Steroid hormone receptors in parotid gland cystadenolymphoma (Warthin's tumour).

The aetiopathogenesis of cystadenolymphoma is mostly unknown. Cystadenolymphomas have a significantly higher incidence in the male than the female population. This might be as a result of endocrine dependency in this kind of tumour. The purpose of the present study was to determine the sex hormone receptor status in cystadenolymphoma. Tissue samples of cystadenolymphoma, pleomorphic adenoma and normal samples of the parotid gland were examined immunohistochemically for oestrogen and progesterone receptors. Progesterone-positive cells could be found in the salivary duct system of normal glands and in the epithelial components of cystadenolymphomas. There was no evidence for the presence of oestrogen receptor in any sample studied. The evidence of progesterone receptors in cystadenolymphoma may implicate a potential role of endocrine factors in the development of this tumour.     

Steroid hormone receptors in parotid gland cystadenolymphoma (Warthin's tumour)

The aetiopathogenesis of cystadenolymphoma is mostly unknown. Cystadenolymphomas have a significantly higher incidence in the male than the female population. This might be as a result of endocrine dependency in this kind of tumour. The purpose of the present study was to determine the sex hormone receptor status in cystadenolymphoma. Tissue samples of cystadenolymphoma, pleomorphic adenoma and normal samples of the parotid gland were examined immunohistochemically for oestrogen and progesterone receptors. Progesterone‐positive cells could be found in the salivary duct system of normal glands and in the epithelial components of cystadenolymphomas. There was no evidence for the presence of oestrogen receptor in any sample studied. The evidence of progesterone receptors in cystadenolymphoma may implicate a potential role of endocrine factors in the development of this tumour.     

Malignancy of a cystadenolymphoma of the parotid gland

Summary The authors describe malignant degeneration of the epithelial component of a cystadenolymphoma (CAL) of the parotid gland in a 79-year-old man. This development of carcinoma in CAL is a very rare occurrence, with only eight cases described thus far in the literature.     

Cyclooxygenase-2 expression in Warthin's tumour

OBJECTIVES: To determine whether cyclooxygenase-2 (COX-2) is overexpressed in Warthin's tumours, and to characterize its pattern of expression. METHODS: Twenty-one paraffin-embedded Warthin's tumour specimens were analysed by immunohistochemical staining for expression of human COX-2. Semi-quantitative analysis of the staining was performed. RESULTS: In all of the specimens, we found that there was overexpression of COX-2 within the epithelial component of the tumours, with no expression in the lymphoid components. There was also overexpression of COX-2 in the salivary duct system of normal parotid tissue. CONCLUSIONS: Our results suggest that COX-2 is up-regulated in the epithelial component of Warthin's tumours. Our findings support the hypothesis that Warthin's tumours originate from heterotopic ductal epithelial cells of the parotid gland. The role of COX-2 expression in the pathogenesis of Warthin's tumours remains to be determined.     

Warthin's tumor. A high incidence and no sex predominance in central Pennsylvania.

Papillary cystadenolymphoma, or Warthin's tumor, is a monomorphic adenoma found in salivary glands. It nearly always occurs in the parotid gland, and is reported to occur in 5% to 14% of all parotid tumors according to most studies. The tumor has a universally accepted male predominance, with an increasing incidence in females having been reported over the last four decades. A review of all primary parotid gland tumors seen at York (Pa) Hospital for the last 10 years was performed. Warthin's tumor was diagnosed histologically in 42 (30%) of 138 primary parotid gland tumors, with no significant sex predominance identified (22 men, 20 women). A significantly higher percentage of all parotid gland tumors, and especially Warthin's tumor, was associated with smoking in both males and females.     

The origin of the non-specialized epithelial cells cultured from human parotid gland

Summary We investigated the origin of the non-specialized cells proliferated in primary expiant culture of human parotid gland.The predominant cells in surface layer were morphologically epithelial origin with desmosomes and intercellular digitations. The cultured cells did not show any specific affinity to parotin isolated from bovine parotid gland, which seemed to be one of the marker for duct cell. However, it was demonstrated autoradiographycally that DNA synthesis in the cells was rapidly induced by isoproterenol, a potent stimulator of acinar cell. From these results, the non-specialized epithelial cells in expiant culture seemed to be derived from acinar cell in human parotid gland.Abbreviations HEPES N-2-Hydroxyethylpiperazine-N-2-ethanesulfonic acid - PBS phosphate-buffered saline - BSA bovine serum albumin - HRPO horseradish peroxidase - DAB diaminobenzidine     

Tonsillendifferenz bei infraaurikul?rer Raumforderung

We report on a very rare case of iceberg tumor. A giant lipoma arising from the deep lobe of the parotid gland led to an infraauricular mass and tonsil protrusion. After appropriate imaging (ultrasound and MRI) surgical resection was performed. Tonsil protrusions require differential diagnostic evaluation. Apart from the most prevalent parotid gland tumors, like pleomorphic adenoma and cystadenolymphoma, one must consider rare lipomas. Malignancy (e.g. liposarcoma) can only be excluded by histological examination of the whole specimen.     

Cysts and pseudocysts of the parotid

Parotid gland are subdivided in malformative dysgenetic cysts and in acquired cysts. Among malformative cysts, lymphoepithelial cysts so-called branchial cysts are the most frequent. Histologically the cystic cavity is lined by squamous epithelium with various amounts of underlying lymphoid tissue. Other varieties of malformative cysts are exceptional: cystic teratomas with several sorts of adult tissues, polycystic parotid gland and congenital ductal ectasia. Acquired cysts are another important group: retention cysts are found in adult and old people. Microscopically these cysts are lined by a single or pseudostratified epithelium rested on a layer of connective tissue without any lymphoid tissue. Lymphoid cystic hyperplasia arising in HIV infection can be included in this group of acquired cysts. Finally these parotid cysts have to be differentiated from pseudocysts without an epithelial lining and from cystic tumors as cystadenolymphoma and cystic mucoepidermoid carcinoma.     

The origin of the non-specialized epithelial cells cultured from human parotid gland

We investigated the origin of the non-specialized cells proliferated in primary explant culture of human parotid gland. The predominant cells in surface layer were morphologically epithelial origin with desmosomes and intercellular digitations. The cultured cells did not show any specific affinity to parotin isolated from bovine parotid gland, which seemed to be one of the marker for duct cell. However, it was demonstrated autoradiographically that DNA synthesis in the cells was rapidly induced by isoproterenol, a potent stimulator of acinar cell. From these results, the non-specialized epithelial cells in explant culture seemed to be derived from acinar cell in human parotid gland.     

Is Malherbe calcifying epithelioma in the ENT area of a rare tumor?

The calcifying epithelioma (pilomatrixoma) is a benign tumour of the skin originating from hair sheath cells. The head, especially the cheek and preauricular region with the parotid gland, is a very common site (about 50%). The tumour arises predominantly in younger people, with a 2:1 female to male ratio. It is not so rare as suggested by the few ENT publications. The histologic picture shows two characteristic epithelial cells, the basophilic and ghost cell. Calcification is present in most cases. The prognosis after removal of the tumour is good. Two personal cases are reported, multiple pilomatrixomas on the cheek of an 12 year old girl, and a tumour on the auricle, an unusual site.     

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.     

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.     

Adenocarcinoma of the salivary glands. The pathohistology and subclassification of 77 cases

Seventy-seven adenocarcinomas of the salivary glands recorded in the Salivary Gland Register between 1965 and 1984 were analysed and classified histopathologically. The following results were obtained: 1. 2% of all salivary gland tumours and 10% of all malignant epithelial salivary gland tumours were allotted to the group of adenocarcinomas. The age peak lies in the 7th to 8th decade. 60% occurred in women, 58.5% were localized to the parotid gland, 28.5% to the minor salivary glands (palate, lips, and cheek), 11.5% to the submandibular gland and only 1.5% to the sublingual gland. 2. Solid, tubular and papillary adenocarcinomas can be distinguished. Additional criteria are microcysts, mucus production and grade of differentiation. 3. The solid adenocarcinoma (13%) is predominantly localized in the parotid gland and characterized by a low differentiation, invasive growth and metastases. 4. 62.5% of tubular adenocarcinomas (52%) are localized in the parotid gland, 27.5% to the minor salivary glands and 10% to the submandibular gland. Most of the tumours are highly differentiated. A distinct mucus production is present in 40% of the cases. Microcysts are very frequent. 5. Papillary adenocarcinomas (28.5%) are localized in almost 50% of cases to the minor salivary glands, 45% to the parotid and only 5% to the submandibular gland. Microcysts and mucus production can be observed in 50% of the cases. 6.5% of the cases have a mixed tubular papillary structure. 6. In differential diagnosis, thyroid gland carcinomas and metastases of other adenocarcinomas must be distinguished, the former by negative result of the thyroglobulin reaction, and absent mucus production. 7. Adenocarcinomas arise from the salivary duct system. Solid or tubular adenocarcinomas imitate stages of the embryonal development of the salivary ducts.     

Tuberkulose in der Glandula parotidea

The different tumours of the parotid gland can be divided in benign or malignant tumours, regional inflammations and enlarged lymph nodes. We report on a 26-year-old male from Uganda with a slowly growing tumour of the right parotid gland for several months. The CT scan showed a poorly defined intraparotideal tumour. Ultrasonography revealed multiple enlarged cervical lymph nodes. Suspecting a neoplasm of the parotid gland we decided to perform a superficial parotidectomy for histological examination. The pathological analysis revealed a caseous necrosis and epitheloid granulomata containing Langhans giant cells. The polymerase chain reaction could not confirm our suspicion of tuberculosis. The Ziehl-Neelsen staining did not show any acid-proof rods. Only the breeding of the suspicious probes generated Mycobacterium tuberculosis. Initially denying any infections the patient admitted to having had tuberculosis that had been treated with antibiotics 2 years previously. Tuberculosis is a rare finding in parotid tumours. It must be considered as a differential diagnosis of parotid enlargements.     

A rare malignancy of the parotid gland: oncocytic carcinoma

Oncocytic carcinomas are uncommon; they represent 11% of all oncocytic salivary gland neoplasms, 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. A 65-year-old woman was admitted to our ENT clinic with a history of a painless left preauricular mass. No lymph node was palpable on either side of her neck. Computed tomography demonstrated a 3×3-cm solid lesion in the left parotid gland. As oncocytes and atypical cells were seen at the cytologic examination of a fine-needle aspiration biopsy, this finding suggested a malignant epithelial tumor. Total parotidectomy by preserving the facial nerve was performed. The result of the pathologic examination was oncocytic carcinoma regarding histopathologic and immunohistochemical findings and especially the invasive growth pattern. We preferred a close follow-up to an elective neck dissection, and reserved the neck dissection for a recurrence. The prognosis of oncocytic carcinomas is not well known because of their low incidence. Further investigation of the prognosis of patients with oncocytic carcinoma of the parotid gland is warranted as more cases are reported.     

The ultrasound examination in assessment of parotid gland tumours: the novel graphic diagram

Ultrasound is one of the main diagnostic techniques for parotid gland tumours. It is inexpensive, non-invasive and widely available. However, interpretation of the images is highly subjective and constitutes a major limitation. To overcome this problem, we developed a graphic diagram to provide a standardised template that can be used for more precise identification of the tumour localisation within the parenchyma of the parotid gland. This new diagram may be used to provide surgeons with an improved and more objective localisation of the tumour. The study included 237 patients who underwent surgery for parotid tumours. To obtain the precise spatial location of the tumours, three topographic coordinates of tumour location in the coronal, sagittal and transversal plane were marked preoperatively during sonography within the parenchyma of the parotid gland. The localisation identified ultrasonically was then compared to the postsurgical report: 197 (83 %) tumours were found within the superficial lobe of the parotid gland and 40 (17 %) within the deep lobe of the parotid gland. In 157 (66 %) cases, tumours were found within the lower pole of the parotid gland, and in 64 (27 %) at the level of earlobe and its insertion, 16 (7 %) tumours were located at the level of the tragus and above it. Based on the results obtained, a graphic diagram of parotid gland tumour locations was developed.     

Fazialisparese durch einen benignen Parotistumor

Facial nerve palsy is rarely associated with an inflammatory parotid process. We present a case of peripheral facial palsy initiated by infection of a cystadenolymphoma of the parotid gland. The paresis progressed rapidly despite abating inflammation and 48-h antibiotic therapy. Following total parotidectomy the facial nerve paresis persisted for a period of 4 months. Histological work-up yielded a diagnosis of Warthin’s tumor with necrotic changes. This case indicates that even benign processes can be associated with facial nerve palsy.     

erbB-2/Her-2 gene amplification and overexpression in parotid gland tumors

Summary Proto-oncogenes represent a family of normal cellular genes that were identified on the basis of their similarity to genetic sequences with known tumorigenic + or transforming potential. Accumulating evidence links alterations in either the structure, copy number, or expression of one or another of these genes to neoplasia. One such gene, called erbB-2/Her-2 was found amplified in an adenocarcinoma of the human salivary gland and has also been found associated with primary human breast cancer. Patients with multiple copies of the gene have had a shorter overall survival. In the present study, 21 tumors of the parotid gland were examined by Southern and Northern blot hybridization for amplification and possible overexpression of the erbB-2/Her-2 oncogene. Normal parotid gland tissue was used as negative control. The parotid gland lesions comprised 7 pleomorphic adenomas, 5 squamous cell carcinomas, 4 cases of chronic fibrotic sialadenosis, 3 mucoepidermoid carcinomas as well as 1 lymphoma and 1 cystadenolymphoma. Gene amplification was found in 1 of the pleomorphic adenomas, with 2 tumors showing a significant overexpression of the erbB-2/Her-2 oncogene. Because 3–5% of all pleomorphic adenomas undergo malignant transformation, close follow-up of patients is currently underway.     

Perinatal salivary gland tumours (embryomas)

Epithelial salivary gland tumours presenting in the first month of life (perinatal tumours) are exclusively of major salivary gland origin and predominantly of the parotid gland. Approximately 25 per cent of these rare tumours have been histologically and/or biologically malignant. Except for an occasional pleomorphic and monomorphic adenoma, the majority of the tumours are proliferations suggesting a tumourous arrest of maturation of the salivary gland anlage, hence their designation as embryomas. A case report of an embryoma of the parotid is presented, accompanied by a review of the literature.     

Interdigitating dendritic cell sarcoma of the parotid gland: case report and literature review

Interdigitating dendritic cell sarcoma (IDCS) is an exceedingly rare neoplasm arising from the antigen-presenting cells of the immune system. We report a case of IDCS occurring in a 69-year-old man who presented to an outside institution with a painless mass in his right parotid gland for several months. He presented to our institution after undergoing a superficial parotidectomy. A diagnosis of undifferentiated neoplasm, favoring poorly differentiated carcinoma, was made at that time. He underwent a total parotidectomy and neck dissection at our institution. Microscopically, the tumor was composed of atypical spindle cells involving the parotid gland and an ipsilateral level III lymph node. Immunophenotypic analysis demonstrated positive staining for S100, fascin, vimentin, and HLA-II. Follicular dendritic cell, lymphoid, epithelial, myoepithelial, and melanoma markers were negative. Taken together, the above features were consistent with IDCS. An IDCS of the parotid gland is extremely rare, with only 2 cases reported in the literature. The unusual location and morphological similarity to follicular dendritic sarcoma and other types of soft tissue sarcomas can be a diagnostic challenge. Awareness of this tumor and the use of appropriate markers are crucial in making the diagnosis. The patient did well postoperatively, and he underwent a complete course of postoperative irradiation to the right parotid and neck.