Viruses and salivary gland disease (SGD): lessons from HIV SGD

Viral infections are often associated with salivary gland pathology. Here we review the pathogenesis of HIV-associated salivary gland disease (HIV-SGD), a hallmark of diffuse infiltrative lymphocytosis syndrome. We investigate the presence and contributions of viral diseases to the pathogenesis of salivary gland diseases, particularly HIV-SGD. We have detected BK viral shedding in the saliva of HIV-SGD patients consistent with viral infection and replication, suggesting a role for oral transmission. For further investigation of BKV pathogenesis in salivary glands, an in vitro model of BKV infection is described. Submandibular (HSG) and parotid (HSY) gland salivary cell lines were capable of permissive BKV infection, as determined by BKV gene expression and replication. Analysis of these data collectively suggests the potential for a BKV oral route of transmission and salivary gland pathogenesis within HIV-SGD.     

Salivary autoantibodies in HIV-associated salivary gland disease

A subset of HIV-positive patients develops salivary gland disease (HIV-SGD), characterized by salivary gland enlargement and/or decreased salivary flow. While clinical symptoms are similar to Sjögren's syndrome (SS). patients with HIV-SGD lack circulating anti-SS-A/Ro and anti-SS-B La. Occasionally, SS patients lacking circulating anti-SS-A/Ro and anti-SS-B'La have these antibodies in their saliva. Salivas from II patients with HIV-SGD, 13 HIV+ patients without HIV-SGD, 14 HIV-negative men controls, and 11 patients with SS were screened for autoantibodies. Five HIV-SGD salivas had antibodies recognizing the cytoplasm of a salivary cell line. No HIV 4- controls showed reactivity. Ten of 11 SS patients had salivary autoantibodies, and one HIV-negative control was positive for them. Salivary anti-SS-A/Ro was present in 8/11 SS patients, and 7 also contained anti-SS-B/La. No HIV-SGD salivary samples had these specific autoantibodies. These findings suggest that while glandular polyclonal expansion occurs in both HIV-SGD and SS, different autoantibodies are produced.     

Murine autoimmune exocrinopathy: the minor salivary gland network shows a dichotomous pattern of histopathologic involvement

The minor salivary gland network of the MRL/1 mouse was investigated in a kinetic study and compared with the major submandibular gland. We report that minor salivary glands adopt two mutually exclusive patterns of inflammatory lesions depending on the gland. The first pattern is characteristic of human Sjogren's syndrome. It developed during the second month, affected 89% of the animals over 20 weeks old, and consisted of an accumulation of mononuclear cells around the duct system. Only the anterior buccal gland (ABG) showed this pattern, which is shared by the major salivary glands. The ratio of CD44+ to CD8+ cells was the same in lesions and in healthy tissue. No neutrophils were found in these lesions. The second pattern affected all the minor salivary glands except the ABG. These lesions were never observed before the age of 20 weeks and affected 38% of MRL/1 mice between the ages of 10–32 weeks. In this pattern, neutrophils were frequently found, but mainly gathered at the periphery of the gland lobules. That a systemic immunoregulatory defect may be expressed as two different patterns of histopathology in the minor salivary glands suggest that the network behaves as a dichotomous entity depending on particular microenvironmental influences.     

Less common oral lesions associated with HIV infection: Prevalence and classification

This paper deals with a number of group II and III lesions, ie lesions definitely but less commonly, and lesions possibly associated with HIV infection, respectively. Salivary gland disease includes dry mouth and/or swelling of major salivary glands, often as a part of CD8-lymphocytosis syndrome. Xerostomia occurs commonly (2–10%) in HIV-infected individuals. Enlargement of the major salivary glands occurs frequently (19%) among HIV-infected children, but rarely among adults (0.8%). The major salivary glands show lymphoepithelial lesions or cysts histopathologically. Hyperpigmentation of the oral mucosa was found in 2.2% of 1710 HIV⁺ individuals in seven studies. The hyperpigmentation has been ascribed to a number of medicaments, and possibly to HIV. The prevalence of pigmentation is not significantly higher among HIV⁺ than HIV^? individuals. Thrombocytopenia frequently occurs in HIV infection. Oral petechiae were reported in 2% of 1121 HIV⁺ in five studies. Human papilloma virus (HPV) infection occurred in 1.1 % of 989 HIV⁺ in seven studies. Drug reactions (white lichenoid lesions, ulceration, toxic epidermal necrolysis) have been reported in a number of cases, not allowing prevalence figures. However certain drugs, notably Foscarnet, Interferon and 2,3-dideoxycytidine, may frequently cause oral ulcerations. Oral neurologic manifestations such as peripheral facial paralysis and sensory neuropathy have been reported in a few cases or series only.     

Sialolithiasis of minor salivary glands: a clinical and histopathological study

Sialolithiasis is one of the most common disorders of particular major salivary glands. It is caused by sialolith within the ducts or parenchyma of particularly major salivary glands. Although sialolithasis is not uncommon, it often is clinically misdiagnosed when minor salivary glands are affected. This article describes the clinical and microscopic findings of nine cases of sialolithiasis of minor salivary glands. The lesions frequently appeared as single and asymptomatic nodules in middle-aged patients. Only three sites were affected: four lesions were found in the upper lip, three in the buccal mucosa, and two in the lower lip. The most common clinical hypotheses for diagnosis were mucocele, sialoadenitis, and benign salivary gland tumor. Sialolithiasis of minor salivary glands was misdiagnosed frequently. It should be considered as a possible diagnosis when swelling of the oral tissues is observed.     

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.     

Absolute indications for salivary gland scintigraphy with 99mTc-pertechnetate

In recent years salivary gland scintigraphy has gained widespread acceptance as a useful means for evaluating salivary gland disorders. An absolute indication for this procedure exists when the ductal orifice of one or several major salivary glands cannot be found or cannot be cannulated. Clinical conditions in which this problem occurs include technical failure to probe and cannulate the duct, developmental anomalies, obstructive disorders, traumatic lesions and fistulae and the need of postsurgical information after glandular excision or after ligation or repositioning of a major excretory duct. The clinical value of scintigraphy in these conditions is demonstrated by means of case presentations.     

HLA-DR antigens in normal, inflammatory, and neoplastic salivary glands

A monoclonal antibody to HLA-DR antigens that is reactive in formalin-fixed tissues was used with the immunoperoxidase method to evaluate 212 salivary gland lesions (normal, nonspecific, and autoimmune inflammatory, benign, and malignant tumors). Results of immunostaining showed that (1) intercalated ducts, myoepithelial cells, and acinous cells of normal salivary glands express HLA-DR antigens, (2) autoimmune salivary gland disease results in greater HLA-DR expression than that seen in nonspecific inflammatory lesions or normal glands, (3) stromal cells associated with benign and malignant salivary gland tumors express HLA-DR antigens, and (4) numerous benign and malignant salivary gland tumors express HLA-DR antigens. It was of interest that lymphocyte-rich Warthin's tumors displayed epithelial immunoreactivity, whereas oncocytomas devoid of a lymphocytic component were invariably negative. This suggests a lymphocyte-mediated role in salivary epithelial HLA-DR expression. It appears that HLA-DR expression is both a normal and an inducible phenomenon in salivary glands, salivary gland neoplasia, and the desmoplastic host response. There is no discriminatory role in the immunologic detection of HLA-DR for differential diagnosis of salivary gland tumors.     

Hyposalivation in a 16‐year‐old girl: a case of salivary gland aplasia

Salivary gland aplasia is a rare condition with only a small number of cases reported worldwide. It is more commonly seen in males and can occur either in isolation or association with other defects or syndromes. It may or may not occur with a hereditary background. Scant literature exists detailing the status of sublingual salivary glands in patients with any form of major salivary gland aplasia. This case report describes the clinical and magnetic resonance imaging presentation of a 16‐year‐old girl with major salivary gland aplasia detailing the status of all six major salivary glands.     

唾液腺肌上皮瘤的影像学分析

目的:探讨唾液腺肌上皮瘤(ME)的CT及MRI表现和临床特点。方法:回顾性分析2003年至2007年间17例肌上皮瘤患者的影像学资料。男7例,女10例;年龄23～70岁,平均46岁。结果:病灶直径均小于2.5cm。病灶位于大唾液腺者13例,位置浅表,大多与腺体包膜接触(12/13),有明显结节状强化,包膜可见;位于小唾液腺者4例,无明显强化,其中发生于软腭者1例,发生于硬腭者3例,腭板有压迫性吸收者2例(2/3)。结论:了解唾液腺肌上皮瘤的影像学表现,结合其临床表现,可以提高对ME的诊断和鉴别诊断能力。     

1878例涎腺肿瘤WHO组织病理学新分类的统计分析

目的 根据ＷＨＯ１９９０年涎腺肿瘤组织病理学新分类标准对１８７８例涎腺肿瘤及肿瘤样疾病进行重新分类,并重点对涎腺上皮性肿瘤的临床发病情况进行统计分析。方法 统计描述。结果 １８７８例涎腺肿瘤以诞腺上皮性肿瘤为主,为１４３１例,占７６．２０％,其中腺瘤发病居首位,其次是涎腺癌,涎腺肿瘤样疾病居第三位;多形性腺瘤是涎腺肿瘤中最常见者,恶性多形性腺瘤为最常见的涎腺癌,特别注意了腺癌亚分类中的几种少见类型     

Submaxillary gland mucocele: presentation of a case

The term mucocele is referred to two concepts: the extravasation cysts resulting from salivary glandular duct rupture, with mucin leakage into the surrounding peri-glandular soft tissue, and the retention cysts, caused by a glandular duct obstruction and resulting in a decrease or even an absence of glandular secretion. Mucocele can not be considered as a true cyst because its wall lacks an epithelial lining. These lesions are very common in the minor salivary glands (particularly in the labial glands), but are very infrequent in the major salivary glands--including the submaxillary glands. The present study describes a clinical case of a right submaxillary gland mucocele resolved by surgical treatment and reviews the differential diagnosis with other clinical entities.     

The diagnosis and surgical management of major salivary gland pathology

BACKGROUND: Major salivary gland pathology is an uncommon but important finding which may initially present to general dental and medical practitioners. The consequences of misdiagnosis are important, as acute obstruction and neoplasia are the main pathological lesions diagnosed. The purpose of this study was to analyze a consecutive series of major gland pathologies treated surgically to determine diagnostic and treatment problems. METHODS: A retrospective analysis of all cases of the major salivary glands treated on an inpatient surgical basis over a five-year period by the Oral and Maxillofacial Surgery Unit of the Royal Adelaide Hospital was performed. Particular emphasis was placed on the referring diagnosis as compared to the final diagnosis. RESULTS: Fifty-four patients had surgical management of 62 major salivary glands over the five-year period. By gland, 18 (33.3 per cent) were parotid, 35 (51.1 per cent) submandibular and nine (16.6 per cent) were sublingual. Fifty-one (82 per cent) of all lesions were inflammatory and 11 (18 per cent) neoplastic. The most common presentations were swelling (72 per cent) and pain (33 per cent). Most patients were referred by general dentists (37 per cent), followed by general medical practitioners (32 per cent) and specialists (28 per cent). The referring diagnosis was correct for only 45 per cent of the dentists but 76 per cent for the general medical practitioners and 87 per cent for the specialists. Only two of the 11 gland neoplasms were correctly identified as neoplasms, both by specialists. The morbidity of the surgical treatment was low. CONCLUSION: The general dental practitioner is often the first health professional with the opportunity to assess salivary gland pathology, and therefore needs to be aware of the presenting signs and symptoms of major salivary gland lesions.     

The effect of X-ray irradiation on the function and saliva composition of rat parotid and submandibular/ sublingual glands

Radiation therapy to the head and neck area frequently causes severe salivary gland dysfunction and xerostomia. Morphological studies of irradiated salivary glands have suggested that the submandibular/sublingual gland may be less radiosensitive than the parotid gland. The purpose of this study was to evaluate the effect of radiation on major salivary gland functions in rats with radiation-induced xerostomia. The effect of salivary gland irradiation on salivary function was examined in specific pathogen-free Sprague-Dawley rats. The animals were irradiated with a single exposure of either 22 Gy or 32 Gy. Stimulated saliva excretion time was measured for the parotid and submandibular/ sublingual glands, and the total protein in saliva was analysed. Our results showed that the saliva flow rate and protein concentration of parotid saliva were significantly reduced in the 32 Gy-irradiated rats.     

Intraosseous pleomorphic adenoma of the mandible: report of a case and review of the literature

Salivary gland tumors constitute approximately 3% of all head and neck tumors. The most common neoplasm involving both major and minor salivary glands is pleomorphic adenoma. Salivary gland tumors are also known to develop within jawbones probably arising from ectopic salivary tissue. Pleomorphic adenomas arising within the jaws as primary central lesions are extremely rare with only a few cases reported. Clinically and radiographically these may resemble lesions of odontogenic origin. We present a rare case of intraosseous pleomorphic adenoma of the mandible mimicking a lateral periodontal cyst along with an extensive review of literature.     

Primary Squamous Cell Carcinoma of the Submandibular Salivary Gland: A Rare Entity

Salivary gland tumors make up about 3% of all neoplasms of the head and neck. Salivary gland tumors vary widely in histopathological appearance, thus it prompted the development of a revised histopathological classification of tumours. Malignant tumors can arise in the major salivary glands or numerous minor salivary glands lining the mucosa of the upper aerodigestive tract. This case highlights one of the rare variants of primary squamous carcinoma of the sub mandibular salivary gland and the management of submandibular salivary gland malignancies.     

Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions

J Oral Pathol Med (2012) 41 : 106–112 Background: Fine‐needle aspiration cytology (FNAC) is used as the main initial diagnostic investigation for lumps in the head and neck region. Major salivary glands and some minor salivary glands are easily accessible; therefore, they are optimal targets for FNAC. The aim of this study was to discuss the advantages and pitfalls of FNAC as compared to histopathology in the salivary gland lesions. Material and methods: A total of 127 FNAC were carried out on salivary gland lesions from January 2006 to December 2010 – a 5‐year period. Histopathological follow‐up data were obtained in 56 cases. The study was conducted to examine the sensitivity, specificity, and accuracy of FNAC for salivary gland swellings in comparison with histopathology. Results: The male‐to‐female ratio was 2.4:1. Parotid gland was involved in 51.1%, submandibular gland in 37%, sublingual gland in 4.7%, and minor salivary glands in 7% of patients. There were 55.9% cases of non‐neoplastic lesions and 44.1% cases of neoplastic lesions on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for malignant neoplastic lesions were 84.61%, 86.48%, 68.75%, and 94.11%, respectively, whereas for benign neoplastic lesions, they were 84.61%, 91.66%, 91.6%, and 85%, respectively. Conclusion: Fine‐needle aspiration cytology is found to be a good sensitive and specific technique for the diagnosis of most of the salivary gland lesions. FNAC should be adopted as an initial investigation for all salivary gland swellings in conjunction with other investigations where appropriate.     

Plasmacytoid myoepithelioma of a minor salivary gland

Plasmacytoid myoepitheliomas are rare salivary gland neoplasms that probably represent a variant of the pleomorphic adenoma. They appear to occur more frequently in the minor salivary glands of the mouth. The mean average age at time of diagnosis of intraoral lesions is 18.8 years. Cytologic pleomorphism is a frequent histologic feature, which has led to a questionable diagnosis of malignancy in five out of ten cases. Caution is advocated in the evaluation of a salivary gland neoplasm with such features, and confusion with primary squamous cell or undifferentiated carcinoma of the salivary glands should be avoided. Patients who have cytologically pleomorphic lesions should be assessed for evidence of metastases. Rapid growth, neurologic evidence of sensory or motor dysfunction, and bone invasion should be regarded as ominous clinical parameters. Therapy should be directed toward complete surgical extirpation.     

Prognostic factors in primary salivary gland mucoepidermoid carcinoma: an analysis of 376 cases in an Eastern Chinese population

Mucoepidermoid carcinoma (MEC) is an infrequent malignant neoplasm that originates most commonly in the salivary glands. The present study aimed to provide new information on prognostic factors in patients with salivary gland MEC. A retrospective analysis of the medical records of patients diagnosed with primary salivary gland MEC between 2003 and 2010 was conducted. The incidence of MEC in the minor salivary glands (62.2%) was almost twice that in the major salivary glands (37.8%). The most frequently affected sites were the parotid gland and palate. Lymph node metastasis was reported more frequently in male than female patients (P = 0.02), in high-grade than low/intermediate grade lesions (P < 0.001), and in lesions involving the submandibular gland (P < 0.001). The disease-free survival (DFS) at 5 years was 80.47%, with rates of 98.0%, 86.5%, and 38.5% for low-, intermediate-, and high-grade tumours, respectively. Among various clinicopathological factors, the only independent prognostic factor was histological grade (P < 0.001). Primary tumour site and histological grade are two important factors affecting cervical lymph node metastasis. Histological grade is the only independent factor affecting survival beyond tumor lymph node metastasis (TNM) staging in salivary gland MEC. Further advances in therapy are needed to improve the outcomes for patients with high-grade lesions.     

The value of cone beam computed tomography in the detection of salivary stones prior to sialendoscopy

This study aimed to assess the value of cone beam computed tomography (CBCT) in the detection of salivary stones in patients with signs and symptoms of salivary gland obstruction. A total of 142 major salivary glands were analysed in a cohort of 127 patients with signs and symptoms of salivary gland obstruction. CBCT scans were performed in order to determine the presence of one or more salivary stones. All glands were also investigated by sialendoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for the submandibular gland, the parotid gland, and the whole group, based on the observers’ abilities to diagnose the presence or absence of calculi in the CBCT scan using the sialendoscopy data as the gold standard. Fifty salivary stones were detected in the CBCT scans of the 142 glands analysed: 34 in the submandibular gland and 16 in the parotid gland. The sensitivity (94%), specificity (90%), positive predictive value (84%), and negative predictive value (97%) for the whole group were good to excellent, with an overall accuracy of 92%. CBCT appears to be an ideal first-line imaging modality for patients with signs and symptoms of obstructed major salivary glands.