunocytochemical differentiation was performed by the avidin-biotin-system; the findings were evaluated morphometrically. The following results were obtained: The incidence of a marked or massive infiltration with lymphocytes and immunocytes, especially in the periductal area, showed the following distribution: floor of the mouth 36%, sublingual gland 27%, cheek 26%, palate 25%, lower lip 12%, other salivary glands less than 10% (tip of the tongue 9%, submandibular gland 8%, parotid gland 6%, retrolingual region 4%). 90% of the immunocytes contained IgA, whereas only 10% showed IgG or IgM. The highest density of IgA producing immunocytes was found in the upper lip, followed by the glands in the cheek and lower lip, the submandibular gland and the glands in the floor of the mouth. The lowest infiltration rate with IgA containing immunocytes was seen in the glands of the tip of the tongue, of the cheek and in the submandibular and parotid glands. The glands of the lips and the cheek predominated with respect to IgG and IgM.(ABSTRACT TRUNCATED AT 250 WORDS)     

The determination of salivary pH by contact pH meter in individuals receiving psychotropic therapy. Study of pH on the tongue and at the orifice of Wharton's and Stenon's ducts (author's transl)]

The authors studied salivary pH at different sites in 172 patients receiving psychotropic therapy in hospital. For statistical purposes, the study was limited to individuals receiving a "moderate" dose of: --a benzodiazepine derivative --a neuroleptic and benzodiazepine --antidepressant, neuroleptic and benzodiazepine. Regardless of the type of psychotropic therapy and of the site of measurement, acidification of salivary pH which was statistically significant in comparison with values found in healthy subjects was noted. This acidification was particularly marked with regard to "lingual" pH. In addition, regardless of the site of measurement, a higher degree of acidification of salivary pH was seen in individuals receiving a combination of psychotropic agents. This acidification was particularly striking with regard to salivary pH in patients given a combination of antidepressant, neuroleptic and a benzodiazepine derivative. The cause of this acidification is not definitely known. A number of hypotheses may be put forward: decrease in salivary volume (Laudenbach, 6, and Vermeil, 7), excretion of acid metabolites by the salivary glands, effect of psychotropic agents upon the action itself of the salivary glands.     

Eosinophilic granuloma manifesting as painless cervical lymphadenopathy in a patient positive for human immunodeficiency virus 1

Eosinophilic granuloma is rarely reported within lymph nodes. Furthermore, it is even more rarely reported in the setting of human immunodeficiency virus (HIV) infection. No definitive etiologic association exists between Langerhans cell histiocytosis (LCH) and HIV. However, their potential relationship underscores the significance of cytokines and their influence on biological niches required for Langerhans development and homeostasis.     

Hodgkin and Non-Hodgkin lymphomas in otorhinolaryngology

Lymphomas of the head and neck arise in lymph nodes and extranodal areas as Waldeyer ring, nasal cavity, thyroid gland and salivary glands. Though anatomically in close proximity, lymphomas presenting at the ENT area have different clinical characteristics if they are Hodgkin or Non-Hodgkin. We included 31 patients with the diagnosis of lymphoma and diagnosed in our Department between 1999 and 2002. We studied all the different variables that differentiate Hodgkin and Non-Hodgkin's lymphoma. Both types of lymphoma usually present as a cervical mass. Non-Hodgkin lymphoma have extranodal involvement more frequently and also a more advance disease at diagnosis. It is important to include the lymphoma in the differential diagnosis of any cervical mass or ENT lesion.