High incidence of lymph node metastasis in major salivary gland cancer

OBJECTIVE: To analyze the incidence and risk factors for clinically apparent and occult lymph node metastases in patients with major salivary gland cancers. DESIGN: Cohort of patients with a median follow-up of 46 months (range, 1-174 months). SETTING: University-based referral center. PATIENTS: A total of 160 consecutive patients with complete clinical and pathologic data. INTERVENTION: Neck dissection was performed in all cases. Patients were treated with surgery alone (55%); surgery and radiation therapy (43%); or a combination of surgery, radiation, and chemotherapy (2%). MAIN OUTCOME MEASURE: Incidence of apparent and occult lymph node metastases. Univariate and multivariate analyses were used to evaluate the significance of clinical and pathologic data. RESULTS: Histologically confirmed positive neck was found in 53% of all cases. Histologic diagnosis was significantly related to the incidence of lymph node metastasis: 89% (16/18) for undifferentiated carcinomas. However, so-called low-risk tumors had incidence rates of 22% to 47%. Twenty-one patients (13%) presented with clinically apparent cervical lymph node metastasis. Of the 139 patients with clinical N0 neck, 45% had occult neck metastasis. Neck metastasis was found in 29% (10/34) of T1, 54% (38/70) of T2, 65% (20/31) of T3, and 54% (16/25) of T4 tumors. Assessment of survival according to nodal status revealed significant correlations for overall (P<.001) and disease-free survival (P<.001). CONCLUSIONS: We found a high incidence of lymph node metastasis from major salivary gland cancers. Neck dissections should be considered as an integral part of the surgical approach in patients with major salivary gland cancer, especially if no postoperative radiation therapy is planned.     

涎腺癌颈淋巴结转移的临床分析

目的 了解涎腺癌颈淋巴结转移的发生情况,为临床治疗提供参考.方法 选择北京大学口腔医学院具有完整临床及随访资料的涎腺癌患者815例,记录颈部淋巴结转移情况,分析涎腺癌的颈淋巴结转移的发生规律.结果 815例涎腺癌患者的总体颈淋巴结转移发生率11.53%(94/815).颈淋巴结转移发生率位列前3位的肿瘤分别是鳞状细胞癌...     

Prognostic value of lymph node density for major salivary gland carcinoma without clinical lymph node metastasis

Background and objectiveThis study aimed to investigate whether lymph node density (LND) was correlated with overall survival (OS) in major salivary gland carcinoma without clinical lymph node metastasis.MethodsSixty patients who were diagnosed with major salivary gland carcinoma without clinical lymph node metastasis were enrolled. Of these, 50 patients underwent neck dissection. LND was defined as the ratio of the number of positive lymph nodes to the total number of resected lymph nodes.ResultsAn LND of ≥0.1 was significantly associated with a short OS (p < 0.05). Multivariate analysis with adjustment for pathological N classification and positive surgical margin showed that an LND of ≥0.1 is a predictor of OS.ConclusionResults demonstrated that lymph node density functions as a predictor of outcomes for major salivary gland carcinoma without clinical lymph node metastasis.     

Meibomian gland adenocarcinoma of the eyelid with preauricular lymph node metastasis

Meibomian gland carcinomas of the eyelid are rare neoplasms, accounting for less than 1% of all eyelid tumors. They usually mimic chalazia and undergo repeated curettage before a definitive diagnosis is made. Although they are relatively slow growing tumors they behave in an aggressive manner, frequently metastasizing to regional lymph nodes. Approximately 50% of the patients who develop metastasis to lymph nodes of the neck will survive five years. We present a case of meibomian gland carcinoma with preauricular lymph node metastasis, treated with orbital exenteration, superficial parotidectomy, and radical neck dissection.     

喉癌喉前淋巴结转移

回顾性调查1865例行全喉切除的喉癌病例．发现120例喉癌有喉前淋巴结，其中24例发生喉前淋巴结转移。非转移性喉前淋巴结最大直径从0．2cm大小到1cm左右不等，转移性喉前淋巴结从0．2cm到最大直径1．9cm。喉前淋巴结转移率为1．3％．其中声门上癌、声门癌、声门下癌和跨声门癌的喉前淋巴结转移率分别为0．39％、0．73％、5．02％和2．55％。喉前淋巴结转移与细胞分化无关，与喉癌原发部位及肿瘤分期有关，声门下癌或侵犯声门下区的喉癌较声门上癌和声门癌易发生喉前淋巴结转移，跨声门侵犯的喉癌较声门上癌易发生喉前淋巴结转移；T3、T4期喉癌，较T1、T2期喉癌易发生喉前淋巴结转移；有喉前淋巴结转移的喉癌．易发生颈侧淋巴结转移。     

Distant metastasis of parotid gland tumors

The incidence of distant metastasis in head and neck cancer and especially in salivary gland cancer is relatively low in comparison to other malignancies. However, the presence of distant metastasis heralds a poor prognosis in head and neck cancer, with a median survival of 4.3-7.3 months. Treatment of these patients is usually performed in a palliative setting. Patients with malignant salivary gland tumors should have an X-ray or CT scan of the chest at their initial assessment to exclude the possibility of distant metastasis. The likelihood of developing distant metastasis is associated with high-grade tumors, such as adenoid cystic carcinoma, salivary duct carcinoma, high-grade mucoepidermoid carcinoma and tumors located in the submandibular gland, posterior tongue and pharyngeal tumors. A lower risk of developing distant metastasis is known for all other histological entities of salivary gland tumors. Nevertheless all patients who have a histologically confirmed malignant salivary gland tumor should have lifelong follow-up. On the basis of a clinical case regarding a patient with metastatic parotid gland cancer we present a review of the literature.     

Distant metastasis of parotid gland tumors

The incidence of distant metastasis in head and neck cancer and especially in salivary gland cancer is relatively low in comparison to other malignancies. However, the presence of distant metastasis heralds a poor prognosis in head and neck cancer, with a median survival of 4.3–7.3 months. Treatment of these patients is usually performed in a palliative setting. Patients with malignant salivary gland tumors should have an X-ray or CT scan of the chest at their initial assessment to exclude the possibility of distant metastasis. The likelihood of developing distant metastasis is associated with high-grade tumors, such as adenoid cystic carcinoma, salivary duct carcinoma, high-grade mucoepidermoid carcinoma and tumors located in the submandibular gland, posterior tongue and pharyngeal tumors. A lower risk of developing distant metastasis is known for all other histological entities of salivary gland tumors. Nevertheless all patients who have a histologically confirmed malignant salivary gland tumor should have lifelong follow-up. On the basis of a clinical case regarding a patient with metastatic parotid gland cancer we present a review of the literature.     

Clinical study of cervical lymph node metastasis in maxillary cancer patients

The clinical characteristics of lymph node metastasis in maxillary cancer patients were analyzed. Thirty-eight (23%) of the 166 patients who received intial treatment at Kurume University Hospital between 1978 and 2003 had cervical lymph node metastasis at the time of diagnosis. The disease-specific 5-year survival rate was 63% in the lymph node metastasis negative group and 18% in the lymph node metastasis positive group (p<0.01). There was a statistically significant correlation between bone invasion and lymph node metastasis in the case of the group with bone invasion of the posterior wall of the maxillary sinus. Cervical neck lymph node metastasis developed in 38 (28%) of 135 posterior-wall-invasion-positive group and in none (0%) of the 31 patients in the negative group (p<0.01). Because distant metastasis is common in patients with lymph node metastasis, postoperative adjuvant chemotherapy is highly recommended.     

A case of pleomorphic adenoma of the parotid gland metastasizing to a mediastinal lymph node

OBJECTIVE: Pleomorphic adenomas are the most common salivary gland tumors and are typically cured with complete surgical excision. There are rare reports, however, in which these histologically benign tumors have inexplicably metastasized to distant sites. We present a case of a patient who presented, 27 years after excision of a parotid pleomorphic adenoma, with a recurrence in the parotid bed and a mediastinal metastasis. STUDY DESIGN: Case report. METHODS: A 43-year-old woman presented with a mass in the right parotid bed 27 years after excision of a pleomorphic adenoma of the parotid. The patient's presentation, workup, and final diagnosis of benign metastasizing pleomorphic adenoma will be discussed, along with a pertinent review of the literature. RESULTS: A diagnosis of recurrent pleomorphic adenoma was made from a fine needle aspiration biopsy of the right parotid mass. On subsequent computed tomographic scan, chest images revealed an incidental left mediastinal mass, which also proved to be a pleomorphic adenoma on computed tomography-guided fine needle aspiration biopsy. The patient underwent a completion parotidectomy and sternotomy with excision of the mediastinal mass. Examination of the pathology specimens confirmed a diagnosis of pleomorphic adenoma in both the parotid bed and the mediastinum. No histologic characteristics of malignancy were seen in either specimen; therefore, a diagnosis of benign metastasizing mixed tumor was rendered. CONCLUSION: Benign metastasizing pleomorphic adenoma is a rare and controversial but distinct clinical entity. Although the definition of the term benign precludes metastatic disease, these tumors do not demonstrate any malignant features yet metastasize to distant sites. It remains to be determined whether these benign metastasizing pleomorphic adenomas are really low-grade salivary malignancies.     

Noncervical lymph node metastasis from head and neck cancer.

Nonregional lymph node dissemination must be classified as distant metastasis but axillary and mediastinal metastases can be part of a regional dissemination of the disease. Metastases to lymph nodes of the upper mediastinum are very common among patients with subglottic, hypopharynx and thyroid carcinomas. Axillary metastases are found at autopsy in 2-9% of the patients who died of head and neck squamous cell carcinoma (SCC) and are frequently associated with skin implantation in aggressive recurrent head and neck carcinomas. The possible explanations for this location of metastasis were retrograde dissemination due to lymph system blockage, further tumor dissemination after a parastomal recurrence, hematogenous dissemination, and metastasis from a second primary tumor. Patients with distant metastasis have been considered incurable and only palliative treatment was instituted. Treatment planning for cases with axillary metastasis must take in consideration the likelihood of other regional recurrences and/or distant metastasis. Also, the presence of a second primary tumor must be ruled out. Whenever axilla is the only site of cancer recurrence, a standard axillary dissection must be considered. Upper mediastinal metastases from subglottic and hypopharyngeal cancer are managed by paratracheal and mediastinal dissection through the neck and postoperative radiotherapy.     

术前超声评估分化型甲状腺癌颈部淋巴结转移

目的 探讨术前超声诊断分化型甲状腺癌(DTC)颈中央区及颈侧区淋巴结转移的临床价值。 方法 回顾性分析2017年4月至2018年8月术后病理证实的186例DTC患者,所有患者均于山东大学齐鲁医院(青岛)超声科行术前超声检查,并于耳鼻咽喉头颈外科行颈中央区淋巴结清扫术,其中71例同时行颈侧区择区淋巴结清扫术。以石蜡切片病理结果为金标准,计算术前超声诊断颈中央区淋巴结转移及颈侧区淋巴结转移的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。根据患者有无桥本甲状腺炎(CLT),将所有病例分为两组,A组合并CLT,B组不合并CLT;分别计算两组超声诊断中央区淋巴结转移的敏感度、特异度、PPV、NPV。 结果 术前超声诊断甲状腺癌颈中央区及颈侧区淋巴结转移的敏感度分别为:68.9%、95.3%,特异度分别为:56.3%、57.1%,PPV分别为:75.0%、95.3%,NPV分别为:48.6%、57.1%。A组(60例)与B组(126例),术前超声对颈中央区淋巴结转移诊断的敏感度分别为:85.0%、62.5%,特异度分别为:35.0%、67.4%,PPV分别为:72.3%、76.9%,NPV分别为:53.8%、50.8%。 结论 术前超声检查对DTC颈中央区及颈侧区淋巴结转移的诊断有价值,对颈侧区的诊断准确性高于中央区。合并CLT的DTC患者,超声对颈中央区淋巴结转移的诊断准确性低于不合并CLT的患者。     

Renal carcinoma metastasis to the parotid gland

Metastatic tumours in major salivary glands are uncommon with a higher incidence of primary sites from the head and neck. The lungs and breast are the common primary sites, while metastases from the kidney are very rarely found. The authors describe a case of renal clear-cell carcinoma with metastasis to the parotid gland. The incidence of a metastasis in the parotid gland from a primary renal carcinoma, even if rare, should not be overlooked in making a correct differential diagnosis with acinic cell carcinoma and monomorphic clear cell adenoma.     

Sarcomatoid carcinoma of the parotid gland with apparent metastasis of epidermoid elements to cervical lymph nodes

A case of sarcomatoid carcinoma of the parotid gland is described in a 47-year-old male. Despite radical surgery and postoperative chemoradiation therapy, a distant metastasis occurred 1 month after treatment. The primary site was composed of well-differentiated squamous cell carcinoma intermingled with spindle-shaped malignant mesenchymal cells. Immunohistochemical studies showed that keratin was present in both epithelial cells and spindle cells, whereas vimentin was present in spindle cells and absent in epithelial cells. Two lymph nodes were metastasized by the epidermoid component. The origin of the sarcomatoid component and the differential diagnosis from malignant mixed tumours are discussed.