Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance

Actinomycosis is occasionally an opportunistic infection occurrence in patients with osteoradionecrosis (ORN). A retrospective study (1992-97) of 50 patients with ORN of the jaws was done to evaluate the incidence and its clinical significance in the management of ORN. Actinomycosis was diagnosed in 12% of ORN cases. In 36 of the 50 patients including five cases of actinomycosis, the ORN was considered to be resolved after treatment. The median treatment duration of ORN was significantly longer (P<0.007) in patients with actinomycosis (29.7 months) than those without the disease (13.4 months). In conclusion, bone biopsy should be considered in cases of ORN with unsatisfactory response to its specific therapies, aiming to identify possible opportunistic actinomycosis infection.     

Actinomycosis of faucial tonsil masquerading as oropharyngeal malignancy

Actinomycosis is a rare inflammatory disease caused by anaerobic gram negative bacterium of actinomyces species. Lesions in the head and neck are characterized by their varied presentation and their propensity to mimic other diseases.^[1] Here we present a rare case report of actinomycosis of tonsil in an elderly man masquerading as tumour of oropharynx.     

A false-negative sentinel lymph node in the parotid gland of a melanoma patient: a new algorithm for SLN biopsy in the parotid gland

The sentinel lymph node (SLN) is the first node in the lymphatic basin to be affected by metastatic tumor cells from a primary lesion. It provides a way to avoid elective neck dissection in a case in which there is no metastasis to the SLN. However, identification and excision of the SLN may be difficult due to the shine-through phenomenon, as the SLN in the parotid gland is either located close to the primary lesion or, in many cases, the lymph node of the parotid gland is small and covered by fibrous capsula. When we conducted an SLN biopsy on a 68-year-old male patient with malignant melanoma of the cheeks, the metastasis to the node of the parotid gland identified as the SLN was negative; however, 1 year later, the melanoma recurred on the lymph node of the parotid gland, or in other words, we experienced a false-negative SLN. SLN biopsy in the parotid gland is difficult because the lymph node is small and covered by fibrous capsula. We may consider a total or partial resection of the superficial lobe of the parotid gland, particularly when identification of an SLN in the parotid gland is difficult. Therefore, we propose a new algorithm for SLN biopsy in the parotid gland.     

Fine Needle Aspiration Cytology Utility in Salivary Gland Tumor Diagnosis

We aimed to improve the diagnostic accuracy of tumors by using immunocytochemistry (IHC) on destained smears to correlate the cytological findings with histopathology and/or IHC for final evaluation of results. We have done a randomized and prospective double-blind study. Forty-six clinically suspected patients of salivary gland tumor were enrolled for study. Those with non-neoplastic\ inflammatory salivary gland pathologies and swellings other than salivary gland origin were excluded from the study. The Fine needle aspiration cytological (FNAC) diagnosis of all the patients was compared with the corresponding histopathology. Sensitivity and specificity of FNAC in diagnosing malignancy were 91.3 and 100 %. Diagnostic accuracy of FNAC for malignant tumors was 95.65 %. In our study kappa value came out to be 0.88 (p value <0.00), which indicated an excellent agreement between histological and cytological typing of salivary gland tumors. FNAC is a highly sensitive and specific technique for diagnosis of salivary gland tumors. Histopathology however is the gold standard for diagnosis, classification and grading of tumors. Immuno-cytochemistry can act as adjuvant in diagnosing salivary gland tumors, however it did not help in improving the diagnostic accuracy of FNAC in our study. Considering an excellent agreement between cytology and histology, a type specific diagnosis can be reached on FNAC of salivary gland tumors.     

Activation of certain N-arylacetamides and N-arylacetohydroxamic acids in relation to mammary gland tumorigenesis in the rat

This report describes activation of certain N-aryl-acetamides and N-arylacetohydroxamic acids and its relationship to mammary gland tumorigenesis. Evidence is presented that metabolic activation of N-2-fluorenylacetamide (2-FAA) by mixed function oxidase of liver microsomes is the primary requirement for tumor induction in the mammary gland by this compound in young adult female rats. Mammary gland microsomes of those rats appear incapable of N-hydroxylating 2-FAA. Mammary gland microsomes of lactating rats, however, are capable of converting small amounts of 2-FAA to N-hydroxy-2-FAA, which suggests that the ability to perform certain metabolic activation reactions may depend on the stage of development of the mammary gland which is hormonally regulated. According to a current theory of chemical carcinogenesis, N-arylacetohydroxamic acids would have to be activated to electrophilic reactants to become ultimate carcinogens. Three mechanisms by which such reactants could be generated from N-aryl-acetohydroxamic acids in the mammary gland are reviewed: 1) nonenzymatic acetylation; 2) enzymatic N-O-acetyl transfer to form N-acetoxyarylamines; 3) one-electron oxidation to nitroxyl free radicals. In addition, the potential role of the metabolically formed glucuronide of N-hydroxy-2-FAA in mammary gland tumorigenesis is discussed.     

The function of the parotid gland following radiation therapy for head and neck cancer

The parotid gland was selected for study of its salivary output before and after radiation therapy for head and neck cancer. Before radiation therapy, a sialogram of the parotid gland was performed with the patient's head positioned for radiation therapy; a lateral radiographic view of the parotid gland was used to compare with the radiation treatment portal to determine the portion of the parotid gland to he irradiated. Samples of stimulated saliva were collected from the parotid gland before and at 1 and 6 months post-radiation. Eighteen patients with head and neck cancer who received radiation therapy were studied. The data showed that in the irradiation of nasopharyageal, advanced oropbaryngeal and Waldeyer's ring lesions, 100% of the parotid gland was irradiated; for the early oropharyageal and hypopbaryugeal lesions, from 30 to 90% of the parotid gland was irradiated and for the supragiottic and oral cavity lesions, 25–30% of the parotid gland was irradiated. When 100% of the parotid gland was irradiated, no saliva was produced at 1 month post-radiation; this remained the same when re-tested at 4–8 months, however, when any portion of the parotid gland was not irradiated, there was residual salivary function.     

This is how I do it. Minimizing the blood loss during flap raising in thyroidectomy

Accessory parotid gland tumors are defined as masses within salivary gland tissue located adjacent to Stensen's duct, but separate from the main body of the parotid gland. These tumors usually present as asymptomatic cheek masses. There is a temptation to excise these masses locally; however, the likelihood of injury to branches of the facial nerve is high. The best surgical approach to tumors in the accessory parotid region is via a standard parotid incision and concomitant superficial parotidectomy. Eight patients have been surgically treated with accessory parotid gland masses. Six patients had mixed tumors, one had a low grade mucoepidermoid carcinoma, and one had a localized parotitis. Our approach included a standard parotid incision, raising an anterior flap beyond the mass, and exposing the main trunk of the facial nerve, with careful tracing of all its branches. This approach to accessory parotid gland tumors is superior in that it provides a better margin of resection and minimizes functional and cosmetic deformities. Most importantly, there is less danger of injury to branches of the facial nerve. © 1993 Wiley-Liss, Inc.     

Salivary Gland Tumors in Turkey: Demographic Features and Histopathological Distribution of 510 Patients

The aim of this study was to evaluate the demographic and clinicopathologic data of salivary gland tumors managed at a tertiary referral medical center in Turkey. The data of 510 patients with salivary gland tumors managed during the period of January 1984 to May 2012, were reviewed. Only primary neoplasms derived from salivary glands were included. Out of 510 neoplasms, 352 (69.0 %) were classified as benign and 158 (31.0 %) were classified as malignant. There was a male predominance and male:female ratio was 1.23 (281/229). The most common location was parotid gland (372/510, 72.9 %) followed by minor salivary glands (97/510, 19.0 %) and submandibular gland (40/510, 7.9 %). The malignancy rates were 21.5, 40.0, and 56.7 % in parotid, submandibular, and minor salivary glands locations, respectively. The most common location for minor salivary gland neoplasms was oral cavity (61/97, 62.9 %). Pleomorphic adenoma (PA) was the most common histopathological type (45.3 %) in the whole study group and also among pediatric patients. The most common malignant neoplasms were adenoid cystic carcinoma (39/510, 7.6 %) and mucoepidermoid carcinoma (5.7 %). Salivary gland tumors are more common in men. The malignancy rate is almost three times higher in neoplasms derived from minor glands when compared to parotid gland. PA is the most common histopathological tumor type in all locations and in all age groups.     

Bartholin's gland carcinoma: Epidemiology and therapeutic management

Primary carcinoma of the Bartholin's gland is a very rare malignancy of the vulva. Of the utmost importance in the management of these tumors is the management by specialized gynecological oncologist at referral centres. Gynecologists should always consider these unusual neoplasms as a differential diagnosis of potentially benigns lesions of Bartholin's gland.Treatment modality must be tailored to each patient: each histological type of these unusual neoplasms has their natural history and may require a different level of operative aggressiveness to obtain the optimal outcome. Given the rarity of this disease, there have been no prospective randomized trials to evaluate optimal treatment.Therapeutic principles in the management of median vulvar cancer are applicable for Bartholin's gland carcinoma.In this review, we aim to update the current knowledge on the treatment of Bartholin's gland carcinoma.     

Cimetidine inhibits salivary gland tumor cell adhesion to neural cells and induces apoptosis by blocking NCAM expression

Background  

Cimetidine, a histamine type-2 receptor antagonist, has been reported to inhibit the growth of glandular tumors such as colorectal cancer, however the mechanism of action underlying this effect is unknown. Adenoid cystic carcinoma is well known as a malignant salivary gland tumor which preferentially invades neural tissues. We demonstrated previously that human salivary gland tumor (HSG) cells spontaneously express neural cell adhesion molecule (NCAM), that HSG cell proliferation may be controlled via a homophilic (NCAM-NCAM) binding mechanism and that NCAM may be associated with perineural invasion by malignant salivary gland tumors. We further demonstrated that cimetidine inhibited NCAM expression and induced apoptosis in HSG cells. Here, we investigated the effects of cimetidine on growth and perineural/neural invasion of salivary gland tumor cells.     

Deletion of Foxa1 in the mouse mammary gland results in abnormal accumulation of luminal progenitor cells: a link between reproductive factors and ER-/TNBC breast cancer?

In humans, parity without breastfeeding increases risk of estrogen receptor-negative (ER-) breast cancer and is associated with hypermethylation of FOXA1, a pioneer factor regulating lineage commitment of mammary gland luminal progenitor cells. We postulate that pregnancy-associated repression of FOXA1 results in the accumulation of aberrant, differentiation-arrested luminal progenitor cells which, following additional genetic and epigenetic insults, may give rise to ER- tumors. Consistent with this hypothesis, we show that deletion of Foxa1 in the mouse mammary gland results in a two-fold increase in the proportion of luminal progenitor cells and a reduction in mammary gland epithelial cells that stain positive for ER. These results provide compelling support for the notion that reduced Foxa1 expression is sufficient to alter mammary gland luminal cell fate determination in vivo, which could be a mechanism linking parity with ER- breast cancer.     

Basal Cell Adenoma of Parotid Gland: Case Report and Review of Literature

Basal cell adenoma (BCA) of the salivary gland is a rare neoplasm consists of a monomorphic population of basaloid epithelial cells, and it accounts for approximately 1–2 % of all salivary gland tumors. Its most frequent location is the parotid gland. It usually appears as a firm and mobile slow-growing mass. Histologically, isomorphic cells in nests and interlaced trabecules with a prominent basal membrane are observed. In contrast to pleomorphic adenoma, it tends to be multiple and its recurrence rate after surgical excision is high. Due to prognostic implications, differential diagnosis with basal cell adenocarcinoma, adenoid cystic carcinoma and basaloid squamous cell carcinoma is mandatory. We report a case of BCA of the parotid gland. We also review the literature and discuss the diagnosis and management of this rare entity.     

Epidermoid cyst of the submandibular gland

Primary epidermoid cyst of the salivary gland is extremely rare and has only been reported once in the parotid gland A case of epidermoid cyst of the submandibular gland is presented, which required excisional biopsy for the diagnosis. Such excision is also curative.     

Carcinogenicity in rats of a mutagenic compound, 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline

Carcinogenicity of 2-amino-3,8-dimethylimidazo[4,5-f]-quinoxaline(MeIQx), which is a potent mutagen first isolated from friedbeef and widely present in various cooked foods, was testedin both sexes of F344 rats. Rats were continuously given a dietcontaining 0.04% MeIQx or basal diet and the experiment wasfinished on day 429. In experimental animals, the incidenceof liver, Zymbal gland, clitoral gland and skin tumors was significantlyhigher than in control animals. The incidence of liver tumorswas 100% in males and 53% in females; most liver tumors of maleswere hepatocellular carcinomas and all liver tumors of femaleswere neoplastic nodules. The incidence of Zymbal gland tumorswas 75% in males and 53% in females. Clitoral gland tumors wereinduced in 63% and skin tumors were observed in 35% of malesand 5% of females. Most of these three types of tumors werediagnosed as squamous cell carcinoma. In the control rats, liver,Zymbal gland, clitoral gland and skin tumors were not observedin either sex.     

The In Vitro mammary gland response to mammotropic hormones in mice with different mammary tumorigenesis

Mammary gland DNA synthesis estimated by the in vitro incorporation of [³H]thymidine in response to mammotropic hormones was compared between high and low mammary tumor strains of virgin mice (SHN and SLN). In SHN, mammary gland DNA synthesis when cultured in the medium containing insulin (I), aldosterone (A), estradiol-17β (E), progesterone, prolactin (PRL) and growth hormone (GH) showed a peak on day 2 of culture and declined thereafter. Quite the opposite was the case in SLN mammary glands. There was little strain-difference in mammary gland DNA synthesis when cultured for 6 days in the medium containing complete hormone mixture. However, DNA synthesis of SHN mammary glands cultured in the medium deficient in PRL was less than one-third of the control, whereas that of SLN glands was two-thirds of the control. Moreover, mammary gland DNA synthesis was decreased significantly by deficiency in GH or E in SHN strain only. In both strains, mammary gland DNA synthesis declined with an increasing dose of PRL when cultured in the medium containing I, A and PRL, which was associated with an activated secretory function. However, the changes were much more marked in SHN than in SLN. The results have demonstrated the higher dependency of SHN mammary glands than SLN glands upon mammotropic hormones, especially PRL. They further indicate that mammary gland potential for both growth and function is well reflected by mammary gland sensitivity to PRL.     

Epidermal growth factor receptor (EGFR) in salivary gland carcinomas: Potentials as therapeutic target

AimsEpidermal growth factor (EGFR) is involved in angiogenesis, cell differentiation, proliferation and progression of many cancers and is an important therapy target in lung and colorectal cancer. To determine the potential applicability of EGFR targeted therapies, EGFR status of over 800 salivary gland tumors of different entities were analyzed on DNA and protein level by FISH and IHC.Materials and methodsA tissue microarray was constructed from 721 carcinomas and 205 adenomas of the salivary gland. EGFR expression and EGFR gene copy number was assessed by means of immunohistochemistry and fluorescence in situ hybridization (FISH). EGFR mutation analysis of exon 19 and 21 was performed in a subset of 107 carcinomas.ResultsPositive immunohistochemical staining (definition?) for EGFR was shown in 324 of 663 (48.9%) salivary gland carcinomas. The frequency was dependent on the tumor entity and ranged from 17.9% (30 of 168 cases) positive immunostaining in acinic cell adenocarcinomas to 85.7% (42 of 49 cases) in Warthin tumors. No EGFR amplification was found by FISH. EGFR mutation analysis of Exon 19 and 21 in 107 salivary gland carcinomas revealed mutations in two acinic cell adenocarcinomas .ConclusionEGFR protein expression is common in salivary gland tumors but is not associated with gene amplification. Activating mutations of EGFR are rare. Nonetheless, selected cases of patients with salivary gland carcinomas might potentially benefit of anti-EGFR therapy.     

Dose de tolérance à l’irradiation des tissus sains : les glandes salivaires

Xerostomia is one of the most a common complication of radiotherapy for head and neck cancers, affecting quality of life. Parotid glands produce approximately 60% of saliva and submandibular glands 20% of saliva while the rest is secreted by sublingual and accessory salivary glands. Methods of measuring the salivary output are collection of unstimulated or stimulated saliva or 99mTc-pertechnate scintigraphy. Several studies demonstrated that late salivary dysfunction after radiotherapy has been correlated to the mean parotid gland dose, with recovery occurring with time. Severe xerostomia could be avoided if at one parotid gland is spared to a mean dose of less than approximately 25–30 Gy. Clinical benefit of submandibular gland sparing is more controversial. A mean dose less than 39 Gy could preserve submandibular gland function. This paper aims to review main studies evaluating tolerance dose of salivary glands.     

原发性恶性甲状腺淋巴瘤的诊断与治疗

原发性恶性甲状腺淋巴瘤是一种罕见病，约占甲状腺恶性疾病的1%-3%，甚至不到非何杰金氏淋巴瘤的1%。根据改良的Ann-Arbor分类法对原发性甲状腺淋巴瘤所下的定义，此类淋巴瘤或局限于甲状腺（ⅠE期），或累及甲状腺与其邻近的膈上淋巴结（ⅡE期）。原发性甲状腺淋巴瘤是一种异源性疾病，它包括许多淋巴瘤的特性。本文的重点在于原发性甲状腺淋巴瘤的诊断和治疗。     

11C-methionine PET, a novel method for measuring regional salivary gland function after radiotherapy of head and neck cancer.

BACKGROUND AND PURPOSE: Loss of salivary gland function is a distressing side-effect of radiotherapy (RT) for head and neck cancer. The aim of this study was to develop a positron emission tomography (PET) method for measuring regional salivary gland function in the major salivary glands irradiated during RT. PATIENTS AND METHODS: Eight head and neck cancer patients were included; two were examined before RT and six after parotid sparing RT. Patients were examined by dynamic 11C-methionine PET of the major salivary glands and parotid gland salivary flow measurements. PET data were analysed using a kinetic model of salivary gland 11C-methionine metabolism, in which salivary gland function was quantified by the net metabolic clearance of 11C-methionine, K. Functional voxel-wise images of K were calculated and matched with the CT-dose-plan for comparing regional salivary gland function with the regional radiation dose. RESULTS: Parotid gland K correlated positively with parotid gland salivary flow, indicating that K can be used as an index of salivary gland function. K of parotid and submandibular glands was reduced dependent on the median radiation dose. In one patient, receiving a heterogeneous radiation dose to the parotid glands, regional salivary gland function was inversely correlated to the regional radiation dose. CONCLUSIONS: Salivary gland function can be measured by dynamic 11C-methionine PET. The net metabolic clearance of 11C-methionine of salivary glands was reduced dependent on the radiation dose. Dynamic 11C-methionine PET offers a method for studying the individual response of the major salivary glands to irradiation.     

Keratin 6 is not essential for mammary gland development

Introduction  

Keratin 6 (K6) has previously been identified as a marker of early mammary gland development and has also been proposed to be a marker of mammary gland progenitor cells. However, the function of K6 in the mammary gland was not known, so we examined the expression pattern of the protein during both embryonic and postnatal mammary development, as well as the mammary gland phenotype of mice that were null for both K6a and K6b isoforms.