Analysis of the clinical relevance of histological classification of benign epithelial salivary gland tumours

IntroductionA vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, forseveral reasons, thishas not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour.MethodsA search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically.ResultsPleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur.ConclusionsA correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types ofbasal cell adenoma canoccasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.info:eu-repo/semantics/publishedVersio

Incidence and prevalence of salivary gland tumours in Valparaiso, Chile

Background : To determine the incidence and prevalence of salivary gland tumours in the province of Valparaíso, Chile. Material and Methods : Retrospective review of salivary gland tumours diagnosed between the years 2000 and 2011 from four local pathology services. Information on demographics and histopathology were retrieved from the medical records. Results : The study sample consisted of 279 salivary gland tumours. Prevalence and incidence rates per 100.000 persons were 15.4 and 2.51, respectively. Most of the neoplasms corresponded to benign tumours (70.3%). The most affected gland was the parotid gland. Pleomorphic adenoma was the most common benign tumour (53.8%) and mucoepidermoid carcinoma was the most common malignant tumour (7.2%). Conclusions : Salivary gland tumours are uncommon neoplasms that usually arise in the parotid gland. Pleomor- : Salivary gland tumours are uncommon neoplasms that usually arise in the parotid gland. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant tumours reported in this series

Papillary adenocarcinoma in submandibular region

Lateral ectopic thyroid is a rare event and even more uncommon is a primary malignancy in lateral ectopic thyroid. We present a case of papillary adenocarcinoma in lateral ectopic thyroid in submandibular space in a 55-year old male. To our knowledge this is the third case documented in the world and the first one in Europe. Lateral ectopic thyroid in this region is easily masqueraded as a submandibular gland swelling and so was our patients' tumor preliminarily diagnosed as a submandibular gland tumor. Furthermore, in the preoperative computed tomography (CT) scan the tissue was misinterpreted being adjacent to the submandibular gland. The diagnosis was revealed during the surgery and confirmed by the histology. This report demonstrates the difficulty in the differential diagnosis of neck masses. Although rare, ectopic tissue should be remembered as a possible diagnosis of all neck masses and the relevant preoperative examination should be performed by skilled professionals.Peer reviewe

Long-Term Remission of an Aggressive Sebaceous Carcinoma following Chemotherapy

Sebaceous carcinoma (SC) is an uncommon neoplasm manifesting itself either in the eyelid or extraocularly in the head and neck area. Surgery is the standard of care. Irradiation is rarely proposed as monotherapy but is frequently administered as an adjuvant regimen following surgical resection. There is no known strategy concerning chemotherapeutic treatment in highly aggressive recurrent - or metastatic - forms of the disease. Our patient presented with an aggressive SC of the scalp recurring after multiple excisions and local radiotherapy. Chemotherapy with 5-fluorouracil, cisplatin and docetaxel was then initiated; 4 cycles were administered, followed by capecitabine maintenance. Shortly after starting chemotherapy, dermal lesions had completely disappeared and radiological response could be seen. The patient experienced an extended period (>20 months) of complete remission. In this report, we show an excellent response of a highly aggressive SC after a combination of chemotherapy as for head and neck cancers

Role of Fine Needle Aspiration Cytology in Salivary Gland Pathology and its Histopathological Correlation: A Two Year Prospective Study in Western India.

Background and objectives: Salivary gland lesions account for 2-6.5% of all the neoplasms of the head and neck. Fine needle aspiration cytology (FNAC) is being increasingly used in the diagnosis of salivary gland lesions. The objective of this study was to evaluate the diagnostic accuracy and the sensitivity and specificity of FNAC in various salivary gland lesions in correlation with their histopathology, which helps in the appropriate therapeutic management. Methods: A total of 120 FNACs were done on salivary gland tumours from July 2010 to June 2012 in the Department of Pathology, P.D.U. Government Medical College, Rajkot (Gujarat, India). Formalin fixed (10%), surgically resected specimens were received, they were processed and slides were prepared for histopathological diagnosis. The stained cytological and histopathological slides were studied, analyzed and correlated. Results: The cytomorphological features were studied and analyzed and the following lesions were observed: Pleomorphic adenoma (88), Warthin’s tumour (2), Cystic lesion (4), Mucoepidermoid carcinoma (6), Acinic cell carcinoma (2), Primary lymphoma (2), Carcinoma EX pleomorphic adenoma(4), metastatic malignancy deposits (2), benign parotid tumour (8) and malignant tumour (unspecified)(2). A histopathological correlation was available in 78 cases. Out of these, 71 cases were true positive, 1 was false positive, 2 were false negative and 4 were true negative. Interpretation and conclusion: The overall sensitivity, specificity and the diagnostic accuracy were 97%, 80% and 92% respectively. Hence, the appropriate therapeutic management could be planned earlier. This study documents that FNAC of the salivary gland tumours is accurate, simple, rapid, inexpensive, well tolerated and harmless for the patient

Adenoma sebáceo de la glándula parótida

Los tumores de las glándulas salivales constituyen un área importante de la patología oral y maxilofacial. La mayor parte de las neoplasias glandulares salivales son benignas, representando las malignas entre el 15 y el 32% del total. La localización más común de estas entidades es la glándula parótida, en la que asientan hasta el 80% de todos los casos. En este artículo se presenta un caso de adenoma sebáceo salival, de localización parotídea. El tumor, formado por células epiteliales que tapizan conductos, exhibe amplias áreas de diferenciación sebácea y zonas con metaplasia oncocítica. El patrón histológico es predominantemente quístico, observándose cavidades rellenas con material sebáceo. Si bien la presencia de glándulas sebáceas en las glándulas salivales es frecuente, las neoplasias exclusivamente formadas por las mismas son muy infrecuentes. Dada su rareza, este tumor plantea problemas diagnósticos diferenciales con otras entidades benignas y malignas. Su tratamiento implica la extirpación de la lesión, lo que generalmente involucra la eliminación de la glándula en la que ha surgido. El presente caso constituye el séptimo publicado de esta entidad.Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven

Aspects on the management of salivary gland mucoepidermoid carcinoma in Finland

According to the Finnish Cancer Registry, salivary gland cancer (SGC) is rare, with approximately 50 to 60 new cases in Finland annually. For pediatric patients, the Finnish Cancer Registry reported 15 new cases between 1990 and 2009. The wide spectrum of different subtypes makes this group of diseases difficult to diagnose, grade, and treat. Due to the rarity of these diseases, no specific risk factors are known, and long-term outcome data are difficult to obtain. In adults, 20% of parotid gland tumors, 50% of submandibular gland tumors, and 90% of sublingual gland tumors are malignant. Most tumors of the minor salivary glands are malignant. However, in the pediatric patient population, 50% of parotid gland tumors are malignant, but only 10% of submandibular gland tumors do. Mucoepidermoid carcinoma (MEC) is the most common (29 to 35%) malignant neoplasm of the major and minor salivary glands in both adults and children. According to the WHO, MEC is classified into three grades: low grade (LG), intermediate grade (IMG), and high grade (HG). These three grades have different growth potentials as well as different potentials to metastasize and to recur; consequently, they show major differences in outcome. Correct histopathological diagnosis thus remains vital. We evaluated the prevalence, treatment, and outcome of 52 Finnish patients with MEC of the major salivary glands. All LG-MECs (23/52) were localized to the primary site, and most patients with LG-MEC were treated and cured surgically. The three-year overall survival rate was 95% for LG-MEC, 67% for IMG-MEC, and 55% for HG-MEC patients. Patients with LG-MEC experienced no recurrences during the three-year follow up. IMG-MEC (7/52) more closely resembled HG-MEC (20/52) in its biological behavior, contradicting reports from other institutions. Patients with IMG-MEC had cervical nodal metastases in 43% of cases, and 67% developed locoregional or distant metastases during follow up. Radiotherapy was administered for 86% of IMG-MEC patients. In the HG-MEC group, nodal metastases were present at presentation in 50% of patients, and 80% also received radiotherapy. Our results suggest an aggressive treatment protocol for IMG-MEC, and that surgery seems adequate for LG-MEC. Claudins are integral protein components of tight junctions contributing to tight sealing between cells. Deregulation of claudins leads to loss of cell integrity, uncontrolled cell proliferation, advantageous potential for tumor growth and metastatic potential. No previous studies have explored the possible role of claudins in SGC. Immunohistochemical studies on claudins 1, 3, 4, and 7 for 39 major salivary gland MEC patients have revealed statistically significant differences in staining intensities. The high intensity for claudin-1 increased the likelihood of LG tumors with a favorable prognosis. HG- and IMG-MEC tumors more often had higher intensities for claudin-3, portending a worse prognosis. This feature again emphasizes that IMG-MEC differs from LG-MEC. Claudins may, therefore, aid in grading tumors correctly and also serve as surrogate prognostic protein markers. The extent of immunostaining had less impact on grading than anticipated. The intensity of claudin-1 immunostaining classified tumors correctly in 90% of cases corresponding to conventional histopathological features. Between 1992 and 2011, 10 new pediatric SGC cases were identified. No gender predominated, and the median age was 14 years. The majority of SGC cases were parotid gland tumors (7/10); all tumors were LG and localized to the primary site. No recurrences occurred during the 7-month to 14-year follow up. MEC was the most common histological subtype (50%), which reflects results from other institutions. Because pediatric SGC is infrequent, experience with and guidelines for managing pediatric cases must be adapted from guidelines for adults with SGC. Establishing national or international cancer databases could offer help in managing these rare diseases. Between 1974 and 2009, information was retrieved on 437 sequential SGC patients treated at the Helsinki University Central Hospital. Due to the long time period and the most often elderly patients, many were deceased at the time of the study. Consequently, the study cohort consisted of 161 patients who were alive and able to reach. Of these, 88 (55%) answered a patient questionnaire to identify possible hereditary forms of SGC as well as elevated risk for other malignancies among the relatives of SGC patients. The enquiry revealed no cases of SGC in first-degree relatives. Thus, most likely no significant familial predisposition for SGC exists in Finland.Sylkirauhassyöpä on harvinainen ja Suomen Syöpärekisterin mukaan Suomessa diagnosoidaan vuosittain noin 50-60 uutta tapausta. Lapsilla sylkirauhassyöpädiagnooseja tehtiin ajanjaksolla 1990-2009 15. Sylkirauhassyövän alatyyppejä on WHO-luokituksen mukaan 24. Taudin vaihtelevien histopatologisten ominaisuuksien vuoksi diagnostiikka, kasvainten luokittelu ja hoito on vaikeaa. Tämän tautiryhmän harvinaisuuden vuoksi selkeitä riskitekijöitä ei tunneta ja pitkän aikavälin seurantatietoja on vaikea kerätä. Aikuisten korvasylkirauhasten kasvaimista 20%, leuanalussylkirauhasten kasvaimista 50% ja kielenalussylkirauhasten kasvaimista 90% on maligneja. Pienten sylkirauhasten kasvaimet ovat lähes aina maligneja. Lasten korvasylkirauhasten kasvaimista puolet on maligneja, mutta ainoastaan 10% submandibulaarirauhasten kasvaimista. Mukoepidermoidikarsinooma (MEC) on yleisin (29-35%) aikuisten ja lasten pienten ja suurten sylkirauhasten maligni kasvain. WHO-luokituksessa MEC jaetaan kolmeen luokkaan: matalan maligniteettiasteen syöpä (LG), kohtalaisen maligniteettiasteen syöpä (IMG) ja korkean maligniteettiasteen syöpä (HG). Eri luokkien syöpäkasvaimilla on toisistaan eroava kasvutapa, metastasointi- ja uusiutumiskyky ja sen vuoksi suuret erot syövästä parantumisen suhteen. Oikea histopatologinen diagnoosi on äärimmäisen tärkeä nimenomaan tässä syöpätyypissä. Helsingin yliopistollisessa keskussairaalassa hoidettujen 52 suurten sylkirauhasten MEC potilaiden prevalenssi, hoito ja hoitotulokset arvioitiin. Kaikki LG-MEC kasvaimet (23/52) oli-vat paikallisia ja suurin osa potilaista hoidettiin kuratiivisesti leikkauksella. Eri ryhmien kolmen vuoden eloonjäämisluvut olivat seuraavat: LG-MEC 95%, IMG-MEC 67%, HG-MEC 55%. LG-MEC potilailla ei havaittu yhtään paikallisresidiiviä kolmen vuoden seurannassa. Poiketen aiemmista tutkimustuloksista, IMG-MEC (7/52) muistutti biologiselta käyttäytymisellään enemmän HG-MEC:aa (20/52). Kaulan imusolmukemetastaaseja oli 43%:lla IMG-MEC potilaista, seurannassa 67% kehitti paikallisresidiivejä tai kaukoetäpesäkkeitä. Sädehoito annettiin 86%:lle IMG-MEC potilaista. Puolella HG-MEC potilaista oli kaulametastaaseja diagnoosihetkellä ja suurin osa näistä potilaista sai liitännäissädehoidon. Näiden tulosten valossa IMG-MEC potilaiden hoidon pitää olla aggressiivista ja LG-MEC potilaiden hoidossa kirurgia on yleensä riittävä. Claudiinit ovat proteiineja, jotka ovat solujen välisten tiiviiden liitosten olennaisia osia. Solu-solu kontaktien menetys voi johtaa kasvainten kasvupotentiaaliin ja metastasointikykyyn. Claudiinien mahdollista osuutta sylkirauhassyövässä ei ole aiemmin selvitetty. Claudiinien 1, 3, 4 ja 7 immunohistokemiallisia värjäytymisominaisuuksia tutkittiin 39 suurten sylkirauhasten MEC potilaan ryhmässä. Mikäli kasvain värjäytyi voimakkaasti claudin-1:llä, oli se todennäköisesti LG ja ennuste oli hyvä. HG-MEC kasvaimet värjäytyivät voimakkaammin claudin-3:lla, jolloin ennuste oli selvästi huonompi. IMG-MEC kasvainten värjäytymisominaisuudet muistuttivat HG-MEC:aa, mikä edelleen korostaa tämän kasvaimen eroavaisuutta LG-MEC:sta. Värjäytymisen intensiteetillä oli tilastollinen merkitsevyys kasvainten luokittelun suhteen, laajuudella ei. Claudin-1 intensiteetti luokitteli kasvaimet 90% oikein verrattuna tavallisiin histopatologisiin kriteereihin. Claudiinit ovat apuvälineitä MEC:n oikeassa luokittelussa ja sitä kautta myös ennusteellisia tekijöitä. Vuosina 1991-2011 diagnosoitiin Suomessa 10 uutta lasten sylkirauhassyöpää, joista saatiin riittävästi seurantatietoja. Suurin osa oli korvasylkirauhasen kasvaimia (7/10), kaikki olivat paikallisia, matalan maligniteettiasteen kasvaimia. Seuranta-aika vaihteli seitsemän kuukauden ja 14 vuoden välillä eikä tänä aikana tavattu yhtään taudin uusiutumista, metastasointia tai kuolemia. MEC oli yleisin histologinen alatyyppi (50%), mikä on raportoitu myös muualla maailmassa. Mediaani-ikä oli 14 vuotta eikä selkeää sukupuolieroa ollut. Lasten sylkirauhas-kasvaimet ovat harvinaisia, minkä vuoksi hoitokokemukset on omaksuttava aikuisväestöstä. Kansalliset/kansainväliset syöpärekisterit mahdollistaisivat tämän harvinaisen tautiryhmän kattavamman hoitotulosten analysoinnin. Helsingin yliopistollisessa keskussairaalassa hoidettiin vuosina 1974-2009 437 sylkirauhassyöpäpotilasta. Ottaen huomioon pitkän otantajakson ja sen, että sylkirauhassyöpäpotilaat ovat useimmiten iäkkäitä, useat heistä olivat tutkimushetkellä jo kuolleita. Osoitetiedot olivat saatavilla 161 potilaan osalta, ja näistä 88 (55%) vastasivat postitse lähetettyyn kyselyyn. Sen tarkoituksena oli selvittää mahdollisia perinnöllisiä sylkirauhassyöpätapauksia sekä sylkirauhassyöpäpotilaan sukulaisten mahdollista lisääntynyttä riskiä muihin syöpiin. Kyselyssä ei paljastunut yhtään ensimmäisen asteen sukulaista, jolla olisi ollut sylkirauhassyöpä. Tämän tutkimuksen valossa Suomessa ei ole osoitettavissa lisääntynyttä perinnöllistä alttiutta sylkirauhassyövälle

Sebaceous Carcinoma of Submandibular Gland Presenting with Upper Airway Obstruction: A Case Report and Review of the Literature

Sebaceous carcinoma (SC) of the salivary gland is a very rare tumor occurring more in the parotid gland. It is extremely rare in the submandibular gland. Only four cases of submandibular gland SC have been reported worldwide in English literature. We present the first case of submandibular gland SC in our environment and the fifth to be reported in English literature. A 55‑year‑old male farmer presented to our facility with a 10-year history of progressive, painless left submandibular mass, which worsened 4 months before presentation, associated with dysphagia to solid, muffled voice, weight loss, and upper airway obstruction. He had emergency tracheostomy and biopsy of the left submandibular mass. Histopathological examination of the mass confirmed SC. He was referred for radiotherapy but said to have died few weeks later while still preparing to travel for the radiation therapy. The rarity of these cases made the clinicopathologic pattern to be poorly understood thus making the choice of treatment option difficult. More cases need to be reported in other to develop the best treatment modalities

One-year oral toxicity study on a genetically modified maize MON810 variety in Wistar Han RCC rats (EU 7th Framework Programme project GRACE)

The GRACE (GMO Risk Assessment and Communication of Evidence; www.grace-fp7.eu) project was funded by the European Commission within the 7th Framework Programme. A key objective of GRACE was to conduct 90-day animal feeding trials, animal studies with an extended time frame as well as analytical, in vitro and in silico studies on genetically modified (GM) maize in order to comparatively evaluate their use in GM plant risk assessment. In the present study, the results of a 1-year feeding trial with a GM maize MON810 variety, its near-isogenic non-GM comparator and an additional conventional maize variety are presented. The feeding trials were performed by taking into account the guidance for such studies published by the EFSA Scientific Committee in 2011 and the OECD Test Guideline 452. The results obtained show that the MON810 maize at a level of up to 33 % in the diet did not induce adverse effects in male and female Wistar Han RCC rats after a chronic exposure