Gingival metastasis from salivary duct carcinoma of the parotid gland

BACKGROUND: This article reports a rare case of metastasis of salivary duct carcinoma of the parotid gland to the gingiva and reviews the occurrence of metastatic processes to the oral mucosa. METHODS: A 67-year-old white male presented with a chief complaint of a painless nodular tissue growth on the gingiva with reportedly 5 months of evolution. The intraoral examination revealed a reddish, superficially ulcerated nodular lesion ( approximately 2 cm in diameter) on the right mandibular buccal attached gingiva, and the clinical aspect was that of a benign reactive lesion. The patient had undergone a parotidectomy for removal of a salivary duct carcinoma of the parotid gland almost 1 year before. A biopsy of the gingival lesion was performed, and the biopsied tissue was forwarded for histopathologic examination. RESULTS: The analysis of the histopathologic sections of the gingival lesion revealed histomorphologic characteristics very similar to those of the primary parotid gland tumor. The definitive diagnosis was gingival metastasis from a salivary duct carcinoma of the parotid gland. The patient died of complications of a pulmonary metastasis 1 month after the diagnosis of the oral metastatic lesion. CONCLUSIONS: Gingival lesions that mimic reactive and hyperplastic lesions may be metastases from malignant neoplasias of diverse origins. An accurate and timely diagnosis is crucial to establish proper and immediate treatment of the metastatic tumor and possibly identify an occult primary malignant neoplasia.     

Synchronous bilateral pleomorphic adenomas of the parotid gland

Bilateral pleomorphic adenomas of the parotid gland are extremely rare, accounting for less than 0.2% of all parotid gland tumors. We present a rare case of a patient with synchronous bilateral pleomorphic adenomas of the parotid gland. A 27‐year‐old woman presented with a 5‐month history of a slowly‐growing, painless swelling of the right parotid gland. After a thorough bilateral parotid examination and magnetic resonance imaging evaluation, bilateral tumors of the parotid gland were found. The patient underwent surgical excision of the bilateral tumors in one surgical setting. Histopathological examination showed that both tumors were pleomorphic adenomas. The patient has been followed for 24 months without recurrence of tumors. Careful preoperative examination and radiological evaluation of bilateral parotid glands might be necessary for the early diagnosis of synchronous bilateral tumors. We suggest that treatment be individualized depending on the sizes and locations of tumors, and the surgical and neurological risks.     

Basal cell adenocarcinoma of the oral minor salivary glands: review of the literature and presentation of two cases

Basal cell adenocarcinoma (BCA) is an unusual salivary gland malignancy that very rarely affects the minor glands. Here we present 2 cases of BCA arising in the minor salivary glands of the left cheek and junction of the hard and soft palate, respectively. The patients were both women aged 66 and 42 years. The tumors assumed a tubular-trabecular and a solid-membranous pattern, respectively. Both tumors showed immunopositivity for S-100, Bcl-2, and cytokeratin 7. One tumor was also immunopositive for epithelial membrane antigen and carcinoembryonic antigen, and the other tumor was reactive with p53 and vimentin. Both tumors were surgically removed. A comprehensive literature review revealed only 21 previously reported cases of BCA of oral minor salivary glands. This is an exceptionally rare salivary gland tumor, which, despite its low-grade behavior, demands complete surgical removal with adequate margins. Immunohistochemical studies may complement a thorough histopathologic analysis in discriminating BCA from other salivary gland tumors.     

Synchronous occurrence of ipsilateral synovial chondromatosis of the temporomandibular joint and pleomorphic adenoma of the parotid gland

We present a unique case characterized by true coexistence of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) with a salivary gland tumor, specifically pleomorphic adenoma, of the ipsilateral parotid gland. The possibility that the condition was the result of a single pathologic entity, ie, SC with extracapsular involvement or pleomorphic adenoma affecting the TMJ, received strong consideration. Nonetheless, careful assessment of the clinical, radiographic, MRI, and surgical findings strongly suggested the synchronous occurrence of 2 separate pathologic processes, despite their close proximity. Further, histopathologic examination confirmed the presence of both SC of the TMJ and pleomorphic adenoma of the superficial lobe of the ipsilateral parotid gland. Previous reports have pointed out the possibility of misdiagnosing extracapsular spread of SC as a salivary gland tumor. Vice versa, it has been noted that parotid gland tumors, especially malignant, may cause TMJ symptoms similar to those of SC. However, to the best of our knowledge, this is the first time that true synchronous occurrence of ipsilateral SC and pleomorphic adenoma, or parotid tumor of any kind, is reported.     

Preauricular transcondylar approach for basal cell adenoma of parotid coexist with ganglion cyst of the ipsilateral temporomandibular joint

The concurrence of 2 independent neoplasias in the ipsilateral parotid and the temporomandibular joint (TMJ) region was infrequently reported. In this article, we present a unique case characterized by the coexistence of a rare salivary gland tumor, basal cell adenoma, of the parotid gland with a ganglion cyst in the ipsilateral TMJ region. A special surgical procedure was also presented here using a modified preauricular incision and transcondylar approach for extracapsular dissection of both lesions. Previously published literature are about the traditional treatment of benign parotid tumors using partial or total parotidectomy with the preservation of facial nerve mainly via an S-shaped submandibular incision and approach. Here, for the first time, a special surgical method using preauricular transcondylar approach for this unique case of synchronous occurrence of parotid tumor and TMJ cyst is reported.     

Oncocytic adenocarcinoma of salivary glands

Oncocytic adenocarcinoma of salivary gland origin is an extremely rare neoplasm. The diagnosis is established on the basis of oncocytic cellular features in conjunction with dysplastic change. These dysplastic changes may occur in benign oncocytomas or arise de novo. The tumor occurs most commonly in the parotid glands of persons over 60 years of age. Tumors that measure less than 2 cm at the initial surgical procedure appear to have a better prognosis than larger tumors. Aggressive surgical intervention at the initial presentation of the neoplasm, compared to simple enucleation, seems to offer a more favorable prognosis. Recurrence is an ominous feature. Metastasis, when it occurs, is widespread.     

Synchronous mucoepidermoid carcinoma of tongue and pleomorphic adenoma of submandibular gland

Presentation with synchronous salivary gland tumors is rare, with the most typical combination being Warthin's tumor and pleomorphic adenoma of the parotid gland. Involvement of minor salivary glands in such occurrences is extremely uncommon. We report a case of simultaneous mucoepidermoid carcinoma of the tongue and pleomorphic adenoma of the submandibular gland in a 40-year-old woman. The submandibular mass was initially considered to represent regional lymph node tumor metastasis but later was shown to be an intraglandular primary neoplasm.     

Metastatic malignancy in the submandibular gland.

Metastatic disease in the major salivary glands has been observed and reported in the literature. Often the site of origin of the primary tumor is the skin or mucosal lining of the head and neck structures, and the primary tumors most commonly are melanomas or squamous-cell carcinomas. The most frequently involved salivary gland is the parotid. The submandibular and sublingual glands are rarely involved by mestastatic disease. Secondary lesions arising from distant primary tumors may occasionally involve the parotid gland, but they are extremely rare in the other major salivary glands. The second reported case of metastatic carcinoma in the submandibular gland is presented here. Our case and the previously reported case are similar in that both primary tumors originated in the breast. The clinical and morphologic features are reviewed.     

Malignant mixed salivary tumor presenting as a mandibular metastasis

A rare case of a central mandibular metastatic mixed salivary gland tumor is reported which presented following a 45-year history of recurrent benign mixed salivary gland tumor of the parotid gland on the same side. The mandibular tumor included a predominantly benign mixed salivary gland component as well as frankly invasive adenocarcinoma. The clinicopathologic features of the mandibular and residual parotid tumors suggested that the metastatic event may have occurred prior to the development of frank carcinoma in the parotid tumor.     

Synchronous lymphomas arising in ipsilateral parotid and submandibular glands: video-assisted surgery

The incidence of lymphomas in salivary glands is 5%, and it represents 10% of malignant salivary tumors. Synchronous tumors arising in different major salivary glands are not only very infrequent but also extremely rare; on the other hand, synchronous lymphomas in ipsilateral major salivary glands have not been reported previously. This article reports a case of synchronous lymphomas in mucosa-associated lymphoid tissue in the ipsilateral parotid and submandibular glands. Parotidectomy with facial nerve conservation and resection of the submandibular gland by video-assisted surgery using only a Blair-modified classic incision was performed. One year after the surgical procedure, the patient was followed up at regular intervals, and residual mucosa-associated lymphoid tissue lymphoma did not appear. This case illustrates the importance of the diagnostic possibility of synchronous primary tumors after identification of a simple one; this also reports the video-assisted resection of the submandibular gland using only a Blair incision, when a parotidectomy must be also made.     

Synchronous pleomorphic adenomas of the major salivary glandsA case report

The presentation of multiple distinct tumors in major salivary glands is rare. Although the most common tumor with bilateral synchronous or metachronous development is the Warthin tumor, pleomorphic adenomas have been diagnosed simultaneously as well. We report the case of a female patient who was diagnosed with pleomorphic adenomas in the right parotid and submandibular glands, concomitant with sialolithiasis affecting the submandibular gland. This patient had been exposed to head and neck radiotherapy in childhood, which may have played a role in the development of her tumors. A review of the relevant literature is included.     

Evaluation of parotid gland masses by rectilinear scanning.

Twelve salivary gland scans, done preoperatively for evaluation of parotid masses, included nine cases of Warthin's tumor. In addition to Warthin's tumor showing an accumulation of pertechnetate, increased activity was also present in two cases of mixed tumors. Warthin's tumor may also show decreased activity, with or without a large cystic component. Therefore, the interpretation of preoperative salivary gland scans must be made with caution.     

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.     

Rapidly growing intraparotid mass in a young child

Nodular fasciitis (NF) is a pseudosarcomatous lesion typically involving the subcutaneous tissue and fascia; rarely, it has been observed within a parotid gland. We report a case of NF in an 8-year-old boy who presented with a rapidly growing nodule in the right parotid gland. A preoperative fine-needle aspiration suggested a diagnosis of nodular (pseudosarcomatous) fasciitis. After fine-needle aspiration, the surgical excision of nodule with a conservative approach was made. Intraparotid NF was diagnosed by histopathologic examination confirming the former cytologic diagnosis. This case demonstrates that NF, although rarely may occur in unusual site as parotid gland, in cases of rapidly growing tumor masses in the parotid, a correct cytologic diagnosis in the fine-needle aspirate might spare unnecessary aggressive surgical treatment.     

腮腺淋巴上皮癌22例临床分析

目的探讨腮腺淋巴上皮癌的诊断方法、治疗方式及预后情况,为临床提供参考。方法 2012年至2019年期间收治的腮腺淋巴上皮癌病例22例,对患者的临床表现、影像学检查、治疗方式及随访结果进行回顾性分析。结果 22例患者中,男性8例,女性14例;年龄26~61岁,主诉病程3天~18年,单侧腮腺区多发肿块1例,其余21例均为腮腺区单侧单发肿块。所有患者均行术前螺旋CT检查,CT所示腮腺组织内软组织肿块影,其内密度影欠均匀,CT值26~81 HU,15例表现为类圆形,界限尚清晰;7例表现为结节状,界限稍不清晰或部分不清晰。所有病例诊断最终依据病理学检查,HE染色图像可见肿瘤细胞边界清楚,上皮细胞生长活跃伴有异型性,可见核分裂像,肿瘤间质可见丰富的淋巴细胞浸润。22例患者均接受手术治疗,其中9例患者未行颈淋巴清扫。20例患者术后接受辅助放疗,其中10例同时行辅助化疗;1例患者术后仅行化疗,1例患者术后未行其他任何辅助治疗。所有病例均得到回访,21例无瘤生存13个月~8年,1例患者术后16个月因肝转移死亡。结论腮腺淋巴上皮癌是临床上较为罕见的恶性肿瘤,病理仍是诊断腮腺淋巴上皮癌的金标准。根治性手术切除肿瘤是首选治疗方法,根据临床检查及影像学检查及颈部情况进行选择性颈淋巴清扫,术后辅助放化疗可获得较好的治疗效果。     

Synchronous tumours of the unilateral parotid gland: rare or undetected?

INTRODUCTION: Multiple tumours of the parotid gland with the same histological appearance may occur as synchronous unilateral tumours, but bilaterality has also been reported. Synchronous multiple unilateral parotid tumours with different histology remain rare. METHODS: Between January 1988 and May 2002, a total of 341 patients underwent parotidectomy in our department. Medical charts were reviewed retrospectively for synchronous multiple unilateral tumours. RESULTS: Fourteen patients had two or more tumours within the same specimen. The combinations encountered were two to four adenolymphomas (n=9), adenolymphoma plus pleomorphic adenoma (n=3), adenolymphoma plus MALT lymphoma (n=1), and pleomorphic adenoma plus acinic cell carcinoma (n=1). The outcome was clinical freedom from signs of tumour recurrence in any patient (mean follow-up = 51 months). CONCLUSION: Synchronous multiple unilateral parotid tumours usually include two or more adenolymphomas and might occur more often than previously realized. The possibility of a concomitant carcinoma, and the prevention of recurrent tumours, may warrant a more radical surgical excision of the parotid gland, accurate intraoperative examination of the resected specimen, and routine histological evaluation of the entire specimen. Preoperative radiological investigation may further increase the chances of finding multiple parotid tumours.     

同侧腮腺多形性腺瘤合并淋巴上皮癌1例报告及文献复习

同侧腮腺良、恶性多原发肿瘤极为罕见。本文报告同侧腮腺同时性多形性腺瘤和淋巴上皮癌1例,结合文献回顾,分析腮腺多原发肿瘤临床诊治过程中应注意的问题,并提出病理诊断的必要指征。     

Unilateral agenesis of the parotid gland: a case report

Agenesis of the parotid gland is an extremely rare condition and may be partial or total, unilateral or bilateral, and may occur on its own or associated with other developmental abnormalities. We report a case of unilateral agenesis of the parotid gland without involvement of other major salivary glands together with a compensatory hypertrophy of the contralateral parotid gland.     

腮腺嗜酸细胞腺瘤合并Warthin瘤1例报告及文献复习

一侧腮腺区同时发生不同组织学类型的肿瘤极少见。本文报告1例发生在腮腺一侧瘤体内同时存在嗜酸细胞腺瘤与Warthin瘤2种不同成分的罕见病例,并结合相关文献复习,对其病因、临床特点、诊断及治疗进行讨论。     

Warthin tumor arising from the minor salivary gland

ABSTRACT: Warthin tumor (WT) accounts for 4% to 13% of all salivary gland tumors. This benign tumor, which commonly arises in the parotid gland, is the second most common tumor of the salivary gland. WT is multicentric in 12% to 20% of patients and is bilateral in 5% to 14%. The mean age at diagnosis is 62 years (range, 12-92 years), and it rarely presents (<6%) before age 40 years. Extraparotid WT, arising from the submandibular gland or cervical lymph node for example, is very infrequent, with corresponding incidences of 0.4% to 6.9% and 8%, respectively. Moreover, WT arising from the minor salivary gland is extremely rare, with a reported incidence of merely 0.1% to 1.2%. We report here WT arising from the minor salivary gland in the buccal mucosa in a 66-year-old woman and review cases of WT of the minor salivary gland reported in the English literature.