Improving diagnosing performance for malignant parotid gland tumors using machine learning with multifeatures based on diffusion-weighted magnetic resonance imaging

In this study, the performance of machine learning in classifying parotid gland tumors based on diffusion-related features obtained from the parotid gland tumor, the peritumor parotid gland, and the contralateral parotid gland was evaluated. Seventy-eight patients participated in this study and underwent magnetic resonance diffusion-weighted imaging. Three regions of interest, including the parotid gland tumor, the peritumor parotid gland, and the contralateral parotid gland, were manually contoured for 92 tumors, including 20 malignant tumors (MTs), 42 Warthin tumors (WTs), and 30 pleomorphic adenomas (PMAs). We recorded multiple apparent diffusion coefficient (ADC) features and applied a machine-learning method with the features to classify the three types of tumors. With only mean ADC of tumors, the area under the curve of the classification model was 0.63, 0.85, and 0.87 for MTs, WTs, and PMAs, respectively. The performance metrics were improved to 0.81, 0.89, and 0.92, respectively, with multiple features. Apart from the ADC features of parotid gland tumor, the features of the peritumor and contralateral parotid glands proved advantageous for tumor classification. Combining machine learning and multiple features provides excellent discrimination of tumor types and can be a practical tool in the clinical diagnosis of parotid gland tumors.     

Granulomatous sialadenitis of the major salivary glands. A clinicopathological study of 57 cases

Fifty-seven of 469 major salivary glands excised for various reasons were found to contain granulomas. The aetiologies were tuberculosis (eight parotid, one sublingual), sarcoidosis (two parotid), calculous duct obstruction (34 submandibular), carcinomatous duct obstruction (four submandibular, one sublingual) and undetermined (four submandibular, three parotid). The tuberculous glands showed caseation in the majority of cases but two cases consisted predominantly of discrete granulomas with minimal necrosis. The sarcoid granulomas were typically non-caseating but a few were centrally necrotic. The cases of calculous and carcinomatous duct obstruction contained single to multiple small granulomas which contained mucin and were related to ruptured ducts. It is suggested that the frequency of calculi and the mixture of serous and mucous acini in the submandibular gland account for the distribution of obstructive granulomas. This study establishes calculous sialadenopathy as a major cause of granulomatous sialadenitis.     

Mycobacterium tuberculosis infection within Warthin's tumor: report of two cases

We report two patients with Warthin's tumor who were also infected with Mycobacterium tuberculosis. Case 1 was a 75-year-old woman with Warthin's tumor and multiple small epithelioid granulomas with caseous necrosis involving the submandibular gland. This patient died of tuberculous meningitis 4 months after biopsy. Case 2 was a 78-year-old man with a 10-year history of a parotid mass which had enlarged rapidly over 2 months. Surgical excision revealed Warthin's tumor and epithelioid granulomas involving the left parotid gland. DNA extracted from paraffin sections was amplified by nested polymerase chain reaction (PCR) with primer sets for the mycobacterial 65-KDa antigen gene. Restriction enzyme digestion of the PCR products could differentiate Mycobacterium tuberculosis from other mycobacteria in both cases. Although the histogenesis of lymphoid components of Warthin's tumor is controversial, the frequent prevalence of inflammation or necrosis and our present findings suggest these components have a similar behavior to regional lymph nodes.     

Fine-needle aspiration cytological features of dermoid cyst of the parotid gland: a report of two cases.

We describe the cytological features of dermoid cyst of the parotid gland the value of preoperative diagnosis by fine-needle aspiration (FNA) cytological evaluation. Both patients had painless parotid masses. On physical examination, a freely movable parotid mass was found in each case. CT scan showed a cystic mass in the parotid gland in each patient. FNA in both cases showed anucleated and nucleated squamous epithelium and keratin debris. The clinical features and cytological findings in each case were interpreted as suggestive of a dermoid cyst. Histological examination of surgical specimens confirmed the presence of a dermoid cyst of the parotid gland in each case. FNA is a reliable method for preoperative diagnosis and permits selection of an appropriate form of surgical procedure for dermoid cyst of the parotid gland.     

Recombinant human erythropoietin prevents motor neuron apoptosis in a rat model of cervical sub-acute spinal cord compression

The main goal of our study was to investigate the chemical coding of the superior cervical ganglion (SCG) sympathetic neurons supplying the porcine parotid gland. Additionally, the chemical nature of the vicinal nerve fibers surrounding the parotid SCG perikarya was investigated. Fast blue (FB) retrograde tracing of the parotid gland and immunofluorescent labelling of SCG neurons were studied in juvenile female pigs. Microscopic analysis revealed that only ipsilateral SCG neurons were retrogradely labelled. The labelled neurons formed a discrete cluster in the middle and caudal region of the ganglion. Immunofluorescent labelling revealed that virtually all of the FB-positive parotid gland neurons were immunoreactive to tyrosine hydroxylase (TH), confirming their sympathetic nature. In addition to TH, the majority of the FB-positive neurons were found to be immunoreactive to calbindin (CB) and to a lesser extent for neuropeptide Y (NPY), leu-enkephalin (LENK) and galanin (GAL). In the close proximity of the FB-traced perikarya, a large number of immunoreactive (IR) vasoactive intestinal peptide (VIP-IR), pituitary adenylate cyclase-activating polypeptide (PACAP-IR), nitric oxide synthase (NOS-IR) processes were identified. Moreover, calcitonin gene related peptide-immunoreactive (CGRP-IR), substance P-immunoreactive (SP-IR), vesicular acetylcholine transporter (VAChT-IR), calretinin (CRT-IR), GAL-IR, LENK-IR and CB-IR protrusions were observed. The results of the present study provide a detailed characteristic of the location and neurochemical coding of sympathetic SCG neurons innervating the parotid salivary gland of the pig and lay ground for more advanced, clinical studies on salivary gland innervations.     

Effects of alloxan diabetes and insulin in vivo on rat parotid gland

Parotid gland growth and secretory enzyme levels were studied in male Sprague-Dawley rats following the induction of alloxan diabetes. Diabetes resulted in a retardation of parotid gland, as well as body growth, and in a reduction of parotid gland DNA, RNA, and total protein compared with control rats. Morphologically, parotid glands of diabetic animals were characterized by an intracellular accumulation of lipid within acinar and intercalated ductal cells. Parotid amylase was reduced 40% in diabetic rats compared with control rats. In contrast, peroxidase levels increased by 54%, and DNase was unaffected. Insulin treatment of diabetic rats led to a restoration of gland and body growth. Parotid gland DNA, RNA, total protein, and secretory enzyme levels returned to control values within 7 days. Thus, insulin in vivo may play a major role in the regulation of parotid gland growth and function.     

脱细胞基质制备方法及其在涎腺组织工程中的应用

背景:由脱细胞基质组成的生物支架被广泛应用于动物及临床研究,以修复和重建组织与器官,但所有的脱细胞方法都会在一定程度上破坏基质结构与功能。目的:综述脱细胞基质制备方法、优缺点及其在涎腺组织工程研究中的应用。方法:应用计算机检索CNKI数据库、中国生物医学文献数据库、PubMed数据库及Elsevier数据库2008至2019年发表的相关文献,检索词为“脱细胞基质,制备方法,涎腺,组织工程,再生;decellularization,preparation method,parotid gland tissue engineering”,共纳入74篇文献。结果与结论:大部分组织与器官脱细胞基质制备方法需要化学、生物(酶)、物理及以上几种方法联合使用,具体方法取决于组织与器官的厚度、组成和性质。虽然不是所有脱细胞方法均可去除组织与器官中的细胞成分,但完全去除细胞的组织与器官具有重塑组织特异性的优势,为接种细胞的增殖和分化提供有利的微环境。由于涎腺结构复杂和组织工程化在临床应用中的挑战,应用于患者的临床移植进展有限,该领域的体内研究仅限于动物,而基于颌下腺脱细胞基质生物支架材料方面的应用有望为涎腺组织工程提供有利的来源。     

Fibrous histiocytoma of the parotid gland.

The light microscopic, electron microscopic, and immunocytochemical characteristics of a case of a fibrous histiocytoma arising in the parotid gland is presented. This neoplasm is very rare in this site and must be distinguished from other spindle cell tumors of the parotid gland, particularly those of epithelial and myoepithelial origins. Histologic characteristics similar to those displayed by dermatofibromas and dermatofibrosarcoma protuberans help to differentiate this tumor from other spindle cell tumors. The absence of cytochemical epithelial markers and the electron microscopic demonstration of fibroblasts and histiocytes are useful in establishing the diagnosis. This tumor, which was confined completely to the parotid gland, appears to have arisen from mesenchymal elements within the gland.     

#br# 肿瘤发生相关的腮腺体表分区的临床解剖

目的 基于腮腺的解剖学和肿瘤影像学资料对人体腮腺进行体表解剖分区。 方法 基于腮腺肿瘤的CT影像学资料,本研究提出了腮腺解剖分区的方法,以鼻翼、口角、耳垂以及下颌支后缘等体表标志点,确定A、B两条线,将腮腺分为Ⅰ、Ⅱ及Ⅲ区。解剖观察腮腺区结构,并对影像学上腮腺肿瘤的发生部位进行分区分析。 结果 腮腺Ⅰ区内主要包括面神经分支、耳大神经、颈外静脉及下颌后静脉,Ⅱ区内主要包括面神经分支以及面横动脉,Ⅲ区内主要包括耳颞神经以及颞浅动、静脉。对照分析影像学资料,可以发现在不跨区生长的肿瘤中,Ⅰ区肿瘤的发生率较高（38.89%）,肿瘤跨区生长不会发生在Ⅰ区/Ⅱ区内,发生跨区生长的肿瘤大部分为直径较大的肿瘤,其中62.5%肿瘤直径大于3 cm。 结论 本研究提出的腮腺解剖分区的方法,具有一定的解剖学和肿瘤生物学价值,可为腮腺肿瘤的临床手术治疗提供参考。     

Parotid gland mucosa associated lymphomas and their cytologic mimics

Although the parotid is a target for myoepithelial sialadenitis and lymphomas of mucosa associated lymphoid tissue (MALTomas), MALTomas are rare and have not been well characterized in the cytology literature. We examine fine needle aspiration biopsies from 19 lymphoid lesions of the parotid gland with particular emphasis on MALTomas and their cytologic look-a-likes. Purely on cytology it is difficult to distinguish with certainty a MALToma from a late-phase reactive lymph node. Both conditions were predominantly composed of small mature appearing lymphocytes and both occasionally had larger lymphocytes with tingible body macrophages. By contrast, the diagnosis of non-MALT lymphoma was usually straight forward, as they had overt cytologic atypia. In applying fine needle aspiration biopsy to large or persistent lymphoid lesions of extra-nodal sites like the parotid gland, we recommend the liberal use of flow cytometric analysis to distinguish between reactive lymph nodes and MALToma and to more precisely classify non-MALT lymphomas.     

Electrical potentials of the parotid salivary gland recorded from the body surface in cats

Correlation was found between the dynamics of the electrical potential on the surface of the parotid salivary gland and on the corresponding body surface in cats during stimulation of the secretory nerves and other procedures. The absence of a potential gradient when the electrode was on the body surface confirms the macrostructure of the global field of the salivary gland. The experimental results indicate the glandular origin of electrical responses on the body surface.Laboratory of Physiological Mechanisms of Adaptation, Institute of Physiology, Siberian Branch, Academy of Sciences of the USSR, Novosibirsk. Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 86, No. 12, pp. 643–644, December, 1978.     

Basal cell adenoma of the parotid gland: clinical and pathological findings in 29 cases

Objective: To determine the clinical and pathological features of basal cell adenoma (BCA) of the parotid gland. Methods: This is a retrospective study of 29 parotid BCAs in 28 patients who underwent surgery at the Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, between October 2000 and June 2013. The tumors were categorized according to their location in the parotid gland as superior superficial lobe, inferior superficial lobe and deep lobe. Results: The mean age was 57.0 years (range, 32-83 years). The clinical manifestations of parotid BCAs were consistent with those of other benign parotid tumors. There were no significant differences in age, average disease duration and tumor size among the three tumor groups. There were 11 deep tumors (11/29, 37.9%), and five of them exhibited cystic degeneration (5/11, 45.5%). A total of 15 patients underwent FNAB examination, and the results were positive in seven patients (7/15, 46.7%). Mild facial nerve function impairment occurred in five patients (House-Brackmann grade II), of whom, three had recovered by the 6-month follow-up. No cases of local recurrence or malignant transformation were observed during follow-up. Conclusion: The clinical features of BCA are consistent with those of other benign tumors. The deep lobe of the parotid gland is more likely to develop BCAs, and thus, this diagnosis should be considered in patients with deep-lobe tumors, especially when accompanied with cystic degeneration. FNAB can increase the rate of preoperative diagnoses.     

Parotid involvement by desmoplastic melanoma

Desmoplastic malignant melanoma often arises in sun damaged skin of the head and neck and shows frequent neurotropism. Although metastatic melanoma frequently involves the parotid, direct spread to the parotid has been rarely reported. We evaluated five cases of desmoplastic malignant melanoma involving the parotid gland with clinical and pathological evidence of precursor cutaneous lesions in four of the five cases. The parotid involvement in four cases was tumoural, and three of these were not clinically suspected to be melanoma. The histological appearance in all five cases was that of a sarcomatoid tumour. Immunohistochemistry and electronmicroscopy performed on three of the cases showed only evidence of schwannian differentiation: the tumour cells were positive for S-100 protein and vimentin, and negative for cytokeratin and HMB-45. Electronmicroscopy showed no evidence of melanogenesis. All five tumours showed histological evidence of prominent neurotropism with one case demonstrating extension from overlying skin along cutaneous nerves to the superficial parotid. Thus, desmoplastic malignant melanoma may involve the parotid by neurotropic spread and can be pathologically indistinguishable from malignant schwannoma, a diagnosis which may be made erroneously in the absence of clinical information.     

UNDIFFERENTIATED CARCINOMA OF THE PAROTID GLAND WITH BIZARRE GIANT CELLS

A rare autopsy case of undifferentiated carcinoma of the parotid gland with bizarre giant cells is reported. Grossly, the tumor was fist-sized, firm, solid, grayish-white in color, and was not encapsulated, with a bean-sized ulceration on the skin. Microscopical examination revealed undifferentiated carcinoma of the parotid gland composed of bizarre giant cells, large tumor cells, and spindle cells in part. Ultrastructural examination, recovered from formalin-fixed material, disclosed filamentous structure in some large tumor cells. It is strongly suggested that myoepithelial cells played an important role in the development of the undifferentiated carcinoma of the parotid gland. The clinical and histopathological characteristics of this case is described, and the literature concerning undifferentiated carcinoma of the parotid gland is reviewed.     

腮腺淋巴上皮瘤样癌与EB病毒感染的关系

目的：研究ＥｐｓｔｅｉｎＢａｒｒ 病毒（ＥＢＶ）与腮腺淋巴上皮瘤样癌（ｌｙｍｐｈｏｅｐｉｔｈｅｌｉｏｍａｌｉｋｅｃａｒｃｉｎｏｍａ,ＬＥＬＣ）的关系,并检测瘤细胞内ＥＢＶ 基因编码产物。方法：作者收集了中山医科大学所属病理科１９８６ 年１ 月至１９９５ 年１２ 月间３２ 例腮腺ＬＥＬＣｓ．。３２ 例ＬＥＬＣ石蜡包埋标本再次切片。采用免疫组化和原位核酸杂交法检测瘤细胞内ＥＢＶ 基因表达产物。结果：（１） 在１２５例腮腺癌中有３２ 例淋巴上皮瘤样癌,占总病例的２５－６％ （３２／１２５） 。（２）所有３２ 例腮腺ＬＥＬＣ组织中均有数量不等的ＥＢＮＡ１ 和ＥＢＥＲｓ 阳性瘤细胞。（３）２７ 例ＬＥＬＣ 组织中部分瘤细胞表达ＬＭＰ１ 。（４） 所有标本中均未见ＺＥＢＲＡ 阳性细胞。（５）３２例腮腺ＬＥＬＣ组织中ＥＡＤ、ＶＣＡ和ＭＡ的阳性表达率分别为７１－９ ％（２３／３２） 、６８－８ ％（２２／３２） 和１２－５％ （４／３２） 。结论：（１） 在鼻咽癌高发的广州地区,腮腺ＬＥＬＣ的发病率也较高。（２）腮腺ＬＥＬＣ 组织中均有ＥＢ病毒感染。（３）ＥＢ病毒在腮腺ＬＥＬＣ的感染主要为潜伏Ⅱ型,即表达ＥＢＮＡ１ 、ＥＢＥＲｓ 和ＬＭＰ１     

Membranous basal cell adenoma of the parotid gland. Malignant transformation in a patient with multiple dermal cylindromas

The rare association of dermal cylindroma (turban tumor), trichoepithelioma, eccrine spiradenoma, and membranous basal cell adenoma of the parotid gland has been previously reported. It is believed that this combination represents a peculiar inherited tumor diathesis involving neoplasms of presumed ductal origin, eccrine in the skin and intercalated in the parotid gland. We describe a patient in whom the basal cell adenoma of the parotid gland underwent malignant transformation.     

Crystalloid granuloma of the parotid gland: A case report

A case of an uncommon granulomatous lesion of the parotid gland is presented. A tumorous lesion was pointed out in the upper left neck region of a 63 year old Japanese female and then extirpated. Histologically, the tumor arose in the parotid gland and showed a chronic granulomatous lesion with lymphocytes and histiocytic cells, including the multinucleated foreign body type. In addition, numerous so-called crystalloids were deposited throughout the lesion. The crystalloids were partially positive on von Kossa's stain and non-birefringent under polarized light. To the authors'knowledge, this is the second reported case of crystalloid granuloma of the parotid gland since the first one was described by Takeda in 1991.     

Metastatic tumors to the parotid and submandibular glands--analysis and differential diagnosis of 108 cases

The distinction between primary salivary gland tumors and metastases of other primary tumors in salivary glands is of special importance for therapy and prognosis. In the files of the Salivary Gland Register, 10,944 cases were collected during 1965 and 1985. Among these cases, there were 108 cases of metastatic tumors to the parotid and submandibular gland. The pathohistological analysis of these tumors revealed the following data: 47 cases (43%) of metastatic tumors were localized in the parenchyma of the parotid gland (37 cases) or of the submandibular gland (10 cases). 61 cases (57%) displayed metastases in the lymph nodes of the parotid gland (38 cases) or of the submandibular gland (23 cases). The sublingual gland was free of metastatic tumors. 65 metastatic tumors originated from primary tumors in the neighborhood (head and neck). 32 tumors were carcinomas of the skin, 17 tumors were melanomas, and 13 tumors were nasopharyngeal cancers. Metastases of thyroid cancers were found in 3 cases. The relative frequency of metastases in the lymph nodes of the salivary glands is due to the intense drainage with lymph vessels and the presence of many lymph nodes which are localized especially in the gland parenchyma or around the parotid gland. 21 metastatic tumors originated from primary tumors distant from the head and neck region. There were metastases of lung cancers (7 cases), renal cancers (6 cases), mammary cancers (6 cases), colonic cancer (1 case) and uterus cancer (1 case). Clear cell carcinomas in salivary gland tissue should always be checked for a metastasis of a primary renal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Parotid gland fine-needle aspiration cytology: an approach to differential diagnosis

Parotid glands can undergo a wide range of pathologic changes that may be difficult to characterize by clinical features alone. No single diagnostic modality is currently accepted unequivocally as the definitive approach to parotid gland enlargement or tumors. Although it is generally accepted that fine-needle aspiration (FNA) biopsy is useful in the preoperative setting, the accuracy is highly dependent on both operator experience and the interpretative skills of the cytopathologist. Results of FNA biopsy must be considered in a global context, in conjunction with clinical and radiographic findings. The objectives of this paper are threefold: (1) to define the clinical role of parotid FNA, such that pathologists performing and/or interpreting such specimens have a clearer understanding of the expectations of our surgical colleagues; (2) to clearly describe a protocol for the performance of parotid FNA biopsy, including a discussion of complications and pitfalls; and (3) to present the cytologic differential diagnoses of diverse clinicopathologic parotid gland processes that may present as generalized enlargement, cystic lesions, or discrete masses.     

颌下腺及腮腺超声检查对原发性干燥综合征的诊断价值

目的 探讨颌下腺及腮腺超声检查对原发性干燥综合征（pSS）的诊断价值。方法 回顾性研究。选取2017年1月—2020年12月南通大学附属江阴医院确诊pSS患者88例为pSS组,其中男3例、女85例,年龄27~78（53±11）岁。纳入同期有口干或眼干临床表现的非pSS患者49例为对照组,其中男2例、女47例,年龄21~79（55 ±13）岁。患者均行双侧颌下腺及腮腺超声检查,并据二维灰阶图采用0~4分法进行评分。观察指标：（1）比较2组患者年龄、性别、口眼干燥等临床基线资料;（2）记录2组患者的颌下腺和腮腺超声评分,分别绘制颌下腺、腮腺、颌下腺联合腮腺超声评分诊断pSS的受试者操作特征（ROC）曲线,据约登指数确定超声评分的最佳诊断阈值,以及相应的灵敏度、特异度,比较颌下腺、腮腺、颌下腺联合腮腺超声评分的曲线下面积（AUC）;（3）比较pSS组患者双侧颌下腺和腮腺的超声评分,分析颌下腺与腮腺超声评分的相关性。结果 （1）88例pSS组及49例对照组患者的年龄、性别及口眼干燥表现差异均无统计学意义（P值均>0.05）;（2）ROC曲线显示,颌下腺、腮腺、颌下腺联合腮腺超声评分诊断pSS的约登指数分别为0.669、0.650、0.628,3种方式的最佳诊断阈值均为2分;3种方式诊断pSS的灵敏度分别为95.5%、77.3%、95.5%,特异度分别为71.4%、87.8%、67.3%,AUC[95%可信区间（CI）]分别为0.908（0.856~0.959）、0.845（0.780~0.910）及0.900（0.847~0.953）。其中颌下腺及颌下腺联合腮腺的AUC均高于腮腺,差异均有统计学意义（Z=2.43、2.31,P=0.015、0.021）,而颌下腺与颌下腺联合腮腺的AUC差异无统计学意义（Z=1.36,P=0.175）。（3）pSS组患者中,颌下腺超声评分为3（2,3）分,高于腮腺的2（2,3）分（Z=-8.22,P<0.001）;颌下腺与腮腺的超声评分呈正相关（r_s=0.79,P<0.001）。结论 颌下腺及腮腺超声对pSS均具有较高的临床诊断价值,颌下腺超声可能较腮腺更具优势。