Small-cell carcinoma of the parotid gland with neuroendocrine features

An 82-year-old woman had a small-cell carcinoma of the parotid gland with cells containing neuroendocrine secretory granules. To our knowledge, these dense-core granules have been identified in only three other major salivary gland small-cell carcinomas. The findings of histologic and ultrastructural evaluations of this neoplasm suggested a salivary duct cell origin. The tumor appears to arise from cells of the salivary duct system that differentiate into cells with either neuroendocrine or epithelial features. Electron microscopy to determine the type of small-cell carcinoma should be performed, as this may have prognostic significance. Aggressive therapy should be undertaken, since small-cell carcinomas of the major salivary glands appear to have a better prognosis than bronchogenic or laryngeal small-cell carcinomas have.     

Small cell undifferentiated carcinoma of the submandibular gland with neuroendocrine features

This article reports the clinical, histopathologic, and immunohistochemical findings in a case of small cell undifferentiated carcinoma of the submandibular gland. The tumor was composed of anaplastic cells slightly larger than lymphocytes without ductal differentiation. On immunohistochemical analysis, the tumor contained cells that reacted positively with antibodies to cytokeratin, neuron-specific enolase, synaptophysin, and chromogranin. The present case supports the hypothesis that small cell undifferentiated carcinomas of the salivary glands arise from presumed multipotential ductal stem cells. When this tumor entity is located on the salivary glands, it appears to behave less aggressively than when it is a primary tumor of the bronchial tree.     

Carcinomas ex monomorphic adenoma of salivary glands

A clinicopathological analysis of eight examples of carcinomas arising from salivary gland monomorphic adenomas, carcinomas ex monomorphic adenoma, is presented. These uncommon to rare neoplasms have a predilection for the parotid glands, are diagnosed about a decade later than their benign precursors, and most often arise from the dermal analogue type of monomorphic adenoma. As judged by follow-up periods of two to 16 years, carcinomas ex monomorphic adenoma are locally aggressive neoplasms with the clinical course marred by recurrences but without regional or distant metastases.     

Salivary duct carcinoma of the larynx: report of a rare case

Salivary duct carcinomas are primarily high-grade, aggressive malignancies that affect men in the fifth and sixth decades of life. These tumors are usually found in the major salivary glands; rarely do they originate in the minor salivary glands. The distinctive feature of these neoplasms is their remarkable histologic resemblance to infiltrating ductal carcinomas of the mammary gland; both types of tumor feature epithelial and myoepithelial cells arrayed in solid, papillary, and cribriform patterns. To the best of our knowledge, only one case of a primary salivary duct carcinoma of the larynx has been previously reported. In this article, we describe a new case, and we review the literature on salivary duct carcinomas.     

Adenosquamous carcinoma of the palate

A rare case of adenosquamous carcinoma in a 74 year-old man is reported. Presenting as a nodule on the soft palate, diagnosis was prolonged because of the benign macroscopic aspect. CT-scan and MR-tomography showed an encapsulated lesion but biopsy and histologic examination revealed the typical features of adenosquamous carcinoma. The tumour consisted of adenocarcinoma and squamous cell carcinoma in close proximity to minor salivary glands of which the tumour seemed to have its origin. This entity, although rare in the head and neck region has been documented to be very aggressive with early regional and hematogenic metastasis. Therefore it has to be distinguished from other tumours, especially from mucoepidermoid carcinomas of the salivary glands, which have a better prognosis. Adenosquamous carcinoma is considered to have poor radiosensitivity and chemotherapeutic approaches have also not been successful in the literature. In our case radical surgical therapy was performed by excision of the whole soft palate and bilateral neck dissection. This resulted in total removal of the tumour but revealed bilateral lymph node metastases. Vital functions were saved by reconstruction of the palate with a free vascularized tensor-fasciae-latae-perforator-flap. For the first time in a case of adenosquamous carcinoma carcinoembryonic antigen in serum was monitored. A pretherapeutical 29-fold elevation resulted in a marked decrease after surgery, but supranormal values indicated remaining tumour burden which was found in metastases in the lung. Because of the limitations in therapy, early histologic diagnosis is most important in this highly malignant tumour.     

Small cell carcinoma of parotid gland--a case report

BACKGROUND: Small cell carcinoma of the major salivary glands are very seldom. If there is such a tumor always have in mind that it can be a metastatic process of another small cell carcinoma in other locations of the body. That's why first of all a primary in the bronchial system has to be excluded with special diagnostics. CASE REPORT: We present the case of a 72-year-old woman suffering from a small cell carcinoma of Parotid gland. Because a surgical therapy was impossible she underwent a radiotherapy. CONCLUSION: First choice for therapy of tumors of the major salivary glands is surgical therapy in combination with radiation/chemotherapy. If this is not possible a primary radiotherapy sometimes in combination with chemotherapy seems to be another therapeutic option.     

Malignant epithelial salivary gland tumors. Clinical review of 2 decades]

PURPOSE: In this retrospective study we give a clinical review of our experience with different tumor entities of salivary gland cancer. PATIENTS: Between January 1983 and December 2002, a total of 155 patients with carcinomas of the salivary glands received initial treatment at the Department of Oral and Maxillofacial Surgery, Hanover Medical School. RESULTS: There were 51.0% adenoid cystic carcinomas, 27.1% mucoepidermoid carcinomas, 7.7% adenocarcinomas, 6.5% polymorphous adenocarcinomas, and altogether 7.7% other less frequent tumor entities. Complete resection was achieved for 63.5% of patients with high-grade carcinomas and for 80.0% of patients with low-grade carcinomas. Postoperative radiation was administered to 26.2% of patients with high-grade carcinomas and 13.3% of patients with low-grade carcinomas. Overall local control rates at 5, 10, and 15 years were 77.5%, 66.2%, and 59.0%. Overall regional control rates at 5, 10, and 15 years were 93.5%, 87.6%, and 85,4%. Overall distant control rates at 5, 10, and 15 years were 85.9%, 77,2%, and 73,6%. Overall survival rates at 5, 10, and 15 years were 65,9%, 48,0%, and 39,8%. There was a significant difference between patients with low-grade and high-grade carcinomas. Polymorphous adenocarcinomas showed the best prognosis, followed by low-grade mucoepidermoid carcinomas, adenoid cystic carcinomas, adenocarcinomas, and high-grade mucoepidermoid carcinomas. The number of the remaining tumor entities was too small to be divided into independent subgroups for statistical analysis. Tumor entity, tumor stage, and margin status significantly influenced prognosis. Statistically, we were not able to demonstrate a positive effect for postoperative radiation. CONCLUSION: Grading is important, but should be considered in the context of stage. In the future, patients with salivary gland carcinomas should be randomized for prospective multicenter clinical trials, which could provide reliable information about adjuvant treatment modalities and their results even for rare subtypes of salivary gland cancer.     

Small cell anaplastic carcinoma of the larynx: Review of the literature and report of a case

The case study of a patient with small cell anaplastic carcinoma (oat cell) of the larynx is detailed and the literature is reviewed. Small cell anaplastic carcinoma of the larynx has been demonstrated to be histologically identical to small cell anaplastic carcinoma of bronchogenic origin. The aggressive biologic behavior of this tumor justifies managing small cell anaplastic carcinoma as a systemic disease. Because of early widespread dissemination of tumor, surgery or radiotherapy alone or in combination have not been successful in controlling the disease. The combination of radiotherapy with chemotherapy has been shown to be the most effective approach to the treatment of small cell anaplastic carcinoma of the lung. We believe that a similar regimen should be considered the treatment of choice for small cell anaplastic carcinoma of the larynx.     

Small cell carcinoma of the larynx: imaging findings

Small cell carcinoma of the larynx is an uncommon epithelial tumor, which is the most aggressive subtype of neuroendocrine carcinomas. Because of its nonspecific clinical and radiological manifestations, the diagnosis of small cell carcinoma of the larynx is essentially based on the light microscopic examination aided by electron microscopy or immunohistochemical staining. We report a case of supraglottic small cell carcinoma accompanied by large bilateral cervical lymph node metastasis ocurring in a 70-year-old man. On CT scans, no area of low attenuation indicating necrosis was demonstrated within such large metastatic lymph nodes. We suggest that small cell carcinoma of the larynx should be included in the diagnostic considerations when a laryngeal mass is accompanied by large cervical lymph nodes without necrosis shown by CT.     

Immunophenotypic comparison of salivary gland oncocytoma and metastatic renal cell carcinoma

OBJECTIVES/HYPOTHESIS: The differential diagnosis of oncocytic neoplasms of salivary glands includes both primary and metastatic tumors, one of which is renal cell carcinoma. This study compared immunohistochemical staining characteristics of oncocytomas arising from salivary gland to metastatic renal cell carcinoma using a panel of markers. STUDY DESIGN: Immunohistochemistry for cytokeratin 7 (CK7), cytokeratin 20 (CK20), epithelial membrane antigen (EMA), vimentin, CD10, and renal cell carcinoma marker (RCC) was performed on 10 oncocytomas and compared with ten metastatic renal cell carcinomas. RESULTS: There were overlapping histologic findings in the oncocytomas and metastatic renal cell carcinomas, with oncocytomas displaying clear cell changes in 2 of 10 cases. CK7 was positive in 9 of 10 oncocytomas and CK20 in 8 of 10 (7/10 stained for both), and vimentin was only weakly positive in 4 of 10 oncocytomas. All oncocytomas were EMA positive, with membranous staining, and all were negative for CD10 and RCC. Metastatic renal cell carcinoma was strongly positive for vimentin, EMA, and CD10 in most cases. RCC and CK7 were variably positive in metastatic renal cell carcinomas (4/10), and only 1 of 10 showed weak staining with CK20. CONCLUSIONS: Salivary gland oncocytomas and metastatic renal cell carcinomas share some similar histologic and immunohistochemical characteristics. CD10 and CK20 were the most useful markers to distinguish metastatic renal cell carcinoma from oncocytomas in the salivary gland, whereas RCC, EMA, CK7, and vimentin are not as useful.     

Small cell carcinoma of the larynx treated with irinotecan and cisplatin

We report a case of advanced small cell carcinoma in the larynx, which was treated with Irinotecan hydrochloride (CPT-11) chemotherapy. The patient was free of disease for 4 years after treatment. Several chemotherapeutic agents for small cell carcinoma have been proposed; however, median survival time has been miserable, especially in advanced cases. For the cure of the aggressive lethal behavior of this disease, chemotherapy with CPT-11 might be effective to improve median survival of patients with small cell carcinomas of the larynx.     

Primary oat cell carcinoma of the larynx

A case of oat cell carcinoma of the epiglottis eleven years after radiotherapy to the larynx for squamous cell carcinoma of the vocal cords is presented. There is a 13.5 per cent incidence of a second neoplasm in these cases. This is a very aggressive tumour and a combination of surgery, radiotherapy and multi-drug chemotherapy appears to offer the best hope of cure. The two-year survival rate is only 8.5 per cent.     

Clinicopathological study of undifferentiated carcinoma of the parotid gland

OBJECTIVE: Undifferentiated carcinoma of the salivary gland is a rare malignant tumor, and is difficult to distinguish from other poorly differentiated types of carcinoma or sarcoma. The present study investigated clinical and pathological characteristics for undifferentiated carcinoma of the parotid gland. PATIENTS AND METHODS: Forty-four patients with previously untreated carcinoma of the major salivary glands were treated at our institution between 1986 and 1999. Of these, five patients (two males, three females) were diagnosed with undifferentiated carcinoma of the parotid gland and treated. For histological reinvestigation, multislices of resected specimens were made and diagnosed. RESULTS: Although all patients were treated by radical surgery (more than subtotal parotidectomy), all died of distant metastasis, including two patients with locoregional relapse. Tumors in these two patients included a small portion of poorly differentiated epidermoid or mucoepidermoid carcinoma. The remaining three patients did not show any differentiated portions, and histological findings demonstrated heterogeneous patterns of lymphoepithelial carcinoma, small cell carcinoma and unclassified (a pattern of malignant hemangiopericytoma), respectively. CONCLUSIONS: Investigation using multislice sections is needed to diagnose undifferentiated carcinoma of the salivary glands. Regarding prognosis, carcinoma that is too poorly differentiated but including slightly-differentiated portions should be considered undifferentiated carcinoma. All patients died of distant metastasis despite radical surgery, suggesting that chemotherapy is needed to improve patient outcomes.     

Basal cell adenoma of the salivary glands

Basal cell adenoma is an unusual type of salivary gland tumor which has only recently been classified as a separate entity. Four cases are presented. Three were discovered by reviewing a series of adenoid cystic carcinomas and mixed tumors, and one was diagnosed originally. Three cases involved the parotid; one, the submaxillary gland. There was no facial nerve involvement in any case. Treatment was local excision. Follow-up from two to nine years revealed no recurrence. The lesions typically are slow growing, firm, non-tender, asymptomatic masses present for several years before treatment. The average age of the patients is generally older than those with mixed tumors. They are most often found in the parotid gland, but have been reported from the submaxillary and minor salivary glands of the upper lip, cheek, and palate. Microscopically the tumor consists of monomorphic basaloid cells with an absence of myoepithelial cells. Myoepithelial cells play an important role in salivary gland tumors. Their range of activity and products determine to a certain degree the morphology of adenoid-cystic and mixed tumors. They resemble muscle cells as demonstrated by electron microscopy studies and also by functioning as contractile elements. The cell of origin is unknown. The tumors may closely resemble adenoid cystic carcinoma and mixed tumors; therefore, diagnostic and therapeutic questions may arise. The tumors are benign. No malignancy has been reported. The lesions can be unencapsulated; therefore, the best treatment is adequate local excision rather than enucleation, tumor may contribute more knowledge concerning the histogenesis of certain salivary gland tumors. With increased awareness and acceptance of this lesion as a separate entity by pathologists, we perhaps can expect an increase in its diagnosis. As otolaryngologists we should have a thorough knowledge of its clinicopathology in terms of clinical presentation, pathology, treatment, and prognosis.     

Metastatic basal cell carcinoma

Objective

The purpose of this study is to review our series of metastatic basal cell carcinomas of the head and neck.

Study Design

A retrospective review was conducted for this study.

Methods

All cases of documented metastatic basal cell carcinomas arising from a primary within the head and neck region and presenting for treatment to one of the authors (Y.D.) were included in this review.

Results

Nine patients were available for review. Five patients had extension to but not transgression of the base of skull. Sites for metastatic disease included 4 lungs and 5 parotid glands. All metastatic lesions were treated with surgical excision, and 6 also received postoperative radiation therapy. No patient deaths from disease have been noted at an average follow-up of 4.7 years (range, 3-8.5 years). No evidence of further metastatic disease has been noted in any of these patients on follow-up.

Conclusions

Metastatic basal cell carcinoma arising from a head and neck primary is a rare entity. However, initial involvement of the skull base and/or dura by a basal cell carcinoma appears to warrant a complete metastatic workup and metastatic surveillance. When metastatic disease is discovered, it appears to be well treated by surgical resection with/without adjunctive radiation therapy. We do not favor chemotherapy for resectable basal cell carcinomas.     

Salivary duct carcinoma in the sinonasal tract

Salivary duct carcinoma (SDC) is an uncommon malignant tumor, characterized by aggressive behavior and poor prognosis. SDC usually arises from ductal epithelium of the major salivary glands, and it is quite infrequent elsewhere. We present a rare case of a 73-year-old man with SDC, which is possibly originated from the paranasal sinuses or the lacrimal system. Microscopic evaluation revealed that the tumor cells, with pleomorphic nuclei and abundant eosinophilic cytoplasm, formed cell nests and duct-like structure. A cribriform growth pattern was also seen. Immunohistochemical staining was positive for cytokeratins (CAM 5.2 and 34βE12), gross cystic disease fluid protein 15 (GCDFP-15), and androgen receptor protein, while p63 and involucrin were negative. The patient already had multiple metastasis of the tumor in the lung at diagnosis, and he could not undergo definitive surgical procedures, because of severe restrictive lung disease. Although SDC in the sinonasal tract is quite rare, SDC should be in the differential diagnosis in these regions, due to its aggressive behavior and poor prognosis.     

涎腺腺样囊性癌中PCNA、P16和P27的表达及其临床意义

目的 :研究 PCNA、P1 6、P2 7基因在涎腺腺样囊性癌中的表达及其临床意义。方法 :采用 SP免疫组织化学染色方法检测 5 5例涎腺腺样囊性癌中 PCNA和 P1 6、P2 7基因蛋白的表达 ,使用 SPSS统计软件进行统计分析。结果 :PCNA在所有病例中均有不同程度的表达 ,其表达程度在组织类型、肿瘤部位和肿瘤分期方面存在着显著差异性 (P<0 .0 5 ) ,而在局部复发、转移和累积生存率方面无显著性差异。 P2 7基因阳性表达率为 34.5 % ,其表达程度在肿瘤部位和肿瘤分期方面存在着显著性差异 (P <0 .0 5 ) ,而在组织类型、局部复发、转移和累积生存率方面无显著性差异。 P1 6 基因阳性表达率为 6 5 .5 % ,其表达程度在所有变量均无显著性差异。结论 :在涎腺腺样囊性癌中 ,PCNA和 P2 7基因作为评估该肿瘤预后的生物学指标需要进一步的研究分析     

Salivary duct adenocarcinoma: a high grade malignancy

Salivary duct carcinomas of the major salivary glands have two major distinguishing features. They closely resemble ductal carcinomas of the breast and they are high-grade malignancies. In general, but particularly for carcinomas measuring three or more centimeters in size, the clinical course is one characterized by a resistance to local control, metastases to regional lymph nodes and distant sites, and death within a few years after primary surgical treatment.     

Acinic cell carcinoma of minor salivary gland origin

The occurrence of acinic cell carcinoma in the minor salivary glands appears to be exceptional. A review of the English language literature revealed about 80 previously reported cases. In this paper, the clinical behaviour and pathological findings in three cases are reported. The tumours took their origin from the hard palate, soft palate and lower lip. The three cases presented with malignant clinical behaviour; all three recurred. In one case the local recurrence was multinodular with capsular infiltration. Two cases developed regional lymph node metastasis, and one metastasized to the lung and liver. In one the tumour infiltrated bony structures, and nerve in another. These cases tend to support the belief of some authors that acinic cell 'tumours' are clinically malignant and should be included in the carcinoma group.     

Mucoepidermoid carcinoma of the salivary glands after high dosage radiotherapy]

BACKGROUND: High-dose radioiodine therapy following total thyroidectomy is standard for patients suffering from differentiated thyroid carcinoma and contributes significantly to their favourable prognosis. Due to active iodine accumulation, high focal radiation doses are received by the salivary glands. PATIENTS/RESULT: Report on two patients, who received multiple high-dose radioiodine treatments because of a differentiated metastatic thyroid carcinoma. A few years later, they developed a mucoepidermoid carcinoma of the salivary glands. Due to the high cumulative radiation dose, radiation-induced secondary malignancies following radiation-induced sialadenitis appears likely, although no causal connection could be proven. CONCLUSION: Consistent protection of the salivary glands during radioiodine therapy as well as the follow-up of the many long-term survivors of differentiated thyroid carcinomas is desirable to further lower the salivary gland-related side effects and to detect secondary malignancies as early as possible.