Neck mass with marked squamous metaplasia: a diagnostic pitfall in aspiration cytology

Fine-needle aspiration cytology (FNAC) is a highly accurate tool for the diagnosis of pleomorphic adenomas; however, this common salivary gland neoplasm can be diagnostically challenging, causing pitfalls in cytodiagnosis. A 50-year-old woman suffered from a painless, slowly-growing mass in the right posterior upper neck for 5 months. FNAC from this mass revealed many discohesive parakeratotic cells and keratin flakes, and a few stromal elements. Under the impression of metastatic well-differentiated squamous cell carcinoma, the tumor mass was totally excised. Histology confirmed a pleomorphic adenoma with marked squamous metaplasia and frequent keratin pearl formations without the evidence of malignancy. Pleomorphic adenoma occasionally reveals focal squamous metaplastic changes, when extensive, it may be misdiagnosed as metastatic well-differentiated squamous cell carcinoma in FNAC, particularly in the neck region.     

Necrotizing sialometaplasia.

Three cases of necrotizing sialometaplasia of minor salivary glands are presented. Clinically and pathologically, this nonneoplastic lesion of the palate can be easily mistaken for carcinoma. The main histologic features are localized infarction of minor salivary glands and extensive squamous metaplasia with retention of the lobular architecture of the involved glands. The possible etiologic factors are discussed.     

Pleomorphic Adenoma of the Palate

Pleomorphic adenoma is a benign tumor of the salivary glands that has elements of both epithelial and mesenchymal tissues. The tumor most commonly arises in the parotid or submandibular glands. Infrequently, it may arise from the minor salivary glands and present as an intraoral mass over the palate or lip. We report a patient with PA over the hard palate, which resembled common intraoral diseases like oral papilloma, squamous cell carcinoma and condyloma acuminate.     

Clear cell carcinoma of the mandibular gingiva 'minor salivary gland': a case report with immunohistochemical study

Clear cell carcinoma is a rare neoplasm that arises in salivary glands. They are more frequent in the intraoral minor salivary glands than the major salivary glands. The present case involved a 44-year-old Japanese man with a slight reddish swelling on the mandibular gingiva. Initial clinical diagnosis was squamous cell carcinoma based on this erythroplakial lesion. All tumor cells displayed the expected pattern of immunoreactivity, with positive results for pancytokeratin and high molecular weight cytokeratin. This report examined the immunohistochemical characteristics of clear cell carcinoma, minor salivary gland, and reviewed the existing literature.     

Immunohistochemical demonstration of bone morphogenetic protein-2 and type II collagen in pleomorphic adenoma of salivary glands

Immunohistochemical investigation of bone morphogenetic protein-2 (BMP-2) and type II collagen, two cartilage-associated proteins, was undertaken using monoclonal antibodies in 20 cases of salivary pleomorphic adenoma (PA) in order to explore their possible roles in chondroid differentiation of this tumor. Other salivary gland tumors, including adenoid cystic carcinoma (17 cases), polymorphous low-grade adenocarcinoma (10 cases), basal cell adenoma (3 cases), basal cell adenocarcinoma (1 case), and epithelial-myoepithelial carcinoma (2 cases), were also examined for comparison. In PA, BMP-2 immunoreactivity was detected in the luminal and non-luminal cells of the tubulo-ductal structures, plasmacytoid cells, and other scattered tumor cells in solid areas. In addition, tumor cells in chondroid areas in most cases (14/15), and stellate cells in myxoid areas in many cases (7/19), were also intensely labeled for BMP-2. Furthermore, BMP-2 was also detected in the non-neoplastic ductal cells in salivary glands, whereas no other salivary gland tumors were positively stained for this protein. Type II collagen was localized in the intercellular matrix of chondroid areas and in a few chondroid differentiating cells in myxoid areas, confirming its cartilage-specificity. A proportional relationship was observed between BMP-2 expression and chondroid formation, although BMP-2 was also stained in occasional PAs without chondroid formation. It is speculated that BMP-2 might be secreted by tumor cells and play a role in chondroid formation in PA by inducing some tumor cells to produce type II collagen and other chondroid matrical substances, like glycosaminoglycans. The expression of BMP-2 is specific to PA and may possibly be used as a useful marker in differentiating PA from other salivary gland tumors.     

Salivary gland neoplasms: an analysis of 74 cases

Between 2006 and 2009, 74 cases of salivary gland neoplasms were analyzed retrospectively, of which 44 (60%) were benign and 30 (40%) malignant. 61 % percent of neoplasms were in the parotid gland, 22% in the minor salivary glands including sublingual salivary glands, and 17% in the submandibular glands. The most common benign neoplasm was pleomorphic adenoma (64%), and the most common malignant neoplasm were adenoid cystic carcinoma (17%) and mucoepidermoid carcinoma (23%). We analyze the incidence and distribution of all types of salivary gland neoplasms in our series, and provide data for comparison with other epidemiological studies from different geographical sites and races. Demographic data from these studies help us to a better understanding of the biological and clinical characteristics of the disease. Further epidemiological surveys should be encouraged for better understanding of the disease and to provide early and better treatment of salivary gland neoplasms     

Salivary gland neoplasms in Maiduguri, north-eastern Nigeria

OBJECTIVE: To document the pattern of salivary gland neoplasia in Maiduguri, Nigeria. DESIGN AND SETTING: A retrospective clinical and histopathological review (January 1987-December 2002) of cases diagnosed at a tertiary care hospital. MATERIALS AND METHODS: Information on demographics, diagnosis and cancer management in the hospital were retrieved from biopsy reports and case notes of patients. RESULTS: The palatal (71.9%) and parotid (78.3%) glands were the most common minor and major salivary glands involved, with a benign-malignant ratio of 1:1 and 1.4:1, respectively. Pleomorphic adenoma (44.3%) was the most common salivary gland neoplasm recorded. It was commonly reported in the third decade (mean 30.4 years) and among males (M:F, 1.4:1). Ectopic lesions (17.1%) were reported in the neck, nose and cervical nodes. Mucoepidermoid carcinoma (10.1%) was the most common salivary gland malignancy, occurring in the second and sixth decades; of equal gender distribution and predominantly in the palate (50%). The squamous cell carcinoma (10.9%) and adenoidcystic carcinoma (21.9%) were the most common malignancies in the major and minor glands respectively. There was a higher prevalence of malignancies of the parotid than previously reported for northern Nigeria (P = 0.036). CONCLUSION: Pleomorphic adenoma and mucoepidermoid carcinoma were the most commonly reported benign and malignant neoplasia in this series. The prevalence of mucoepidermoid carcinoma contrasts with reported findings in other African studies.     

Epithelial salivary gland tumors of children and adolescents in west China population: a clinicopathologic study of 79 cases

Objective:  Determine the clinical and histopathologic features of epithelial salivary gland tumors of children and adolescents.
Methods:  A total of 79 cases of epithelial salivary gland tumors of children and adolescents were retrieved from the files. Information about demographic, clinical, histopathologic characteristics, and follow-up status were analyzed.
Results:  Sixty tumors (75.9%) were benign and 19 (24.1%) malignant. The most common tumor overall was pleomorphic adenoma (PA). The parotid was the most frequently involved site (43.0%). PA was the most common type of benign tumor. The most common malignant tumor was mucoepidermoid carcinoma. Five patients with parotid PA and two cases with palate myoepithelioma showed local recurrences. One patient with mucoepidermoid carcinoma showed local recurrences and died from the tumor 3 years after the initial treatment. One patient with adenocarcinoma presented local and neck recurrences, and died 4 years after initial treatment.
Conclusions:  Our data showed that the salivary gland tumors in children and adolescents may be the higher incidence of benign tumors, especially of PA; the slightly higher tendency for female predominance; the higher incidence of parotid glands. Mucoepidermoid carcinoma was the most common malignant tumor, with majority of low grade. Initial treatment should be planned to excise the tumor completely with satisfactory margins. The neck dissections or postoperative radiotherapy were performed in patients with low differentiation malignancies, or patients who present nodal metastasis or with clinically suspicious regional metastasis.     

Papillary cystadenoma of the lower lip exhibiting ciliated pseudostratified columnar epithelium: report of a bizarre case and review of the literature

Background

Salivary gland tumors are uncommon and constitute 2–6.5 % of all head and neck neoplasms. Tumors of minor salivary gland origin account for less than 25 % of all salivary gland neoplasms. Papillary cystadenoma of salivary glands is a rare benign epithelial neoplasm characterized by multicystic growth in which the epithelium exhibits adenomatous proliferation. Papillary cystadenoma of minor salivary glands most frequently involves the lip, buccal mucosa, and palate. This tumor typically presents as a slow-growing, painless mass, usually with diameter of less than 1 cm and clinical resemblance to a mucocele. Although most papillary cystadenomas are predominantly of one cell type, a regional variability may be present.

Case Report

We present a case of papillary cystadenoma of the minor salivary glands in a 58-year-old patient exhibiting an upper respiratory tract epithelium, a profoundly atypical benign tumor.

Discussion

This type of minor salivary gland tumor epithelium in the lower lip may be the result of a metaplastic process or simply another neoplastic manifestation of papillary cystadenoma. As far as the differential diagnosis of this entity is concerned, it is important to distinguish it from papillary cystadenoma lymphomatosum (Warthin's tumor), low-grade mucoepidermoid carcinoma, the papillary-cystic variant of acinic cell carcinoma, and cystadenocarcinoma Recognition of this lesion is important for the clinician since the differential diagnosis includes lesions with similar clinical appearance and infiltrative behavior.     

Primary Squamous Cell Carcinoma of the Submandibular Salivary Gland: A Rare Entity

Salivary gland tumors make up about 3% of all neoplasms of the head and neck. Salivary gland tumors vary widely in histopathological appearance, thus it prompted the development of a revised histopathological classification of tumours. Malignant tumors can arise in the major salivary glands or numerous minor salivary glands lining the mucosa of the upper aerodigestive tract. This case highlights one of the rare variants of primary squamous carcinoma of the sub mandibular salivary gland and the management of submandibular salivary gland malignancies.     

Necrotizing sialometaplasia.

Two cases of necrotizing sialometaplasia are reported together with a review of the literature. This self-limiting benign lesion is easily confused with malignant tumors. The lesions are characterized histologically by an extensive necrosis of the salivary gland tissue together with squamous metaplasia of the ducts. The present report of two females who had intense pain in the initial phase differs from previous reports concerning age and symptoms. The importance of rather extensive biopsy specimens is stressed. Antibiotic treatment appears to be insignificant. A clinical history of allergy and a dominance of eosinophilic granulocytes in the inflammatory exudate in both cases may indicate an allergic etiology.     

Necrotizing sialometaplasia in a patient who is HIV positive: a case report

Necrotizing sialometaplasia (NS) is a self‐limiting, benign, inflammatory disease of the minor salivary glands of the hard palate. The main significance of the NS lesion lies in the fact that it may be mistaken for mucoepidermoid or squamous cell carcinoma. A case report is presented of a patient with NS who was HIV positive; the lesion was located in the minor salivary glands of the hard palate. Clinically, the lesion presented as a deep ulcer with slightly elevated irregular borders and a necrotic base in the hard palate. Histologically, the tissue was characterized by squamous metaplasia of ducts and acini, lobular coagulation necrosis, and pseudoepitheliomatous hyperplasia of the overlying epithelium. The lesion disappeared completely after 2 weeks.     

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.     

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.     

Salivary gland tumors in a Brazilian population: a retrospective study of 496 cases

Salivary gland tumors are uncommon and the microscopical features can be complex. Epidemiological data of these tumors in the various parts of the world can be helpful for a better understanding of its biology and clinical characteristics. In this study, 496 epithelial and mesenchymal tumors of major and minor salivary glands diagnosed at Londrina Cancer Institute during the period from 1972 to 2001 were reviewed. Out of all cases, 335 (67.5%) were classified as benign and 161 (32.5%) as malignant. The majority of the cases occurred in the parotid gland (67.7%), followed by the minor salivary glands (22.8%) and submandibular gland (9.5%). Among the minor salivary gland tumors, the palate was the most frequent location (67%). The tumors affected more commonly adult patients with peak incidence between 40 and 50 years of age and with a slightly predominance in females. Pleomorphic adenoma was the most frequent tumor representing 54.2% of all cases, followed by mucoepidermoid carcinoma (13.5%), Warthin's tumor (8.5%) and adenoid cystic carcinoma (7.9%).     

Oral collision carcinoma: salivary duct carcinoma of minor salivary gland origin and squamous cell carcinoma of the oral mucosa

This paper reports a case of oral collision carcinoma consisting of salivary duct carcinoma of minor salivary gland origin and microinvasive squamous cell carcinoma of the oral mucosa in a 65-year-old Japanese man. This is an exceedingly rare example of collision carcinoma in the oral region.     

Relative frequency of intra-oral minor salivary gland tumors: a study of 380 cases from northern California and comparison to reports from other parts of the world

BACKGROUND: The relative frequency of individual intra-oral minor salivary gland tumors (IMSGT) is not well documented in the literature. The aim of this study was to determine the relative frequency and distribution of IMSGT in an oral pathology biopsy service and to compare the data with similar studies from different parts of the world. METHODS: Files from the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, California served as a source of material for this study. Files were systematically searched for all cases of IMSGT during a 20-year period. Tumors were classified according to the 2005 WHO classification of salivary gland tumors. RESULTS: IMSGT were identified in 380 (0.4%) cases of 92 860 accessed. This is the largest series of IMSGT from one source reported in recent years. Of the 380 tumors, 224 (59%) were benign and 156 (41%) were malignant. Of the benign tumors, pleomorphic adenoma (PA) was the most common (39.2%), followed by cystadenoma (6.3%), canalicular adenoma (6.1%), ductal papillomas (4.4%), basal cell adenoma (1.6%), and myoepithelioma (1.3%). Of the malignant tumors, mucoepidermoid carcinoma was the most common (21.8%), followed by polymorphous low-grade adenocarcinoma (7.1%), adenoid cystic carcinoma (6.3%), adenocarcinoma, not otherwise specified (NOS; 2.1%), acinic cell carcinoma (1.6%), clear cell carcinoma, NOS (1.0%), and carcinoma ex PA (0.5%). CONCLUSIONS: Studies related to the relative frequency of individual IMSGTs from different parts of the world are difficult to compare because many studies are outdated, the number of cases is small, the list of tumors is limited, and new entities are not included. To determine the true relative frequency, more studies should be conducted, on a large number of cases from one source, by experienced pathologists in the field of salivary gland tumors.     

Epithelial-myoepithelial carcinoma of the parotid gland associated with a primary carcinoma of the lung

We describe the case of a 64-year-old man who presented with a rare salivary gland tumour, an epithelial-myoepithelial carcinoma. This was removed but recurred and required further surgery and radiotherapy. At the time of the patient's 2nd admission, a further primary tumour was detected. This proved to be a primary mixed adeno and squamous carcinoma of lung: a thoracotomy was performed and a lobectomy. The patient died suddenly 11 months later because of cor pulmonale. We describe the histology of epithelial-myoepithelial carcinoma and the immunohistochemical appearances of the tumour on staining for S-100, vimentin and keratin. The literature on this lesion is reviewed and radical surgery with post-operative radiotherapy are recommended as the best therapeutic approach. The literature on coincident second primary tumours in patients with salivary gland neoplasia is also reviewed. This is only the second case in which this phenomenon has been observed with epithelial-myoepithelial carcinoma.     

Minor salivary gland calculi. A clinicopathologic study of forty-seven new cases.

An analysis of forty-seven previously unreported cases of minor salivary gland calculi revealed that they were usually solitary, firm, freely movable, small masses. Also, we noted that these calculi exhibited a striking predilection for the upper lip and buccal mucosa of adults. The organic matrix of all calculi was similar; however, the amount of mineralized material was variable. A variety of types of epithelial metaplasia was noted in the pericalcular ducts, with the most common type being squamous-cell metaplasia. Chronic periductal and lobular inflammation in addition to duct ectasia were common findings. The cause of minor salivary gland calculi is not known; however, local factors, such as duct morphology or biochemical alterations, or both, may be involved.     

涎腺恶性淋巴上皮病损的免疫组化研究

涎腺恶性淋巴上皮病损（ＭＬＥＬ）是涎腺罕见的恶性肿瘤之一，具有明显的种族特性，好发于南部中国人。本文对１２例ＭＬＥＬ（其中１０例有随访资料）进行Ｋｅｒａｔｉｎ，Ｓ－１００，ＧＦＡＰ，ＣＥＡ免疫组化染色。结果发现Ｋｅｒａｔｉｎ免疫组化染色反应强者预后好，染色反应弱者预后差。以上四种抗体免疫组化染色结果尚提示ＭＬＥＬ的癌细胞具有与正常腺上皮细胞、肌上皮细胞及鳞状上皮细胞相似的抗原特性，提示该瘤来自涎腺导管上皮，常有鳞状上皮化生