Major salivary gland tumors: treatment results and prognostic factors

A retrospective review of 133 patients with major salivary gland carcinomas treated between 1955 and 1981 is presented. The majority of cases (104) originated in the parotid gland. The most common histological type was mucoepidermoid carcinoma (39 cases). Tumor-free interval was longest for patients with acinic cell and mucoepidermoid carcinomas. In contrast, adenoid cystic carcinoma was poorly controlled, regardless of the form of treatment. Initial control of primary major salivary gland tumors was inversely related to the presence of disease at the surgical margins. In cases with microscopic or gross disease at the surgical margins, postoperative radiation therapy controlled the tumor locally in 18 of 26 patients (69%). Postoperative radiation therapy was generally used only in cases with high-grade histologies, advanced stages, or positive surgical margins. Of the patients treated with surgery alone, 53% achieved local control, as compared to 75% of the group which received postoperative radiation therapy. Although the difference was not statistically significant, we would have expected the combined therapy group to have a lower control rate due to more advanced disease. There was a low salvage rate (22%) and a high incidence of distant metastasis (60%) in recurrent cases. The data indicates that complete surgical resection results in the best local control, with or without adjuvant radiation. When the surgical margin is inadequate and re-excision not possible, adjuvant radiation therapy appears to have a role to optimize local control and survival.     

Salivary gland tumors of the palate: the UCLA experience

A retrospective review of 38 patients with salivary gland tumors of the palate treated between 1961 and 1984 is presented. The majority of tumors were identified at an early stage. Most (23 of 38 cases) originated over the hard palate. The most common histological type was adenoid cystic carcinoma (22 cases). Twenty-five patients were treated with surgery alone, of whom, three had wide local excision. Thirteen patients received postoperative radiation therapy in addition to surgery. The local control was comparable for surgery alone and combined therapy (88% and 85%, respectively) although the combined therapy group was biased by more advanced disease, inadequate margins, and/or poorly differentiated histologies. Mucoepidermoid lesions had an excellent prognosis with local control of 100%. In contrast, there was a 23% recurrence rate for adenoid cystic carcinoma. Regional neck node metastasis was noted in 2% of the patients. This experience indicates that radical resection of palate salivary gland malignancy with adequate margins results in excellent local control. Adjuvant radiation therapy is recommended in cases where there is a question of adequate margins and in advanced lesions of high grade tumors.     

Mantle cell lymphoma of the hard palate: a case report and review of the differential diagnosis based on the histomorphology and immunophenotyping pattern

To our knowledge, mantle cell lymphoma (MCL) has never been reported in the hard palate, but it is commonly observed in the nasopharynx and Waldeyer's tonsillar ring. MCL is characterized by a diffuse infiltrate of small lymphocytes with the expression of CD5, CD20, and cyclin D1 (Bcl-1), but not CD10. MCL presenting in the hard palate must be accurately distinguished from other forms of so-called small B-cell lymphomas-such as small lymphocytic lymphoma, follicular lymphoma, and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue-because MCL possesses a worse prognosis. Awareness of MCL of the hard palate will prompt pathologists to perform adequate immunohistochemical analysis to aid in confirming the diagnosis.     

Vitamin E can reduce blood pressure in mild hypertensives

This triple-blind placebo-controlled clinical trial was performed to determine the effects of the anti-oxidant vitamin E on blood pressure and heart rate in patients with mild hypertension. A total of 70 new mild hypertensive subjects (systolic blood pressure, SBP: 140-160 mmHg; diastolic blood pressure, DBP: 90-100 mmHg) without secondary hypertension were selected from among people referred to the Hypertension Unit of Isfahan Cardiovascular Research Center and divided randomly into two groups of drug (DG) and placebo (PG). All subjects were aged from 20 to 60 years old, without any other cardiovascular risk factors. The drug group received vitamin E tablets (200 IU/day) and the placebo group received placebo only for 27 weeks. At the beginning and the end of the study, the blood vitamin E level was measured fluorimetrically in all subjects according to the Hansen and Warwick method [14, 15]. Blood pressure and heart rate were measured at the beginning, during, and at the end of the study. Blood pressure was measured by a physician using one random zero mercury sphygmomanometer. Personal information and dietary habits of subjects were collected by separate questionnaire. At the end of the study, it was found that the vitamin E supplement had caused a remarkable decrease in SBP (-24% in DG versus -1.6% in PG) and a less remarkable decrease in DBP (-12.5% in DG versus -6.2% in PG) (p < 0.05). The change in heart rate was -4.3% in DG, and -14.0% in PG (p < 0.05). It is concluded that a vitamin E supplement of 200 IU/day can be effective in mild hypertensive patients in the long term, probably due to nitric oxide, and improve their blood pressure status. Therefore, vitamin E supplement could be recommended to such patients.     

Characteristics of indolent non-Hodgkin lymphoma in patients with type 1 human immunodeficiency virus infection

BACKGROUND: There is recent evidence that the incidence of indolent non-Hodgkin lymphoma (NHL) appears to be increased in persons with the acquired immunodeficiency syndrome (AIDS). The current study was conducted to describe the clinical, immunologic, and pathologic characteristics of indolent B-cell lymphoma in patients infected with the human immunodeficiency virus (HIV). METHODS: The current report was a retrospective study of 10 cases of indolent NHL identified from the AIDS-Lymphoma Registry at the University of Southern California School of Medicine. These patients were compared with 336 consecutive patients with systemic intermediate/high-grade AIDS-related NHL who were diagnosed and treated at a single institution. RESULTS: The pathology of the indolent cases included follicular lymphoma (five patients), small lymphocytic lymphoma (two patients), and one case each of mucosa-associated lymphoid tissue (MALT), monocytoid B-cell, and marginal zone lymphoma. When comparing the indolent lymphomas with the intermediate/high-grade AIDS-NHL cases, no differences were observed with regard to demographic characteristics or history of prior opportunistic infection. HIV patients with indolent lymphomas were found to have a significantly higher median CD4+ lymphocyte count compared with patients with intermediate/high-grade NHL (531 /mm3 vs. 90 /mm3) (P < 0.0001). Bone marrow involvement was significantly more common in indolent NHL cases (50%) versus intermediate/high-grade NHL cases (17%) (P = 0.02). The median survival for patients with indolent NHL was significantly longer compared with patients with intermediate/high-grade NHL (66.8 months vs. 7.1 months) (P = 0.007). CONCLUSIONS: Indolent lymphomas occurring in patients infected with HIV appear to differ from intermediate/high-grade lymphomas with regard to immune status and propensity for bone marrow involvement and prolonged survival. The median survival in the group of HIV-seropositive patients with indolent NHL examined in the current study was found to be comparable to that reported in HIV-negative individuals.     

Galectin-1 modulates human glioblastoma cell migration into the brain through modifications to the actin cytoskeleton and levels of expression of small GTPases

We show that high-grade astrocytic tumors with high levels of galectin-1 expression are associated with dismal prognoses. The immunohistochemical analysis of galectin-1 expression of human U87 and U373 glioblastoma xenografts from the brains of nude mice revealed a higher level of galectin-1 expression in invasive areas rather than non-invasive areas of the xenografts. Nude mice intracranially grafted with U87 or U373 cells constitutively expressing low levels of galectin-1 (by stable transfection of an expression vector containing the antisense mRNA of galectin-1) had longer survival periods than those grafted with U87 or U373 cells expressing normal levels of galectin-1. Galectin-1 added to the culture media markedly and specifically increased cell motility levels in human neoplastic astrocytes. These effects are related to marked modifications in the organization of the actin cytoskeleton and the increase in small GTPase RhoA expression. All the data obtained indicate that galectin-1 enhances the migratory capabilities of tumor astrocytes and, therefore, their biological aggressiveness.     

Unusual CT features of dermoid cyst in the posterior fossa

A dermoid cyst of the posterior fossa in a 73-year-old man is reported. The presentation of the cyst was unusual because of the age of the patient, the spontaneously hyperdense aspect of the mass on CT, the partial rim enhancement of the lesion, and the presence of perilesional edema. On pathologic examination, the cyst contained small amount of fat, hairs, necrosis, and small areas of hemorrhage. The amount of hemorrhage found could not explain the spontaneous hyperdensity of the lesion found on CT. The hyperdensity may be related to high protein content of the lesion. Electronic Publication     

Gingival squamous cell carcinoma appearing as a benign lesion: report of case

A case of a 37-year-old female who had a squamous cell carcinoma on the attached gingiva is discussed. The report emphasizes the importance of a correct diagnosis of all lesions, including lesions that appear atypical. A brief review of the literature also is presented.     

Angiomas of the epidural space (author's transl)]

The authors describe two cases of angiomas strictly limited to the spinal epidural space. They review the literature and stress the rarity of these tumours.