Primary lymphoepithelioma-like carcinoma of minor salivary gland: a case report with immunohistochemical and in situ hybridization studies

BACKGROUND: Lymphoepithelioma-like carcinomas (LEC) of salivary glands represent rare epithelial malignancies, with most cases affecting the parotid gland. To our knowledge, there was only one LEC arising from the minor salivary gland described in the English-language literature. METHODS: We report the second LEC of the minor salivary gland in the buccal area of a 50-year-old Taiwanese woman, who underwent surgical resection and adjuvant radiotherapy and remained alive and well after 120 months of follow-up. Histologically, irregular tumor nests of undifferentiated epithelial cells with syncytial cell boundaries were found embedded within rich lymphoplasmacytic stroma. The tumor cells also showed strong c-KIT expression and evidence of Epstein-Barr virus (EBV) infection. CONCLUSIONS: Our case suggests potential pathogenic implications of both c-KIT and EBV in LEC of the minor salivary gland that can be cured by the combination of surgery and radiotherapy and has a very favorable long-term prognosis.     

MUC4 and ERBB2 expression in major and minor salivary gland mucoepidermoid carcinoma

BACKGROUND: Peptide sequence homology between the gene product of human MUC4 and rat sialomucin complex (SMC) has recently been reported. Each contains a mucin subunit with antiadhesive activity linked to the plasma membrane by means of a transmembrane subunit with two epidermal growth factor (EGF)-like domains that act as ligand for ErbB2. This study investigates MUC4 and ErbB2 receptor expression in major and minor salivary gland mucoepidermoid carcinoma and correlates patterns of expression with clinical outcomes. METHODS: MUC4 antigens and ErbB2 receptor expression are localized by immunohistochemical studies that use archival formalin-fixed and paraffin-embedded tissue. Clinical outcomes are determined by retrospective chart review of all patients (n = 28) with available archived pathologic specimens at the University of Miami-affiliated hospitals treated between 1994 and 2000. RESULTS: Median survival time was 24 months (range, 2-60 months) among the nine patients who died, whereas median follow-up time in the remaining 19 patients is 33.4 months (range, 4.7-73 months). A trend toward a reduction in MUC4 antigen expression in high-grade tumors (55% expression) compared with low-grade (91% expression) and intermediate-grade (100% expression) tumors is identified (chi square, p =.0975). Patients with tumors expressing MUC4 antigens are at reduced risk of death (hazard ratio [HR], 0.20; p =.0531). Adjustment for pathologic grade, T stage, and age results in a much higher risk of death for patients whose tumors do not express MUC4 antigens, although this does not meet statistical significance (HR, 26.6; p =.1). Analysis of recurrence adjusting for T stage reveals that patients whose tumors do not express MUC4 antigens are at increased risk of recurrence compared with patients whose tumor expresses MUC4 antigens (HR, 6.37; p =.03). ErbB2 receptor staining is noted in seven of 28 patients, with five of these seven showing 2+ and 3+ membrane-staining patterns. Adjustment for pathologic grade and age suggests that patients whose tumors express high levels of ErbB2 (2+, 3+) are at increased risk of death compared with patients with low or no expression of ErbB2 (HR, 2.29; p =.32). MUC4 antigen positivity is seen in two of the five cases with 2+ and 3+ staining for ErbB2. CONCLUSIONS.: These findings suggest MUC4 antigen positivity is associated with reduced risk of death and reduced risk of recurrence and may identify a subset of patients with more favorable prognosis. Although limited by small sample size, analysis reveals ErbB2 overexpression is not consistently associated with MUC4 antigen positivity and might be associated with increased risk of death.     

Papillary cystadenoma of a minor salivary gland: report of a case involving cytological analysis and review of the literature.

A 91-year-old man presented with an asymptomatic swelling in the roof of his mouth. Clinically the lesion was nontender and appeared cystic. A CT scan showed a soft tissue swelling of his palate with no bony involvement. An orthopantogram and blood tests were noncontributory. A fine-needle aspiration biopsy was suggestive of a minor salivary gland neoplasm. An excision biopsy showed papillary cystadenoma of the minor salivary gland, with numbers of psammoma bodies. A stepwise approach is demonstrated in the diagnosis of this rare minor salivary gland neoplasm. To the authors' best knowledge, this is the 12th case of this tumor seen in the palate. Furthermore, no previous case has included a fine-needle aspiration biopsy in the work-up, the cytological features of which will be described.     

Epithelioid haemangioendothelioma of the parotid salivary gland: a case report

Haemangioendothelioma is a vascular tumour characterised by the proliferation of endothelial cells with an epithelioid appearance. The behaviour of this neoplasm is intermediate between haemangioma and angiosarcoma. It may be localised in a wide range of sites, with a preference for soft and bone tissue. It is only rarely localised in the head and neck and even more rarely in the salivary glands. We describe a case of haemangioendothelioma in a 28-year-old man that originated in the retroneural region of the parotid gland, compressing the gland tissue and posteriorly infiltrating the muscular plane. A total parotidectomy surgical operation including the removal of lymph nodes in the region was performed followed by radiotherapy. An immunohistochemical investigation, carried out using the oxidase-antiperoxidase method, indicated that the neoplastic elements of the marker of the endothelial cells CD34 were positive for vimentine and for muscle-specific actin, showing a moderate proliferative action of the cellular elements with MIB-1 positivity estimated at around 6%. The peculiarity of the case we describe resides in the rarity of the haemangioendothelioma localisation in the parotid gland.     

Congenital ectopic fistula of a minor salivary gland

A rare case of congenital salivary gland fistula is reported. A 3-year-old girl presented with clear discharge from a dimple on the left cheek. An ectopic salivary gland fistula was unexpectedly diagnosed during operation. This is the first case of congenital salivary fistula draining from a minor salivary gland to a cutaneous pit. We completely excised the lesion, and the patient remains complication free.     

Adult granulosa cell tumor with minor foci of juvenile granulosa cell tumor in postmenopausal woman: A rare case report

IntroductionGranulosa cell tumor (GCT) is a rare neoplasm that is divided into adult GCT (AGCT) and juvenile GCT (JGCT). Generally, a patient will only have the AGCT or JGCT subtypes. Here, we presented the first case of AGTC accompanied by focal JGTC in a postmenopausal woman.Presentation of caseA 63-year-old postmenopausal woman came with distended abdomen accompanied by postmenopausal bleeding. CT scan shows a solid mass with cystic degeneration. Laparotomy found a solid mass from the right ovary measuring 18 × 15 × 14 cm. The pathological results showed a diffuse tumor representing AGCT, accompanied by Call-Exner bodies and nuclear groove. In addition, minor foci were also found, which consist of well-defined margins tumor and follicular-like structures that resemble JGCT. The patient underwent bilateral salpingo-oophorectomy with a total hysterectomy and no recurrence in three months follow-up.DiscussionAge and clinical symptoms cannot be used as specific differentiators between AGTC and JGTC. Radiological imaging also shows a similar appearance of solid masses tumors with hemorrhagic or fibrotic changes, multilocular cystic lesions, or completely cystic tumors. The concomitant findings of JGCT and AGCT could be distinguished very carefully by anatomical pathology examination. It is crucial to differentiate AGCT from JGCT, especially to see the prognosis.ConclusionThe role of pathologists is needed in differentiating AGCT and JGCT, primarily when found simultaneously.     

Outcomes of patients with mucoepidermoid carcinoma of minor salivary gland in palate undergoing radical resection followed by submental flap reconstruction

ObjectiveTo investigate the outcomes of patients with mucoepidermoid carcinoma of the palate undergoing pedicled facial-submental artery island flap (FSIF) reconstruction following resection.Patients and methods41 patients with early stage disease and 9 patients with advanced-stage disease underwent radical excision and neck dissection. 37 IIb, 4 class IIa and 9 IIIb maxillary defects were reconstructed with FSIF, folded FSIF or folded FSIF with titanium mesh respectively. The skin paddles were 3 × 8 to 5 × 15 cm and 3 × 8 to 5 × 14 cm, respectively. 5 patients with high grade disease were treated with cobalt 60 adjuvant radiotherapy after operation.ResultsOne flap failure occurred, yielding a success rate of 98.0% in the reconstruction of palate II and III defects with FSIF or titanium mesh. The patients were seen for follow-up for 16–60 months postoperative. 76.0% patients alive with no disease (AND); 14.0% patients alive with disease (AD) and 10.0% died of disease (DD). Rates of AND, AD and DD differed significantly according to histopathologic grade and TNM stage (P < 0.001); rates of AND, AD and DD differed obviously according to necrosis of the tumors lymph node metastasis, and tumour cell anaplasia and treatment (P < 0.05).ConclusionsRadical resection with wide safety margins of normal tissues including neck dissection is the mainstay of treatment modality. The patients with high grade disease should be treated with postoperative radiotherapy. The FSIF is a reliable and safe method for repairing Brown class II maxillary defects.     

Adenocarcinoma of the salivary gland metastatic to the pituitary gland: case report

OBJECTIVE AND IMPORTANCE: A case of metastasis to the pituitary gland from a ductal adenocarcinoma of the salivary gland is presented. Metastasis to this site is rare, and a salivary gland source has never previously been described. CLINICAL PRESENTATION: This patient presented with hypopituitarism, including diabetes insipidus. INTERVENTION: A craniotomy was performed to alleviate visual loss. The histological features of the sellar tumor were identical to those of a tumor removed from the parotid gland 18 months earlier. CONCLUSION: Although intrasellar tumors originating from embryonic rests of salivary gland tissue have been reported, metastasis from a malignant neoplasm arising within a true salivary gland is also possible and should not be excluded from consideration for patients in whom a salivary gland-like tumor is discovered in the sella turcica.     

Calcifications in a clear cell mucoepidermoid carcinoma: a case report with histological and immunohistochemical findings.

The aim of this study was to report an unusual case of mucoepidermoid carcinoma (MEC) in a 39-year-old woman. The tumor showed a prominent population of clear and intermediate basal cells. Clear cells rarely predominate over other cell types. Such cases are called clear cell variant of MEC. The case also revealed a variable amount of calcified material in the tumor mass. Calcifications are rare in clear cell MEC. These structures were periodic acid-Schiff positive and diastase resistant, excluding glycogen origin. Immunohistochemistry was performed, and the epidermoid component was positive for cytokeratin (CK)7, CK13, CK14, and CK19. The mucous and clear cells presented mild staining for CK7. Cytokeratins 7, 13, and 19 stained luminal cells, and intermediate cells exhibited positivity for CK7, CK14, and vimentin. The origin of the calcifications is speculated to be the result of dystrophic calcification of the amorphous eosinophilic material secreted by intermediate basal cells.     

Primary salivary acinar cell carcinoma of the parotid gland with parietal skull metastasis: A case report

Acinar cell carcinoma of the salivary gland (AciCC) is a rare low-grade epithelial malignant tumor of the salivary gland. The primary site of the disease is often in the parotid gland, followed by the submandibular gland and small salivary gland. In the early stage of the disease, there are no obvious symptoms, most of which are slow enlargement of the mass, accompanied by local pain or discomfort, or facial paralysis involving the facial nerve. Although the disease is a low-grade malignant tumor, it is invasive to a certain extent and prone to recurrence and metastasis. The metastasis sites are usually liver, lung, stomach and other visceral organs, while the metastasis of brain and skull is rarely reported by other authors.This paper reports a case of skull tumors, unlike other skull tumors, the patients had typical clinical manifestations and imaging findings are not ideal at the same time, considering the history of patients with parotid gland tumor, in the process of diagnosis for us to produce a large disturbance, single-shot, due to the lesions in the exclusion of the patients with other diseases, we decided to surgery was performed in patients with the treatment, The patient's condition improved after surgical treatment and was diagnosed as salivary adenocarcinoma with skull metastasis by pathology. This article summarizes the diagnosis and treatment of the patient, and summarizes some of the author's treatment experience, in order to increase the understanding of the disease, improve the accuracy of diagnosis, and accumulate relevant clinical experience.     

Mixed tumor of an ectopic salivary gland. Presentation of a case

A case of mixed tumour in an island of ectopic salivary glandular tissue at the right nostril and surrounding labial skin is reported. An anatomopathological classification of salivary neoplasias is provided and the histological picture of mixed tumours described. Stress is laid on the rarity of the finding. An extensive tissue area was removed because the neoplasia was a recurrence of a previous intervention (done by others) not followed up by histological examination.     

Response to paclitaxel and carboplatin in metastatic salivary gland cancer: a case report

BACKGROUND: Malignant tumors of the salivary gland are rare entities that are treated primarily by surgical resection. For patients with recurrent or unresectable disease, options include radiation therapy or chemotherapy; however, responses are few and of short duration. Patients with metastatic disease have been treated with chemotherapy, but, again, response rates have been low and of short duration. METHODS: A 52-year-old man was seen with a mass on his tongue. A biopsy revealed adenocarcinoma of a minor salivary gland. Ten months after surgical resection, neck dissection, and radiation therapy, the patient was found to have metastatic disease to the lung. Chemotherapy was initiated with carboplatin and paclitaxel. RESULTS: The patient obtained a complete response after six cycles of carboplatin and paclitaxel. CONCLUSIONS: The use of carboplatin and paclitaxel in the setting of metastatic salivary gland cancer is a viable option.     

Renomedullary interstitial cell tumor: a case report

Renomedullary interstitial tumor is a common tumor in the renal medulla, present in 26-41% of consecutive autopsy specimens. However clinically evident case is infrequent because this lesion is usually small (less than 3 mm). We report a case of renomedullary interstitial tumor in a 76-year-old woman. Ultrasonogram incidentally revealed a mass in the left kidney while she visited to the hospital for hypertension and unstable angina. A CT scan showed a 2 cm mass that was not clearly enhanced. MR images showed low signal intensity in both T1 and T2 images. Arteriography demonstrated no neo-vascularity. Those findings showed that this lesion was benign one or hypovascular carcinoma. So Left nephrectomy was performed and histological examination revealed a renomedullary interstitial tumor.