Cerebral radionecrosis following the treatment of parotid tumours: a case report and review of the literature

Radiotherapy is an accepted part of the treatment of malignant tumours of the parotid gland. The use of radiotherapy in benign parotid tumours, where spillage of tumour cells has occurred at operation, is more controversial. Radiotherapy to the parotid bed is not without morbidity. Complications may arise as a result of radiation damage to neighbouring structures and there is also potential to induce malignant disease. A patient, whose postoperative radiotherapy following resection of a pleomorphic salivary gland adenoma was complicated by cerebral necrosis, is discussed. The literature pertaining to morbidity of radiotherapy for parotid tumours is reviewed.     

涎腺导管癌临床病理和免疫组化研究

目的　探讨涎腺导管癌 ( SDC)的临床病理特点。方法　对 5例 SDC患者的临床和病理资料进行回顾性分析 ;用免疫组化方法检测细胞角蛋白 ( CK) ,平滑肌肌动蛋白 ( SMA)在 SDC中的表达 ,并与腺样囊性癌对照。结果　 1例术后 2年死于全身广泛转移 ,2例带瘤生存 2～ 5年 ,2例失访。5例 SDC镜下呈典型导管癌表现 ,侵犯神经、血管壁和周围的软组织。 2例曾误诊为腺样囊性癌。免疫组化 CK阳性 ,SMA阴性 ,示肿瘤细胞为导管上皮。结论　涎腺导管癌是一种高侵袭性的涎腺癌 ,易发生转移 ,预后差。彻底手术联合放疗和 (或 )化疗的综合治疗有助于延长生存期。     

2489例涎腺上皮性肿瘤临床病理分析

目的:了解涎腺上皮性肿瘤的临床病理特点。方法:对2489例涎腺上皮性肿瘤临床病理资料进行统计分析。结果:涎腺恶性上皮性肿瘤840例,腺样囊性癌、黏液表皮样癌、癌在多形性腺瘤中居其前3位;涎腺良性上皮性肿瘤1649例,多形性腺瘤、Warthin瘤、基底细胞腺瘤居其前3位。涎腺恶性、良性上皮性肿瘤男女之比为1.13∶1和0.99∶1;平均发病年龄47.86岁和44.86岁;腮腺和腭部为好发部位。结论:腺样囊性癌和多形性腺瘤是最常见的涎腺恶性、良性上皮性肿瘤。     

Salivary duct carcinoma: clinicopathological and immunohistochemical studies

Nine cases of salivary duct carcinoma were reviewed clinically, histologically and immunohistochemically, with special evaluation of biomarkers with prognostic significance (p53, Ki67, c-erbB-2 and DNA content). Eight tumours occurred in the parotid gland and one in the submandibular gland. The average age of the patients (8 males and 1 female) was 62.8 years (range = 47 − 74 years). Tumour size ranged from 1 to 6 cm (mean = 3.46 cm). Recurrences were found in 33.3% (3 patients), regional metastases in 44.4% (4 patients) and systemic metastases in 33.3% (3 patients). Three patients died of their disease (median survival = 12.3 months), one is alive with the disease (follow-up of 222 months) and 5 are alive without evidence of disease (mean follow-up of 75 months). p53 protein nuclear immunostaining was positive in 66.6% and c-erbB-2 overexpression was observed in 100% of the tumours. Ki 67 positivity ranged from 6.75% to 47.5% of tumour cells (mean = 21.3%). DNA aneuploidy was found in 4 tumours (44.4%) and DNA diploidy in 5 (55.5%). Our results seem to indicate that Ki67 immunostaining can be useful in the evaluation of the biological behaviour of these tumours, as well as the presence of a high proliferative index of aneuploid cells and the presence of distant metastases.     

Salivary gland tumours treated in the stomatological clinics in Bratislava.

During the period of 1951-1996 a group of 1021 patients (484 men and 537 women, mean age 53 years, range 2-87 years) with salivary gland tumours were analysed retrospectively. The mean follow-up period was 8 years (range 10 months-25 years). The frequency of benign tumours was 74% (n = 755) and malignant tumours 26% (n = 266). Lesions were sited in the parotid gland 83% (n = 847), in the submandibular gland 10.8% (n = 110), in the sublingual gland 3.2% (n = 33) and in the minor salivary glands 3% (n = 31). The most common benign tumours were pleomorphic adenoma in 53.9% (n = 550) and Warthin's tumour 9.7% (n = 99). Of the malignancies, the adenoid cystic carcinoma was most common (6.4% of cases, n = 65) and mucoepidermoid carcinoma occurred in 5.2% (n = 53). The predominant therapy was surgery alone or in combination with postoperative radiotherapy in 93.7% (957 cases), radiotherapy alone after fine needle aspiration biopsy for 4.7%, and 19 patients remained untreated.     

Salivary gland tumours: 25 years of experience from a single institution in Croatia

IntroductionThe aim of this study was to determine the types, frequency, distribution, and demographic characteristics of salivary gland tumours in a large representative sample.Patients and methodsWe retrospectively analysed the medical records of 779 patients with tumours of the salivary glands surgically treated from 1985 to 2009 at a single institution.ResultsThere were 500 benign and 279 malignant tumours. The average age of patients with benign tumours was 50 years and of malignant salivary gland tumours 56 years. No differences in age and incidence of tumours existed between males and females. The majority of the tumours occurred in the parotid gland (509), followed by the minor salivary glands (212), the submandibular gland (51) and lastly, the sublingual gland (7). Minor salivary gland tumours occurred most frequently on the palate, the pleomorphic adenoma being the most frequent benign tumour type and the adenoid cystic carcinoma being the commonest malignant tumour. Tumours of the sublingual gland were rare, but all were malignant. Malignant tumours were more common in the minor salivary glands and the submandibular gland.ConclusionThis large study of salivary gland tumours in Croatia could improve our understanding of the significant differences in the global distribution of salivary gland tumours which have been reported.     

Maintaining a high level of suspicion for recurrent malignant disease: report of a case with periapical involvement

Aim: To report the unusual endodontic presentation and radiographic features of a subgroup of pleomorphic adenoma called carcinoma ex pleomorphic adenoma and to stress the importance of maintaining a high level of suspicion in cases where primary or recurrent neoplasia is included in the differential diagnosis. SUMMARY: This paper describes a case in which a patient with a previous history of malignant neoplasm presented with signs and symptoms similar to a dental infection. The pathology report however confirmed recurrence of the previous tumour in a malignant fashion. The importance of maintaining a high level of suspicion in early management of such disease is highlighted. KEY LEARNING POINTS: *Pleomorphic adenomas, also known as benign mixed tumours, are common salivary gland tumours, which infrequently undergo malignant transformation, with potentially devastating consequences. *Malignant salivary gland tumours can present as dental swelling, dental pain and sudden loss of vitality of teeth so both general practitioners and specialists have the responsibility to evaluate such patients with a broad vision. *Radiographic differential diagnosis of periapical radiolucency should also include malignant salivary gland tumours. *This case highlights the need of vigilance at all times and emphasizes the benefits of biopsy and histological examination in the diagnosis of recurrent malignant salivary gland tumours.     

Bilateral intraosseous adenoid cystic carcinoma of the mandible: report of a case with lung metastases at first clinical presentation

OBJECTIVE: Malignant epithelial tumours arising in the jaws are very rare. Adenoid cystic carcinoma (ACC) represents approximately 7.5% of all carcinomas and only a few cases of intraosseous (central) ACC have been reported in the literature. MATERIALS: The salient clinico-pathological features of a case of ACC, bilaterally occurring in the mandible of a young caucasian woman who also had lung metastases are reported to appropriately characterize such unusual lesions and discriminate them from other tumours that more commonly affect the mandible. RESULTS: The patient presented with a painful swelling of the right retro-molar area and paraesthesia of the ipsilateral lower lip and radiological investigations disclosed bilateral radiolucent lesions of the mandible with unequivocal signs of malignancy but without intra-lesional calcifications or association with teeth roots or cystic component. Conventional histological examination disclosed typical ACC with solid and cribriform growth patterns and extensive infiltration of the adjacent tissues. CONCLUSIONS: The diagnosis of intraosseous malignant salivary gland type neoplasms is very difficult in view of their rarity and lack of specific signs and mainly achieved after histological examination and complete clinico-radiological work up. As surgical treatment of the patient was not indicated, due to extensive neoplastic disease, the patient is being controlled with multimodal treatment, including chemo- and radiotherapy and is alive with persistent disease 3 years after the original diagnosis.     

Parotid neoplasms in children: experience of diagnosis and management in a district general hospital

Parotid neoplasms are uncommon in children and the available literature is predominantly from specialized centres. This paper highlights our experience at a district general hospital, in the diagnosis and management of parotid neoplasms in children. The case records of all parotidectomies performed in a 26-year period between 1974-1999 were scrutinized and patients aged 18 years and below identified. The demographic data, histology, presentation, investigations, treatment, outcomes and complications were analysed. 545 parotidectomies were performed in 536 patients, in whom 569 neoplasms were diagnosed. Only 12 patients aged 18 and under were identified (2.2%). The relative frequency of individual tumours differed markedly from that in adults. 75% of the tumours were benign. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common tumours. A painless mass was the most frequent clinical presentation and CT sialogram was the most common investigation. Parotidectomy with preservation of the facial nerve was performed in all cases, and adjuvant radiotherapy employed in the case of malignant tumours. All patients were alive and well at the time of last follow up. Transient facial nerve palsy and hypertrophic scars were the most common complications.     

术中液氮冷冻加术后放疗在治疗腮腺癌保留面神经中的应用

目的研究手术联合术中液氮冷冻和术后放疗治疗面神经与肿瘤紧贴的腮腺癌能否达到既局部控制肿瘤、又保留面神经功能的效果。方法分析9例采用手术联合术中液氮冷冻、术后放疗治疗腮腺癌保留面神经患者的临床病理资料,对患者进行2～19年的随访,平均随访时间9年,观察局部有无肿瘤复发。8例患者行House-Brackmann系统（HB系统）面神经功能评价,7例患者行神经电图（ENoG）检测,评估面神经功能恢复效果。结果在随访期间,9例患者中1例肿瘤复发伴颈淋巴结转移,行再次手术治疗,在首次治疗后6年无瘤生存。其余8例患者原发灶均无复发。6例患者分别在首次术后7年（2例）、10年、11年、15年、19年无瘤生存。2例患者分别于术后2年和2.5年死于肺心病和肺转移。8例患者面神经功能均得到恢复,4例达HBⅠ级,2例为HBⅡ级,2例为HBⅢ级。ENoG检查的7例患者的面神经各分支均能引出电生理反应。结论对于面神经与癌瘤紧贴,但可在完整切除癌瘤的前提下分离保留面神经的腮腺癌患者,当缺乏125I放射性粒子植入或192Ir后装组织内近距离放射治疗的条件时,手术联合术中液氮冷冻和术后放射治疗是可行的综合治疗方案。     

Tumour recurrence after surgical removal of parotid pleomorphic salivary adenoma using a retrograde facial nerve dissection technique

Recurrence after surgical removal of parotid pleomorphic salivary adenoma using retrograde facial nerve dissection is not well researched. We adopted retrograde nerve dissection for parotid surgery for benign disease as a standard procedure in 1995. The objective of this study was to establish the rate of recurrence of primary tumours associated with the technique after removal of parotid pleomorphic salivary adenoma. We recruited 59 patients over a 16-year (1995-2011) period and collected the data prospectively. Eight patients were excluded as they had died or had been lost to follow up. Male:female ratio was 16:35 and age range was 15-69 years. The mean tumour size as measured on magnetic resonance imaging (MRI) was 27.4mm. Thirty-eight patients had superficial parotidectomy, 8 had total parotidectomy, and 5 had partial superficial parotidectomy. Mean follow up from the date of operation was 104 months (median 98, range 17-171). All patients were reviewed and examined in 2011 to establish whether the tumour had recurred. One patient had developed a solitary nodular recurrence 8 years after the initial procedure. Recurrence was 2%. The rate of clinically apparent recurrence after parotidectomy for pleomorphic salivary adenoma in this study is low and is comparable with others reported.     

Salivary gland tumors: a single institution experience in India

Between 1991 and 2006, 684 cases of salivary gland tumours were analysed retrospectively, of which 422 (62%) were benign and 262 (38%) malignant. Sixty-one percent of tumours were in the parotid gland, 22% in the minor salivary glands, and 17% in the submandibular glands. The most common benign tumour was pleomorphic adenoma (86%), and the most common malignant tumours were adenoid cystic carcinoma (25%) and mucoepidermoid carcinoma (18%). Among the minor salivary gland tumours, most were seen in the palate (68%).We analyse the incidence and distribution of all types of salivary gland tumours in an Indian series, and provide data for comparison with other epidemiological studies from different geographical sites and races. Demographic data from these studies should help us to a better understanding of the biological and clinical characteristics of the disease.     

36例良、恶性淋巴上皮病临床病理分析

目的：分析恶性淋巴上皮病（MLEL）、良性淋巴上皮病（BLEL）及与之相联系的黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤（MALToma）的临床特点、病理学特征、发病机制、诊断、治疗及转归。方法：对13例MLEL、20例BLEL及3例MT进行免疫组化染色和HE染色观察，复习相关临床资料并随访。结果：MLEL的病理学特征为大量增生的淋巴组织中见成簇或条索状分布的肿瘤细胞，界限不清，核分裂像多见；免疫组化示CKpan全部阳性（13／13），Vim部分阳性（3／13），SMA部分阳性（2／13）；8例MLEL可随访资料中，术后1例死于复发，1例死于其他疾病，1例局部复发，5例未见复发或转移，随访3．5个月-4a。BLEL的病理学特点为腺实质萎缩，间质淋巴细胞浸润及形态温和的腺肌上皮岛；免疫组化示CKpan19例阳性，LCA17例阳性。UCHL-1、L2616例阳性。CK10 10例阳性．S-1002例阳性；12例可随访的BIEL中，2例术后复发诊断为MLEL，其余健在，随访3个月～6a不等。3例MT中。1例术后6个月复发，经再次手术并化疗后缓解；免疫组化L26、LCA、CD79、CD43均阳性；UCHL-1、CKpan、EMA均有2例阳性。结论：MLEL好发于腮腺，且女性多见，来源于唾液腺导管上皮。对已发生颈淋巴结转移的患者行原发灶一颈联合根治，术后放疗，少数MLEL可在BLEL基础上发生，故BLEL局部切除后应长期随访；MT为B细胞淋巴瘤，手术切除辅以适当化疗可获较好疗效。术中冷冻切片是本病目前最可靠的术中诊断手段。     

The treatment of sublingual gland tumours

This study assessed the clinical and histological features and therapeutic efficacy of 25 cases of sublingual gland tumours from 1998 to 2008. There were 17 female patients and 8 male, the ratio of females to males was 2.1:1. The mean age was 48.6 years. 4 cases were benign tumours (16%). 21 cases were malignant sublingual gland tumours (84%) and of these, 18 were adenoid cystic carcinoma (86%). Adenoid cystic carcinoma was mainly of the histological type, and the other histological classifications included mucoepidermoid carcinoma, pleomorphic adenoma, myoepithelioma, oncocytoma and polymorphous low-grade adenocarcinoma. Sublingual gland tumours are rare and most are malignant. For malignant sublingual gland tumours, early diagnosis and aggressive surgical treatment, especially for tumours with nerve involvement, is the key to improving prognosis. Free radial forearm flap or pectoralis major myocutaneous flap are appropriate methods for mouth floor reconstruction. For benign sublingual gland tumours, the resection of tumour and sublingual gland is the preferred treatment.     

腭部涎腺肿瘤116例临床分析

目的探讨腭部涎腺肿瘤的临床病理类型、诊断及治疗方法。方法对在1983年至2006年问住院治疗的116例腭部涎腺肿瘤病人的临床病理类型、诊断、治疗、预后进行分析和总结。结果116例中良性肿瘤71例（61．21％）,以多形性腺瘤最为多见。恶性肿瘤45例（38．79％）,以腺样囊性癌最多见,黏液表皮样癌次之。肿瘤发生在软腭者38例,硬腭者33例,软硬腭交界处者45例。114例经外科手术治疗,95例获3年以上随访,良性肿瘤复发率为7．4％,恶性肿瘤复发率为22．0％。结论腭部涎腺肿瘤治疗以手术切除为主,应重视术前组织学诊断,尽量避免术后复发及并发症的发生。     

Intraoral minor salivary gland neoplasm: a single institution experience of 80 cases

From March 1991 to February 2001, 80 cases of minor salivary gland tumours were diagnosed in the Department of Oral and Maxillofacial Surgery at the University of Maryland at Baltimore (Baltimore, MD, USA). Data extracted from a retrospective chart review included age, sex, symptoms, site, histological diagnosis. treatment and outcome. Pleomorphic adenoma was the most common benign tumour and makes up 89.5% of all benign tumours. The percentage of malignancy (76.3%) was much higher than that found in other studies. Of the malignant tumours, 54.1% were mucoepidermoid carcinomas. This study differs from many previous reviews that were published by pathologists rather than a surgical unit.     

Central mucoepidermoid carcinoma of the mandible: report of four cases with long-term follow-up

Central mucoepidermoid carcinomas are uncommon tumours, representing about 2 to 4% of all mucoepidermoid carcinomas. They are histologically low-grade cancers, usually affecting the mandible as uni- or multilocular radiographic lesions. The authors report four cases of central mucoepidermoid carcinomas affecting the mandible and discuss their clinical, radiographic and histological findings. Four females were affected, with a mean age of 42 years and all cases involved the posterior mandible. Treatment included surgery in three cases and surgery associated to neck dissection and radiotherapy in one case. Two patients showed no recurrence and were alive without signs of the disease after a mean follow-up of 78 months. The other two patients showed local recurrence and one was alive with disease after a follow-up of 384 months, and the other was followed-up for 324 months dying by other causes without signs of the tumour. Central mucoepidermoid carcinomas of the mandible are low-grade tumours, and effective surgical treatment involving wide local excision or en bloc resection allows patients to have a favourable prognosis after long-term follow-up.     

Expression of PLUNC family members in benign and malignant salivary gland tumours

Objectives: The aim of this study was to determine the expression of PLUNC proteins in benign and malignant salivary gland tumours and thus their potential use as diagnostic and / or prognostic tools. Materials and methods: A tissue microarray was assembled from 64 salivary gland tumours including adenoid cystic carcinoma, carcinoma ex‐pleomorphic adenoma, mucoepidermoid carcinoma, polymorphous low‐grade adenocarcinoma, pleomorphic adenoma, acinic cell carcinoma, myoepithelial carcinoma and papillary cystadenocarcinoma. Clinicopathological data were collected retrospectively and immunohistochemical analysis of three PLUNC proteins (SPLUNC1, SPLUNC2 and LPLUNC1) was performed. Immunoreactivity was assessed as positive or negative. Results: PLUNC expression was only found in mucoepidermoid carcinomas and papillary cystadenocarcinoma; all other tumours studied were negative. Mucin plugs, mucous and intermediate cells of mucoepidermoid carcinomas were positive for LPLUNC1 and SPLUNC2, but areas composed of epidermoid and clear cells were negative for all PLUNCs. Papillary cystadenocarcinoma was positive for all PLUNCs. No correlation was found with tumour grade or outcome. Conclusions: Intense expression of two PLUNC proteins in mucous cells and mucin plugs of mucoepidermoid carcinoma and papillary cystadenocarcinoma indicate that they could be used as additional diagnostic tools in some equivocal cases, but further studies are needed to understand the biological processes involved in PLUNC expression.     

Epithelial salivary gland tumors of children and adolescents in west China population: a clinicopathologic study of 79 cases

Objective:  Determine the clinical and histopathologic features of epithelial salivary gland tumors of children and adolescents.
Methods:  A total of 79 cases of epithelial salivary gland tumors of children and adolescents were retrieved from the files. Information about demographic, clinical, histopathologic characteristics, and follow-up status were analyzed.
Results:  Sixty tumors (75.9%) were benign and 19 (24.1%) malignant. The most common tumor overall was pleomorphic adenoma (PA). The parotid was the most frequently involved site (43.0%). PA was the most common type of benign tumor. The most common malignant tumor was mucoepidermoid carcinoma. Five patients with parotid PA and two cases with palate myoepithelioma showed local recurrences. One patient with mucoepidermoid carcinoma showed local recurrences and died from the tumor 3 years after the initial treatment. One patient with adenocarcinoma presented local and neck recurrences, and died 4 years after initial treatment.
Conclusions:  Our data showed that the salivary gland tumors in children and adolescents may be the higher incidence of benign tumors, especially of PA; the slightly higher tendency for female predominance; the higher incidence of parotid glands. Mucoepidermoid carcinoma was the most common malignant tumor, with majority of low grade. Initial treatment should be planned to excise the tumor completely with satisfactory margins. The neck dissections or postoperative radiotherapy were performed in patients with low differentiation malignancies, or patients who present nodal metastasis or with clinically suspicious regional metastasis.     

Intraoral Minor Salivary Gland Tumours: A Retrospective Study from a Dental and Maxillofacial Surgery Centre in Salem,Tamil Nadu

Abstract

Minor salivary gland tumors (MSGTs) constitute a heterogeneous group of neoplasms with variation in histopathology. These are rare neoplasms usually occurring in the palate. Dental examination may provide an opportunity for early detection.

Aim

This study was undertaken to do an epidemiological survey of minor salivary gland tumours reporting to a single dental and maxillofacial surgery centre and to determine the correlation of the histopathologic characteristics with the clinical features.

Materials and Methods

A retrospective survey of the histopathological findings of 1,020 consecutive biopsy reports in a single dental and maxillofacial surgery centre was done to identify cases of MSGT. The results were tabulated based on various criteria.

Results

In our study, only 8 tumors were benign (26.67 %), and 22 tumors were malignant (73.33 %). Mucoepidermoid carcinoma (MEC) was the most common tumor (15 of 30). Pleomorphic adenoma was most common benign MSGT in our series (7 of 30). This was followed by adenoid cystic carcinoma (6 of 30). Palate was the most common site (13 of 30) followed by buccal mucosa (5 of 30) and lip (4 of 30).

Conclusions

Unlike many previous studies, malignant salivary gland tumours were predominant. MEC was the most common malignant tumour in our study similar to many other studies. The palate was the most common site for minor salivary gland neoplasms.